ACMT Toxicology Visual Pearls – In “Spore” Taste

By |Categories: ACMT Visual Pearls, Tox & Medications|

A 15-year-old male presents symptomatic several hours after inhaling spores of this mushroom as a home remedy for epistaxis. What is the presentation and pathophysiology of the toxic syndrome associated with this mushroom? For a video of this mushroom in action: https://youtu.be/G_DXTlvvsco Dyspnea and cough from hypersensitivity alveolitis Flushing, nausea and vomiting from acetaldehyde accumulation Nausea, vomiting and hepatoxicity from RNA synthetase inhibition Seizures from reduced GABA production in the central nervous system [+]

EMRad: Can’t Miss Pediatric Elbow Injuries

By |Categories: EMRad, Orthopedic, Pediatrics, Radiology, Trauma|

  Have you ever been working a shift at 3 am and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This can be a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify common and catastrophic injuries. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for [+]

SplintER Series: Kitty Nibble: A Case of the Sausage Finger

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

  A 30-year-old female presents with left second finger pain with overlying erythema, warmth, and swelling the day after her cat bit her finger. She cannot fully extend the finger, it is tender and she has pain when it is passively extended. Her hand appears as shown above (Figure 1. Case courtesy of Kristina Kyle, MD).   [+]

  • humeral shaft fracture xray

SplintER Series: A Case of Hip Pain

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

Figure 1. Image prompt: AP view of the pelvis and left hip. Authors’ own images. A 70-year-old male presents with left hip pain and inability to ambulate after a mechanical trip and fall. Examination demonstrates that the left lower extremity is shortened, abducted and externally rotated. Hip and pelvis x-rays are obtained (Figure 1).   [+]

ALiEM AIR Series | Gastroenterology 2020 Module

By |Categories: Approved Instructional Resources (AIR series)|Tags: , , |

Welcome to the AIR Gastroenterology 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 gastroenterology in the Emergency Department. 6 blog posts within the past 12 months (as of November 2020) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 5 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module. AIR Stamp [+]

Teaching LGBTQ+ Health: 10 Clinical Pearls

By |Categories: CME, Public Health|

Are you confident in your skills when taking care of LGBTQ+ patients? Are you able to teach principles of LGBTQ+ health to trainees in your clinical practice and the classroom setting? Learners across the health professions demand improved LGBTQ+ health content and additional training opportunities in their schools’ curricula. However, most clinician educators received little, if any, training in LGBTQ+ health when they were students. 10 Clinical Pearls on Teaching About LGBTQ+ Health The following are some sneak-peak clinical pearls from the Teaching LGBTQ+ Health online course that just launched. This open access, interactive, CME course was published in conjunction [+]

  • Sail sign

EMRad: Radiologic Approach to the Pediatric Traumatic Elbow X-ray

By |Categories: EMRad, Orthopedic, Pediatrics, Radiology, Trauma|

This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department [1]. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. We recently covered the adult elbow, here we will cover the approach to the pediatric elbow. Learning Objectives Interpret traumatic pediatric elbow x-rays using a standard approach Identify clinical scenarios in which an additional view might improve pathology diagnosis Why the pediatric elbow matters and the radiology rule of 2’s The Pediatric Elbow 10% of [+]

  • axillary varix

SplintER Series: Venous Thoracic Outlet Syndrome

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

    A 29-year-old male presents with right shoulder pain, throbbing, and swelling. He states that a bulge has appeared over his right anterior shoulder recently (Image 1). While he was doing pushups today, he began to have numbness, tingling, and weakness in his right arm. While in the waiting room, his symptoms have completely resolved. Image 1: Bedside ultrasound of the anterior shoulder at the site of the bulge. AA=axillary artery. AV=axillary vein. Author’s image.   [+]

Does the Combination of Parenteral Olanzapine with Benzodiazepines for Agitation in the ED Increase the Risk of Adverse Events?

By |Categories: EM Pharmacy Pearls, Psychiatry|

A previous EM Pharm Pearl focused on the adverse events associated with the use of IV olanzapine for agitation. This pearl addresses concerns around using parenteral (IV or IM) olanzapine with parenteral benzodiazepines. Background Olanzapine has two FDA boxed warnings, one for increased mortality when used long-term in older adults with dementia-related psychosis and another pertaining to adverse effects of extended release IM olanzapine. However, there exists a potential risk of excess sedation and respiratory depression when IM/IV olanzapine is administered with parenteral benzodiazepines for agitation. The European Medicines Agency recommends separating the administration of IM/IV olanzapine and parenteral benzodiazepines [+]