SAEM Clinical Images Series: Blue is Bad

By |Categories: Heme-Oncology, SAEM Clinical Images|

66 year-old-male with a history of type 2 diabetes and hypertension presented as a transfer for rapid progression of lower extremity pain, swelling, and blue-purple discoloration of the entire limb with concern for a possible necrotizing infection. His symptoms began earlier in the day and progressed over just a few hours. He had no known thromboembolic risk factors. MSK: Swollen, tender, and blue/purple-colored right lower extremity Complete Blood Count (CBC): WBC 8.7; Hb 15; Hct 45; Plt 172 Glucose: 472 Severe venous thromboembolism (VTE), also known as Phlegmasia Cerulea Dolens, [+]

SAEM Clinical Images Series: Insidiously Contracted Hand

By |Categories: Orthopedic, SAEM Clinical Images|

A 64-year-old Caucasian male with a history of alcohol use disorder and tobacco use disorder presents with painless bilateral hand contractures that have been worsening for the past several months. He denies any recent trauma, fever, chills, or decreased sensation. The patient works as a construction worker. Vitals: BP 143/83 ; HR 94; RR 18; T 98.6°F; O2 saturation 98% on room air Musculoskeletal: He has bilateral palmar contractures proximal to the fourth digits. No tenderness to palpation along digits. Passive extension of the digits is limited bilaterally but does not elicit [+]

SAEM Clinical Images Series: Contact Your Nearest Ophthalmologist

By |Categories: Ophthalmology, SAEM Clinical Images|

A 29-year-old female with a past medical history of migraine headaches presented to the emergency department (ED) for several hours of bilateral eye pain, redness, and decreased visual acuity. The patient is a contact lens wearer. The night prior to presentation at 18:00, the patient inserted her contacts that she had washed and soaked in a hydrogen peroxide (H2O2) cleaning solution. She removed the contacts five hours later at 23:00, at which time she noted her eyes to feel drier than normal but did not note significant pain with removal, significant trauma, or a partial [+]

SAEM Clinical Images Series: A Dangerous Cause of Abdominal Pain

By |Categories: Gastrointestinal, SAEM Clinical Images|

A 65-year-old male presented with chest and abdominal pain for three weeks. He endorsed a poor appetite and a weight loss of 16 kilograms in the last month. He denied fever, vomiting, diarrhea, and tarry stools and described having his usual bowel movements.   Vitals: BP 172/71; HR 127; T 35.9°C; O2 Sat 100% General: In acute distress Cardiovascular: Regular rate and rhythm; no murmur; bilateral upper extremity and lower extremity pulses palpable Gastrointestinal: Soft; generalized tenderness, no abdominal masses, palpable subcutaneous emphysema Complete blood count (CBC): WBC 31 x 10^3/mcl; [+]

SAEM Clinical Images Series: There’s a Stone Under My Tongue

By |Categories: HEENT, SAEM Clinical Images|

A 44-year-old female presented to the emergency department with the complaint of a "stone under [her] tongue." She reported that the “stone” had been present and painless for two years. The day prior, she began experiencing pain at this site while brushing her teeth. She squeezed the area in an attempt to expel it, but this action only increased her pain.   Vitals: BP 156/92; Pulse 80; Temp 98.4°F; Resp 14; SpO2 100% General: Sitting on chair, no acute distress HEENT: Localized swelling to the inferior lingual frenulum at Wharton’s duct with [+]

SAEM Clinical Images Series: A Painful Swollen Digit

By |Categories: Infectious Disease, Orthopedic, SAEM Clinical Images|

A 50-year-old male with a history of polysubstance use disorder and poorly-controlled type 2 diabetes mellitus presents with left hand pain. One week ago, the patient sustained a macerating injury of the left distal middle digit. Since that time he has experienced worsening pain throughout the digit, now associated with diffuse swelling and discoloration. The patient also reports reduction in range [+]

SAEM Clinical Images Series: A Man with Blurry Vision

By |Categories: Neurology, SAEM Clinical Images|

A middle-aged man with a past medical history of hypertension and tobacco use disorder presented to the Emergency Department after evaluation by an ophthalmologist.  He complained of ten days of a right-sided headache and three days of diplopia. He denied eye pain, pain with eye movements, photophobia, and vision loss. Vitals: Temp 98.4 °F (36.9 °C); BP 122/72; Pulse 90; Resp 16; SpO2 100% Neuro: Ptosis, “down and out” deviation and pupil dilation of [+]

SAEM Clinical Images Series: The Color Purple

By |Categories: Infectious Disease, SAEM Clinical Images|

A 64-year-old female with a history of quadriplegia and bladder rupture secondary to a motor vehicle accident two years ago, complicated by chronic indwelling suprapubic foley, presents from her skilled nursing facility with fever, oliguria, tachycardia, low blood pressure, and a change in the color of her urine. Vitals: T 100.4°F; HR 126; BP 105/74; RR 24 General: Pleasant but mildly confused morbidly obese female smelling strongly of urine Genitourinary: Poorly maintained indwelling suprapubic catheter with purulence noted around the ostomy and purple urine in her foley tubing and bag Urinalysis (UA): [+]

PEM POCUS Series: Pediatric Lung Ultrasound

By |Categories: Expert Peer Reviewed (Clinical), Pediatrics, PEM POCUS, Radiology, Ultrasound|

Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric lung ultrasound. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU PEM POCUS: Pediatric Lung Ultrasound Quiz Module Goals List indications for performing a pediatric lung point-of-care ultrasound (POCUS). Describe the technique for performing lung POCUS. Recognize anatomical landmarks and artifacts related to lung POCUS. Interpret signs of a consolidation, interstitial fluid, effusion, and pneumothorax on POCUS. Describe the limitations of lung POCUS. Child with [+]

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,
Shuhan He, MD