• Hook of Hamate Fracture on Carpal Tunnel view

SplintER Series: Pain in the Palm

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

A 17 year-old left hand dominant high school baseball player presents with severe, sharp pain in his right hand at the hypothenar eminence with associated numbness and tingling of his 4th and 5th digits. The pain and tingling began after he swung his bat and hit a ground ball. You obtain x-rays and see an abnormality. What is the most likely diagnosis, differential diagnosis, and management plan? […]

Just-in-Time Training for Emergency Medicine Radial Arterial Line Placement

By |Categories: Academic, Critical Care/ Resus, Medical Education|

A 63-year-old male presents for acute onset of headache, neck pain, and altered mental status. He has a prior history of hypertension and hyperlipidemia but recently lost his insurance and has been unable to fill his medications. As a well-informed 2nd year resident, you suspect the presence of a ruptured subarachnoid hemorrhage and arrange an expedited trip to the CT scanner. The patient’s blood pressure continues to remain elevated and you initiate an antihypertensive drip. You decide that in order to have accurate titration, you need more reliable data and decide to place a radial arterial line. However, the last [...]

ALiEM AIR | Orthopedics Lower Extremity 2019 Module

By |Categories: ALiEMU, Approved Instructional Resources (AIR series), Orthopedic|

Welcome to the AIR Orthopedics Lower Extremity Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to orthopedic lower extremity emergencies. 5 blog posts within the past 12 months (as of July 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 4 Honorable Mentions. We recommend programs give 2.5 hours (about 30 minutes per article) of III credit for this module. […]

SAEM Clinical Image Series: Facial Burn

By |Categories: Allergy-Immunology, Dermatology, SAEM Clinical Images, Tox & Medications|

A 50-year-old female with a history of bipolar disorder, ADHD, anxiety, depression, and alcoholism presented to the ED after her family found her at home agitated, restless, and with a “large black burn” on her face. Her husband reported that she had been “picking” at this area of her face earlier in the day; at that time it appeared only slightly red. Per her husband, the patient had also felt “bugs crawling on her legs” and had been picking at and grabbing her legs on the day of presentation. […]

SAEM Clinical Image Series: Chest Wall Mass

By |Categories: Pulmonary, SAEM Clinical Images|

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. […]

SAEM Clinical Image Series: Mysterious Blood Sample

By |Categories: Gastrointestinal, SAEM Clinical Images|

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, [...]

Guideline Review: 2018 IDSA Update on Influenza (Infographic)

By |Categories: Guideline Review, Infectious Disease|Tags: |

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. […]

Trick of the Trade: Combine Adenosine with the Flush

By |Categories: Cardiovascular, Tox & Medications, Tricks of the Trade|

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 [...]

Measles 2019 Updates: The Comeback Kid

By |Categories: Dermatology, Infectious Disease, Pediatrics|

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. [...]