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|

ACMT Toxicology Visual Pearls: Mushroom Mania

After eating the mushroom pictured, a 15-year-old patient arrives to the emergency department agitated, diaphoretic, and hallucinating, and then acutely becomes more somnolent and less responsive. Which neurotransmitter systems are affected by the toxins contained in this mushroom?

Acetylcholine and histamine
Dopamine and norepinephrine
Gamma-aminobutyric acid (GABA) and N-methyl-D-aspartate (NMDA)
Glycine and serotonin

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By Mary Grady, MD|2019-11-12T19:02:10-08:00Aug 16, 2019|ACMT Visual Pearls, Environmental, Tox & Medications|

SAEM Clinical Image Series: Corneal Foreign Body

[Click for larger view]

Chief complaint: Eye pain

History of Present Illness: A 41-year-old man presents with pain and a foreign body sensation in the right eye since welding 4 days ago. The patient wore eye protective gear; however, he explains that he only wore sunglasses. A spark flew in from above his glasses and hit him in the right eye. The pain has been steady since. He complains of irritation exacerbated by blinking, but vision has remained unchanged. He has no other injury and no other physical complaint.

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By Hamid Ehsani-Nia, DO|2019-08-12T06:54:40-07:00Aug 12, 2019|Ophthalmology|