• posterior malleolar fracture

SplintER Series: The Hidden Post

By |Nov 30, 2022|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).   [+]

  • EM Match Advice questions

EM Match Advice Podcast: Mid-Interview Season Check-In | We want to hear from you

By |Nov 29, 2022|Categories: EM Match Advice|

We are at the mid-point of the academic year and smack in the middle of residency interview season for EM-bound medical students. Look at how far you've come since your first interview! As you stare down the finish line of the interview season, the questions you now have are likely different than those in September. We are just checking in with you and want to hear from YOU. This is the first time we are hosting a Q&A episode. What questions do you have about the EM residency match process? Dr. Sara Krzyzaniak (EM Match Advice host and Stanford [+]

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

By |Nov 28, 2022|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. [+]

How I Educate Series: Jessie Werner, MD

By |Nov 23, 2022|Categories: How I Educate, Medical Education, Uncategorized|

  This week’s How I Educate post features Dr. Jessie Werner, the Clerkship Director and Medical Education Fellowship Director at UCSF Fresno. Dr. Werner spends all of her shifts with learners which include emergency medicine residents, off-service residents, medical students, physician assistants, nurse practitioners, and fellows. She describes her practice environment as a busy (120,000 patients/year) ED in the central valley healthcare desert. Below she shares with us her approach to teaching learners on shift.  Name 3 words that describe a teaching shift with you. Educational, hands-on, and accessible.  What delivery methods do use when teaching on shift? I'm [+]

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

By |Nov 21, 2022|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 |Nov 11, 2022|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 |Nov 9, 2022|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 |Nov 7, 2022|Categories: Dermatology, Pediatrics, SAEM Clinical Images, Uncategorized|

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 |Nov 2, 2022|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). [+]

How I Educate Series: Stephanie Lareau, MD

By |Oct 26, 2022|Categories: How I Educate, Medical Education|

This week’s How I Educate post features Dr. Stephanie Lareau, the Wilderness Medicine Fellowship Director and Medical Director of Emergency Services at Virginia Tech Carilion Clinic. Dr. Lareau spends approximately 50% of her shifts with learners which include emergency medicine residents, off-service residents, and medical students. Her practice environment is split between an academic and community hospital. She spends 25% of her time at the academic level 1 trauma center that is home to an EM residency and medical school. The other 75% of her clinical shifts are at a 12-bed community ED which also has both resident and [+]