SAEM Clinical Images Series: Pediatric Genitourinary Bleeding

By |Categories: Ob/Gyn, Pediatrics, SAEM Clinical Images|

A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. The grandmother first noted blood in the patient’s underwear the previous morning when she was helping the patient wipe and she noticed it again prior to arrival, this time saturating the patient’s underwear. There is no history of any recent falls or trauma, abdominal pain, pain to the vagina, dysuria, prior incidents of vaginal bleeding, or any noticeable behavioral changes per the grandmother. The patient lives at home [+]

ACMT Toxicology Visual Pearl – Apricot Kernels: Eat or pass?

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

What toxin is found in bitter apricot kernels? Cardiac glycoside Cyanogenic glycoside Dinitrophenol Lysergic Acid [+]

Maureen Nsofor, MD

Maureen Nsofor, MD

Pediatric Emergency Medicine Fellow
Atrium Health’s Carolinas Medical Center

SAEM Clinical Images Series: More Than Skin Deep

By |Categories: Dermatology, Pulmonary, Rheumatology, SAEM Clinical Images|

A 57-year-old female college counselor living in the northeastern United States with no PMH presented for evaluation of rash, joint pain, and dyspnea for the past three weeks. The patient first noticed the rash on her upper back, describing it as being itchy. The rash then spread to her face, scalp, and thighs. Two weeks ago, she noticed swelling in her hands and had a gradual onset of dyspnea on exertion. The patient has pain in her hands and when moving her fingers. She denied fever, cough, chills, chest pain, headache, vision changes, focal weakness, [+]

SAEM Clinical Images Series: Man with a Recurrent Rash

By |Categories: Allergy-Immunology, Dermatology, SAEM Clinical Images|

A 33-year-old male presented to the emergency department with a diffuse pruritic rash that appeared several days after starting Trimethoprim/Sulfamethoxazole (TMP-SMX) for a dental infection. Initially beginning on the torso and low back, the rash spread to the palms, soles, and genitalia. Progression stopped after discontinuing TMP-SMX. He conveyed a remote history of a similar rash following use of an unknown medication, and noted that several of the current lesions arose at the same location as previous.   Skin: Widely distributed violaceous, non-blanching patches with a dusky center. Lesions ranged from 3 [+]

ACMT Toxicology Visual Pearl: Making Rash Decisions

By |Categories: ACMT Visual Pearls, Expert Peer Reviewed (Clinical), Tox & Medications|

Which of the following best describes the pictured rash occurring 4 weeks after starting minocycline? Anaphylaxis Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Erythema multiforme Serum sickness Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) [+]

Destiny D. Folk, MD

Destiny D. Folk, MD

Emergency Medicine Resident
Carolinas Medical Center
Destiny D. Folk, MD

Latest [+]

SAEM Clinical Images Series: Wolf in Sheep’s Clothing

By |Categories: Cardiovascular, ECG, SAEM Clinical Images|

A 55-year-old female with a history of hyperlipidemia presents after a syncopal episode. She had mild nausea and diarrhea on the morning of presentation but otherwise had no prodromal symptoms before suddenly losing consciousness in a grocery store. Of note, she recalls a similar syncopal episode in the remote past, also preceded by gastrointestinal symptoms at that time. At present, she is symptom-free. Vitals: BP 135/71; HR 52; Temp 98°F; RR 18; SpO2 100% on room air General: Tired appearing CV: 2+ peripheral pulses. Regular rate and rhythm, no murmurs, rubs, or [+]

ALiEM AIR Series | Trauma 2023 Module

By |Categories: Approved Instructional Resources (AIR series), Expert Peer Reviewed (Clinical), Trauma|

Welcome to the AIR Trauma Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to related to trauma in the Emergency Department. 8 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 3 AIR and 5 Honorable Mentions. We recommend programs give 4 hours of III credit for this module. AIR Stamp of Approval and Honorable Mentions [+]

  • test tube of different color urine

ACMT Toxicology Visual Pearl: Who Doesn’t Like a Nice Rosé?

By |Categories: ACMT Visual Pearls, Expert Peer Reviewed (Clinical), Tox & Medications|

What clinical presentation and medication is associated with this urinary discoloration? Critical illness requiring intubation and propofol sedation Cyanide toxicity requiring sodium thiosulfate Iron toxicity treated with deferoxamine Refractory vasoplegic shock treated with methylene blue Septic shock treated with vancomycin and cefepime [+]

Allison Frazure, MD

Allison Frazure, MD

Emergency Medicine Resident
Carolinas Medical Center
Allison Frazure, MD

SAEM Clinical Images Series: Intracranial Abnormality

By |Categories: Neurology, SAEM Clinical Images|

A 26-year-old male with no significant past medical history presented to the ED after slipping on wet pavement and hitting his head on the ground three hours prior. He endorsed a constant, achy 7/10 headache accompanied by nausea and photophobia. He denied vomiting, dizziness, diplopia, loss of consciousness, or seizures. Nothing made it better or worse.   Vitals: BP 101/63; HR 76; RR 14; T 36.7°C General: Alert and oriented, no acute distress HEENT: Normocephalic, atraumatic, tenderness elicited over right occipital bone, PERRLA, + photophobia Neurologic: WNL with no focal motor or [+]

SAEM Clinical Images Series: Dangerous Eye Drainage

By |Categories: HEENT, Ophthalmology, SAEM Clinical Images|

A 32-year-old man with a history of traumatic globe rupture from a stab wound two months ago, status post repair, presented to the emergency department for worsening right eye pain and green malodorous drainage for the past three days. These symptoms started when he got a fleck of sawdust in the right eye about four days prior to presentation, which he was able to brush out with his finger. He described the pain as severe, throbbing, constant, and non-radiating. He had been unable to open the right eyelid for three days, both due to pain [+]

Shuhan He, MD
ALiEM Senior Systems Engineer;
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
Shuhan He, MD