ACMT Toxicology Visual Pearls: Mushroom Mania

By |Categories: ACMT Visual Pearls, Environmental, Tox & Medications|Tags: |

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 […]

SAEM Clinical Image Series: Corneal Foreign Body

By |Categories: Ophthalmology|

[Click for larger view] 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. […]

SAEM Clinical Image Series: Tea & Toast | A Case of an Abdominal Rash

By |Categories: Dermatology, Environmental|Tags: |

[Click for larger view] 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 [...]

  • Peritonsillar abscess pelvic speculum

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

By |Categories: ENT, Tricks of the Trade, Ultrasound|

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 [...]

PEM Pearls: Ultrasound for Diagnosing Occult Supracondylar Fractures

By |Categories: Pediatrics, PEM Pearls|

Supracondylar humerus fractures are the most common type of elbow fracture in pediatric patients, most often seen in a fall on an outstretched hand (FOOSH) or a fall on a hyper-extended elbow.​1,2​ If there is no obvious fracture on x-rays, the patient may have an occult fracture; look for secondary radiographic signs including a posterior fat pad sign, an enlarged anterior fat pad or ‘sail sign’, or malalignment. Occult supracondylar fractures (those with initial normal radiographs that are later diagnosed in follow up) make up 2-18% of all the fractures we see in kids.​3​ When x-ray findings are nonspecific but the [...]

ALiEM AIR | Orthopedics Upper Extremity 2019 Module

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

Welcome to the AIR Orthopedics Upper 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 orthopedics upper extremity emergencies. 5 blog posts within the past 12 months (as of March 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 0 AIR and 5 Honorable Mentions. We recommend programs give 2.5 hours (about 30 minutes per article) of III credit for this module. […]

  • elder hand palliative emergency medicine care

What is palliative emergency medicine and why now?

By |Categories: Geriatrics, Palliative Care|

The skilled and rapid resuscitation of critically ill patients is a central premise in the specialty of emergency medicine (EM). A paradox for providers often arises when in the midst of resuscitating a patient with advanced chronic illness, the question of risks versus benefits arises. For this patient, we may successfully stabilize vital signs, but at what cost? Will this patient return to a quality of life they deem acceptable? What are the patient’s goals of treatments given his/her underlying disease? These questions illustrate the need for emergency physicians to be more aware of and comfortable with palliative care practices. [...]

SAEM Clinical Image Series: Rash After a Sore Throat and Ibuprofen Use

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

[Click for larger view] 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 [...]

New free P3 app: PECARN Publication Prospectus

By |Categories: Pediatrics|

One of the gold standard for building and sustaining collaborative, multi-institutional research networks in medicine is the Pediatric Emergency Care Applied Research Network (PECARN) organization. Their efforts on studying pediatric emergency care has resulted some of our specialty's landmark papers in Lancet, New England Journal of Medicine, JAMA Pediatrics, and Annals of Emergency Medicine. Although we are not officially affiliated with them, we fully support their efforts and wanted to help disseminate their evidence-based findings with an educations. Thus was born the PECARN Publication Prospectus (P3) app project [download free P3 app]. The P3 Project and Team As with many [...]

SAEM Clinical Image Series: Another Heart Attack?

By |Categories: Cardiovascular, ECG, SAEM Clinical Images, Ultrasound|

[Figure 1: Click for larger view] 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. […]