11 Tips to Improve Epistaxis Management in the Emergency Department
Managing epistaxis is often challenging, time-consuming, and takes practice. Even under the best circumstances, epistaxis often results in return visits for rebleeding and poor outcomes. Rarely should you do “nothing” for adults who present to the ED with or following epistaxis. If it produced enough blood to seek care (even without hemodynamic compromise), epistaxis frequently recurs even if currently resolved. This is a less true in pediatric patients. A careful and comprehensive evaluation is essential in both populations, whether epistaxis is ongoing. The following 11 pearls with a bonus tip should help you avoid common pitfalls, improve outcomes, and [+]
ALiEM AIR Series | Orthopedics Lower Extremity Module
Welcome to the AIR Orthopedics Lower Extremity Module! After carefully reviewing all relevant posts in the past 12 months 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 related to neurologic emergencies in the Emergency Department. 4 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 1 AIR and 3 Honorable Mentions. We recommend programs give 2 hours of III credit for this module. AIR Stamp of Approval [+]
SAEM Clinical Images Series: A Rare Cause of Post-traumatic Neck Pain
A 15-year-old male presents to the pediatric Emergency Department (ED) for evaluation of neck pain for three weeks. The patient is vague as to the development of his symptoms, but his mother reveals patient was assaulted by peers three weeks ago and has had progressively worsening neck pain and stiffness. The patient states symptoms have gotten to the point where he is unable to turn his head but denies fevers, chills, nausea, vomiting, focal weakness, or sensory changes. Vitals: [+]
ACMT Toxicology Visual Pearl: Is the Silver Bullet for Refractory Vasoplegia Really Blue?
What is the proposed mechanism for the pictured antidote when used as a pressor for refractory vasoplegic shock? Alpha-1-adrenergic agonist Angiotensin II receptor antagonist Nitric oxide/cyclic GMP pathway inhibition Vasopressin-1 receptor agonist [+]
Parker Hambright, MD
Atrium Health Carolinas Medical Center
Charlotte, NC
ACMT Toxicology Visual Pearl: Swollen Lips
Photo used with permission The following physical finding would be most consistent with exposure to which of the following? Bee sting Household bleach Isopropyl alcohol Potassium hydroxide [+]
Maha M Farid MBBCh, MSc, PhD
Faculty [+]
SAEM Clinical Images Series: Hey Doc, Can You Come Look at This Urine?
A 4-year-old male with no significant past medical history presents as a transfer from an outside hospital for suspected inhalation burn secondary to a house fire. The patient was home with his father and sibling when the apartment caught fire from a suspected flame in the kitchen. The patient was evacuated from the building by fire rescue after an unknown period of time. He was intubated at the outside hospital due to concern for inhalation injury. It is unknown if the patient sustained any trauma prior to extraction. Vitals: T 98.1°F; BP [+]
Trick of the Trade: Antibiotic ointment for removal of artificial nail glue from eyelids
A bottle of nail glue and timolol eye drops (reproduced with permission from BMJ Publishing Group Ltd [1]) You are working a busy shift in your department’s fast track area and sign up for a patient with a complaint of “eye pain.” The patient is a fan of glue-on nails and mistook her nail glue bottle for her eyedrops. Now she is unable to open her eyelid for the exam and you struggle to open it yourself. You want to avoid cutting the adhered eyelashes and wonder if there’s a better solution. Background rise of artificial, press-on nails [+]
SAEM Clinical Images Series: An Adult with a Lower Extremity Rash
A 37-year-old male with a past medical history of type 2 diabetes presents to the Emergency Department (ED) with a rash. Initial symptoms began one week prior with small spots on the right leg with associated itching and burning. He initially presented to an outside facility where he was diagnosed with an allergic reaction versus scabies and was given a short course of oral steroids and topical permethrin that provided some relief. The rash progressed to bilateral lower extremities prompting re-presentation to the ED. He also reports associated dark urine and nausea. [+]
SplintER Series: Patellar Tendon Rupture
A 46-year-old female with a history of diabetes and morbid obesity presents to the emergency department (ED) with difficulty walking after she tripped on a curb and fell onto her right knee. You obtain X-rays (Figure 1). What is your suspected diagnosis? What is your initial workup in the ED? What is your management and disposition? Figure 1. AP/lateral x-ray of the right knee. Author’s own images. [+]
SAEM Clinical Images Series: Spicy Gum Leads to Spicy Gums
A 32-year-old male with a past medical history of asthma presents with a two-day history of cracked lips and progressively worsening oral pain, associated with white discharge, foul smell, and a metallic taste. The patient presented to urgent care and was sent to the Emergency Department (ED) for a sepsis workup. The worsening sores caused him to eat and drink less, including the gum he normally chews. He endorses oral sex with one [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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