Photograph

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Lightning Ground Current Injury: A Subtle Shocker

Gregory S Podolej, MD* and Naomi Nardi, MD*

DOI: https://doi.org/10.21980/J8KD1C Issue 4:1[mrp_rating_result]
The first photograph demonstrates a dendritic blister (Lichtenburg figure) on the medial aspect of his right foot where the ground current injury entered the patient's foot. Although no data exists regarding the sensitivity or specificity of Lichtenberg figures as skin findings, they are considered pathognomonic for lightning injuries and are not produced by alternating current or industrial electrical injuries. The second photograph demonstrates a 4 x 3 cm area of petechiae where the ground current injury exited the patient.
WildernessDermatologyVisual EM
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Facial Fracture Induced Periorbital Emphysema

Hamid Ehsani-Nia, DO* and Robert Eisenstein, MD*

DOI: https://doi.org/10.21980/J8F05HIssue 3:4[mrp_rating_result]
Physical exam showed marked left palpebral subcutaneous crepitus, as well as bulbar and palpebral conjunctival bulging. Visual acuity was normal with intact extraocular movements, and normal pupillary exam. Computed tomography (CT) imaging of the face was obtained and revealed multiple displaced fractures involving the left orbital floor and zygomatic arch associated with moderate periorbital and postseptal extraconal gas, resulting in orbital proptosis.
TraumaENTVisual EM
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Corneal Rust Ring

Joseph Zakaria, BS* and Jonathan Peña, MD*

DOI: https://doi.org/10.21980/J8X067Issue 3:4[mrp_rating_result]
The photograph reveals a limbic metallic foreign body with a surrounding corneal rust ring (arrow) in the three o’clock position of the left cornea. 
OphthalmologyVisual EM
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Cauliflower Ear Secondary to a Chronic Auricular Hematoma

Nichole Niknafs, DO*

DOI: https://doi.org/10.21980/J8S63XIssue 3:4[mrp_rating_result]
On exam, the patient has a gross deformity to the left pinna that was not painful to touch or fluctuant. Findings and history are consistent with cauliflower ear, secondary to a chronic auricular hematoma.
ENTVisual EM
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Various Degrees of Thermal Burns

Hamid Ehsani-Nia, DO*, Mohammad I Ehsani-Nia, BS* and John Collins, MD*

DOI: https://doi.org/10.21980/J8R91WIssue 3:4[mrp_rating_result]
On exam,there is a large swath of skin with evidence of thermal injury involving the neck, shoulder, chest, and face, including damage to the ear, external nostril, and lips. Burns exhibit varying degrees of severity and total approximately 4.5% of the body surface area. Several areas are charred and insensate to pinprick. The left earlobe is partially burned off. Patient's airway is patent with no evidence of thermal injury or obstruction to the oropharynx or nasal vestibule.
TraumaVisual EM
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Pemphigoid Gestationis

Michael Niechayev, BS* and Lauren Sylwanowicz, MD*

DOI: https://doi.org/10.21980/J8MG9DIssue 3:4[mrp_rating_result]
Physical exam findings were significant for 1-3 cm diameter well-demarcated superficial ulcers on the patient’s abdomen and extremities, with mucosal sparing. Several small tense bullae were present on the bilateral inner thighs and numerous small reddish plaques were scattered over the patient’s back. Nikolsky’s sign was negative. No lymphadenopathy was noted.
DermatologyVisual EM
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Fight Bite with Tendon Laceration

Michelle Chang, MD*, Grant Wei, MD*, Christopher J Bryczkowski, MD*, Sha Yan, DO* and Chirag N Shah, MD*

DOI: https://doi.org/10.21980/J8MP7QIssue 3:3[mrp_rating_result]
The video shows a water bath ultrasound of the right 4th digit, demonstrating soft tissue swelling with a hypoechoic region along the tendon consistent with edema and tendon disruption (see video and annotated still image).
OrthopedicsTraumaVisual EM
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Dorsally-Displaced Metacarpal Dislocation-Fracture

Richard Barnett, DO* and Richard Brodsky, MD*

DOI: https://doi.org/10.21980/J8ZW54Issue 3:3[mrp_rating_result]
A two-view radiograph of the right hand was obtained which revealed a dorsal dislocation of the distal fourth and fifth metacarpals (see red and blue outline, respectively) with a concomitant fracture of the distal fifth metacarpal (see yellow line) and avulsion fracture of the lateral aspect of the hamate (see green line). After reduction the fourth and fifth metacarpal dislocations are resolved; however, the distal fifth metacarpal fracture (yellow line) and avulsion fracture of the lateral aspect of the hamate (green line) are still visible.
OrthopedicsVisual EM