SAEM Clinical Image Series: Tick Bite

A 14 year old girl presenting from Mexicali with altered mental status. Her mother reports a rash about a week ago following a tick bite. She had been going to school until 4 days ago when she became very fatigued with associated vomiting, diarrhea, tactile fevers, and headache. She subsequently collapsed at home today and was difficult to arouse which prompted EMS activation. Her mother denies any prior complaint of neck stiffness, shortness of breath, cough, hematemesis, or hematochezia.

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By Nicholas Pokrajac, MD|2020-01-27T07:25:25-08:00Jan 27, 2020|Environmental, Infectious Disease, Pediatrics, SAEM Clinical Images|

SplintER Series: The Recurrent Shoulder Dislocation

A 17 year-old football player with prior shoulder dislocation presents to the emergency department reporting shoulder pain after fall. You obtain shoulder x-rays and see the following injury (Image courtesy of Richard Hopkins, MD).

What is your diagnosis? Are there any associated lesions you could expect to find? What is your emergency department management?

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By William Denq, MD CAQ-SM|2020-01-24T21:21:28-08:00Jan 22, 2020|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

ACMT Toxicology Visual Pearls – Look, Don’t Touch

What toxin is responsible for the most serious clinical effects experienced by patients bitten by the creature in this photo?

latrotoxin
Conotoxin
Helothermine
Tetrodotoxin
Verrucotoxin

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By Ashley Mazo, MD|2020-02-02T12:59:29-08:00Jan 20, 2020|ACMT Visual Pearls, Tox & Medications|

SAEM Clinical Image Series: Fever and Aches

A 62 year old female with no past medical history presented to the ED with fevers, generalized weakness, severe muscle aches, and a rash. She had returned home from the Philippines 3 days prior to evaluation. Twenty-four hours prior to arrival, the patient noticed a rash on her shins. She denied any nausea, vomiting, diarrhea, abdominal pain, chest pain, shortness of breath, cough, sore throat, dysuria, urinary frequency, headache, and neck pain. The patient was in the Philippines for a family funeral and was indoors for most of the trip. She was unsure if she was stung by any bugs or mosquitos.

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By Brianna Miner, MD|2020-01-13T15:24:23-08:00Jan 13, 2020|Dermatology, Infectious Disease, SAEM Clinical Images|

EMRad: Can’t Miss Adult Wrist Injuries

Have you ever been working a shift at 3 AM and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify common and catastrophic injuries. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. Last post, we reviewed the elbow. Now, the “Can’t Miss” adult wrist injuries.

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By Stephen Villa, MD|2020-05-14T22:36:19-07:00Jan 8, 2020|EMRad, Orthopedic, Radiology, Trauma|

This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. Last post, we focused on the elbow. Now: the wrist.

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By Stephen Villa, MD|2020-05-14T22:36:28-07:00Jan 8, 2020|EMRad, Orthopedic, Radiology, Trauma|