A 15 year-old male presents to the emergency department with left knee pain and swelling after jumping while attempting to dunk a basketball. You obtain a knee x-ray (image 1 courtesy of Mark Hopkins, MD). What is your diagnosis? What patient population is at risk for this injury? What other injuries occur in this anatomical location? What is your emergency department management?
Which administered antidote causes this appearance in a blood sample?
a) Hydroxocobalamin
b) Intravenous Lipid Emulsion (ILE)
c) Methylene blue
d) N-acetylcysteine
Two patients present to your emergency department: Patient 1 is a 17 year-old soccer player who fell during a game onto their right side and is now complaining of mild right shoulder pain. You obtain x-rays (Figure 1). Patient 2 is a 21 year-old motorist who lost control and went over the handlebars. They heard a pop and are complaining of left shoulder pain. You obtain shoulder x-rays (Figure 2). For these cases, what are your diagnoses, expected physical examination findings, and emergency department management?
Patients who are tracheostomy and ventilator dependent are at increased risk for complications the longer they remain in this condition. One common complication is tracheomalacia. Progressive tracheomalacia can lead to air leaks around the tracheostomy cannula balloon. Initially, this can be managed by placing a longer tracheostomy cannula deeper into the trachea, however, these are often unavailable in the emergency department [1]. A second line strategy is to temporarily over-inflate the balloon, however, with chronic overinflation, eventually both the trachea and the neck stoma become too large, leading to an inability to maintain appropriate positive pressure (PEEP) and tidal volume necessary to ventilate the patient [2].
A 54 year-old male presents to the emergency department with an eye complaint. The patient works as a cook and while cleaning the grill several hours ago felt something fly into his eye. He did not immediately feel pain, but notes blurred vision and an increasing pressure-like sensation in his left eye. He describes his left-sided blurred vision as a haziness, like cobwebs over his eye. He has been able to open his eye and keep it open without difficulty.
Welcome to the AIR Respiratory Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to respiratory emergencies. 8 blog posts within the past 12 months (as of November 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 6 Honorable Mentions. We recommend programs give 4 hours (about 30 minutes per article) of III credit for this module.
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.