Case: 55-year-old restrained driver is reporting severe shortness of breath and right sided chest pain after a high-speed motor vehicle collision. Her respiratory rate is 26 breaths/min and her oxygen saturation is 96% on a 15-liter non-rebreather. She has decreased breath sounds on the right, epigastric tenderness, and an abdominal seatbelt sign. What is the diagnosis?
Seasons greetings from the ALiEM team. We have been publishing so many posts this year that you may have missed a few. Did you catch at least the top 20 most-read ALiEM clinical posts, which were published in 2015? Check them out.
“Ugh I have to work Christmas Eve and Christmas day.”
“I hate not being with my family for the holidays.”
“Hanukkah won’t be the same this year if I can’t be with my Dad.”
“New Year’s Eve in the ED, sounds like a blast… said no one ever.”
These are just a few of the comments I have heard over the last few weeks leading up to the holidays. The last one is courtesy of myself. While I complain, deep down I know it’s not so bad. If you look hard enough I have found you can find the holiday spirit all over the Emergency Department. There are also easy tips and tricks to incorporate the spirit in the medicine and care that we provide to our patients.
Your triage nurse complains of numerous patients in the waiting room complaining of nausea, retching, and emesis. They ask you “why can’t we have an antiemetic on hand in triage?” Turns out they might have had an effective antiemetic on hand, or rather in their scrub pocket the entire time. They just didn’t know about it yet.
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Children with chest pain commonly present to the emergency department. Both the child and family members may think their symptoms are due to a serious illness. Among adolescents seen for their chest pain, more than 50% thought they were having a heart attack or that they had cancer.1 In reality, only 6% of pediatric chest pain has a cardiac etiology.2 Nonetheless, extensive and costly emergency department (ED) evaluations are common and there is wide practice variation.3
But prior to reassuring your patient, what can you do to reassure yourself that your patient doesn’t need a more extensive workup? What would make you suspicious for cardiac causes of pediatric chest pain?
Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In this case, a 55-year-old man presents with acute-onset chest pain.
Unlike the previous cardiology modules, the environmental module was comparatively under-represented in the top 50 sites of the Social Media Index. Below we have listed our selection of the 4 highest quality blog posts within the past 12 months (as of October 2015) related to environmental emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 2 AIRs and 2 Honorable Mentions.