A 41-year-old male presents with left-hand pain after an altercation. The patient’s hand is noted to be swollen and tender, particularly over the 4th-5th metacarpals, with mild swelling extending to the 4th-5th digits. The patient also notes that he slightly deformed his wedding ring during the fight and he has since been unable to remove it. It’s a busy overnight and the patient has been in the waiting room for an hour. While waiting nursing staff had the patient ice his hand while elevated and attempted to remove the ring with a water-based lubricant. All attempts to remove the ring thus far have been unsuccessful.
A 25-year-old man presents with 6 hours of penile pain and swelling after recreational penile injection of Trimix (alprostadil, papaverine, and phentolamine). He denies any history of sickle cell disease or penile trauma. On exam, he is in moderate discomfort and has a tumescent penis with a soft glans. You suspect the patient is suffering from ischemic, low-flow priapism. Manual compression and ice application have been attempted with no significant improvement in the patient’s clinical status.
A 25-year-old woman is brought into the emergency department by friends due to “acting weird.” She was at a rave and is reported to have consumed alcohol, marijuana, and ecstasy. On exam, she is afebrile, tachycardic, normotensive, and breathing comfortably on room air. She is lethargic, mumbling incomprehensibly, and does not follow commands. Her glucose is 115 mg/dL, her pregnancy test is negative, her EKG reveals sinus tachycardia, her ethanol level is 30 mg/dL, and a stat CT head is negative. Her chemistry panel reveals a sodium level of 114 mEq/L. You order a 100 mL 3% sodium chloride bolus, but it may take 30 minutes to arrive from the central pharmacy. At this point, the nurse informs you that the patient is seizing.
Will there be a return to book publishing in this era of digital information chaos and overload? We believe so. We are proud to announce “Tricks of the Trade in Emergency Medicine: Where Experience, Ingenuity, and Evidence Intersect.” Being our own publishers (ALiEM Publishing) and selling through a print-on-demand bookstore has allowed us to design the book with full creative license. In stark contrast to our blog and other digital-based projects, we aimed to create a hardback, full-color book that you can read on a lazy Sunday afternoon, give as a graduation gift, or look delightful on your coffee table. We hope these tips spark your own creativity on how you can better improve your troubleshooting abilities on your next Emergency Department shift.
Foreign bodies in the ear or the nose can be extremely challenging to remove, especially considering that a majority of them occur in children less than 7 years old who are likely to be uncooperative with exam . In a previous post, we emphasized the need to pick the best tool for the job in order to minimize complications. What happens when you find yourself in an austere environment and the usual tools are not available?
Your team in the Emergency Department (ED) receives a call from your local Emergency Medical Services (EMS) crew informing you that they are transporting a patient with high suspicion of COVID-19 in severe respiratory distress. As you assemble your team in preparation for a Protected Code Blue (PCB), your staff (including physicians, nurses, respiratory therapists, etc.) begins donning full Personal Protective Equipment (PPE). PPE includes donning a gown, gloves, face mask, goggles and/or a face shield.
With several team members assembled in the resuscitation bay in full PPE, it can be challenging to identify specific individual members of the team and their role.
A 35-year-old male working as a healthcare worker presents for evaluation of ear discomfort. The skin behind his ears has been red and irritated since having to wear a surgical face mask with the majority of his patient interactions . He has tried to minimize wearing his mask in the appropriate circumstances, using lotions and emollients, but still has a significant amount of discomfort .