SplintER Series: Don’t forget about the (tibial) spine!
A 13-year-old patient presents to the Emergency Department after sustaining a twisting knee injury while playing soccer. There was a pop, and the patient was subsequently unable to bear weight due to pain and knee instability. The swelling and pain increased in the hours after the injury occurred. On examination, there is a large knee effusion and a positive Lachman test. You obtain imaging (Figure 1). What is your suspected diagnosis? What is your initial workup in the ED? What imaging confirms the diagnosis? What is your management and disposition? Figure 1: AP [+]
SAEM Clinical Images Series: Facial Swelling
A 5-year-old male with a history of recent frontal sinusitis associated with preseptal cellulitis requiring surgery presented with facial swelling. Swelling developed in the 24 hours prior to presentation without facial pain, nausea, or emesis. Denied facial trauma as well as any neurologic deficits, loss of consciousness, headaches, or fever/chills. At the time of his prior surgery, he presented with swelling localized to the left eye along with worsening [+]
SplintER Series: Hip, Hip, Hooray!
A 67-year-old male with a history of bilateral total hip arthroplasties (THA) several years ago presents with left hip pain after a fall. He was walking downstairs and slipped, twisting his leg internally and with adduction and flexion of the hip to catch himself. He denies falling but felt an immediate pop in his left hip and could no longer bear weight. AP and lateral radiographs of the pelvis and left hip were obtained and are shown above (Image 1. Case courtesy of Dr Andrew Taylor, Radiopaedia.org, rID: 67457). [+]
Free Comprehensive Curriculum: Climate Change and Emergency Medicine
During the COVID-19 pandemic, a few of us interested in climate change science met through the Society for Academic Emergency Medicine (SAEM), and our group slowly expanded with the virtual world. We discussed the ever-growing number of climate publications and scholarship opportunities available. Some of us did research, education, or policy work, and all of us practiced clinically. Negative climate-related impacts that we see in the Emergency Department We discussed how climate-related impacts negatively affected our patients, and brainstormed how we could tackle the problem now. For us in Rhode Island, Pennsylvania, Wisconsin, Colorado, and California, the climate crisis [+]
SAEM Clinical Images Series: Finger Pain
A 57-year-old male presents after accidentally firing his son’s expired epinephrine autoinjector containing 0.3 mg of epinephrine into his left thumb two hours prior to arrival. He endorses mild pain and numbness at the tip of his thumb. The patient had spoken to poison control who had instructed him to present to the Emergency Department if his symptoms did not improve after two hours. He denied any palpitations or other systemic symptoms. Vitals: HR 81; BP 128/81; RR 18; SpO2 99% Extremities: Pallor noted at the distal tip of his left [+]
SplintER Series: The Hidden Post
A 23-year-old male presents to the emergency department with right ankle pain after he rolled his ankle while walking down the stairs. An ankle exam reveals ecchymosis over the posterior ankle and tenderness of the distal tibia. His neurovascular exam is intact. The radiograph above was obtained (Image 1. X-ray right ankle. Original image provided by Justine Ko, MD). [+]
SAEM Clinical Images Series: A Rash You Don’t Want to Miss
A 54-year-old female with a past medical history of diabetes presented to the Emergency Department (ED) for evaluation of unresponsiveness. The patient was found unresponsive by her spouse, who notes she had missed several doses of insulin over the past few days. EMS notes the glucometer read ‘HIGH’ on fingerstick. The patient remains unresponsive on presentation and is unable to contribute further history. Vital Signs: BP 148/105; HR 120; RR 24; Pulse Oximetry 98% on room air; Temperature 97.7°F Constitutional: Patient is morbidly obese, unresponsive, and toxic-appearing. Cardiovascular: Regular rhythm with tachycardia. [+]
SAEM Clinical Images Series: ‘Tis Not the Season to be Wheezing
A 2-year-old male with a history of solitary kidney presented with greater than one month of daily coughing, wheezing, and decreased appetite. The patient was previously seen by his primary care physician after three weeks of symptoms where he was prescribed albuterol as needed for viral bronchospasm. The patient’s wheezing did not improve after two weeks of albuterol treatment so a chest x-ray was ordered. The patient’s mother denied any fevers, vomiting, diarrhea, weight changes, or night sweats. Vitals: BP 131/60; Pulse 148; Temp 36.7 °C (98.1 °F) (Axillary); Resp 28; [+]
Trick of the Trade: Managing Epistaxis with Merocel Nasal Packing and an Angiocatheter
There are many ways to manage epistaxis. Once nasal clamping and cauterization fail, the next step is to consider using tranexamic acid (TXA) and performing nasal packing. Inflatable packing devices such as a Rhinorocket are painful to insert and do not conform well to the shape of the naris. The expandable Merocel nasal packing, a compressed, dehydrated sponge, provides a softer, alternative option, although the insertion process can be painful given its initial rigid, edged structure. We propose 2 strategic tricks to optimize your nasal packing technique using the Merocel sponge. Trick of the Trade: Strategic expansion of the [+]
SplintER: Pop, Lock & Drop It
A 38-year-old female presents to the ED with right shoulder pain after a fall directly onto that shoulder. She noticed immediate pain and difficulty moving the arm associated with mild tingling in her right fingers. The radiographs above were obtained in the ED (Image 1. AP and lateral radiographs of the right shoulder, author’s own images). [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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