SAEM Clinical Image Series: Inguinal Masses
A 50-year-old female with a past medical history of gastritis and marijuana abuse presents to the Emergency Department (ED) with epigastric abdominal pain for one day. The patient reports she was seen in the ED one month prior for similar symptoms and had an ultrasound of the gallbladder, which was negative. She was discharged home with prescriptions for Pepcid, Carafate, and Zofran. Once discharged home she did not experience any symptoms until the day prior to presenting again to the ED. The patient denies nausea, vomiting, back pain, dysuria, hematuria, subjective fevers, chills, diarrhea, vaginal bleeding, vaginal discharge, chest [+]
Apply now for the ALiEM Faculty Incubator 2021-22 Class: Scholarship and Community
Happy new year! Make one of your new year's resolutions to accelerate your scholarly career in health professions education. The ALiEM Faculty Incubator is opening its doors to the sixth class of 30 educator-scholars. We have been thrilled by the quality of collaboration, growth, and scholarship output from this community ever since our first class in 2016. Led by Dr. Sree Natesan as the Chief Operations Officer and Dr. Antonia Quinn, Associate Chief Operations Officer, we are excited to kick off this new year. We feature an all-star leadership team which includes Dr. Sara Krzyzaniak (Chief Academic Officer), Dr. Michael [+]
SAEM Clinical Image Series: I Have a Stomachache
An 18-year-old male with no significant past medical history presents with diffuse abdominal pain and multiple episodes of non-bloody, non-bilious vomiting for three days. The patient was seen yesterday at another facility and states he was diagnosed with gastritis and discharged with Zofran, which provided no relief. He denies fever, diarrhea, or urinary symptoms and states his last bowel movement was two days ago and was consistent with his usual bowel movements. Vitals: T 97.7ºF; HR 138; BP 122/98; RR 18; O2 sat 99% on RA General: Thin male, appears uncomfortable Abdominal: Mild distention [+]
Improving Your ED Efficiency: Upgrade This Elusive Skill
No specialty in medicine requires “efficiency” more than Emergency Medicine (EM). Being able to seamlessly and quickly move between tasks is a necessary skill to function in the Emergency Department (ED). The controlled chaos and many moving parts can be overwhelming to new learners in the department and takes dedicated time and experience to overcome. Along with learning the necessary medical knowledge, efficiency expertise is crucial to becoming a high-performing emergency physician. Unfortunately, there is minimal formal training on how to maximize efficiency skills, leading many new EM learners (e.g. medical students and junior residents) having to troubleshoot and create [+]
SAEM Clinical Image Series: Vomiting in the Pediatric Patient
A 2-year-old boy with a past medical history of Hirschsprung disease presents to the emergency department (ED) with vomiting, abdominal distension, and inability to tolerate PO for one day. His parents had been instructed by their pediatric surgeon to perform rectal irrigations 2-3 times daily for the few days prior to presentation. Vital signs within normal limits. General: Appears lethargic HEENT: Oral mucosa dry Abdomen: Moderately distended; decreased bowel sounds Skin: Normal turgor Non-contributory The differential diagnosis for pediatric patients presenting with vomiting is broad and includes but is not limited to gastritis, [+]
Teorías de la Educación en la Práctica (Education Theory Made Practical): An International Collaboration
The vast majority of medical education materials (free or with cost) are available in the English language, a consequence of its hegemony as the language of science at a global level. In the world there are about 560 million people who speak Spanish, 460 million are native speakers, so Spanish is the language that has the second largest population of native speakers in the world after Mandarin. Although written English is understood by the Spanish-speaking community of health professionals, the best way to fully understand a text is reading it in the mother tongue! It is therefore important to thank [+]
SplintER Series: My Arm Is Stuck Like This
A 70-year-old female presents with right shoulder pain and the inability to adduct her arm after she fell on the sidewalk. You obtain shoulder x-rays and see the following images (Image 1: AP, scapular Y, and axillary views of the right shoulder. Author’s own images). [+]
William C. Chan, MD
Department of Emergency [+]
SAEM Clinical Image Series: Painful Weeping Rash
A 67-year-old nontoxic appearing male patient with a history of coronary artery disease, hyperlipidemia, transient ischemic attack, gout, renal colic, and squamous cell carcinoma presents with concern for multiple new painful lesions on his body. The rash first appeared five months ago but disappeared for some time before reappearing. It has worsened over the past few weeks. He has pain, erythema, pruritus, and urticarial, blistering, crusted lesions. He has had clear drainage from ruptured blisters. His only recent change in medication is an increase in his allopurinol (initiated four months ago; increased three weeks ago). He has tried Benadryl [+]
Dose Order Matter? Which Antibiotic to Give First for a Bloodstream Infection
Background Early antibiotics are recommended for treatment of many infections, including patients with sepsis or septic shock [1]. Critically-ill patients and those with a suspected infection at risk for severe illness are generally administered two (or more) empiric antibiotics in the emergency department (ED) which cover a wide range of potential pathogens. A typical approach includes utilizing a broad-spectrum antibiotic (frequently a beta-lactam such as cefepime or piperacillin-tazobactam) plus an anti-MRSA agent (typically vancomycin). Early in the patient's hospital stay they may have limited IV access, so the question often arises as to which antibiotic to give first, the broad-spectrum [+]
SplintER Series: My Foot Shouldn’t Look Like This
A 45-year-old male presents with left foot pain and deformity after he inverted his foot while running on uneven pavement. You obtain foot and ankle x-rays and see the following images (Image 1. AP and lateral views of the left foot. Author’s own images). [+]
Jonathan Jong, DO
Department of Emergency Medicine
New York Presbyterian-Queens