Trick of the Trade: Directed Saline Irrigation for Nasal Suctioning

By |Categories: Emergency Medicine, Pediatrics, Tricks of the Trade|

You are just starting out your mid-January evening shift, and you go to the room of an 8-month old male with nasal congestion. He is afebrile, and mildly tachycardic, but his lung exam is fairly benign and he’s breathing easily without retractions. You can clearly see he has congestion. You instruct the parents to use saline irrigation and then nasal suctioning to clear the congestion as needed, and they say, “How can we do this if our child struggles? Won’t we just end up with a wet, angry, and congested child?” […]

  • rash fever

SAEM Clinical Image Series: Fever and Aches

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

A 62 year old female with no past medical history presented to the ED with fevers, generalized weakness, severe muscle aches, and a rash. She had returned home from the Philippines 3 days prior to evaluation. Twenty-four hours prior to arrival, the patient noticed a rash on her shins. She denied any nausea, vomiting, diarrhea, abdominal pain, chest pain, shortness of breath, cough, sore throat, dysuria, urinary frequency, headache, and neck pain. The patient was in the Philippines for a family funeral and was indoors for most of the trip. She was unsure if she [...]

  • lateral elbow fat pads

EMRad: Can’t Miss Adult Wrist Injuries

By |Categories: EMRad, Orthopedic, Radiology, Trauma|

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 common and catastrophic injuries. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially [...]

  • AP wrist radiograph

EMRad: Radiologic Approach to the Traumatic Wrist

By |Categories: EMRad, Orthopedic, Radiology, Trauma|

This is EMRad, a series aimed at providing “just in time” approaches to 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. Last post, we focused on the elbow. Now: the wrist. […]

PECARN: Its relevance and importance in pediatric emergency care

By |Categories: Pediatrics|Tags: , |

Did you know that many of the landmark pediatric emergency medicine (EM) studies come from the Pediatric Emergency Care Applied Research Network (PECARN) collaborative? It works to address the challenging pediatric questions that only multicenter studies can. In this blog post, we highlight PECARN’s goal to translate, disseminate, and implement evidence to all providers of emergent and urgent care for pediatric patients. […]

  • trapeziometacarpal dislocation xray

SplintER Series: A Rare Cause of Traumatic Thumb Pain

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

A 45 year-old male presents with right thumb pain and deformity after falling off his bicycle. You obtain hand x-rays and see the following images. What is the most likely diagnosis, differential diagnosis, and management plan? Figure 1. AP and oblique views of the hand. Author’s own images.   […]

  • ankle anatomy

SplintER Series: The 2 minute ankle exam | Leg Day #5

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

Welcome to Leg Day #5 of the SplintER Series. The focused history and physical ankle exam of the patient with an acute ankle injury is a crucial tool often overlooked in the Emergency Department (ED). Our hope is that after enough practice, you will be able to complete your ankle exam within 2 minutes! The key is to practice, practice, and practice some more. […]

SAEM Clinical Image Series: A Multifactorial Skin Eruption

By |Categories: Dermatology, SAEM Clinical Images|

A 9-year-old male with no past medical history, brought in by his mother to the ER with a new rash on his face and torso. The rash began 10 days ago. On the day he developed the rash, the patient noted swimming in a newly chlorinated outdoor pool. That same day he also played with freshly picked oranges and limes outdoors with his friends, having squeezed the juices onto his head and body. He developed a non-painful, non-pruritic, hyper-pigmented rash on his left cheek. Over the course of 3 days, the patient and his family [...]