• constipation

Trick of Trade: Topical lidocaine jelly to make constipation relief less painful

By |Categories: Gastrointestinal, Tricks of the Trade|

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. […]

  • strep pharyngitis

Strep Pharyngitis in Children: Review of the 2012 IDSA Guidelines

By |Categories: ENT, Guideline Review, Infectious Disease, Pediatrics|

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. […]

SplintER Series: Ankle Dislocation | Leg Day #4

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

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.  […]

SAEM Clinical Image Series: Fishing in Papua New Guinea

By |Categories: SAEM Clinical Images, Trauma|

[Click for larger view] Chief Complaint: Right lower extremity injury while spear fishing History of Present Illness: A 33-year-old male went river fishing with a homemade spear and diving mask in Papua New Guinea. He felt sudden pain and tugging to the right lower extremity. He was near shore and grabbed a tree root. He held on for dear life as he was being pulled back into the water. It felt as if his foot had been torn off. He did not let go of the tree root and eventually the pulling force ceased. He [...]

  • lunate dislocation xray

SplintER Series: A Case of Traumatic Wrist Pain After Fall on Outstretched Hand

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

A 46 year-old male presents with wrist pain after sustaining a mechanical fall and catching himself on his outstretched hand. An anteroposterior (left) and lateral (right) plain films of the wrist are obtained (photo credit). What is the diagnosis (hint – there are 2 findings), injury classification system, associated findings, and the recommended management plan? […]

SAEM Clinical Image Series: Distended Bowels

By |Categories: Gastrointestinal, SAEM Clinical Images|

[Click for larger view] Chief Complaint: Abdominal distention History of Present Illness: A 36-year-old male with a history of cerebral palsy, gastrointestinal dysmotility, epilepsy, hypertension, gastroesophageal reflux disease, and insomnia presents to the ED after referral by his family physician for a 3-day history of abdominal distention. Due to the patient’s neurological disorder, he is unable to communicate but is accompanied by his mother who provides his medical history. The patient’s mother states that he had a loose bowel movement this morning, which is normal for him. He has had a history of bowel problems [...]

SAEM Clinical Image Series: Rash with Blood Pressure Cuff Inflation

By |Categories: Dermatology, Heme-Oncology, SAEM Clinical Images|

[Click for larger view] Chief Complaint: Possible seizure, Left arm rash History of Present Illness: A 29-year-old with a history of migraine headaches, thalassemia of unknown phenotype, and no history of hypertension or epilepsy arrived to the emergency department via ambulance after possible seizure. The patient had nausea and vomiting the morning after a night of heavy drinking. After several rounds of vomiting, she felt shaky, lightheaded and experienced paresthesia in both of her hands and feet. There was no loss of consciousness, confusion or incontinence. EMS reported hypertension and tremors with upper extremity spasms. [...]

  • intussusception

Pediatric Point of Care Ultrasonography ALiEMU Course on Intussusception

By |Categories: ALiEMU, Gastrointestinal, Pediatrics, Radiology, Ultrasound|

Our ALiEMU learning management system, which currently houses the AIR series, Capsules series, and In-Training Exam Prep courses, is ready to slowly open the doors to welcome external authors with high quality content. We are thrilled to welcome a UCSF-sponsored pediatric emergency medicine (EM) point of care ultrasonography (POCUS) series, led by Dr. Margaret Lin. The first course is on the intussusception scan, filled with multiple ultrasound scans showing normal variants and two different types of intussusception. […]

ALiEM AIR | Cutaneous 2019 Module

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

Welcome to the AIR Cutaneous 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 cutaneous emergencies. 6 blog posts within the past 12 months (as of February 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 3 AIR and 3 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module. […]