Purple Urine Bag Syndrome: A visual diagnosis and what it means for your patient

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?

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By Robert Barnes, MD|2020-09-02T11:30:29-07:00Sep 23, 2020|Diagnose on Sight, Genitourinary|

SAEM Clinical Image Series: Distended Abdomen after ROSC

A 64-year-old female presented to the emergency department (ED) in cardiac arrest. Her family members heard her fall in the bathroom and started CPR. EMS intubated the patient and 20 minutes of CPR was done en route. Return of spontaneous circulation (ROSC) was achieved after fifteen minutes of resuscitation in the ED.

At baseline, the patient ambulated with her walker and was conversant. She was having abdominal pain and nausea for the past three days after recently being diagnosed with a urinary tract infection. On arrival to the ED, the patient was pulseless with ventricular fibrillation. The patient received ten doses of epinephrine, two doses of sodium bicarbonate, calcium, amiodarone, magnesium, and one dose of naloxone during the resuscitation. One defibrillatory shock was administered. She was started on a norepinephrine drip and an amiodarone drip.

Computed tomography (CT) of the head was negative. CT of the chest was significant for left pneumothorax and left-sided subcutaneous emphysema. A pigtail chest tube was placed. After a few hours, she developed worsening abdominal distension. An abdominal CT scan revealed the images shown.

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By Sheri-Ann Olivia Kaltiso, MD|2020-09-18T20:43:44-07:00Sep 21, 2020|Critical Care/ Resus, Gastrointestinal, SAEM Clinical Images, Uncategorized|

IDEA Series: 3D-printed pediatric lumbar puncture trainer

Pediatric lumbar puncture trainers are less available than adult trainers; most are the newborn size and quite expensive. Due to age-based practice patterns for fever diagnostic testing, most pediatric lumbar punctures are performed on young infants, and residents have fewer opportunities to perform lumbar punctures on older children.¹ Adult lumbar puncture trainers have been created using a 3D-printed spine and ballistics gel, which allows for ultrasound guidance.² No previous model has been described for pediatric lumbar puncture.

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By Patrick Leaf,MD|2026-06-16T16:16:31-07:00Sep 16, 2020|IDEA series, Medical Education, Neurology, Pediatrics, Simulation|

ACMT Toxicology Visual Pearls: Awake Seizures?

Which of the following rodenticides, often used to kill the rodent pictured, causes seizure-like activity without altered mental status or a postictal period?

Barium
Brodifacoum
Carbamate
Strychnine
Zinc phosphide

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By Kregg Laundon, MD|2020-09-17T20:08:16-07:00Sep 14, 2020|ACMT Visual Pearls, Emergency Medicine, Tox & Medications|

Announcing ALiEMU SplintER Course: Approach to Splinting

ALiEMU Course Approach to Splinting badge

We are so thrilled to announce that we created an ALiEMU Course on the Approach to Splinting, using one of our most popular series, the SplintER Series, as the learning foundation. We have created a custom quiz assessing the learning objectives. Are you a medical student getting ready for your EM rotation or internship? Or an EM resident needing to brush up on your splinting knowledge? Take this free course for 2 hours of ALiEMU course credit, and receive your “Approach to Splinting” badge.

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By Michelle Lin, MD|2020-11-05T18:30:58-08:00Sep 9, 2020|ALiEMU, Orthopedic, SplintER|

SAEM Clinical Image Series: Juvenile Snake Bite

A 62-year-old male presented thirty minutes after being bitten by a snake in his garden. He stated that he thinks his finger was bitten twice. The patient presented with pain and swelling of his right hand and forearm.

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By Keegan McNally, MD|2020-09-05T17:24:23-07:00Sep 7, 2020|Emergency Medicine, Environmental, SAEM Clinical Images, Tox & Medications|

SAEM Clinical Image Series: Atraumatic Proptosis

An 85-year-old female with a past history of hypertension presents with acute right-eye pain, redness, and proptosis/bulging for the past two months that has been worsening over the past two days. She endorses blurry vision that began two days prior. She does not use contacts or glasses. No trauma, headache, or loss of consciousness are reported. She reports a “whooshing” sound in her right ear for two to three months.

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By Timothy Montrief, MD MPH|2020-09-08T14:58:05-07:00Sep 7, 2020|Emergency Medicine, HEENT, Ophthalmology, SAEM Clinical Images|