Diagnosis on Sight: Neck Bruising Leads to a Surprise Diagnosis

By |Categories: Diagnose on Sight, Heme-Oncology|

A 76-year-old female with a history of HTN, TIA, CAD, left CEA, and CKD presented to the emergency department for evaluation of neck bruising and swelling. The patient stated that the night before, she was eating popcorn and choked on a kernel. She states that she coughed to clear her throat and shortly after she developed swelling and bruising to the left side of her neck, which has progressively gotten worse. The patient has a remote history of left carotid endarterectomy and was concerned that her symptoms could be related to the prior surgery. On examination, she had ecchymosis and [+]

Trick of the Trade: Upsize the IV with the tourniquet infusion technique

By |Categories: Critical Care/ Resus, Tricks of the Trade|

There you are, middle of the night and EMS just brought you one of the sickest of the sick: a septic-looking, chronically ill-appearing, frail, and malnourished patient with low blood pressures. They need vascular access for fluids, antibiotics, and possibly even vasopressors. The patient arrives with only a 22-gauge peripheral IV in the hand. You ask for two large bore IVs. But unfortunately, your best nurses and techs can’t find a vein, and their initial attempts are unsuccessful. Do you move right towards ultrasound-guided placement, intraosseous needle, or a central line? What if the patient only needs a fluid bolus, [+]

Utility of Nebulized Naloxone

By |Categories: EM Pharmacy Pearls, Tox & Medications|

Background Naloxone can be administered via multiple routes, with nebulization gaining popularity in the past decade. A previous ALiEM Trick of the Trade presented this unique method of administration. In order for nebulized naloxone to be effective patients need to have some level of respiratory effort. It should not be used in patients in respiratory arrest or impending respiratory arrest. It may be a more gentle way to wake up patients to confirm the diagnosis of opioid toxicity and to gather a history. Theoretically, if the patient arouses enough to start experiencing mild withdrawal, they can ‘self-titrate’ and remove the [+]

  • Ankle Fracture

SplintER Series: Open Fracture

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

A 65-year-old farmer presents to the ED after his ankle was run over by a piece of farm equipment in the field. His x-ray is shown above (Figure 1: Case courtesy of Dr. Oyedepo Victor Olufemi, radiopaedia.org) He also has an associated soft tissue injury overlying the area that is grossly contaminated with mud and manure. [+]

  • PEM POCUS peripheral IV ultrasound badge

PEM POCUS Series: Pediatric Peripheral IV Access

By |Categories: PEM POCUS, Ultrasound|

Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric peripheral IV placement. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU PEM POCUS: Peripheral IV Quiz - test your skills PATIENT CASE: Child with Sickle Cell Pain Abigail is a 10-year-old girl with known sickle cell disease, who presents with severe atraumatic pain in her hips and back. She is afebrile, but tachycardic and tachypneic with 10/10 pain. Nurses have made several attempts but have been unsuccessful in establishing [+]

PEM POCUS Series: Hip Effusion

By |Categories: Orthopedic, PEM POCUS, Ultrasound|

Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric hip effusion. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU PEM POCUS: Hip Effusion Quiz - test your skills PATIENT CASE: Child with a Limp Sarah is a 4-year-old girl who comes into the emergency department complaining of a limp for the last day. She had an upper respiratory infection which started a week ago for which she had been taking acetaminophen and ibuprofen with her last dose of [+]

  • Ramadan

Caring for the Fasting Patient in the ED

By |Categories: Emergency Medicine, Expert Peer Review (Non-Clinical)|

Millions of Muslims around the world observe the holy month of Ramadan. Some may have mild or chronic medical conditions that can become exacerbated, requiring emergent medical attention. Emergency Physicians ought to have a working knowledge about the religious rules of Ramadan and their medical implications. In this article, we will provide an overview of the significance of Ramadan to Muslims, its practices, and discuss the important considerations for emergency physicians when providing care to Muslim patients in the Emergency Department (ED). Lastly, we will explore ways to mitigate the ethical dilemma when a fasting patient refuses a life-saving treatment [+]

  • CT cervical spine demonstrating a Jefferson Fracture

SplintER Series: Diver’s Nightmare

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

A 27-year-old male presents with neck pain after diving headfirst into the shallow water of his pool. He has midline cervical spine tenderness and a normal neurological exam. CT of the cervical spine is shown below (Figure 1). Figure 1. Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 9601 [+]

PEM POCUS Series: Intussusception

By |Categories: Gastrointestinal, PEM POCUS, Ultrasound|

Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric intussusception. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit.     Take the ALiEMU PEM POCUS: Intussusception Quiz - test your skills   PATIENT CASE Johnny is a 2-year-old boy who comes into the emergency department for abdominal pain for the last day. His parents are concerned that he has been having intermittent abdominal pain and has seemed very tired all day. Parents deny bloody stool. On arrival, his vital signs are: [+]