SAEM Clinical Images Series: Man with a Recurrent Rash
A 33-year-old male presented to the emergency department with a diffuse pruritic rash that appeared several days after starting Trimethoprim/Sulfamethoxazole (TMP-SMX) for a dental infection. Initially beginning on the torso and low back, the rash spread to the palms, soles, and genitalia. Progression stopped after discontinuing TMP-SMX. He conveyed a remote history of a similar rash following use of an unknown medication, and noted that several of the current lesions arose at the same location as previous. Skin: Widely distributed violaceous, non-blanching patches with a dusky center. Lesions ranged from 3 [+]
ACMT Toxicology Visual Pearl: Making Rash Decisions
Which of the following best describes the pictured rash occurring 4 weeks after starting minocycline? Anaphylaxis Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Erythema multiforme Serum sickness Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) [+]
Destiny D. Folk, MD
Carolinas Medical Center
SAEM Clinical Images Series: Wolf in Sheep’s Clothing
A 55-year-old female with a history of hyperlipidemia presents after a syncopal episode. She had mild nausea and diarrhea on the morning of presentation but otherwise had no prodromal symptoms before suddenly losing consciousness in a grocery store. Of note, she recalls a similar syncopal episode in the remote past, also preceded by gastrointestinal symptoms at that time. At present, she is symptom-free. Vitals: BP 135/71; HR 52; Temp 98°F; RR 18; SpO2 100% on room air General: Tired appearing CV: 2+ peripheral pulses. Regular rate and rhythm, no murmurs, rubs, or [+]
ALiEM AIR Series | Trauma 2023 Module
Welcome to the AIR Trauma Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to related to trauma in the Emergency Department. 8 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 3 AIR and 5 Honorable Mentions. We recommend programs give 4 hours of III credit for this module. AIR Stamp of Approval and Honorable Mentions [+]
ACMT Toxicology Visual Pearl: Who Doesn’t Like a Nice Rosé?
What clinical presentation and medication is associated with this urinary discoloration? Critical illness requiring intubation and propofol sedation Cyanide toxicity requiring sodium thiosulfate Iron toxicity treated with deferoxamine Refractory vasoplegic shock treated with methylene blue Septic shock treated with vancomycin and cefepime [+]
Allison Frazure, MD
Carolinas Medical Center
Coaching for Faculty: The Secret to Unlocking Professional Success
Dr. Garcia is a freshly minted faculty member at Big Name University Medical Center. She's excited to have finally finished residency and dive into her career as a full time (and fully paid) attending. After spending her first year acclimating to the new department and achieving board certification, Dr. Garcia finds herself at a bit of a crossroad. She likes teaching, but are not sure residency or medical student education leadership is for her. The same goes for clinical operations and research – interesting, but there hasn’t been any “a ha” moment to illuminate her calling. She heard that [+]
SAEM Clinical Images Series: Intracranial Abnormality
A 26-year-old male with no significant past medical history presented to the ED after slipping on wet pavement and hitting his head on the ground three hours prior. He endorsed a constant, achy 7/10 headache accompanied by nausea and photophobia. He denied vomiting, dizziness, diplopia, loss of consciousness, or seizures. Nothing made it better or worse. Vitals: BP 101/63; HR 76; RR 14; T 36.7°C General: Alert and oriented, no acute distress HEENT: Normocephalic, atraumatic, tenderness elicited over right occipital bone, PERRLA, + photophobia Neurologic: WNL with no focal motor or [+]
IDEA Series: Specialised Lectures in Emergency Medicine (SLEM) – A virtual conference to strengthen EM education in the developing world
The Problem: Emergency Medicine (EM) in Pakistan has moved from developing to developed stage in the last decade [1]. As the specialty evolves in Pakistan and other countries, there is a need to improve and assimilate novel learning methods to elevate education standards. The COVID-19 pandemic catalyzed the routine use of video-conference platforms such as Zoom. Virtual educational programming offers the opportunity to leverage educational resources across space and time, foster collaborations, and improve knowledge, clinical and evidence-based practice globally. The Innovation Specialised Lectures in Emergency Medicine (SLEM) is a virtual program for learning, collaboration and social engagement. The [+]
SAEM Clinical Images Series: Dangerous Eye Drainage
A 32-year-old man with a history of traumatic globe rupture from a stab wound two months ago, status post repair, presented to the emergency department for worsening right eye pain and green malodorous drainage for the past three days. These symptoms started when he got a fleck of sawdust in the right eye about four days prior to presentation, which he was able to brush out with his finger. He described the pain as severe, throbbing, constant, and non-radiating. He had been unable to open the right eyelid for three days, both due to pain [+]
SAEM Clinical Images Series: A Case of Painful Skin Lesions
A 50-year-old Caucasian female with a history of hypertension, coronary artery disease, and insulin-dependent diabetes mellitus presents to the emergency department with a complaint of painful sores on the top of her left foot. She notes that ulcerations have formed over the past two weeks and reports a history of multiple recurrent usually non-tender skin lesions to her lower extremities, forearms, and hands over the past twenty years. She is homeless and medically non-compliant secondary to financial issues. Vitals: T 37.2°C; BP 149/77; HR 94; RR 20 Skin: Multiple yellow-brown and violaceous [+]