A 32 year old female presents to the urgent care clinic with complaints of pain and swelling to her left leg. She reports a history of Type I diabetes and neuropathy. A point of care glucose check reveals a glucose of 259. The patient denies any recent traumas, though states she worked in her yard for several hours 3 days ago. On exam you see the patient below.  What is this patient’s most likely diagnosis? 

The following are considered at higher risk for tuberculosis except:

Patient was found in mobile home, unresponsive. She presents to ER with confusion, irritability, heart rate 132 bpm, and headaches. She is a poor historian due to clinical condition. After stabilization, the family is updated on patient’s status. What report from family is concerning for environmental component of current patient status? 

A 67 year old male presents to the emergency department with shortness of breath that has worsened over the last 3 weeks. He reports now he cannot lay flat at night, and becomes very fatigue with activity. Initial vital signs reveal an oxygen saturation of 87% on room air. The nurse applies 2L per nasal cannula and the patient’s oxygen saturation improves to 92%. His medical history includes hypertension, COPD, and sleep apnea. He reports non-compliance with his CPAP machine. The nurse practitioner orders a chest x-ray that reveals pulmonary edema. What is the most likely cause of the patient’s pulmonary edema?

All of the following are included in emergent burn management, except:

What age is recommended for initial pneumococcal vaccine?

A 65 year old male presents to the emergency department with  complains of altered mental status. His daughter accompanies him and reports he underwent a liver transplant 4 weeks ago.  Vital signs: Temp 100.3F, Pulse 110, BP 95/74, RR 22, Oxygen 94% on room air.  Labs: WBC 22K, H&H 10.9 & 28.8, Plt 110K. Na+ 143, K+ 5.0, BUN 35, Cr 2.5, Glucose 187, Ca+ 7.9. Ammonia 85. AST 350, ALT 421.  What is the nurse practitioner’s next best step? 

56 y/o male presents to emergency department with reports of pain and rash to right side of face. He reports that pain started prior to rash, and he describes the pain as “stabbing and prickling” around right side of face and eye. He reports pain is unrelieved by anything and he denies any vision changes. He denies any known injuries. What is this patient’s likely diagnosis? 

What medication is used to thin sputum secretions?

Rib fractures are always associated with trauma and does not affect the lungs.