• Neck pain

SplintER Series: A Temporary Pain in the Neck

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

  An 18-year-old football player presents to the Emergency Department after an episode of transient numbness, tingling, and inability to move his right upper extremity after making a tackle. He continued playing without recurrence. The above imaging was obtained (Figure 1. Lateral cervical spine x-ray. Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 32505).   [+]

SAEM Clinical Image Series: What’s This Thing on My Face?

By |Categories: Academic, Dermatology, SAEM Clinical Images|

A 91-year-old female patient presented with her family after concern for multiple new lesions on her face and hands. The patient thinks the lesions grew over the course of a few months. There is no pain at the sites, no erythema, and no pruritis. She has caught the lesions on clothing and bedding, which has irritated the lesions on occasion, and the family is concerned/embarrassed by the growths on her face, which are harder to conceal than those on her hand. [+]

SAEM Clinical Image Series: Guess Who’s Back?

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

A 27-year-old male with no significant past medical history presented to the emergency department with one week of progressively worsening, non-pruritic, and intermittently painful rash to his bilateral dorsal and plantar feet. The patient also described lesions to his left inguinal region and scrotal sac. There was no fever, chills, nausea, vomiting, chest pain, or shortness of breath. The patient was sexually active with men and women, with inconsistent condom use. [+]

Adverse Events from IV Olanzapine for Agitation in the ED

By |Categories: EM Pharmacy Pearls|

The ability to safely and effectively sedate agitated patients in the emergency department (ED) is paramount to provide prompt medical care and protect ED staff. Intravenous (IV) antipsychotics are frequently utilized, instead of other routes, given their more rapid onset of action. Similar to haloperidol, olanzapine can be used safely via the IV route despite both being FDA-approved for intramuscular (IM) administration only. What is the adverse event profile for IV olanzapine when administered for agitation in the ED? The table below summarizes the primary data evaluating IV olanzapine in the ED [1-5]. While IV olanzapine is a safe option [+]

Tricks of Trade: Benign paroxysmal positional vertigo | Beyond the Basics

By |Categories: Neurology, Tricks of the Trade|

Clinical Case A 63-year old female presents to your ED with positional dizziness since rising out of bed from a nap this afternoon. She says she had a similar episode in the past and reports, “they took the stones out of my ear by making me lay down and move my head a few times.” Based on your assessment of the patient’s history and physical exam you determine she has peripheral vertigo, likely BPPV. However, despite multiple attempts with the Epley Maneuver, the patient is still symptomatic. What next steps could you consider? Benign paroxysmal positional vertigo: The basics Benign [+]

SAEM Clinical Image Series: Finger Pain

By |Categories: Academic, Emergency Medicine, SAEM Clinical Images|

The patient is a 24-year-old female who presents to the emergency department for left middle finger pain and swelling. She is right hand dominant and works in a kitchen. The patient states that ten days ago she avulsed the distal tip of the left middle finger, including the majority of the nail. At that time, the patient was evaluated at an outside hospital where the wound was cauterized with silver nitrate due to soft tissue bleeding. Since then, the patient states that she has had swelling over the dorsal distal phalanx. [+]

Geriatric EM: Falls Can Be Sentinel Events

By |Categories: Emergency Medicine, Geriatrics|

  A 72-year-old woman is brought to your Emergency Department (ED) after falling while rushing to the toilet. She has no visible deformity on examination and is discharged with pain medications. Two weeks later, EMS transports her to the ED after a loss of consciousness. Computed tomography (CT) of the head at that time shows a subdural hematoma. Unfortunately, this scenario is common. Given time constraints in the ED, management plans often miss opportunities to assess a patient’s risk for falling and may not be compliant with recommendations [1, 2]. However, falling can be a sentinel event for older adult [+]

IDEA Series: Handheld Ultrasound for Emergency Medicine Residents Rotating on Cardiology Services

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

Point-of-care ultrasound (PoCUS) has become an essential skill that emergency medicine (EM) residents learn during their training [1]. Accordingly, most EM programs schedule a block early in residency dedicated to obtaining and interpreting high-quality PoCUS images. Likewise, the ability to efficiently diagnose and manage acute cardiovascular pathologies is a critical aspect of EM, and most EM residents also rotate on a cardiology service to develop these skills. Despite evidence that PoCUS improves the ability of both cardiologists and non-cardiologists to quickly diagnose cardiac disease at the bedside, integration of this relatively novel technology on cardiology services is often limited by [+]

SplintER Series: A Stressful Step – Midfoot Pain in a Female Runner

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

A 17 year-old female who recently started training for a marathon presents with progressively severe pain over her midfoot, notable for point tenderness over the 2nd metatarsal shaft. The above image was obtained (Image 1. X-ray of the left foot. Image courtesy of Matthew Negaard, MD). [+]