SAEM Clinical Image Series: A Page Turner

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Chief complaint: Abdominal pain

History of Present Illness: A 36-year-old male with a history of alcohol abuse, hypertension, hyperlipidemia, and myocardial infarction with a subsequent stent on ticagrelor and aspirin presents with abdominal pain.

He reports 3 days of epigastric and periumbilical pain and multiple episodes of non-bloody, non-bilious emesis. He denies fever, diarrhea, blood in his stool, and urinary symptoms. He endorses bruising to his bilateral flanks and multiple falls recently while drinking.

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By Kimberly Fender, MD|2019-09-23T09:58:06-07:00Sep 23, 2019|SAEM Clinical Images, Trauma|

SAEM Clinical Image Series: Left Shoulder Pain

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Chief complaint: Arm pain

History of Present Illness: A 30-year-old obese male presents to the ED after a ground level fall onto his left arm with immediate isolated left shoulder pain. He did not lose consciousness and denies dyspnea, numbness, weakness, vomiting, and chest pain.

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By Sean Murray, MD|2019-09-23T09:58:20-07:00Sep 23, 2019|Orthopedic, SAEM Clinical Images|

Techniques for Ultrasound-Guided IV Placement

Imagine a busy evening shift interrupted by the news that the unstable dialysis patient still has no access. Begrudgingly, you drag the ultrasound into the patient’s room. Buried beneath a layer of muscle, a tiny vein lurks below an intimidating artery with a nerve nestled close by. Making matters worse, the patient is becoming increasingly more frustrated. “This always happens. I told them not to remove my last PICC line,” he notes. The use of ultrasound-guided IV improves successful cannulation and decreases complications, but cases like this have caused many emergency providers to resent, even fear, this basic procedure.^1–4 Below, we provide additional techniques to increase your success and to avoid the risks associated with central line placement.

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By Kimon Ioannides, MD|2019-09-19T17:39:55-07:00Sep 19, 2019|Ultrasound|

EMRad: Can’t Miss Elbow Injuries

Have you ever been working a shift at 3 am and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify injuries that ideally should not be missed. This list is not meant to be comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. To begin: “Can’t Miss” adult elbow injuries.

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By Stephen Villa, MD|2020-05-14T22:36:36-07:00Sep 16, 2019|EMRad, Orthopedic, Radiology, Trauma|

EMRad: Radiologic Approach to the Traumatic Elbow

Radiology teaching during medical school is variable, ranging from informal teaching to required clerkships.¹ Many of us likely received an approach to a chest x-ray, but approaches to other studies may or may not have not been taught. We can do better! Enter EMRad, a series aimed at providing approaches and improving interpretation of commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. To begin: the elbow.

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By Stephen Villa, MD|2020-05-14T22:36:46-07:00Sep 16, 2019|EMRad, Orthopedic, Radiology, Trauma|

Building Equipment Kits for Streamlined Care

In the setting of emergent care, the ability to access equipment rapidly and reliably can be a deciding factor in patient outcome. Poor stocking, inconsistent organization, and dispersal of equipment throughout a large geographic area are realities of practice as well as barriers to rapid and effective patient care. Equipment kits are a great way to ensure rapid access to a select set of tools to deal with emergent scenarios. They result in both decreased time to arrival and decreased time to successful completion of procedure.^1,2 Scenarios that can benefit from organized and well provisioned kits include central or peripheral access, airway management, initial stabilization, monitor application, chest tube placement, or cricothyroidotomy. A word of caution: equipment kits are not a substitute for skill and cannot be thought of as a fix-all. They keep a specific set of equipment in an easy-to-locate, all-in-one package for use in a predetermined set of scenarios.

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By Matthew W. Earle, MD|2019-09-05T08:56:05-07:00Sep 11, 2019|Administrative, EMS|

SAEM Clinical Image Series: Hip Pain

$hip pain anterior inferior iliac spine fracture$

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Chief complaint: Left hip pain

History of Present Illness: A healthy right leg-dominant 13-year-old male athlete presents with left hip pain after kicking a soccer ball.

He states that he kicked the ball awkwardly and experienced hip pain immediately afterwards. He did not feel a pop or cracking sensation but could not stand after the kick and fell to the ground. He can ambulate but only with significant pain.

He now has 8/10 sharp, non-radiating left hip pain that is worse with movement, weight-bearing and palpation.

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By Louis Yu, MD MA|2019-09-09T17:23:16-07:00Sep 9, 2019|Emergency Medicine, Orthopedic, SAEM Clinical Images, Ultrasound|