SmilER 104: Pericoronitis and Dry Socket
This fourth and final installment in the SmilER series covers the diagnosis and management of 2 common dental conditions that present to the emergency department: pericoronitis and dry socket. Author: Richard Ngo, DMD Editors: Cameron Lee, DMD, MD; Andrew Eyre, MD, MS-HPEd Series Editor: Chris Nash, MD How well did you learn the material? Go to ALiEMU to take the multiple-choice quizzes to receive your badges and certificates. Learning Objectives Understand diagnostic criteria of pericoronitis and alveolar osteitis (dry socket). Understand treatment modalities for patients with pericoronitis and alveolar [+]
SAEM Clinical Image Series: Silver Scales
A 6-year-old otherwise healthy female presented to the emergency department (ED) with a rash across all four extremities. She has had seven months of pruritic, expanding lesions starting on her shins, now beginning to expand on her forearms. No history of allergies or irritant exposure. Due to Covid-19, she has been unable to see a provider before today’s ED visit. Vitals: T 98.3°F; BP 96/72; HR 92; RR 24; O2 sat 100% Skin: Numerous patchy red lesions scattered across bilateral upper and lower extremities with silver plaque accumulation. No nailbed involvement. No mucous membrane [+]
SmilER 103: Odontogenic Infections
This third module for the SmilER series covers the diagnosis and management of odontogenic infections seen in the emergency department (ED). What anatomical structures should be avoided? When is imaging necessary? What is the discharge plan? Author: Richard Ngo, DMD Editors: Cameron Lee, DMD, MD; Andrew Eyre, MD, MS-HPEd Series Editor: Chris Nash, MD How well did you learn the material? Go to ALiEMU to take the multiple-choice quizzes to receive your badges and certificates. Learning Objectives Understand the major classifications and diagnostic criteria of odontogenic infections. Understand the [+]
ED Management of Cannabinoid Hyperemesis Syndrome: Breaking the Cycle
What is cannabinoid hyperemesis syndrome? Cannabinoid hyperemesis syndrome (CHS) is a condition in which patients who have been using cannabis or synthetic cannabinoids for a prolonged period of time develop a pattern of episodic, severe vomiting (usually accompanied by abdominal pain) interspersed with prolonged asymptomatic periods. When should you consider cannabinoid hyperemesis syndrome as a diagnosis? The diagnostic criteria for CHS require evidence of relief of symptoms with sustained cessation from cannabis, which makes them of limited utility in the Emergency Department (ED) [1]. However, a number of ED-based diagnostic criteria have been proposed with overlapping features [1,2]. There are [+]
ALiEM AIR Series | Vascular 2021 Module
Welcome to the AIR Vascular 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 vascular emergencies in the Emergency Department. 9 blog posts met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 3 AIR and 6 Honorable Mentions. We recommend programs give 4.5 hours (about 30 minutes per article) of III credit for this module. AIR Stamp of Approval and Honorable Mentions In an effort to truly [+]
SmilER 102: Dental Trauma
This second module for the SmilER series covers the management of common dental trauma cases seen in the emergency department (ED). What should you do with the various types of dental fractures and avulsions, how do you manage them in the ED, and what sort of follow-up should the patient receive? Author: Richard Ngo, DMD Editors: Cameron Lee, DMD, MD; Andrew Eyre, MD, MS-HPEd Series Editor: Chris Nash, MD How well did you learn the material? Go to ALiEMU to take the multiple-choice quizzes to receive your badges and certificates. [+]
SAEM Clinical Image Series: Traumatic Swollen Eye
A 53-year-old caucasian male with a history of alcohol and amphetamine abuse presents to the Emergency Department via ambulance immediately after sustaining a fist-blow injury to the right eye. The patient denies loss of consciousness and complains of eye pain with the inability to see. Vitals: T 36.9°C; BP 181/119; HR 110 General: Alert and oriented; anxious; agitated Ophthalmic: OD: Visual acuity – no light perception Pupil 4mm, irregular shape, and fixed Extraocular movement – none Proptotic; Conjunctival prolapse; Subconjunctival hemorrhage Anterior chamber hyphema IOP 55 mmHg OS: Visual acuity – 20/20 Pupil 3mm [+]
Pre-Arrest Acidemia and the Effect of Sodium Bicarbonate on ROSC
Background Sodium bicarbonate during a cardiac arrest is widely debated and used in many cases. In a 2018 PULMCrit post, Dr. Josh Farkas reviews much of the data and concludes that use of sodium bicarbonate is a “source of eternal disagreement.” A 2013 EMCrit article and podcast by Dr. Scott Weingart also details some of the controversy. The 2020 ACLS Guidelines state that routine use of sodium bicarbonate is not recommended in cardiac arrest [1]. Despite this recommendation, sodium bicarbonate is still often administered during resuscitations if a metabolic (or respiratory) acidosis is suspected or after a prolonged downtime. A [+]
SmilER 101: Oral Exam and Regional Anesthesia in Dental Care
The purpose of the SmilER series on dental trauma and infection management is to teach fundamental principles, pearls, and pitfalls in the care for dental patients in the emergency department. As many as 1.5% of ED visits are dental-related¹ and many emergency physicians have expressed the need for more comprehensive training in the oral cavity. This series was created as an introductory guide on the management of patients who report to the ED with dental-related conditions. The first module teaches the oral examination and demonstrates how to provide anesthesia in the oral cavity. Author: Richard Ngo, DMD [+]
SAEM Clinical Image Series: Pediatric Penis Swelling
A 3-year-old healthy uncircumcised male presents to the Emergency Department with five days of penis swelling and pain. Five days prior, his father noted that the patient’s foreskin appeared stuck behind the head of the penis. The patient was seen at an urgent care facility four days prior and was given an antifungal cream for presumed balanitis, however, this did not resolve the patient’s symptoms. Since that time, the penis has been getting progressively more swollen and painful. The patient has not experienced the inability to urinate, decreased urine output, penile discharge, other penile lesions, fever, chills, [+]