SAEM Clinical Image Series: Facial Swelling in a 2 Year Old

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Chief complaint: Left-sided facial swelling

History of Present Illness: A 2-year-old male presents to the emergency department in January after waking up with left-sided facial swelling. Mother states her son has had cough and congestion for the past 4 days for which she has been giving Tylenol and a children’s cough medication. The patient went to bed, awoke the following morning with facial swelling, and was brought to the emergency department.

He has no allergies, history of trauma to the area, or bug bites. The patient is fully vaccinated including the influenza vaccine.

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By Mara Perch, DO|2019-08-22T08:42:23-07:00Aug 19, 2019|ENT, HEENT, Infectious Disease, Pediatrics, SAEM Clinical Images|

ACMT Toxicology Visual Pearls: Mushroom Mania

After eating the mushroom pictured, a 15-year-old patient arrives to the emergency department agitated, diaphoretic, and hallucinating, and then acutely becomes more somnolent and less responsive. Which neurotransmitter systems are affected by the toxins contained in this mushroom?

Acetylcholine and histamine
Dopamine and norepinephrine
Gamma-aminobutyric acid (GABA) and N-methyl-D-aspartate (NMDA)
Glycine and serotonin

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By Mary Grady, MD|2019-11-12T19:02:10-08:00Aug 16, 2019|ACMT Visual Pearls, Environmental, Tox & Medications|

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Chief complaint: Eye pain

History of Present Illness: A 41-year-old man presents with pain and a foreign body sensation in the right eye since welding 4 days ago. The patient wore eye protective gear; however, he explains that he only wore sunglasses. A spark flew in from above his glasses and hit him in the right eye. The pain has been steady since. He complains of irritation exacerbated by blinking, but vision has remained unchanged. He has no other injury and no other physical complaint.

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By Hamid Ehsani-Nia, DO|2019-08-12T06:54:40-07:00Aug 12, 2019|Ophthalmology|

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Chief complaint: Abdominal pain, nausea, and vomiting

History of present illness: A 46 year-old female with a past history of fibromyalgia, irritable bowel disease, and chronic abdominal pain presented to the emergency department with abdominal pain, nausea, and vomiting. She reported a one-year history of similar symptoms but states that her symptoms are worse today than usual, and not improved by her home hydrocodone, medical marijuana, or heating pad use – all of which she uses daily. She has not been able to tolerate oral intake today, vomiting up her breakfast of plain toast.

The patient was observed using her home heating pad in the emergency department.

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By Jonathan Abraham, MD|2019-08-12T07:11:03-07:00Aug 12, 2019|Dermatology, Environmental|

Peritonsillar abscess drainage pelvic speculum

A 25-year-old medical student comes in with a muffled voice, sore throat and trismus. You look at the back of her throat and you see the uvula deviated to the right. You astutely diagnosed a peritonsillar abscess (PTA). You consider aspirating and want to check for tips on how to successfully do this.

Dr. Michelle Lin and Dr. Demian Szyld have created great guides for the common and important emergency medicine procedure of draining a PTA (laryngoscope lighting and spinal needle for aspiration; ultrasound localization and spinal needle guard; avoiding awkward one-handed needle aspiration). This update reviews these tricks as well as some additional techniques for optimal success in draining a PTA, while avoiding the ultimate feared complication of puncturing the carotid artery.

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By Margaret Davis|2020-08-13T11:15:27-07:00Aug 9, 2019|ENT, Tricks of the Trade, Ultrasound|

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Chief complaint: Rash

History of Present Illness: The patient is an 18 year-old male who presents with a rash that appeared 7 days ago. The rash is located on his torso, back, and lower lip. It is pruritic. Three days prior to the appearance of the rash, he had a sore throat and intermittently took ibuprofen over the ensuing 3 days. He stopped taking ibuprofen 4 days after his sore throat abated. He denies any fever, nausea, vomiting, shortness of breath, chest pain, abdominal pain, diarrhea, extended travel in the past year, sick contacts, new soaps/detergents, insect bites, chemical exposure, and new foods.

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By Zachary Smith, MD|2019-07-28T21:17:29-07:00Jul 29, 2019|Dermatology, SAEM Clinical Images, Tox & Medications|

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Chief Complaint: Chest pain

History of Present Illness: An 89-year-old female with a past medical history of coronary artery disease and with recent admission for myocardial infarction that was medically managed, presented with chest pain and shortness of breath. She reports worsening midsternal chest pain that occasionally radiates to her back and right arm since discharge.

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By Andrew Ortega, MD|2019-07-28T21:30:40-07:00Jul 23, 2019|Cardiovascular, ECG, SAEM Clinical Images, Ultrasound|