SAEM Clinical Image Series: An Oropharyngeal Mass

A fifty-year-old male presented to the emergency department (ED) unconscious with CPR in progress. Per EMS report, the patient was found down surrounded by emesis with no pulse or respirations. Fifteen minutes of CPR was performed prior to arrival in the ED with a King Tube in place. The King Tube was filled with emesis and increasingly difficult to bag. The King Tube was removed to attempt intubation and maximize oxygenation and ventilation.

When the Mac 4 blade was placed in the mouth, a large, pink, fleshy, and vascularized structure was seen in the mouth just anterior to where the uvula should have been located. Attempts were made to compress the mass into the tongue, separate the tongue from the mass, and sweep the mass out of the way. All attempts failed to expose the epiglottis. An attempt was made to remove the mass, but it appeared to be part of the mouth. The decision was made to proceed with a cricothyrotomy; a 6.0 tube was successfully placed, and the patient was able to be ventilated. Return of spontaneous circulation was never achieved and the patient expired in the ED.

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By Matthew Sherman, MD|2020-08-25T17:47:32-07:00Aug 31, 2020|Emergency Medicine, ENT, Gastrointestinal, SAEM Clinical Images|

A 50-year-old male presents to the emergency department with a new inability to extend his 5th digit of the left hand. He states he was playing a game of pick-up basketball last week when he jammed the finger while attempting to catch a pass from a teammate. An AP and lateral radiograph of the digit is obtained (Image 1 courtesy of Dr Alborz Jahangiri, Radiopaedia.org). What is your diagnosis? What causes this injury? What exam maneuver can help diagnose the underlying injury before the deformity is evident? What is the treatment/management of this injury? What are the surgical indications?

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By Randall Beaupre, MD|2020-08-11T09:31:59-07:00Aug 26, 2020|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

Unlocking the MIC-KEY: Understanding and Troubleshooting Low-Profile Gastrostomy Tubes

You are working an overnight clinical shift at your community emergency department when a worried mother brings in her 15-year-old child with cerebral palsy due to their gastric tube “coming out.” As you begin to obtain a history of the patient’s gastric tube (when it was placed, where it was placed, why is it in place, etc.) you realize you will be the one replacing it tonight, and frankly you haven’t done this before. The following post serves as a refresher on the use, placement, and complications of gastrostomy tubes.

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By Marc Cassone, DO|2020-08-23T17:00:00-07:00Aug 24, 2020|Emergency Medicine, Gastrointestinal|

SplintER Series: Hip Pain Following an MVC

A 48-year-old female presents to the emergency department after a high-speed motor vehicle collision (MVC). She is complaining of left hip pain. Her radiographs are shown (Image 1 courtesy of Dr Ayaz Hidayatov, Radiopaedia.org, rID: 52760). What is your diagnosis? What is the likely mechanism of injury? What physical exam findings are expected? What is your management in the emergency department and when should you consult orthopedics?

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By Kayla Prokopakis, DO|2020-08-11T08:46:57-07:00Aug 19, 2020|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

SAEM Clinical Image Series: The Cocaine Gut

A sixty-five-year-old male with a medical history of gastroesophageal reflux disease (GERD), hypertension, alcohol dependence, homelessness, and cocaine abuse presents to the emergency department with abdominal pain for three days. The patient describes his abdominal pain as knife-like, 9/10, located diffusely throughout his abdomen, with associated anorexia and nausea. He reports that he had one episode of coffee ground emesis this morning which provoked him to come to the ED. He reports frequent cocaine use with his last use three days ago. He endorses subjective fevers, chills, and no bowel movement for two days. He has had no sick contacts.

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By Eric M. Beyer, MD|2020-08-14T13:13:28-07:00Aug 17, 2020|Emergency Medicine, SAEM Clinical Images, Tox & Medications|

SAEM Clinical Image Series: Severe Cutaneous Lesions in an Immunocompromised Host

A thirty-one-year-old female presented to the emergency department with the complaint of a painful rash for 2 days. She has a history of HIV with a known CD4 count < 200 cells/µL. She states that the rash began two days ago and progressed to the current size. She describes the rash as burning and has never experienced these symptoms before. She has tried topical corticosteroids which did not alleviate the pain.

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By Rykiel Levine, DO|2020-08-18T09:09:28-07:00Aug 17, 2020|Dermatology, Emergency Medicine, Infectious Disease, SAEM Clinical Images|

SplintER Series: Elbow Injury

A 70-year-old female presents with left elbow pain and deformity after falling on an outstretched hand. You obtain shoulder x-rays and see the above images. What is the most likely diagnosis, likely mechanism of injury, expected physical exam findings, and management plan? (Image 1: AP and lateral views of the left elbow. Author’s own images)

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By Victor Huang, MD|2020-07-29T14:41:00-07:00Aug 12, 2020|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|