what’s the best way of managing this fx? | Figure 1

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Emergency Medicine

What’s the best way of managing this fx?

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42 years old, female. This patient works in orthostasis most of the time. She says that at the end of the day she feels a lot of pain in her feet, especially in the first phalangeal metatarsal joint. She reports that she made use of specific insoles, but there was no improvement. She is afraid that her case is a surgical indication. What can be done in this case?

50 y/o female slipped off jumping pillow onto sand caught foot underneath. Immediate pain 10/10 immediate swelling with deformity over dorsum unable to weight bear since.

This woman was seen in ER a year ago, had to have surgery of foot due to collapse. A year later the X-rays have come back and on the left side was after surgery and right side is a year later. Woman is concerned due to an amputation as only resolve since it continues to have pain and has again collapsed. If someone has any better ideas please let me know so I can speak to the patient about it.

Image description AP (image 1) and oblique (image 2) radiographs show flattening, sclerosis, and fragmentation (arrow) of the second metatarsal head. Teaching point: Advanced Freiberg infraction demonstrates collapse and fragmentation of the metatarsal head, reflecting progression of osteonecrosis. Later stages are associated with secondary degenerative changes and chronic forefoot pain.

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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?