SAEM Clinical Image Series: I Have a Stomachache
An 18-year-old male with no significant past medical history presents with diffuse abdominal pain and multiple episodes of non-bloody, non-bilious vomiting for three days. The patient was seen yesterday at another facility and states he was diagnosed with gastritis and discharged with Zofran, which provided no relief. He denies fever, diarrhea, or urinary symptoms and states his last bowel movement was two days ago and was consistent with his usual bowel movements. Vitals: T 97.7ºF; HR 138; BP 122/98; RR 18; O2 sat 99% on RA General: Thin male, appears uncomfortable Abdominal: Mild distention [+]
SAEM Clinical Image Series: Vomiting in the Pediatric Patient
A 2-year-old boy with a past medical history of Hirschsprung disease presents to the emergency department (ED) with vomiting, abdominal distension, and inability to tolerate PO for one day. His parents had been instructed by their pediatric surgeon to perform rectal irrigations 2-3 times daily for the few days prior to presentation. Vital signs within normal limits. General: Appears lethargic HEENT: Oral mucosa dry Abdomen: Moderately distended; decreased bowel sounds Skin: Normal turgor Non-contributory The differential diagnosis for pediatric patients presenting with vomiting is broad and includes but is not limited to gastritis, [+]
SplintER Series: My Arm Is Stuck Like This
A 70-year-old female presents with right shoulder pain and the inability to adduct her arm after she fell on the sidewalk. You obtain shoulder x-rays and see the following images (Image 1: AP, scapular Y, and axillary views of the right shoulder. Author’s own images). [+]
William C. Chan, MD
Department of Emergency [+]
SAEM Clinical Image Series: Painful Weeping Rash
A 67-year-old nontoxic appearing male patient with a history of coronary artery disease, hyperlipidemia, transient ischemic attack, gout, renal colic, and squamous cell carcinoma presents with concern for multiple new painful lesions on his body. The rash first appeared five months ago but disappeared for some time before reappearing. It has worsened over the past few weeks. He has pain, erythema, pruritus, and urticarial, blistering, crusted lesions. He has had clear drainage from ruptured blisters. His only recent change in medication is an increase in his allopurinol (initiated four months ago; increased three weeks ago). He has tried Benadryl [+]
Dose Order Matter? Which Antibiotic to Give First for a Bloodstream Infection
Background Early antibiotics are recommended for treatment of many infections, including patients with sepsis or septic shock [1]. Critically-ill patients and those with a suspected infection at risk for severe illness are generally administered two (or more) empiric antibiotics in the emergency department (ED) which cover a wide range of potential pathogens. A typical approach includes utilizing a broad-spectrum antibiotic (frequently a beta-lactam such as cefepime or piperacillin-tazobactam) plus an anti-MRSA agent (typically vancomycin). Early in the patient's hospital stay they may have limited IV access, so the question often arises as to which antibiotic to give first, the broad-spectrum [+]
SplintER Series: My Foot Shouldn’t Look Like This
A 45-year-old male presents with left foot pain and deformity after he inverted his foot while running on uneven pavement. You obtain foot and ankle x-rays and see the following images (Image 1. AP and lateral views of the left foot. Author’s own images). [+]
Jonathan Jong, DO
Department of Emergency Medicine
New York Presbyterian-Queens
ALiEM AIR Series | OB/Gyn 2021 Module
Welcome to the AIR OB/Gyn 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 OB/Gyn emergencies in the Emergency Department. 8 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 6 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 truly emphasize [+]
SplintER Series: I Declare a Thumb War
A 39-year-old female presents to the emergency department with right thumb pain after falling in a skiing accident. On exam, there is mild swelling and tenderness on the ulnar aspect of the 1st MCP joint. Additionally, there is laxity with valgus stressing of the 1st MCP joint. An x-ray is obtained and shown above (Image 1. Provided by Alex Tomesch, MD). [+]
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SAEM Clinical Image Series: Chronic Back Pain
A 52-year-old male with a past medical history of prostate cancer status post radiation therapy 10 years prior presents to the emergency department (ED) with the chief complaint of low back pain worsening over the past year. He characterizes the pain as a “dull, aching stiffness” associated with decreased motility. Vitals: BP 128/82; HR 72; RR 18; T 37°C General: Alert and oriented MSK: Decreased range of motion of the lumbar spine with flexion; Heberden’s and Bouchard’s nodes on multiple fingers Neurologic: Within normal limits with no focal motor or sensory deficits appreciated; deep tendon reflexes [+]
SAEM Clinical Image Series: Pediatric Rash
A previously healthy 8-year-old female presents to the pediatric emergency department due to a rash. Her symptoms started three days prior to presentation with a painful rash on her lower extremities. The rash subsequently spread to the buttocks and upper extremities, and she developed intermittent diffuse abdominal pain, a nonproductive cough, and pharyngitis. The patient denies subjective fever. Known sick contacts include the patient’s mother, who tested positive for COVID-19 two and a half weeks prior. Vitals: T 98.5°F; HR 93; BP 115/68; RR 16; O2 sat 100% on room air Constitutional: Well-developed and in no [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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