SAEM Clinical Images Series: Tangled in the Toilet
An otherwise healthy 46-year-old male presented to the Emergency Department with 18 months of diarrhea and intermittent abdominal cramping that has acutely worsened in the past week. On the morning of presentation, he noticed a worm-like object in his stool, which he brought to the ED (See images), prompting his visit. Throughout these 18 months, he experienced 4-10 loose bowel movements per day. He tried dietary modifications, including the removal of dairy, gluten, and soy, all without relief. The patient frequently travels [+]
SAEM Clinical Images Series: A Case of Sudden Right Arm Pain and Deformity
A 73-year-old male presented to the Emergency Department with acute pain in his upper right arm. The pain began suddenly upon attempting to lift a 30-lb box that had been delivered to his house. He stated that as he began to lift the box, he felt a sudden pop coupled with the acute onset of pain. Since the injury, he had difficulty with flexion of his right upper extremity. He denied any other complaints. [+]
SAEM Clinical Images Series: First a Splash and then a Rash
The patient is a 25-year-old female with no significant past medical history who presents to the Emergency Department with a pruritic rash. She reported three days of progressive pruritus with an associated diffuse rash extending from the lower extremities to the proximal upper extremities with involvement of the chest and back. She denies fevers, chills, difficulty breathing, nausea, vomiting, or history of similar rash. She has no history of dermatologic or immunologic conditions. She has had no new exposures [+]
SAEM Clinical Images Series: Tongue Twisters
The patient is a 68-year-old male with a past medical history of hypertension who presents to the Emergency Department for evaluation of tongue swelling. The patient reports that his left tongue was swollen 3 weeks ago. He was evaluated, prescribed Levaquin, and was advised to gargle peroxide/salt water per his primary care provider. The swelling resolved after approximately 2 days. This morning, he awoke at 2 AM with swelling in the right side of his tongue. He denies any allergies or prior intubations. He denies any new foods, exposures, any other complaints at this time. [+]
Opportunities for Naltrexone: AUD and the Emergency Department
Take-Home Point: Naltrexone is a safe and effective medication for patients with alcohol use disorder that can improve morbidity by decreasing alcohol intake, and most importantly, can be initiated in the emergency department (ED). The Problem: Alcohol Use Disorder in the Emergency Department Alcohol use and its varied consequences, from trauma to withdrawal, are frequently encountered in the ED. Despite being ubiquitous in the ED, alcohol use disorder (AUD) often goes under-recognized and undertreated in the ED. The numbers are staggering-- approximately 29 million individuals across the country and 400 million across the globe meet criteria for AUD [1]. [+]
SAEM Clinical Images Series: There’s a Bird Stuck in Your Throat
The patient is a 61-year-old female with a past medical history of hypertension who presents to the Emergency Department for dysphagia. She states that for the past couple of months, she has experienced some discomfort in her chest as well as progressively worsening pain with swallowing. She was initially able to swallow thoroughly macerated solids and liquids, however over the past several days, she has been unable to tolerate either. She states whenever she eats or drinks something, she feels like the food gets [+]
SAEM Clinical Images Series: Tropical Rash
The patient is a 30-year-old female with no past medical history who presents to the Emergency Department with 2 months of non-healing ulcers on multiple parts of her body. She reports getting bitten by flies while traveling in wooded trails from Venezuela through Mexico. She reports the bites started as small scabs that have since enlarged, but they are non-painful or pruritic. She has ulcerative lesions on her left hand, right arm, back, and gluteal areas. She has taken multiple antibiotics from a doctor in Mexico including clindamycin, ceftriaxone, nitrofurantoin, flagyl, [+]
SAEM Clinical Images Series: When in Doubt, Swab It Out
A 26-year-old female with a history of atopic dermatitis presents with one week of rash that began on her lower lip but spread over her face, eyelids, and neck, plus one day of fevers and headache. She was seen at an urgent care and referred to the emergency department for evaluation and management of “impetigo.” On presentation, she endorsed nausea, headache, and mild neck pain. Vitals: Temp 100.7° F; BP 134/85; HR 121; SpO2: 100% General: Uncomfortable appearing. Cardiovascular: Tachycardia Neurological: AOx3. CN II-XII grossly intact. Moves all extremities [+]
ALiEM ACMT Toxicology Visual Pearl: Cookie Monster
What is most likely contained in this edible product that can cause somnolence and vomiting in a child? Lysergic acid diethylamide (LSD) Methamphetamines Psilocybin Tetrahydrocannabinol (THC) [Authors own image] [+]
Chloe Doris, MD
Carolinas Medical Center, Charlotte, NC
Latest posts by Chloe Doris, [+]
ACMT Toxicology Visual Pearl: Danger in the Shallows
In addition to local pain and dermal injury, stings from this marine animal can result in what systemic symptoms? Acute liver injury Hypotension, arrhythmia, and cardiac arrest Nausea, vomiting, and respiratory arrest Numbness, tingling, and muscle paralysis [Image courtesy of Guido Gautsch, Wikimedia Commons] [+]
Samuel Kerans, MD
Carolinas Medical Center
Charlotte, NC
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)
- The Discharge Severity Index: Early Research on ED Readmission Risk Assessment - August 14, 2025
- Suboxone and the Emergency Physician: Get Waivered Training - August 12, 2022
- A Tale of Two Epidemics: COVID-19 and the Opioid Crisis - April 23, 2020