SAEM Clinical Image Series: Young Woman with a Headache

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Chief complaint: Headaches for 1 year

History of Present Illness: A 31-year-old woman with no significant past history presents with a dull headache.

She notes the headache is generalized, has been almost daily for a year and is worsened by bending over. She denies nausea, vomiting, photophobia, trauma, seizures, focal weakness, numbness, or vision change. Acetaminophen and ibuprofen provide only mild, short-acting relief. She takes oral birth control and her periods have been normal.

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By Walter L Green, MD|2019-09-03T11:17:34-07:00Sep 2, 2019|Neurology, Ophthalmology, SAEM Clinical Images|

SplintER Series: Funny Looking Finger

Figure 1: Terminal extensor tendon avulsion at distal interphalangeal joint of 5th digit

A 17-year-old baseball player presents complaining of finger pain and difficulty straightening his finger after a baseball game. You obtain x-rays and see the following fracture (photo credit).

What is your diagnosis and emergency department management?

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By Sergio Alvarez, MD CAQSM|2019-09-09T13:54:59-07:00Aug 30, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

Differentiating pericardial effusion from pericardial tamponade on ultrasound

Tamponade physiology, in which a pericardial effusion impedes cardiac output, is a medical emergency and requires prompt diagnosis and intervention before cardiovascular collapse ensues. However, not every fluid collection in the pericardial sac results in tamponade physiology. A clinical diagnosis of tamponade (Beck’s triad) has poor sensitivity and will occur only in the late stages of tamponade.¹ In order to know whether or not an intervention is necessary for the setting of pericardial effusion, ultrasound diagnosis of tamponade is paramount.

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By Leen Alblaihed, MBBS, MHA|2019-08-30T10:13:06-07:00Aug 28, 2019|Cardiovascular, Radiology, Ultrasound|

Ultrasound for the Win! 18M with dysphagia #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clinical case where bedside ultrasound changed the management or aided in the diagnosis. In this case, an 18-year-old man presents with a sore throat.

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By Kelly Goodsell, MD|2019-08-27T16:37:53-07:00Aug 26, 2019|ENT, Ultrasound|

PEM Pearls: 5 Tips to Demystify Amoxicillin in Pediatric Infections

Amoxicillin is a penicillin derivative antibiotic against susceptible gram positive and gram negative bacteria. It has reasonable coverage for most upper respiratory infections and is used as prophylaxis for asplenia and bacterial endocarditis. This post aims to demystify amoxicillin treatment for common pediatric infections.

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By Rosy Hao, MD|2019-09-05T17:59:37-07:00Aug 23, 2019|Dermatology, ENT, Pediatrics, PEM Pearls, Pulmonary, Tox & Medications|

Fascia iliaca nerve block: A hip fracture best-practice

An 82-year-old woman presents with left hip pain after a mechanical fall while cleaning the kitchen floor. When EMS arrived, the left leg was foreshortened and externally rotated. The paramedics administered 10 mg of IV morphine, but she is still writhing in pain on arrival. The AP pelvic x-ray demonstrates a left femoral neck fracture (arrow). You consider performing a fascia iliaca nerve block for better pain control.

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By William Shyy, MD|2020-11-27T19:04:06-08:00Aug 21, 2019|Orthopedic, Ultrasound|

SAEM Clinical Image Series: Facial Swelling in a 2 Year Old

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Chief complaint: Left-sided facial swelling

History of Present Illness: A 2-year-old male presents to the emergency department in January after waking up with left-sided facial swelling. Mother states her son has had cough and congestion for the past 4 days for which she has been giving Tylenol and a children’s cough medication. The patient went to bed, awoke the following morning with facial swelling, and was brought to the emergency department.

He has no allergies, history of trauma to the area, or bug bites. The patient is fully vaccinated including the influenza vaccine.

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By Mara Perch, DO|2019-08-22T08:42:23-07:00Aug 19, 2019|ENT, HEENT, Infectious Disease, Pediatrics, SAEM Clinical Images|