Ultrasound for the Win! 18M with dysphagia #US4TW

Peritonsillar abscess ultrasound

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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2019-08-27T16:37:53-07:00

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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2019-09-05T17:59:37-07:00

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

Facial swelling


[Click for larger view]

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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2019-08-22T08:42:23-07:00

Trick: Peritonsillar abscess drainage 3.0 | All the steps with added variations

Peritonsillar abscess drainage pelvic speculum

A 25-year-old medical student comes in with a muffled voice, sore throat and trismus. You look at the back of her throat and you see the uvula deviated to the right. You astutely diagnosed a peritonsillar abscess (PTA). You consider aspirating and want to check for tips on how to successfully do this.

Dr. Michelle Lin and Dr. Demian Szyld have created great guides for the common and important emergency medicine procedure of draining a PTA (laryngoscope lighting and spinal needle for aspiration; ultrasound localization and spinal needle guard; avoiding awkward one-handed needle aspiration). This update reviews these tricks as well as some additional techniques for optimal success in draining a PTA, while avoiding the ultimate feared complication of puncturing the carotid artery.

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2019-08-11T21:31:30-07:00

Strep Pharyngitis in Children: Review of the 2012 IDSA Guidelines

strep pharyngitis

Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cases with the rest being primarily viral in etiology. However, clinically differentiating viral versus bacterial causes of pharyngitis is difficult and we, as providers, often don’t get it right. In addition, antimicrobial resistance is increasing.. So who do we test and when do we treat for strep throat? The 2012 Infectious Diseases Society of America (IDSA) guideline on GAS pharyngitis helps answer these questions.

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2019-09-05T20:30:07-07:00

ACMT Toxicology Visual Pearls: Toxic Mouth Pain

betel nut mouthA middle-aged Asian female presents to the emergency department complaining of 2-3 days of mouth pain. She has chewed betel nut for a number of years. Which of the following is true regarding her presentation and management?

  1. Debridement should be avoided.
  2. Metronidazole is contraindicated due to the potential of a disulfiram-like reaction.
  3. Oral secretagogues should be used due to the anticholinergic effects.
  4. The patient is at increased risk of oral cancer.

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2019-03-30T21:21:51-07:00

ALiEMCards: Tranexamic Acid

Tranexamic acid (TXA) is a synthetic form of the amino acid lysine that binds to receptors on plasmin and prevents it from breaking down fibrin clots. Numerous studies have investigated its utility in preventing or treating traumatic hemorrhage, and the World Health Organization now includes TXA on its list of Essential Medicines. In addition to trauma, TXA may be effective in other clinical scenarios relevant to Emergency Medicine, including gynecological hemorrhage and epistaxis. ALiEM Cards: TXA, written by Dr. Sam Ashoo, reviews the dosing and potential indications for TXA use in the ED.

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2018-05-26T21:29:25-07:00