SplintER Series: Hip, Hip, Hooray!

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

  A 67-year-old male with a history of bilateral total hip arthroplasties (THA) several years ago presents with left hip pain after a fall. He was walking downstairs and slipped, twisting his leg internally and with adduction and flexion of the hip to catch himself. He denies falling but felt an immediate pop in his left hip and could no longer bear weight. AP and lateral radiographs of the pelvis and left hip were obtained and are shown above (Image 1. Case courtesy of Dr Andrew Taylor, Radiopaedia.org, rID: 67457).   [+]

Free Comprehensive Curriculum: Climate Change and Emergency Medicine

By |Categories: ALiEMU, Environmental, Medical Education|Tags: |

During the COVID-19 pandemic, a few of us interested in climate change science met through the Society for Academic Emergency Medicine (SAEM), and our group slowly expanded with the virtual world. We discussed the ever-growing number of climate publications and scholarship opportunities available. Some of us did research, education, or policy work, and all of us practiced clinically. Negative climate-related impacts that we see in the Emergency Department We discussed how climate-related impacts negatively affected our patients, and brainstormed how we could tackle the problem now. For us in Rhode Island, Pennsylvania, Wisconsin, Colorado, and California, the climate crisis [+]

SAEM Clinical Images Series: Finger Pain

By |Categories: SAEM Clinical Images|

A 57-year-old male presents after accidentally firing his son’s expired epinephrine autoinjector containing 0.3 mg of epinephrine into his left thumb two hours prior to arrival. He endorses mild pain and numbness at the tip of his thumb. The patient had spoken to poison control who had instructed him to present to the Emergency Department if his symptoms did not improve after two hours. He denied any palpitations or other systemic symptoms.   Vitals: HR 81; BP 128/81; RR 18; SpO2 99% Extremities: Pallor noted at the distal tip of his left [+]

  • posterior malleolar fracture

SplintER Series: The Hidden Post

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

A 23-year-old male presents to the emergency department with right ankle pain after he rolled his ankle while walking down the stairs. An ankle exam reveals ecchymosis over the posterior ankle and tenderness of the distal tibia. His neurovascular exam is intact. The radiograph above was obtained (Image 1. X-ray right ankle. Original image provided by Justine Ko, MD).   [+]

SAEM Clinical Images Series: A Rash You Don’t Want to Miss

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

A 54-year-old female with a past medical history of diabetes presented to the Emergency Department (ED) for evaluation of unresponsiveness. The patient was found unresponsive by her spouse, who notes she had missed several doses of insulin over the past few days. EMS notes the glucometer read ‘HIGH’ on fingerstick. The patient remains unresponsive on presentation and is unable to contribute further history. Vital Signs: BP 148/105; HR 120; RR 24; Pulse Oximetry 98% on room air; Temperature 97.7°F Constitutional: Patient is morbidly obese, unresponsive, and toxic-appearing. Cardiovascular: Regular rhythm with tachycardia. [+]

SAEM Clinical Images Series: ‘Tis Not the Season to be Wheezing

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

A 2-year-old male with a history of solitary kidney presented with greater than one month of daily coughing, wheezing, and decreased appetite. The patient was previously seen by his primary care physician after three weeks of symptoms where he was prescribed albuterol as needed for viral bronchospasm. The patient’s wheezing did not improve after two weeks of albuterol treatment so a chest x-ray was ordered. The patient’s mother denied any fevers, vomiting, diarrhea, weight changes, or night sweats. Vitals: BP 131/60; Pulse 148; Temp 36.7 °C (98.1 °F) (Axillary); Resp 28; [+]

Trick of the Trade: Managing Epistaxis with Merocel Nasal Packing and an Angiocatheter

By |Categories: ENT, Expert Peer Reviewed (Clinical), Tricks of the Trade|

There are many ways to manage epistaxis. Once nasal clamping and cauterization fail, the next step is to consider using tranexamic acid (TXA) and performing nasal packing. Inflatable packing devices such as a Rhinorocket are painful to insert and do not conform well to the shape of the naris. The expandable Merocel nasal packing, a compressed, dehydrated sponge, provides a softer, alternative option, although the insertion process can be painful given its initial rigid, edged structure. We propose 2 strategic tricks to optimize your nasal packing technique using the Merocel sponge. Trick of the Trade: Strategic expansion of the [+]

  • Shoulder

SplintER: Pop, Lock & Drop It

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

A 38-year-old female presents to the ED with right shoulder pain after a fall directly onto that shoulder. She noticed immediate pain and difficulty moving the arm associated with mild tingling in her right fingers. The radiographs above were obtained in the ED (Image 1. AP and lateral radiographs of the right shoulder, author’s own images).   [+]

SAEM Clinical Images Series: An Enlarging Scalp Mass

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

A 27-day-old female infant born at 34 weeks 4 days with a prenatal history of maternal syphilis treated with penicillin presented with an enlarging scalp mass since birth. Since birth, the patient has had a 1 cm erythematous and flat lesion on her scalp. Since that time, the lesion has continued to grow and develop scales. On the day of presentation, the lesion was noted to be 7-8cm in diameter with multiple surrounding smaller lesions. There is some clear to bloody drainage coming from the main lesion. The patient has otherwise been growing and developing [+]

SplintER Series: Let the Feet Drop

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

A 20-year-old male distance runner who was jogging and happened to be running past the emergency department presented with severe bilateral leg pain, foot pain, and foot numbness that had resolved by the time he was evaluated in the ED. The x-ray above was obtained (Image 1. X-ray of the leg. Case courtesy of Andrew Murphy, Radiopaedia.org, rID: 41408). [+]

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, Conductscience.com
Shuhan He, MD