SAEM Clinical Images Series: Finger Pain
A 57-year-old male presents after accidentally firing his son’s expired epinephrine autoinjector containing 0.3 mg of epinephrine into his left thumb two hours prior to arrival. He endorses mild pain and numbness at the tip of his thumb. The patient had spoken to poison control who had instructed him to present to the Emergency Department if his symptoms did not improve after two hours. He denied any palpitations or other systemic symptoms. Vitals: HR 81; BP 128/81; RR 18; SpO2 99% Extremities: Pallor noted at the distal tip of his left [+]
IDEA Series: LUDO game to teach residents about urogenital diseases
The Problem: Urogenital diseases are commonly encountered in the emergency department [1]. Both the WHO and CDC recommend early identification and timely management of such diseases, to prevent morbidity and mortality [2, 3]. Additionally, the sensitive nature of this topic as well as cultural factors can limit the exposure and bedside teaching by emergency physicians (EPs). Novel learning methods are needed to prepare EPs to manage urogenital diseases effectively and efficiently. The Innovation The Learning Urogenital Diseases in Oddity (LUDO) gamification-based, timed activity teaches and assesses clinical practice essentials in the management of urogenital diseases among emergency medicine (EM) [+]
How I Educate Series: Michael Galuska, MD
This week’s How I Educate post features Dr. Michael Galuska, the Program Director at Conemaugh Memorial Medical Center. Dr. Galuska spends all of his shifts with learners which include emergency medicine residents and medical students. He describes his practice environment as a rural community-based residency program. Below he shares with us his approach to teaching learners on shift. Name 3 words that describe a teaching shift with you. Sarcasm, Autonomy, and Coffee. What is one thing (if nothing else) that you hope to instill in those you teach? How learning truly is a lifelong skill that you should continue [+]
SplintER Series: The Hidden Post
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 Podcast: Mid-Interview Season Check-In | We want to hear from you
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
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
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
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
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 [+]
SplintER: Pop, Lock & Drop It
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). [+]
