68 year old female presents to the ED via ems complaining of | Figure 1

Paced_and_Confused
Registered Nurse

68 year old female presents to the ED via ems complaining of ankle pain. She states she slipped on the floor while wearing her boot. This happened approximately six weeks ago.

Key Points:

• Aseptic loosening of total ankle replacement remains enigmatic regarding its underlying mechanisms.
• Although great scientific efforts have been made to explain the mechanisms, it remains poorly understood, complex and multifactorial.
• Many factors, including age, body weight, activity lesions, implant designs, fixation methods, material properties, immunologic responses and biomechanical adaptations to total ankle replacement all contribute to the development of perioprosthetic osteolysis.
  Summary:
  Aseptic loosening of implants remains the most common reason for revision surgery for hip, knee, or ankle prostheses. Although a great scientific effort has been made to explain the underlying mechanisms it remains poorly understood, complex, and multifactorial. Many factors, including age, body weight, activity lesions, implant design, fixation methods, material properties, immunologic responses, and biomechanical adaptations to TAR all contribute to the development of periprosthetic osteolysis.

Conformis custom medial compartment arthroplasty #knee

R TKA I assisted in today. Patient had the same condition when we did her L TKA a few months ago. Prior to replacements, she presented to the ED with an effusion. I aspirated serosanguinous fluid a few days later. What is the diagnosis? Sorry for the picture quality.

Osteoarthritis of knee, total knee replacement.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?