SAEM Clinical Image Series: Chest Wall Mass

A 71 year-old patient with a past medical history of hypertension, percutaneous transluminal coronary angioplasty 7 years ago, and robotic coronary artery bypass grafting of the left internal mammary artery to the left anterior descending artery 9 years ago presents with worsening dyspnea on exertion. He had a biopsy of the upper lobe of the left lung the week before. He was having a neoplastic mass evaluated. The patient presents with a soft left-sided anterior chest mass, inflating and deflating with respiration.

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By Harry Stark MD, MBS|2019-11-06T17:57:56-08:00Nov 7, 2019|Pulmonary, SAEM Clinical Images|

SAEM Clinical Image Series: Mysterious Blood Sample

34-year-old female with a history of hypertension, diabetes mellitus, and pancreatitis presents for epigastric and left upper quadrant abdominal pain. Her symptoms started yesterday evening and have been worsening since onset. She reports chronic epigastric pain that waxes and wanes for several years since her first episode of pancreatitis in 2014. Yesterday she had an abrupt onset of nausea that accompanied the pain without emesis. The pain worsened and is now currently 10/10 in severity. She describes it as severe and deep. She has no bloody or dark stool. She denies any heavy alcohol use, changes in medications, or drug use.

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By Sarah Monks, MD|2019-11-06T18:36:53-08:00Nov 7, 2019|Gastrointestinal, SAEM Clinical Images|

Did you get your flu shot? We hope so. Influenza season is upon us again and it is always helpful to review the latest 2018 Infectious Disease Society of America (IDSA) update on the diagnosis and treatment of influenza.¹ Notable is that influenza-confirmed patients who present within 2 days of symptoms who are deemed low risk do not automatically warrant antiviral treatment. The subsequent question then is who is high risk? The following infographic by our Guidelines Editor, Dr. Kelly Wong, summarizes the key take-home points for emergency medicine clinicians.

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By Michelle Lin, MD|2021-08-15T10:20:55-07:00Nov 1, 2019|Guideline Review, Infectious Disease|

2019 literature update from this original 2012 Trick of the Trade post!

The success of adenosine depends as much on the administration technique as it does the mechanism of action. The 2010 Advanced Cardiac Life Support (ACLS) Guidelines recommend the following when administering adenosine:

“6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push”

This recommendation remained in the 2015 iteration.

While most drugs are metabolized in the liver, adenosine doesn’t even make it that far, being metabolized in the erythrocytes and vascular endothelial cells. With this extremely short half-life (10 seconds), it is important to help it reach the heart before it’s metabolized and excreted without being effective.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2024-06-18T22:34:55-07:00Oct 31, 2019|Cardiovascular, Tox & Medications, Tricks of the Trade|

The child with a fever and rash in your Emergency Department (ED) may actually have measles. This year, there have been 1,182 cases of measles in the U.S., and counting. This is the highest rate in the past 27 years [1]. Globally, measles kills over a hundred thousand children [2]. In the U.S., one child dies for about every 1,000 cases [3]. Emergency providers must be able to quickly detect short-term complications that can lead to death and distinguish measles from mimics like Kawasaki Disease. It’s no coincidence that this year’s outbreak is in the setting of lower vaccination rates. The CDC now has new vaccine recommendations, and it’s imperative that ED providers join forces with public health providers to prevent future measles cases and deaths (photo credit).

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By Carolina Ornelas|2019-10-31T12:57:05-07:00Oct 28, 2019|Dermatology, Infectious Disease, Pediatrics|

SAEM Clinical Image Series: Eye Trauma and Vision Loss

The patient is a 44-year-old male with a past history of end stage renal disease on hemodialysis, diabetes, and hypertension who presents with acute visual loss after assault 2 hours prior. He was struck in the eye by his partner’s fist (adorned with a large ring), but denies severe pain. He does endorses instant difficulty with his vision. There is no use of contacts or glasses. No other injuries, headache, or loss of consciousness are reported.

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By Cassandra Mackey, MD|2019-11-10T21:42:57-08:00Oct 21, 2019|Ophthalmology, SAEM Clinical Images, Trauma|

SplintER Series: A Toddler’s Missed Step

A mother and father bring their 2-year-old boy to the Emergency Department after the child tripped over the family dog while running across the living room after a ball. He will not walk and points at his right lower leg and says it hurts (photo credit).

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By Matthew Negaard, MD|2019-10-30T20:58:49-07:00Oct 16, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|