SAEM Clinical Image Series: Tick Bite

By |Jan 27, 2020|Categories: Environmental, Infectious Disease, Pediatrics, SAEM Clinical Images|

A 14 year old girl presenting from Mexicali with altered mental status. Her mother reports a rash about a week ago following a tick bite. She had been going to school until 4 days ago when she became very fatigued with associated vomiting, diarrhea, tactile fevers, and headache. She subsequently collapsed at home today and was difficult to arouse which prompted EMS activation. Her mother denies any prior complaint of neck stiffness, shortness of breath, cough, hematemesis, or hematochezia. […]

  • Entrustable professional activities

Should the Trainee be Trusted? A User’s Guide to Assessment with EPAs

By |Jan 24, 2020|Categories: Academic, Medical Education|

You are an attending working with a fourth-year medical student on their emergency medicine clerkship. The student sees a patient with the chief complaint of dizziness. After an initial assessment, the student says that there are no red flags in the history and the patient has a normal neurological exam. In the back of your mind you are thinking, “Does this student know the risk factors, comorbidities, and red flags? Was a thorough neurological exam performed?” How do you know the trainee should be trusted? […]

  • Bankart Lesion

SplintER Series: The Recurrent Shoulder Dislocation

By |Jan 22, 2020|Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|Tags: , , |

A 17 year-old football player with prior shoulder dislocation presents to the emergency department reporting shoulder pain after fall. You obtain shoulder x-rays and see the following injury (Image courtesy of Richard Hopkins, MD). What is your diagnosis? Are there any associated lesions you could expect to find? What is your emergency department management? […]

Introducing the 2020-2021 ALiEM Faculty Incubator Cohort!

By |Jan 17, 2020|Categories: Incubators, Medical Education|

We put the call out, and *wow* did the MedEd community respond! We were beyond excited this year about the quality of our applicants for the 2020-2021 ALiEM Faculty Incubator.  This next cohort will include educators from across the globe and from all arenas of medicine including pre-clinical educators and our first nurse practitioner! […]

Trick of the Trade: Directed Saline Irrigation for Nasal Suctioning

By |Jan 15, 2020|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 |Jan 13, 2020|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 [...]

Peer Accountability: A Strategy for Maintaining Commitment to Personal and Professional Obligations

By |Jan 10, 2020|Categories: Professional Development, Wellness|

There are a number of personal attributes characterizing the professional identity of “physician.” We are dedicated to patients, committed to lifelong learning, and responsible for a variety of other professional obligations. Each requires physicians to be highly accountable – obligated or willing to accept responsibility for one’s actions. In this post we present examples of how we’ve adopted peer accountability as a strategy to help us with the myriad responsibilities and obligations at the heart of our profession. Just in time for the New Year – we challenge each of our readers to consider finding an “accountability partner” in 2020! [...]

  • lateral elbow fat pads

EMRad: Can’t Miss Adult Wrist Injuries

By |Jan 8, 2020|Categories: 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 |Jan 8, 2020|Categories: 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. […]