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
ALiEM AIR Series | OB/Gyn 2021 Module
Welcome to the AIR OB/Gyn Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to OB/Gyn emergencies in the Emergency Department. 8 blog posts met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 6 Honorable Mentions. We recommend programs give 4 hours (about 30 minutes per article) of III credit for this module. AIR Stamp of Approval and Honorable Mentions In an effort to truly emphasize [+]
SplintER Series: I Declare a Thumb War
A 39-year-old female presents to the emergency department with right thumb pain after falling in a skiing accident. On exam, there is mild swelling and tenderness on the ulnar aspect of the 1st MCP joint. Additionally, there is laxity with valgus stressing of the 1st MCP joint. An x-ray is obtained and shown above (Image 1. Provided by Alex Tomesch, MD). [+]
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IDEA Series: Acute Venous Thromboembolism (VTE) Escape Room
Adult learning theory supports medical educators in moving away from long lectures with minimal engagement from the learners [1]. Core emergency medicine (EM) topics lend themselves well to interactive methods such as gamification [2]. Puzzle-based activities can successfully facilitate team building in medical education [3]. EM residents commonly encounter acute venous thromboembolism (VTE) in the ED and must know the spectrum of presentations and approach to evaluation and treatment, including the use of risk stratification calculators. The Innovation To improve teaching of acute VTE to EM residents, we created a puzzle-based activity called “Acute VTE Escape Room.” Two teams competed [+]
SAEM Clinical Image Series: Chronic Back Pain
A 52-year-old male with a past medical history of prostate cancer status post radiation therapy 10 years prior presents to the emergency department (ED) with the chief complaint of low back pain worsening over the past year. He characterizes the pain as a “dull, aching stiffness” associated with decreased motility. Vitals: BP 128/82; HR 72; RR 18; T 37°C General: Alert and oriented MSK: Decreased range of motion of the lumbar spine with flexion; Heberden’s and Bouchard’s nodes on multiple fingers Neurologic: Within normal limits with no focal motor or sensory deficits appreciated; deep tendon reflexes [+]