SplintER Series: A Pain in the Elbow
A 12-year-old male pitcher for a traveling club baseball team complains of acute worsening of right elbow pain that has been bothering him for 3 months. The radiograph is shown below (Frontal elbow view. Case courtesy of Dr. Levente István Lánczi, Radiopaedia.org, rID: 46853). What is your diagnosis? What causes this injury? What patient demographic is most susceptible to this injury? How can this injury be prevented? What is the management of this injury in the Emergency Department? [+]
ACMT Toxicology Visual Pearls: “I have a nanging feeling about this”
Chronic exposure to which substance can cause this finding on a Cervical Spine MRI? Arsenic Carboplatin Nitrous Oxide Toluene [+]
Brian Lewis, MD
Corewell Health West - Butterworth Hospital
Grand Rapids, MI
Latest posts by Brian Lewis, MD (see all)
Is it a Pneumothorax? An Unusual Post-Thoracentesis Radiograph
A 51-year-old female with a history of metastatic ovarian cancer on chemotherapy, malignant pleural effusions requiring repeat thoracentesis, and pulmonary embolism presented to the Emergency Department with worsening shortness of breath and dry cough. Upon arrival, she was hypoxic with an oxygen saturation level of 75% on room air. She was tachycardic, tachypneic, and her blood pressure was 125/56 mmHg. Labs revealed only a mild anemia (Hgb: 10.2). It was determined that her symptoms were secondary to recurrent right-sided malignant pleural effusions. Her presenting chest X-ray is pictured above (Image 1: Author’s own image). [+]
SAEM Clinical Image Series: Man vs Pneumatic Nail Gun
A 40-year-old male presents with injury to his left hand by a nail gun. While at work, the patient accidentally shot himself with a nail gun. The nail went through pneumatic air hose tubing, his third finger, and his thumb, keeping them all connected. He immediately felt uncomfortable in his left arm, and, upon arrival to the emergency department (ED), complained of swelling in his left arm extending to his neck. He feels shortness of breath and “fullness” in his throat. [+]
SAEM Clinical Image Series: Worsening Sore Throat
A 40-year-old male presented to the emergency department (ED) complaining of a sore throat for one week. The patient had presented ten days earlier following a stab wound to the anterior neck that violated the platysma. There was no vascular injury noted on the computed tomography angiography (CTA) but there was extensive soft tissue damage with emphysema extending into the retropharyngeal space. The patient underwent a flexible laryngoscopy by ENT, which showed no airway injury. He was observed in the intensive care unit for two days, then discharged. Following discharge, the patient had progressive sore [+]
Purple Urine Bag Syndrome: A visual diagnosis and what it means for your patient
A 78-year-old male is brought in from his nursing home for evaluation of hypotension. He has a prior history of multiple strokes and is bed bound. He arrives febrile, tachycardic, and hypotensive. On your physical exam, you notice that he has an indwelling foley catheter. The catheter tubing and bag have a vibrant purple color. You wonder if this unusual urine color could be caused by something insidious. Could this be related to a toxin, medication, or infection? [+]
SAEM Clinical Image Series: Distended Abdomen after ROSC
A 64-year-old female presented to the emergency department (ED) in cardiac arrest. Her family members heard her fall in the bathroom and started CPR. EMS intubated the patient and 20 minutes of CPR was done en route. Return of spontaneous circulation (ROSC) was achieved after fifteen minutes of resuscitation in the ED. At baseline, the patient ambulated with her walker and was conversant. She was having abdominal pain and nausea for the past three days after recently being diagnosed with a urinary tract infection. On arrival to the ED, the patient was pulseless with ventricular [+]
IDEA Series: 3D-printed pediatric lumbar puncture trainer
Pediatric lumbar puncture trainers are less available than adult trainers; most are the newborn size and quite expensive. Due to age-based practice patterns for fever diagnostic testing, most pediatric lumbar punctures are performed on young infants, and residents have fewer opportunities to perform lumbar punctures on older children.1 Adult lumbar puncture trainers have been created using a 3D-printed spine and ballistics gel, which allows for ultrasound guidance.2 No previous model has been described for pediatric lumbar puncture. [+]
ACMT Toxicology Visual Pearls: Awake Seizures?
Which of the following rodenticides, often used to kill the rodent pictured, causes seizure-like activity without altered mental status or a postictal period? Barium Brodifacoum Carbamate Strychnine Zinc phosphide [+]
Announcing ALiEMU SplintER Course: Approach to Splinting
We are so thrilled to announce that we created an ALiEMU Course on the Approach to Splinting, using one of our most popular series, the SplintER Series, as the learning foundation. We have created a custom quiz assessing the learning objectives. Are you a medical student getting ready for your EM rotation or internship? Or an EM resident needing to brush up on your splinting knowledge? Take this free course for 2 hours of ALiEMU course credit, and receive your “Approach to Splinting” badge. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Latest posts by Shuhan He, MD (see all)
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