SAEM Clinical Image Series: Left Ear Mass

A 25-year-old male who was previously healthy presents to the emergency department with a painful left posterior ear mass. The mass began as a “pimple” and has been increasing in size for the last 6 months. He has an associated headache, dizziness, and malaise. He denies fever, trauma, drainage, known insect bite, dysphagia, dyspnea, trismus, and hearing loss. He emigrated to the United States from Honduras 8 months ago. He was seen in the emergency department 4 months prior for a similar complaint, which was diagnosed as lymphadenopathy by point-of-care ultrasound.

(more…)

By Gabriela Rivera-Camacho, MD|2021-01-10T20:38:47-08:00Jan 11, 2021|Academic, ENT, Infectious Disease, SAEM Clinical Images|

Welcome to the AIR Immunology 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 immunology in the Emergency Department. 5 blog posts within the past 12 months (as of September 2020) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 3 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

In an effort to truly emphasize the highest quality posts, we have 2 subsets of recommended resources. The AIR stamp of approval is awarded only to posts scoring above a strict scoring cut-off of ≥30 points (out of 35 total), based on our scoring instrument. The other subset is for “Honorable Mention” posts. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score.

Take the AIR Immunology Quiz at ALiEMU

Interested in taking the Immunology 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: Immunological Emergencies

Site	Article	Author	Date	Label
EMCrit: IBCC	Angioedema	Josh Farkas, MD	1 Aug 2019	AIR
EMDocs	Prolonged Pediatric Fever and Evaluating Patients for Kawasaki Disease, Toxic Shock Syndrome, and Multi-inflammatory Syndrome of Children	Chance Sullivan, MD, Skyler Lentz, MD, and Joe Ravera, MD	3 Aug 2020	AIR
EMCrit/PulmCrit	How to Use IV Epinephrine for Anaphylaxis	Josh Farkas, MD	26 Aug 2019	HM
CanadiEM	Convalescent Plasma for COVID-19	Kevin Shopsowitz, MD	7 Jul 2020	HM
Taming the SRU	Angioedema in the ED	Marlena Wosiski-Kuhn, MD	10 Aug 2020	HM

AIR = Approved Instructional Resource; HM = Honorable Mention

(AIR = Approved Instructional Resource; HM = Honorable Mention)

If you have any questions or comments on the AIR series, or this AIR module, please contact us! More in-depth information regarding the Social Media Index.

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.

By Chris Belcher, MD|2020-11-15T16:32:16-08:00Nov 18, 2020|Approved Instructional Resources (AIR series), Infectious Disease|

SAEM Clinical Image Series: Severe Cutaneous Lesions in an Immunocompromised Host

A thirty-one-year-old female presented to the emergency department with the complaint of a painful rash for 2 days. She has a history of HIV with a known CD4 count < 200 cells/µL. She states that the rash began two days ago and progressed to the current size. She describes the rash as burning and has never experienced these symptoms before. She has tried topical corticosteroids which did not alleviate the pain.

(more…)

By Rykiel Levine, DO|2020-08-18T09:09:28-07:00Aug 17, 2020|Dermatology, Emergency Medicine, Infectious Disease, SAEM Clinical Images|

SAEM Clinical Image Series: Found Down with Altered Mental Status

A forty-nine-year-old male with a history of polysubstance abuse, including methamphetamine and intravenous (IV) drug use, rectal cancer, and human immunodeficiency virus (HIV) was brought into the emergency department by emergency medical services (EMS) after he was found down at the bottom of a flight of stairs by his roommate. In the emergency room, he was found to have a Glasgow Coma Scale (GCS) score of 7 and was intubated for airway protection. Non-contrast head CT was performed. Per the roommate, the patient had been “not himself,” exhibiting strange behavior and weight loss. History and review of systems (ROS) were otherwise unobtainable due to the acuity of illness.

(more…)

By Eric M. Beyer, MD|2020-08-09T20:33:43-07:00Aug 10, 2020|Emergency Medicine, Infectious Disease, Neurology, SAEM Clinical Images|

Guideline Review: Pre-exposure prophylaxis (PrEP) for HIV prevention

While HIV medications receive much attention for the treatment of HIV infection, less attention has focused on the prophylaxis indications. In 2017, the Center for Disease Control and Prevention (CDC) updated their guidelines on the indications for the HIV medications tenofovir disoproxil fumarate (TDF) and emtricitabine (2′,3′-dideoxy-5-fluoro-3′-thiacytidine, FTC) for pre-exposure prophylaxis (PrEP). The trade name for the combination medication is Truvada. These daily medications are taken by people at risk for HIV to prevent HIV. This Guideline Review succinctly summarizes the 77-page CDC document into the key pearls for emergency physicians.

(more…)

By Michelle Lin, MD|2020-05-06T18:54:03-07:00Apr 27, 2020|Guideline Review, Infectious Disease, Tox & Medications|

Healthcare Providers in the COVID-19 Era: Keeping Clean When Coming Home

Given overcrowded hospitals and limited availability of personal protective equipment (PPE), showing up for work can feel like entering a battleground without ammunition for many physicians during the COVID-19 outbreak [1]. Despite this, doctors and nurses show up every day ready to do their jobs. While we have committed to the Hippocratic Oath, our families have not. How can we do our duty while preventing exposure of our loved ones at home [2, 3]?

(more…)

By Christian Rose, MD|2020-04-02T13:52:58-07:00Apr 8, 2020|COVID19, Infectious Disease, Life|

Diagnose on Sight: Post-traumatic Finger Pain

Case: A 32-year-old male with a past medical history of diabetes presents with a 1 month history of finger pain after slamming his finger in a car door. 2 weeks after the initial incident he presented to the emergency department for worsening pain and received x-rays that were negative for acute fracture. Today he presents reporting pain radiating up the hand, arm, and into the shoulder, with associated chills. His labs are significant for hyperglycemia, hyponatremia, and an elevated erythrocyte sedimentation rate and c-reactive protein. His x-ray is seen here (figure 1 image courtesy of Daniel Rogan, MD). What is the diagnosis?