SAEM Clinical Image Series: Facial Swelling in a 2 Year Old

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Chief complaint: Left-sided facial swelling

History of Present Illness: A 2-year-old male presents to the emergency department in January after waking up with left-sided facial swelling. Mother states her son has had cough and congestion for the past 4 days for which she has been treating with Tylenol and a children’s cough medication. The patient went to bed, awoke the following morning with facial swelling, and was brought to the emergency department.

He has no allergies, history of trauma to the area, or bug bites. The patient is fully vaccinated including the influenza vaccine.

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2019-08-19T13:11:59-07:00

August 19th, 2019 | ENT, HEENT, Infectious Disease, Pediatrics, SAEM Clinical Images

By: Mara Perch, DO and Margaret Menoch, MD |Editors: Josh Bukowski, MD

EM Match Advice: Program Directors Reflect on the 2019 Residency Match

The National Residency Matching Program® (NRMP) annually publishes data for the Residency Match. In this EM Match Advice episode, program directors reflect on the 2019 data for EM [PDF]. How competitive was emergency medicine (EM), especially given the transition period of having a single-accreditation system? Because it seems that EM remains modestly competitive, how many programs should one apply to and interview at? The below table outlines the data trends for 2011-2019.

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2019-08-18T11:38:49-07:00

August 18th, 2019 | EM Match Advice

By: Michelle Lin, MD and Michael Gisondi, MD

AMCT Toxicology Visual Pearls: Mushroom Mania

After eating the mushroom pictured, a 15-year-old patient arrives to the emergency department agitated, diaphoretic, and hallucinating, and then acutely becomes more somnolent and less responsive. Which neurotransmitter systems are affected by the toxins contained in this mushroom?

Acetylcholine and histamine
Dopamine and norepinephrine
Gamma-aminobutyric acid (GABA) and N-methyl-D-aspartate (NMDA)
Glycine and serotonin

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2019-08-06T22:32:01-07:00

August 16th, 2019 | Environmental, Tox & Medications

By: Mary Grady, MD and Christine Murphy, MD

ALiEM 2019 Gram Rounds Winner

Last month, ALiEM launched a one-of-a-kind social media contest on Instagram to find the most innovative emergency medicine residency education program. Dozens of residency programs from around the country shared incredible didactic, simulation and wellness initiatives. At the end of our contest period, one residency program stood out from the rest.

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2019-08-13T17:14:18-07:00

August 14th, 2019 | Social Media & Tech, Wellness

By: Gabe Sudario, MD

SAEM Clinical Image Series: Corneal Foreign Body

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Chief complaint: Eye pain

History of Present Illness: A 41-year-old man presents with pain and a foreign body sensation in the right eye since welding 4 days ago. The patient wore eye protective gear; however, he explains that he only wore sunglasses. A spark flew in from above his glasses and hit him in the right eye. The pain has been steady since. He complains of irritation exacerbated by blinking, but vision has remained unchanged. He has no other injury and no other physical complaint.

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2019-08-12T06:54:40-07:00

August 12th, 2019 | Ophthalmology

By: Hamid Ehsani-Nia, DO |Editors: Josh Bukowski, MD

SAEM Clinical Image Series: Tea & Toast | A Case of an Abdominal Rash

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Chief complaint: Abdominal pain, nausea, and vomiting

History of present illness: A 46 year-old female with a past history of fibromyalgia, irritable bowel disease, and chronic abdominal pain presented to the emergency department with abdominal pain, nausea, and vomiting. She reported a one-year history of similar symptoms but states that her symptoms are worse today than usual, and not improved by her home hydrocodone, medical marijuana, or heating pad use – all of which she uses daily. She has not been able to tolerate oral intake today, vomiting up her breakfast of plain toast.

The patient was observed using her home heating pad in the emergency department.

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2019-08-12T07:11:03-07:00

August 12th, 2019 | Dermatology, Environmental

By: Jonathan Abraham, MD |Editors: Josh Bukowski, MD

Trick: Peritonsillar abscess drainage 3.0 | All the steps with added variations

Peritonsillar abscess drainage pelvic speculum

A 25-year-old medical student comes in with a muffled voice, sore throat and trismus. You look at the back of her throat and you see the uvula deviated to the right. You astutely diagnosed a peritonsillar abscess (PTA). You consider aspirating and want to check for tips on how to successfully do this.

Dr. Michelle Lin and Dr. Demian Szyld have created great guides for the common and important emergency medicine procedure of draining a PTA (laryngoscope lighting and spinal needle for aspiration; ultrasound localization and spinal needle guard; avoiding awkward one-handed needle aspiration). This update reviews these tricks as well as some additional techniques for optimal success in draining a PTA, while avoiding the ultimate feared complication of puncturing the carotid artery.

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2019-08-11T21:31:30-07:00

August 9th, 2019 | ENT, Tricks of the Trade, Ultrasound

By: Margaret Davis and Al'ai Alvarez, MD