SAEM Clinical Images Series: Unidentified Intrauterine Object
A 31-year-old female G3P2 presented to the emergency department with vaginal spotting for one week and worsening lower abdominal cramping. She tested positive on a home pregnancy test one day prior to presentation. On the day of presentation, she passed a small blood clot and bled through one pad. She had not yet seen an OB for this pregnancy. Her last menstrual period was one month and three days prior. The current pregnancy is undesired. She denied fevers, chills, urinary symptoms, lightheadedness, palpitations, shortness of breath, nausea, or vomiting. Vitals: BP [+]
SAEM Clinical Images Series: Didn’t See That Coming
A 23-year-old healthy male presented to the emergency department with left eye pain, soreness, and blurry vision after being hit in the left eye with a Nerf gun bullet two days prior. He had no prior ophthalmologic history and does not wear corrective lenses. Left eye: Visual acuity 20/30. Intraocular Pressure 17. Pupil 3mm, irregular, minimally reactive. Slit lamp exam revealing 3+ RBCs, vertical layering of blood along the nasal aspect. None Vertical hyphema Blunt trauma induces shearing forces upon the vasculature of the ciliary body and iris, resulting in [+]
Diagnosis on Sight: “Stabbing Belly Pain”
A 24-year-old male with a history of microscopic hematuria presented to the emergency department (ED) with left lower quadrant abdominal pain. His pain started about two weeks ago and has been intermittent. He describes the pain as stabbing. He decided to come to the ED today because of the persistent nature of the pain. He denies chest pain, cough, shortness of breath, fevers, nausea, vomiting, diarrhea, constipation, rectal bleeding, dysuria, and increased urinary frequency. His exam revealed a well-appearing male in no acute distress. His abdomen was soft with left lower quadrant tenderness on palpation but no rebound or [+]
SAEM Clinical Images Series: Below the Chin, Badness Lies Within
A 50-year-old male with insulin-dependent Type 2 Diabetes presented to the emergency department with three days of pain and swelling on the right side of his neck. He endorsed progression of his symptoms, reporting that he was now having fevers, myalgias, and intermittent difficulty swallowing solid foods. Vitals: BP 153/96; HR 110; T 100.0°F; RR 16; O2 sat 97% General: Appears uncomfortable HEENT: Mild right-sided facial swelling. No trismus. No gingival inflammation or swelling or induration to suggest abscess. There is focal swelling and tenderness to palpation, without overlying erythema, throughout [+]
SAEM Clinical Images Series: Dusky Feet
A 94-year-old female with a past medical history of hypertension, coronary artery disease, chronic venous stasis, and permanent pacemaker placement initially presented to triage complaining of left hip pain in the setting of a fall shortly prior to arrival. Upon further evaluation, she endorsed developing sudden bilateral lower extremity weakness causing her to fall to the floor. She then experienced excruciating pain from her umbilicus down to her groin, hips, and legs (left greater than right), describing it as “being in labor.” She denied any recent fevers, chills, chest pain, shortness of breath, leg swelling, [+]
SAEM Clinical Images Series: What’s Coming Out of Your Eye?
A 32-year-old male with no significant past medical history presented to the emergency department (ED) from an outside hospital for further management of right eye pain and vision loss sustained after he was struck by a metal wire while at work. The patient presented to an outside “eye doctor” and was told to go to the nearest hospital for evaluation. At the outside hospital, he was given analgesia, antiemetics, and a tetanus booster, and transferred to our hospital for ophthalmologic evaluation. On arrival to our emergency department, the patient expressed continued eye pain with bloody [+]
SAEM Clinical Images Series: An Unusual Foreign Body
A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today. Associated symptoms included nausea and a mild headache for one day, and one episode of vomiting prior to arrival. The patient denied abdominal pain, dizziness, fever, chills, diarrhea, and constipation. She had no other complaints on a complete review of systems. Past surgical history was significant for laparoscopic ventral hernia repair [+]
SAEM Clinical Images Series: Pediatric Neck Mass
A 5-year-old female presented to the emergency department (ED) with a one-year history of gradually increasing anterior neck swelling. The patient had no significant past medical history. She also endorsed three weeks of cough and congestion, and one day of muffled voice. She denied difficulty swallowing, fatigue, cold intolerance, or hair and nail changes. Vitals: BP 87/62; Pulse 80; Temp 36°C (96.8°F); Resp 21; SpO2 99% Constitutional: No distress. Able to speak in full sentences HEENT: Normocephalic and atraumatic. Right Ear: External ear normal. Left Ear: External ear normal. Congestion present. Mucous membranes [+]
SAEM Clinical Images Series: An Interesting Case of Ocular Trauma
A 27-year-old male with no past medical history presents to the Emergency Department with right eye pain. He states that approximately one week prior, he was working on a wire fence when he lost hold of a wire under tension, and it subsequently hit him in his right eye. He had immediate pain in his affected eye and was unable to see anything but light for the next three days. His vision slowly improved though it never normalized. He continued to have pain, so he presented for evaluation. He also reported seeing floaters and denied [+]
EM Match Advice 45: 2025 ERAS Updates– What EM Applicants Need to Know
Dr. Sara Krzyzaniak, EM Match Advice Podcast Host and Stanford University PD, discusses key changes in the 2025 ERAS (Electronic Residency Application Service) application that all EM applicants should know about. Take a listen to this short 14-minute, high-yield episode before submitting your application. Podcast 45: Key 2025 ERAS updates Highlights Hometown preferences are now limited to 3 (no longer 5). A new section allows you to explaining any unplanned training extensions and interruptions. A PD-perspective on what to put in the Impactful Experiences section Program signals are now limited to 5 (no longer 7). KEY: Do NOT signal [+]