Trick of the Trade: Windex for Ring Removal

A 41-year-old male presents with left-hand pain after an altercation. The patient’s hand is noted to be swollen and tender, particularly over the 4th-5th metacarpals, with mild swelling extending to the 4th-5th digits. The patient also notes that he slightly deformed his wedding ring during the fight and he has since been unable to remove it. It’s a busy overnight and the patient has been in the waiting room for an hour. While waiting nursing staff had the patient ice his hand while elevated and attempted to remove the ring with a water-based lubricant. All attempts to remove the ring thus far have been unsuccessful.

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By Benjamin Bloom, MD|2020-06-16T09:21:38-07:00Jun 16, 2020|Orthopedic, Tricks of the Trade|

Trick of the Trade: Angiocatheter for manual aspiration of priapism

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.

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By Jonathan Hootman, MD|2020-05-13T11:19:13-07:00Jun 10, 2020|Genitourinary, Tricks of the Trade|

ACMT Toxicology Visual Pearls: A Foraging Experience to Die For

What life-threatening symptoms can result from the ingestion of this plant?

Delayed onset bone marrow suppression
Hepatic failure
Mucosal swelling of the anterior airway
Paralysis and respiratory failure

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By Robert Goodnough, MD|2020-06-07T11:39:54-07:00Jun 8, 2020|ACMT Visual Pearls, Tox & Medications|

Trick of the Trade: Sodium Bicarbonate for Acute Symptomatic Hyponatremia

A 25-year-old woman is brought into the emergency department by friends due to “acting weird.” She was at a rave and is reported to have consumed alcohol, marijuana, and ecstasy. On exam, she is afebrile, tachycardic, normotensive, and breathing comfortably on room air. She is lethargic, mumbling incomprehensibly, and does not follow commands. Her glucose is 115 mg/dL, her pregnancy test is negative, her EKG reveals sinus tachycardia, her ethanol level is 30 mg/dL, and a stat CT head is negative. Her chemistry panel reveals a sodium level of 114 mEq/L. You order a 100 mL 3% sodium chloride bolus, but it may take 30 minutes to arrive from the central pharmacy. At this point, the nurse informs you that the patient is seizing.

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By Jonathan Hootman, MD|2020-05-11T06:50:15-07:00Jun 3, 2020|Tox & Medications, Tricks of the Trade|

PEM Pearls: Chest Radiographs for Shortness of Breath

Figure 1: Photo by Tim Bish on Unsplash

Paramedics bring in a 5-month-old boy in respiratory distress. He’s crying furiously and has normal tone and color. Thick, copious secretions are coming from his nose. He is tachypneic with diffuse wheezes, crackles, retractions, and nasal flaring. His respiratory rate is 70 and his oxygen saturation is 88% on room air. Would you order a chest radiograph (CXR) for this child?

CXRs are routinely obtained in adults with respiratory symptoms. Children, however, are more sensitive to radiation and can have multiple respiratory infections every year. CXRs can increase cost, length of stay, and may not always be necessary.

This post presents some guidelines on when (and when not) to get a CXR in pediatric patients.

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By Katrina Stime MD|2026-06-16T16:15:49-07:00May 27, 2020|PEM Pearls, Pulmonary, Radiology|

Beyond the Abstract: Systemic Online Academic Resources Review: Renal and Genitourinary

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?

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By Andrew Grock, MD|2026-06-16T16:15:47-07:00May 20, 2020|Genitourinary, Renal|

IDEA Series: Use of gamification through Clue: Pediatric Rash Edition

Emergency Medicine (EM) physicians care for anyone, with anything, at any time. This includes pediatric patients as well as adults. For those without advanced pediatric training, “sick kids” can be quite intimidating. Rashes in the pediatric population are often benign, but in rare cases they portend significant illness. Rashes are also frequent chief complaints; In 2015, there were 1,452,300 pediatric ED visits for “skin and subcutaneous tissue disorders” [1]. We sought to improve the teaching of pediatric rashes in our residency curriculum.

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By Peter Tomaselli, MD|2020-05-05T16:22:24-07:00May 13, 2020|Dermatology, IDEA series, Pediatrics|