A 78-year-old male is brought in from his nursing home for evaluation of hypotension. He has a prior history of multiple strokes and is bed bound. He arrives febrile, tachycardic, and hypotensive. On your physical exam, you notice that he has an indwelling foley catheter. The catheter tubing and bag have a vibrant purple color. You wonder if this unusual urine color could be caused by something insidious. Could this be related to a toxin, medication, or infection?(more…)
Welcome to the AIR Renal/Genitourinary 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 renal and genitourinary emergencies. 6 blog posts within the past 12 months (as of May 2020) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 5 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module.
AIR Stamp of Approval and Honorable Mentions
Interested in taking the renal/GU quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link. You will need to create a free, 1-time login account.
Highlighted Quality Posts: Renal/GU Emergencies
|emDocs||Complications of Nephrostomy Tubes: ED Presentations, Evaluation, and Management||Michael J. Yoo, MD||11/11/2019||AIR|
|RebelEM||Post Contrast Acute Kidney Injury||Salim Rezaie, MD||1/16/2020||HM|
|EMCrit||The Myth of Contrast Nephropathy||Josh Farkas, MD||5/2/2019||HM|
|EMCrit||Non-Anion Gap Metabolic Acidosis (NAGMA)||Josh Farkas, MD||9/19/2019||HM|
|emDocs||[email protected]: Kidney Transplant Complications||Rachel Bridwell, MD||12/29/2019||HM|
|CanadiEM||Testicular Torsion||Subhrata Verma||11/12/2019||HM|
(AIR = Approved Instructional Resource; HM = Honorable Mention)
Thank you to the Society of Academic Emergency Medicine (SAEM) and the Council of EM Residency Directors (CORD) for jointly sponsoring the AIR Series! We are thrilled to partner with both on shaping the future of medical education.
A 25-year-old man presents with 6 hours of penile pain and swelling after recreational penile injection of Trimix (alprostadil, papaverine, and phentolamine). He denies any history of sickle cell disease or penile trauma. On exam, he is in moderate discomfort and has a tumescent penis with a soft glans. You suspect the patient is suffering from ischemic, low-flow priapism. Manual compression and ice application have been attempted with no significant improvement in the patient’s clinical status.
Production and use of free open access medical education resources (FOAM) has had a meteoric rise over the last decade.1–4 ALiEM works hard to produce content, disseminate knowledge, and consolidate resources in a democratic and accessible way. However, we recognize that FOAM comes with its own limitations:
- Blogs are distinct, individual, and decentralized. How can we search for topic-specific content?
- FOAM doesn’t often have peer review. How can we assess quality and accuracy?
- FOAM is produced on an as-needed basis. How do we achieve curricular comprehensiveness?
Case: A 58-year-old male with no past medical history presents to the emergency department for evaluation of right lower quadrant abdominal pain associated with right scrotal swelling. The patient reports that he had a colonoscopy the day before to remove a 20 mm polyp, which had been seen on an outpatient CT scan. He states that he noticed that his right scrotum appeared slightly swollen immediately away after the procedure, but since then the swelling had increased and he developed mild right lower quadrant abdominal pain. Physical examination reveals mild tenderness to the right lower quadrant and swelling of the right scrotum with palpable crepitus of the right scrotum and inguinal canal. There is no overlying skin discoloration. What is the most likely diagnosis?
Chief Complaint: Flu-like symptoms, lip pain/swelling, mouth pain, eye redness, and rash
History of Present Illness: Patient is a 35-year-old transgender male with a history of bipolar disorder (taking seroquel/lamotrigine) who presents with 2 days of:
- Flu-like symptoms
- Progressive lip pain/swelling
- Mouth pain
- Oral ulcers
- Eye redness
- New erythematous rash involving the palms/soles and lower extremities
The patient initially noted myalgias, fever, and malaise 2 days ago. Yesterday, the patient woke up with bilateral eye redness and itching, and he developed lip swelling/discoloration and mouth pain throughout the day. He presented to an outside emergency department (ED) 12 hours prior, where he was told that he had a viral infection, given pain medication, and discharged home. He has not taken any other medications. The patient presents to this ED due to progression of symptoms, including the development of a pruritic rash on his palms, soles, and lower extremities. Upon further questioning, the patient also reports vaginal itching and a fishy odor. He has a history of bacterial vaginosis and states that these symptoms feel similar. The patient denies genital sores, vaginal discharge, and vaginal bleeding. He is currently sexually active with men and women, and does not regularly use barrier protection.
When should urinary tract infections (UTI) be included in the differential diagnosis for febrile infants and young children? The EM Committee on Quality Transformation in the American Academy of Pediatrics (AAP) thoughtfully outlines a clinical algorithm to help guide clinicians towards a standardized, evidence-based approach. Thanks to the expert content team (Drs. Shabnam Jain, Anne Stack, Scott Barron, Pradip Chaudhari, and Kathy Shaw) for sharing this clinical algorithm.