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. [...]

SAEM Clinical Image Series: Eye Trauma and Vision Loss

By |Categories: Ophthalmology, SAEM Clinical Images, Trauma|

The patient is a 44-year-old male with a past history of end stage renal disease on hemodialysis, diabetes, and hypertension who presents with acute visual loss after assault 2 hours prior. He was struck in the eye by his partner’s fist (adorned with a large ring), but denies severe pain. He does endorses instant difficulty with his vision. There is no use of contacts or glasses. No other injuries, headache, or loss of consciousness are reported. […]

SAEM Clinical Image Series: Double Vision

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

Chief complaint: Double vision History of Present Illness: 61 year old female with history of HTN, DM, hyperlipidemia, and chronic low back pain presenting with double vision. She received an epidural spinal injection yesterday for the 4th time for low back pain. She was sedated for the procedure and woke up with headache, neck stiffness, and left eye “jumping around,” which progressed to double vision 1 hour later. There was no blurry or double vision with either eye closed. She had 1 episode of emesis. She presented to the ED 24 hours later [...]

SAEM Clinical Image Series: Bumps and Balls

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

A 31 year old African-American male, with a history of HIV, non-compliant with medications, presents with 3 months of painful “balls and bumps” on his left thigh. He was evaluated at another hospital prior to this visit and was discharged with 7 days of TMP-SMX. He denies any fever, chills, weight loss, night sweats, or anorexia. […]