SmilER 101: Oral Exam and Regional Anesthesia in Dental Care

By |Sep 15, 2021|Categories: ALiEMU, Dental, SmilER|

The purpose of the SmilER series on dental trauma and infection management is to teach fundamental principles, pearls, and pitfalls in the care for dental patients in the emergency department. As many as 1.5% of ED visits are dental-related¹ and many emergency physicians have expressed the need for more comprehensive training in the oral cavity. This series was created as an introductory guide on the management of patients who report to the ED with dental-related conditions. The first module teaches the oral examination and demonstrates how to provide anesthesia in the oral cavity. Author: Richard Ngo, DMD [+]

SAEM Clinical Image Series: Pediatric Penis Swelling

By |Sep 13, 2021|Categories: Genitourinary, Pediatrics, SAEM Clinical Images|

A 3-year-old healthy uncircumcised male presents to the Emergency Department with five days of penis swelling and pain. Five days prior, his father noted that the patient’s foreskin appeared stuck behind the head of the penis. The patient was seen at an urgent care facility four days prior and was given an antifungal cream for presumed balanitis, however, this did not resolve the patient’s symptoms. Since that time, the penis has been getting progressively more swollen and painful. The patient has not experienced the inability to urinate, decreased urine output, penile discharge, other penile lesions, fever, chills, [+]

The 1440 Doctor: Working From Home (WFH) | 3 Strategies for Being Productive

By |Sep 8, 2021|Categories: 1440 Doctor|

Physicians have practiced medicine in a variety of practice settings in the past. Some in rural environments, others in austere conditions on a mountain top in Nepal. The recent pandemic has created even a new practice environment in the field of medicine: our own homes. The idea of working from home (WFH) is not a new concept. It’s been gaining momentum for several decades in other fields but healthcare has been slow to embrace this trend. COVID19 changed that. There are many benefits of this new practice environment (basically a 0-minute commute, being able to see family/furry friends during the [+]

EMRad: Can’t Miss Adult Traumatic Hip and Pelvis Injuries

By |Sep 3, 2021|Categories: Orthopedic, Radiology, SplintER, 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 injuries that ideally should not be missed. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your [+]

EMRad: Radiologic Approach to the Traumatic Hip/Pelvis

By |Sep 1, 2021|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 [1]. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. Next up: the hip. [+]

SAEM Clinical Image Series: Pulseless and Painful Blue Leg

By |Aug 30, 2021|Categories: Cardiovascular, COVID19, SAEM Clinical Images, Ultrasound|

A 57-year-old male who works as a truck driver with a history of hypertension, type 2 diabetes, and recent COVID-19 infection presents with right lower extremity pain for two hours. He reports experiencing one day of dull aching of the right leg, then being suddenly awakened with the abrupt onset of severe right leg pain and shortness of breath. He denies chest pain. EMS reports a pulseless and painful blue leg en route. The patient denies any history of trauma, irregular heartbeat, or anticoagulation.     Vitals: T 97.5°F; BP 120/78; HR 102; RR 20; oxygen [+]

  • Preexcited Rapid Atrial Fibrillation

Diagnosis on Sight: “I have a rapid heart rate”

By |Aug 25, 2021|Categories: Cardiovascular, Diagnose on Sight, ECG|

A 31-year-old male presented to the emergency department with palpitations. The patient stated that he thinks his symptoms began "last night" and felt like he had “a rapid heart rate.” He said that prior to last night he felt fine. He did admit to drinking alcohol with his friends 2 nights prior. The patient estimated that he "must have drunk about 30 beers." On review of systems, he reported feeling anxious. He denied illicit drug use, headache, chest pain, cough, shortness of breath, fevers, nausea, vomiting, abdominal pain, dysuria, or increased urinary frequency. He reported that he was unaware of [+]

SAEM Clinical Image Series: A Recurring Neck Mass

By |Aug 23, 2021|Categories: HEENT, SAEM Clinical Images|

A 30-year-old female with no significant past medical history presents to the Emergency Department with a six-day history of an enlarging, tender, red “bump” on her anterior neck. She reports similar swelling during bouts of pharyngitis. She also reports a recent upper respiratory infection one week ago that was marked by fever, cough, congestion, sore throat, and myalgia. She denies shortness of breath, neck trauma, travel, or animal exposures. Vitals: T 37°C; BP 122/78; HR 77; RR 17 General: Well-developed, well-nourished female in no acute distress HEENT: 2cm tender, fluctuant, mobile right anterior neck mass with surrounding [+]

INR reduction with FFP – How low can you go?

By |Aug 21, 2021|Categories: EM Pharmacy Pearls, Heme-Oncology|

Background Bleeding patients or those undergoing procedures that are at high risk of bleeding may require correction of their INR. Multiple products can be used to achieve this, including fresh frozen plasma (FFP). FFP contains many substances, including clotting factors, fibrinogen, plasma proteins, electrolytes, and anticoagulant factors. It is sometimes said that the intrinsic INR of FFP is approximately 1.6-1.7 and that it’s not possible to achieve a lower INR. This pearl will further explore these concerns. Evidence What is the INR of FFP? The mean INR of FFP appears to be ~1.1 (0.9-1.3) [1,2]. Reports that the intrinsic INR [+]

  • Talar Neck Fracture

SplintER Series: Pedal to the Metal

By |Aug 18, 2021|Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

A 32-year-old female presents to the emergency department with right ankle pain after a high-speed motor vehicle accident. On exam, she is noted to have ecchymosis and swelling over the distal foot, and pain with ankle dorsiflexion and plantarflexion. An x-ray is obtained as shown above (Image 1. Case courtesy of Dr. Charlie Chia-Tsong Hsu,, rID: 18235).   [+]