SAEM Clinical Image Series: An Uncommon Cause of Shortness of Breath

By |Categories: Gastrointestinal, Geriatrics, Pulmonary, SAEM Clinical Images|

A 102-year-old female presents with intermittent epigastric abdominal pain for the last two days. Episodes have no relieving or exacerbating factors. The pain originates in the epigastrium and radiates diffusely to the abdomen and back, resolving on its own within minutes of onset. She has had one episode of nonbilious, non-bloody emesis. Her last bowel movement was two days prior and she hasn't been able to pass gas. The pain is associated with mild shortness of breath which has been progressively worsening since the onset of symptoms. Her family was concerned and called EMS because the shortness of breath [+]

ALiEM AIR Series | ACS 2022 Module

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

Welcome to the AIR ACS 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 ACS emergencies in the Emergency Department. 7 blog posts met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 4 AIR and 3 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 [+]

Extracorporeal Treatment Options in Poisoned Patients

By |Categories: EM Pharmacy Pearls, Tox & Medications|

Background Caring for a patient that is critically-ill secondary to a toxic ingestion is complicated and, in severe cases, extracorporeal treatments (ECTRs) may be considered. The most commonly used ECTRs are intermittent hemodialysis (iHD) and continuous renal replacement therapy (CRRT), but ECTRs also include exchange transfusion, hemoperfusion, liver dialysis, and therapeutic plasma exchange. Finding and evaluating the supporting literature for these treatment modalities in a timely manner is not feasible in most situations. In order to assist in this effort, the EXtracorporeal Treatments In Poisoning (EXTRIP) workgroup has reviewed and provided free, evidence-based recommendations regarding the use of ECTRs for [+]

SAEM Clinical Image Series: Eye Pain

By |Categories: Dermatology, Infectious Disease, Ophthalmology, SAEM Clinical Images|

A 59-year-old gentleman experiencing homelessness with a history of hepatocellular carcinoma, hepatitis C, alcohol use disorder, and tobacco dependence presented to the emergency department (ED) with severe, worsening right eye pain, blurry vision, swelling, redness, and purulent discharge after scraping his upper face on concrete during a mechanical fall two weeks prior. Of note, his partner presented to the ED at the same time with a necrotic infection of the breast as well as multiple skin lesions reportedly due to insect bites. Vitals: T 102.4°F; HR 108; BP 121/94 Head: Lice nits visible in his hair [+]

Human Trafficking in the ED – What you need to know

By |Categories: Emergency Medicine, Expert Peer Review (Non-Clinical), Psychiatry|

Human trafficking is a devastating crime, where a human being’s labor is exploited through force, fraud, or coercion, for someone else’s profit (1). For survivors, connecting to support in the community can be incredibly difficult, and may come at the expense of their personal safety (1, 2). The emergency department (ED) is a rare exception, with some studies estimating that over 60% of trafficked persons will present at some point during their exploitation to the ED (3). Unfortunately, less than 5% of emergency physicians report feeling confident in their ability to identify a trafficked person, citing confusion around patient characteristics [+]

Beyond the Abstract: Systematic Online Academic Resource Review #2: Endocrine, Metabolic and Nutritional Disorders

By |Categories: Emergency Medicine|

Planning to write the next great FOAM post on hyperkalemia, but not sure what’s already been done? Or maybe a less popular topic, that you hope has minimal coverage? Or are you a resident, medical student, or even a curious attending searching for the latest, best FOAM regarding a specific topic? If so, then we have great news for these answers are here in the recently published second Systematic Online Academic Resource (SOAR) Topic Review.1 This series aims to identify and evaluate online education resources by topic. The inaugural entry has already revealed the FOAM landscape related to the renal [+]

  • trick DIY nasal snot aspirator

Trick of the Trade: DIY Nasal Snot Aspirator

By |Categories: HEENT, Pediatrics, Tricks of the Trade|

Nasal congestion is a common symptom of upper respiratory tract infections, such as bronchiolitis, in newborns and infants. Because newborns are obligate nose breathers, any congestion presents a challenge during feeding and sleeping. These infants become frustrated when they cannot breathe while feeding and tend to have disturbed sleep when their nasal passages are occluded. This often leads to dehydration and irritability. Although the infant bulb syringe (above) can often alleviate the congestion, other commercial products may be able to more forcefully clean out the nasal mucus (e.g., NoseFrida, Bubzi Nasal Aspirator). Trick of the Trade: DIY Nasal Snot Aspirator In [+]

SAEM Clinical Image Series: Pediatric Rash

By |Categories: Dermatology, Pediatrics, SAEM Clinical Images|

A 17-month-old girl with a history of eczema presents to the pediatric emergency department for evaluation of a rash. The rash is different from her usual eczema, developed three days prior to presentation, and is described as red with yellow crusting. Her mother also noticed blistering in her groin and under her axilla. She has associated fussiness and decreased feeding, but no fever.     Vitals: T 37.7°C; HR 161; BP 115/75; RR 24; O2 sat 100% on room air General: Fussy but consolable Eyes: No conjunctival erythema or discharge Mouth: Yellow crusting and fissuring surrounding [+]

Oral Antivirals for Treatment of Mild-Moderate COVID-19 Infection

By |Categories: EM Pharmacy Pearls, Infectious Disease, Tox & Medications|

Background Two new oral agents were given Emergency Use Authorization to be used in patients with mild-moderate COVID-19 at high risk of progression to severe infection, molnupiravir and nirmatrelvir/ritonavir (Paxlovid) [1,2]. Prior to this authorization, most evidence-based COVID therapies were parenteral and required significant healthcare resources to coordinate and administer. Comparison Nirmatrelvir/ritonavir [3] Molnupiravir [4] Mechanism Protease inhibitor leadings to interruption of viral replication Ritonavir has no role in treating COVID-19, it is only included to boost levels of nirmatrelvir via CYP3A4 inhibition Increased frequency of RNA mutations and impaired replication [5] Efficacy vs Placebo (Hospitalization or Death) 0.8% vs [+]