SAEM Clinical Image Series: A Page Turner
[Click for larger view] Chief complaint: Abdominal pain History of Present Illness: A 36-year-old male with a history of alcohol abuse, hypertension, hyperlipidemia, and myocardial infarction with a subsequent stent on ticagrelor and aspirin presents with abdominal pain. He reports 3 days of epigastric and periumbilical pain and multiple episodes of non-bloody, non-bilious emesis. He denies fever, diarrhea, blood in his stool, and urinary symptoms. He endorses bruising to his bilateral flanks and multiple falls recently while drinking. [+]
SAEM Clinical Image Series: Left Shoulder Pain
[Click for larger view] Chief complaint: Arm pain History of Present Illness: A 30-year-old obese male presents to the ED after a ground level fall onto his left arm with immediate isolated left shoulder pain. He did not lose consciousness and denies dyspnea, numbness, weakness, vomiting, and chest pain. [+]
Sean Murray, MD
Techniques for Ultrasound-Guided IV Placement
Imagine a busy evening shift interrupted by the news that the unstable dialysis patient still has no access. Begrudgingly, you drag the ultrasound into the patient’s room. Buried beneath a layer of muscle, a tiny vein lurks below an intimidating artery with a nerve nestled close by. Making matters worse, the patient is becoming increasingly more frustrated. “This always happens. I told them not to remove my last PICC line,” he notes. The use of ultrasound-guided IV improves successful cannulation and decreases complications, but cases like this have caused many emergency providers to resent, even fear, this basic procedure.1–4 Below, [+]
EMRad: Can’t Miss Elbow Injuries
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 is 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 injuries that ideally should not be missed. This list is not meant to be comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. To begin: “Can’t [+]
EMRad: Radiologic Approach to the Traumatic Elbow
Radiology teaching during medical school is variable, ranging from informal teaching to required clerkships.1 Many of us likely received an approach to a chest x-ray, but approaches to other studies may or may not have not been taught. We can do better! Enter EMRad, a series aimed at providing approaches and improving interpretation of commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. To begin: the elbow. [+]
Building Equipment Kits for Streamlined Care
In the setting of emergent care, the ability to access equipment rapidly and reliably can be a deciding factor in patient outcome. Poor stocking, inconsistent organization, and dispersal of equipment throughout a large geographic area are realities of practice as well as barriers to rapid and effective patient care. Equipment kits are a great way to ensure rapid access to a select set of tools to deal with emergent scenarios. They result in both decreased time to arrival and decreased time to successful completion of procedure.1,2 Scenarios that can benefit from organized and well provisioned kits include central or peripheral [+]
SAEM Clinical Image Series: Hip Pain
[Click for larger view] Chief complaint: Left hip pain History of Present Illness: A healthy right leg-dominant 13-year-old male athlete presents with left hip pain after kicking a soccer ball. He states that he kicked the ball awkwardly and experienced hip pain immediately afterwards. He did not feel a pop or cracking sensation but could not stand after the kick and fell to the ground. He can ambulate but only with significant pain. He now has 8/10 sharp, non-radiating left hip pain that is worse with movement, weight-bearing and palpation. [+]
ALiEM AIR | Procedures 2019 Module
Welcome to the AIR Procedures 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 emergency procedures. 10 blog posts within the past 12 months (as of April 2019) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 9 Honorable Mentions. We recommend programs give 5 hours (about 30 minutes per article) of III credit for this module. [+]
SplintER Series: Ankle and Foot Pain in a Child
A 10-year-old female dancer presents with sub-acute onset pain located in her lateral ankle and foot without any history of significant trauma. She has had similar pain occasionally over the past 6 months. Pain is worse while dancing and now has difficulty putting on her shoe. You obtain a foot x-ray and see the adjacent image (photo credit). What is the most likely diagnosis, differential diagnosis, and appropriate management plan? [+]
SAEM Clinical Image Series: Foreign Body Ingestion
[Click for larger view] Chief complaint: Foreign Body Ingestion History of Present Illness: A 4-year-old male presents to the Pediatric ED for evaluation of swallowed foreign body. The mother reports the patient was at his grandmother’s house playing near a cabinet when they witnessed him put a small unknown object in his mouth and swallow. Family denies vomiting, difficulty breathing, change in behavior, abdominal pain, or any additional symptoms at this time. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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