Trick of the Trade: Angiocatheter for manual aspiration of priapism

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.

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By Jonathan Hootman, MD|2020-05-13T11:19:13-07:00Jun 10, 2020|Genitourinary, Tricks of the Trade|

ACMT Toxicology Visual Pearls: A Foraging Experience to Die For

What life-threatening symptoms can result from the ingestion of this plant?

Delayed onset bone marrow suppression
Hepatic failure
Mucosal swelling of the anterior airway
Paralysis and respiratory failure

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By Robert Goodnough, MD|2020-06-07T11:39:54-07:00Jun 8, 2020|ACMT Visual Pearls, Tox & Medications|

Trick of the Trade: Sodium Bicarbonate for Acute Symptomatic Hyponatremia

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.

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By Jonathan Hootman, MD|2020-05-11T06:50:15-07:00Jun 3, 2020|Tox & Medications, Tricks of the Trade|

Social Distancing Simulation: Tips for Leading a Virtual Session With Student Learners

We’ve all had to get a bit creative over the past few weeks. COVID-19 has ushered in an era of not only pushing healthcare workers and hospitals into uncharted territory, but also challenging the structure and delivery of medical education. Simulation education is one of many teaching modalities that is affected by this change given its case-based, in-person structure with a team of learners. These characteristics unfortunately violate the 6-foot rule of social distancing. While traditional simulation is not typically conceptualized as a virtual modality, many of its principals can be successfully adapted for remote learning.

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By Ashley Rider, MD|2020-05-31T19:16:34-07:00Jun 1, 2020|COVID19, Education Articles, Simulation|

PEM Pearls: Chest Radiographs for Shortness of Breath

Figure 1: Photo by Tim Bish on Unsplash

Paramedics bring in a 5-month-old boy in respiratory distress. He’s crying furiously and has normal tone and color. Thick, copious secretions are coming from his nose. He is tachypneic with diffuse wheezes, crackles, retractions, and nasal flaring. His respiratory rate is 70 and his oxygen saturation is 88% on room air. Would you order a chest radiograph (CXR) for this child?

CXRs are routinely obtained in adults with respiratory symptoms. Children, however, are more sensitive to radiation and can have multiple respiratory infections every year. CXRs can increase cost, length of stay, and may not always be necessary.

This post presents some guidelines on when (and when not) to get a CXR in pediatric patients.

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By Katrina Stime MD|2026-06-16T16:15:49-07:00May 27, 2020|PEM Pearls, Pulmonary, Radiology|

The rapid code status conversation guide for seriously ill older adults in acute respiratory failure

You are working a shift in your emergency department (ED) when an 85 year old female presents with a complaint of altered mental status. She comes from an extended care facility, where paramedics are able to tell you “they called us to come get her,”you are handed a stack of paperwork, given some vital signs, and you notice the patient is altered and unable to provide any further history. You dig a little in the paperwork and note a history of dementia as well as a long list of other medical problems, you notice no known advanced directive, and see that her daughter lives out of state but is available via phone. Have you been here? Seen this patient? If you have worked in emergency medicine long enough you certainly have. The tool outlined below is designed to help you know what to do in these difficult situations.

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By Kei Ouchi, MD|2020-05-31T19:05:01-07:00May 25, 2020|Palliative Care|

Work Grief: A Primer for Emergency Medicine Providers

Heartbreaking patient situations are the backbone of Emergency Medicine. Whether it’s a new cancer diagnosis, telling a family member that their loved one has died, or the creeping dread that a mistake that we’ve made will negatively impact one of our patients, we all experience extraordinary stress in our day-to-day clinical practice. Most clinicians are not tasked with routinely sharing news about the violent, unexpected, and horrific life-changing situations that occur in the emergency department, and yet we are given so few tools to help us manage this firehose of grief. This article is intended to share some of the best practices of grief management with clinicians who are immersed in grief, even if unawares.

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By Kai Romero, MD|2020-05-22T12:34:22-07:00May 22, 2020|Palliative Care, Wellness|