SAEM Clinical Image Series: Tick Bite

Rocky Mountain Spotted Fever tick bite hand rash

A 14 year old girl presenting from Mexicali with altered mental status. Her mother reports a rash about a week ago following a tick bite. She had been going to school until 4 days ago when she became very fatigued with associated vomiting, diarrhea, tactile fevers, and headache. She subsequently collapsed at home today and was difficult to arouse which prompted EMS activation. Her mother denies any prior complaint of neck stiffness, shortness of breath, cough, hematemesis, or hematochezia.

(more…)

ACMT Toxicology Visual Pearls: Mushroom Mania

mushroom poisoning amanita muscariaAfter 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?

  1. Acetylcholine and histamine
  2. Dopamine and norepinephrine
  3. Gamma-aminobutyric acid (GABA) and N-methyl-D-aspartate (NMDA)
  4. Glycine and serotonin

(more…)

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

Tea & Toast erythema ab igne rash


[Click for larger view]

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.

(more…)

By |2019-08-12T07:11:03-07:00Aug 12, 2019|Dermatology, Environmental|

Accidental Hypothermia and Cardiac Arrest: Physiology, Protocol Deviations, and ECMO

accidental hypothermia and cardiac arrestAccidental hypothermia is a life threatening condition that can lead to a challenging resuscitation. The very young, old, and intoxicated patient are at high risk to developing hypothermia, even in temperate climates. The pathophysiologic changes from hypothermia make the standard ACLS approach insufficient to care for the hypothermic patient. This article will discuss the physiology of hypothermia and how you should alter your approach in the hypothermic patient, including early consideration of extracorporeal membrane oxygenation (ECMO).

(more…)

By |2018-12-12T04:52:45-08:00Dec 12, 2018|Critical Care/ Resus, Environmental|