SAEM Clinical Images Series: Unilateral Facial Pain

By |Categories: HEENT, SAEM Clinical Images|

A 78-year-old male with a past medical history of Lewy body dementia, hypertension on bisoprolol, hypothyroidism, COPD, chronic lower extremity edema on furosemide, and overactive bladder on oxybutynin presented to the emergency department for evaluation of three days of progressively worsening left-sided neck and facial swelling. Associated symptoms included poor oral intake, a nonproductive cough, and one week of sore throat. The black arrow represents the left parotid gland. Vitals: Afebrile; normal room air saturation HEENT: Firm, tender, warm and erythematous swelling over the left mandibular ramus that extended to the cheek, left neck, and spread [+]

Trick of the Trade: Winging It with External Jugular Cannulation

By |Categories: Tricks of the Trade|

Sankoff J, et al. WJEM (2008) Imagine yourself caring for a patient that needs urgent vascular access, but several attempts at peripheral intravenous (IV) cannulation have been unsuccessful. You aren’t quite at the point where emergent intraosseous or central venous access is indicated. Maybe those options aren’t even available where you’re working. From across the room, though, you can see a very prominent external jugular (EJ) vein. Sadly, you remember the last EJ line you placed falling out almost immediately. Patients with challenging peripheral intravenous access in the extremities may require and benefit from cannulation of the [+]

ALiEM AIR Series | Neurology 2022 Module

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

Welcome to the AIR Neurology 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 neurological emergencies in the Emergency Department. 5 blog posts met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 3 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module. AIR Stamp of Approval and Honorable Mentions In an effort to truly [+]

SAEM Clinical Images Series: Breast Swelling

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

A female in her 50s with a past medical history of coronary artery disease, pacemaker placement, hypertension, and ESRD presented to the emergency department with the chief complaint of missed dialysis, breast engorgement, and an increase in vascularity in her chest and abdomen. The patient reported an increase in breast swelling and increased vascularity in her belly over the past three months. Additionally, she woke up short of breath on the morning of presentation and reported dyspnea at rest. She denied chest pain, diaphoresis, breast pain, fever, rash, trauma to the breasts, or drainage. [+]

ALiEM AIR Series | CVA 2022 Module

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

  Welcome to the AIR CVA 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 CVA emergencies in the Emergency Department. 7 blog posts met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 5 Honorable Mentions. We recommend programs give 4 hours (about 30 minutes per article) of III credit for this module. AIR Stamp of Approval and Honorable Mentions In an effort to [+]

SAEM Clinical Images Series: Localized Weakness

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

A 69-year-old Caucasian female with a past medical history of seizures, cerebral vascular accident, and Parkinson’s disease presents by EMS for evaluation of a 30-minute episode of left upper and lower extremity weakness and left facial drooping. The patient complains of a right-sided “migraine-type” headache similar to that experienced with her prior stroke. Vitals: Temp 36.5°C; BP 186/74; P 74; RR 18; O2 Sat 95% General: Alert; no acute distress Skin: Warm; dry; dark red discoloration localized to the left side of face, neck, chest, and upper extremity HEENT: Normocephalic; left-sided facial [+]

  • suboxone

Suboxone and the Emergency Physician: Get Waivered Training

By |Categories: Public Policy, Tox & Medications|

Clinical scenario: A 56-year-old male with a past medical history of opioid use disorder presents to the emergency department with acute on chronic right lower flank pain. The patient states the pain was exacerbated while shoveling snow over the weekend and worsens with movement. He feels nauseous but denies any chest pain, shortness of breath, vomiting, abdominal pain, or pain with urination. He denies any history of kidney stones, recent surgeries, and recent injuries. He does not smoke cigarettes, but does drink alcohol almost daily. His pain actually first started 2 months ago due to a work incident, for [+]

SAEM Clinical Images Series: Found Down

By |Categories: Cardiovascular, Critical Care/ Resus, Pulmonary, Radiology, SAEM Clinical Images|

A 67-year-old caucasian male experiencing homelessness was “found down” in a parking lot. EMS reported that he had a GCS of 6 with a systolic blood pressure in the 80’s, finger stick glucose of 100, and no response to intranasal naloxone. He was intubated in the field and arrived to the emergency department unresponsive with a BP of 95/60, HR 125, T 38°C, and O2 Sat 100%. Hemodynamic stabilization was achieved with central venous access, and laboratory and imaging studies for the evaluation of altered mental status ensued.   General: Disheveled male [+]

SAEM Clinical Images Series: A Backpacker’s Rash

By |Categories: Dermatology, SAEM Clinical Images|

A 33-year-old female presented with a progressively worsening rash for one week. The patient just finished hiking the John Muir Trail, a backpacking trip that encompassed three weeks and over 240 miles. On the last days of the trip, the patient started to develop a severely itchy, red rash on both feet. She tried using a topical anti-fungal, which seemed to make the rash worse. She now has swelling and difficulty walking. The rash does not involve the hands or other parts of the body. She denies fever, open wounds, nausea, vomiting, or systemic symptoms, [+]

Trick of the Trade: Getting the last bit of ultrasound gel from the bottle

By |Categories: Tricks of the Trade, Ultrasound|

It’s a busy shift and you need to perform a bedside ultrasound on a patient’s belly to rule out cholecystitis, when you realize that the ultrasound gel bottle is nearly empty. No matter how many times you vigorously shake the bottle, it’s impossible to get the viscous gel out. In a pinch, you could use hand sanitizer, sterile lubricant, or even water as a substitute for gel. Or you could run to the storage room on the other side of the busy department to grab a new bottle. Or… Trick of the Trade Use centrifugal force to move the [+]