• posterior malleolar fracture

SplintER Series: The Hidden Post

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

A 23-year-old male presents to the emergency department with right ankle pain after he rolled his ankle while walking down the stairs. An ankle exam reveals ecchymosis over the posterior ankle and tenderness of the distal tibia. His neurovascular exam is intact. The radiograph above was obtained (Image 1. X-ray right ankle. Original image provided by Justine Ko, MD).   [+]

SAEM Clinical Images Series: A Rash You Don’t Want to Miss

By |Categories: Dermatology, Infectious Disease, SAEM Clinical Images|

A 54-year-old female with a past medical history of diabetes presented to the Emergency Department (ED) for evaluation of unresponsiveness. The patient was found unresponsive by her spouse, who notes she had missed several doses of insulin over the past few days. EMS notes the glucometer read ‘HIGH’ on fingerstick. The patient remains unresponsive on presentation and is unable to contribute further history. Vital Signs: BP 148/105; HR 120; RR 24; Pulse Oximetry 98% on room air; Temperature 97.7°F Constitutional: Patient is morbidly obese, unresponsive, and toxic-appearing. Cardiovascular: Regular rhythm with tachycardia. [+]

SAEM Clinical Images Series: ‘Tis Not the Season to be Wheezing

By |Categories: Heme-Oncology, Pediatrics, Pulmonary, SAEM Clinical Images|

A 2-year-old male with a history of solitary kidney presented with greater than one month of daily coughing, wheezing, and decreased appetite. The patient was previously seen by his primary care physician after three weeks of symptoms where he was prescribed albuterol as needed for viral bronchospasm. The patient’s wheezing did not improve after two weeks of albuterol treatment so a chest x-ray was ordered. The patient’s mother denied any fevers, vomiting, diarrhea, weight changes, or night sweats. Vitals: BP 131/60; Pulse 148; Temp 36.7 °C (98.1 °F) (Axillary); Resp 28; [+]

Trick of the Trade: Managing Epistaxis with Merocel Nasal Packing and an Angiocatheter

By |Categories: ENT, Expert Peer Reviewed (Clinical), Tricks of the Trade|

There are many ways to manage epistaxis. Once nasal clamping and cauterization fail, the next step is to consider using tranexamic acid (TXA) and performing nasal packing. Inflatable packing devices such as a Rhinorocket are painful to insert and do not conform well to the shape of the naris. The expandable Merocel nasal packing, a compressed, dehydrated sponge, provides a softer, alternative option, although the insertion process can be painful given its initial rigid, edged structure. We propose 2 strategic tricks to optimize your nasal packing technique using the Merocel sponge. Trick of the Trade: Strategic expansion of the [+]

  • Shoulder

SplintER: Pop, Lock & Drop It

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

A 38-year-old female presents to the ED with right shoulder pain after a fall directly onto that shoulder. She noticed immediate pain and difficulty moving the arm associated with mild tingling in her right fingers. The radiographs above were obtained in the ED (Image 1. AP and lateral radiographs of the right shoulder, author’s own images).   [+]

SAEM Clinical Images Series: An Enlarging Scalp Mass

By |Categories: Dermatology, Pediatrics, SAEM Clinical Images, Uncategorized|

A 27-day-old female infant born at 34 weeks 4 days with a prenatal history of maternal syphilis treated with penicillin presented with an enlarging scalp mass since birth. Since birth, the patient has had a 1 cm erythematous and flat lesion on her scalp. Since that time, the lesion has continued to grow and develop scales. On the day of presentation, the lesion was noted to be 7-8cm in diameter with multiple surrounding smaller lesions. There is some clear to bloody drainage coming from the main lesion. The patient has otherwise been growing and developing [+]

SplintER Series: Let the Feet Drop

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

A 20-year-old male distance runner who was jogging and happened to be running past the emergency department presented with severe bilateral leg pain, foot pain, and foot numbness that had resolved by the time he was evaluated in the ED. The x-ray above was obtained (Image 1. X-ray of the leg. Case courtesy of Andrew Murphy, Radiopaedia.org, rID: 41408). [+]

  • Fork in Road Disappearance of FOAM blog podcast

The Fall of FOAM

By |Categories: Academic, Emergency Medicine, Medical Education, Social Media & Tech|

The landscape of emergency medicine and critical care (EM/CC) blogs and podcasts has changed dramatically over the past 20 years. The number of free, open-access EM/CC blogs and podcasts has plummeted. As reported by Lin and colleagues in JMIR Education (2022), these sites decreased in number from 183 in 2014 to just 109 this year– a drop of 40.1% [1]. via GIPHY This comes after a period of rapid growth of these educational resources in the late 2000's [2], with expectations that new sites would continue to come online. It is unclear when the combined number of EM/CC blogs [+]

PEM POCUS Series: Pediatric Focused Assessment with Sonography for Trauma (FAST)

By |Categories: Expert Peer Reviewed (Clinical), Pediatrics, PEM POCUS, Radiology, Ultrasound|

Read this tutorial on the use of point of care ultrasonography (POCUS) for Pediatric Focused Assessment with Sonography for Trauma. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU PEM POCUS: Pediatric FAST Quiz Module Goals Summarize the indications and role of the FAST in the evaluation of injured children Describe the technique for performing the pediatric FAST Identify anatomical views and landmarks necessary for a complete pediatric FAST Accurately interpret each pediatric FAST anatomic view and corresponding landmarks [+]

IDEA Series: Ultrasound-capable, 3D-printed central line trainer

By |Categories: IDEA series, Medical Education, Ultrasound|

Problem: Central venous line (CVL) placement is a key skill for emergency medicine providers. Sites for central line placement include the internal jugular vein, subclavian vein, and femoral vein. Indications include, but are not limited to fluid resuscitation, medication administration, central venous pressure monitoring, pulmonary artery catheter introduction, and transvenous pacing wire placement. Procedural complications can include catheter-associated infection and arterial puncture. Success rates for CVL placement vary based on location and provider experience [1-3]. Point-of-Care Ultrasound (POCUS) increases both success rate and patient safety when used to guide CVL placement [4]. Figure 1. Setup for ultrasound-capable, 3D-printed [+]