Trick: Peritonsillar abscess drainage 3.0 | All the steps with added variations

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|

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Chief Complaint: Flu-like symptoms, lip pain/swelling, mouth pain, eye redness, and rash

History of Present Illness: Patient is a 35-year-old transgender male with a history of bipolar disorder (taking seroquel/lamotrigine) who presents with 2 days of:

Flu-like symptoms
Progressive lip pain/swelling
Mouth pain
Oral ulcers
Eye redness
New erythematous rash involving the palms/soles and lower extremities

The patient initially noted myalgias, fever, and malaise 2 days ago. Yesterday, the patient woke up with bilateral eye redness and itching, and he developed lip swelling/discoloration and mouth pain throughout the day. He presented to an outside emergency department (ED) 12 hours prior, where he was told that he had a viral infection, given pain medication, and discharged home. He has not taken any other medications. The patient presents to this ED due to progression of symptoms, including the development of a pruritic rash on his palms, soles, and lower extremities. Upon further questioning, the patient also reports vaginal itching and a fishy odor. He has a history of bacterial vaginosis and states that these symptoms feel similar. The patient denies genital sores, vaginal discharge, and vaginal bleeding. He is currently sexually active with men and women, and does not regularly use barrier protection.

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By Nicholas Stark, MD|2019-07-28T21:30:17-07:00Jul 22, 2019|Allergy-Immunology, Dermatology, Genitourinary, SAEM Clinical Images|

Severe constipation, requiring fecal disimpaction and rectal enemas, can be excruciatingly painful for patients. Administering sedatives and opioids to help alleviate this pain poses a challenge, because many of the patients are elderly and tend to be more sensitive to these medications. Furthermore, there may be increased vagal tone when straining, leading to hypotension and bradycardia and which can result in defecation-related syncope. ¹ Also, opioids can exacerbate constipation. Herein we present 2 cases and tricks on achieving better pain control.

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By Kara Bragg DNP, APRN, FNP-C, ENP-BC|2019-07-15T18:29:18-07:00Jul 17, 2019|Gastrointestinal, Tricks of the Trade|

Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cases with the rest being primarily viral in etiology. However, clinically differentiating viral versus bacterial causes of pharyngitis is difficult and we, as providers, often don’t get it right. In addition, antimicrobial resistance is increasing.. So who do we test and when do we treat for strep throat? The 2012 Infectious Diseases Society of America (IDSA) guideline on GAS pharyngitis helps answer these questions.

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By Shannon Flood, MD|2021-08-15T10:21:49-07:00Jul 15, 2019|ENT, Guideline Review, Infectious Disease, Pediatrics|

Welcome to Leg Day #4 of the SplintER Series! Ankle dislocations are an emergent condition in the Emergency Department (ED) that requires expert-level examination and management. We review the pertinent and subtle sports medicine examination and management techniques that will help you feel in control from time of presentation to disposition.

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By Summer Chavez, DO MPH|2019-09-09T13:56:43-07:00Jul 10, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|