ACMT Toxicology Visual Pearls: Toxic Mouth Pain

A 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?

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

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By Heather A. Borek, MD|2019-11-12T19:05:57-08:00Aug 30, 2018|ACMT Visual Pearls, ENT, Tox & Medications|

ALiEM AIR Series: Ear, Nose, and Throat (ENT) Module

Welcome to the Ear, Nose, and Throat (ENT) 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 ENT emergencies. 8 blog posts within the past 12 months (as of December 2017) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 7 Honorable Mentions. We recommend programs give 3 hours (about 20 minutes per article) of III credit for this module.
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By Andrew Grock, MD|2020-09-03T21:45:24-07:00Apr 12, 2018|ALiEMU, Approved Instructional Resources (AIR series), ENT|

PEM Pearls: Regional Facial Nerve Blocks

Regional nerve blocks of the face and ear can be a wonderful choice of analgesia in a child, particularly for wounds that need to be repaired. The benefits include fewer local injections, improved cosmesis due to less wound margin distortion, and improved analgesia within the nerve region.^1,2 The following blog post and brief video tutorial review the key elements of this technique.

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By Ashley Foster, MD|2018-01-21T21:11:01-08:00Jan 22, 2018|ENT, Pediatrics, PEM Pearls|

PEM Pearls: Search & Rescue of Ear Foreign Bodies – Picking the Right Tool

While ear foreign bodies can happen at any age, the majority occur in children less than 7 years of age.¹ The younger the patient, the less likely they are cooperative with the exam and, therefore, the less chance of successful foreign body removal. The first attempt at removal is the best, so it is important to make it count. Similarly, different types of foreign bodies call for different “tools” for removal. It is important to understand when to attempt removal in the emergency department (ED) and what tools are available. This blog post will help you optimize your first pass success at foreign body removal by understanding what tools are at your disposal.

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By Josh Bukowski, MD|2017-10-26T14:32:51-07:00May 8, 2017|ENT, Pediatrics, PEM Pearls|

Epistaxis Management in the Emergency Department: A Helpful Mnemonic

Epistaxis is a common presentation to the emergency department (ED)¹ that can be challenging and time consuming. Knowledge of the pearls, pitfalls, and troubleshooting tips around managing nosebleeds often can be the difference between a frustrating versus straightforward ED stay for patients. Use the EPISTAXIS mnemonic to help you remember these points.

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By Moises Gallegos, MD MPH MEHP|2021-03-02T13:49:57-08:00Feb 15, 2017|ENT|

Trick of the Trade: A cleaner way to apply dental cement for a tooth fracture

$dental cement for tooth fracture$ The management of a dental fracture is a core skill of the emergency physician.¹ When the enamel is violated and the underlying dentin is exposed (i.e. Ellis Class II or greater), the dental pulp becomes at risk.² Protecting the exposed dentin in a timely manner, therefore, is paramount. This is best accomplished through the use of dental cements.

The application of dental cement to a fractured tooth, while a relatively rare procedure, is one often fraught with difficulties. With many of the formulations requiring the rapid application of a fast-drying cement, time for accurate and clean application is limited. This often clumsy, haphazard spackling of the patient’s tooth with cement rarely feels smooth or confidence-instilling. Isn’t there a better way?
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By Jason Hine, MD|2019-04-28T19:59:44-07:00Dec 29, 2016|ENT, Tricks of the Trade|

Trick of the Trade: Ear Irrigation in the Emergency Department

Ear irrigation is an important tool for adult and pediatric patients in the Emergency Department (ED) with ENT complaints. Irrigation can be used to clear ear cerumen, visualize tough-to-see tympanic membranes, and remove foreign bodies. This may reduce the need for subspecialist care and improve the patient’s hearing and quality of life.¹ Commercial electronic and mechanical devices are available for irrigation and have been studied. Moulton and Jones presented the improved efficacy of foreign body removal using an electric ear syringe in an (ED) population.² In this trick of the trade, we present a low cost and effective way of “ear-rigation” taught to us by one of our veteran nurses using easily available tools in the ED.

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By Chris Belcher|2016-11-11T19:47:00-08:00Aug 18, 2016|ENT, Expert Peer Reviewed (Clinical), Tricks of the Trade|

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