SAEM Clinical Images Series: A Pedunculated Bone to Pick
The patient is a 46-year-old male with a past medical history of chronic left knee pain, hypertension, and congestive heart failure who presents to the Emergency Department with worsening left knee pain. He had been walking more frequently of late to increase his exercise, but denies any falls or specific trauma. He noticed some swelling to the area over the past few days but there has been no redness, rash, or fever. He also denies calf pain, lower leg swelling, and shortness of breath. He [+]
SAEM Clinical Images Series: Wake-up Call
The patient is a 53-year-old anuric female with a history of kidney/liver transplant, ESRD on hemodialysis, diabetes mellitus, and atrial fibrillation with recent failed cardioversion who presents to the Emergency Department with one week of worsening generalized weakness. She reports dyspnea on exertion which improves with rest, generalized abdominal pain, and mild vomiting. Her medications include escitalopram 20 mg daily, flecainide 100 mg twice daily, magnesium oxide 400 mg daily, metoprolol 50 mg 3 times daily, pregabalin 50 mg daily, risperidone 0.5 mg twice daily, [+]
SAEM Clinical Images Series: Can I Snooze on This Bruise?
The patient is a 21-month-old male with no medical problems who is brought into the Emergency Department with concerns for bruising of the lower extremities and swelling of feet. His parents noticed the patient was walking differently 4 days ago and then noted bruising and edema of his feet bilaterally. They state there has been no known injury or trauma, and at least one of the parents has been with the child at all times. The bruising has spread and darkened to become widespread on both legs and today they noticed [+]
SAEM Clinical Images Series: An Expanding Painful Neck Mass
The patient is a 20-year-old male who presents to the Emergency Department complaining of painful and rapidly worsening swelling in the anterior neck over the last three days. The patient reports that he had a similar episode in the past for which he was prescribed antibiotics and underwent a needle aspiration procedure at the base of his mouth, which led to resolution of his symptoms. The patient reports subjective chills, change in voice, sore throat, and painful swallowing. He is able to tolerate oral secretions and denies difficulty [+]
Procedural Use of a Mini C-arm in the Emergency Department
C-arms are mobile, C-shaped X-ray units that allow dynamic imaging for a wide range of procedures in outpatient clinics, procedure suites, operating rooms, and even emergency departments. Their uses include: fracture reduction and fixation, hardware placement, joint injections, and other image-guided interventional procedures. They are available in a variety of sizes including a mini C-arm that is specifically designed for imaging smaller body parts such as the hands and wrists. Mini C-arms in emergency departments (ED) are not commonplace but when available they are often in trauma centers and most commonly utilized by orthopedic surgeons. Literature on the use [+]
Gamechanger: Do we really need a lumbar puncture for all febrile infants 0-28 days old?
A new international pooled analysis challenges the age-old dogma that all febrile infants 0-28 days require a lumbar puncture (LP). Can the PECARN febrile infant prediction rule safely identify a low-risk subset for invasive bacterial illnesses (bacterial meningitis and bacteremia) [1]?Bottom LineFor more than four decades, the standard of care for febrile infants in the first month of life has been aggressive: full sepsis workup (including an LP), admission, and IV antibiotics. A new study in JAMA suggests this paradigm may be shifting [2, 3].In an international pooled analysis of more than 1,500 febrile infants aged ≤28 days, the updated [+]
SAEM Clinical Images Series: I Cannot Control My Right Side
The patient is a 47-year-old female whose past medical history includes ESRD on dialysis, type 1 diabetes, and hypertension, who presents to the Emergency Department for uncontrollable right-sided movements of her body. The patient states these symptoms have been present for several weeks and have progressively worsened over the past week. She reports difficulty with ambulation secondary to these involuntary movements of the right side of her body. She denies any missed dialysis sessions. She denies fever, headaches, sensory problems, or any [+]
SAEM Clinical Images Series: Ocular Trauma Following Ground Level Fall
The patient is an 82-year-old female who presents to the Emergency Department after an unwitnessed fall from standing approximately 2 hours prior to arrival. The patient states that she thinks she lost her balance and fell, striking her face. She denies loss of consciousness or any antecedent dizziness or presyncopal symptoms, but has limited recollection of the event. At presentation, she reports pain to the left side of the face, a laceration to the left side of her face, and decreased vision in her left eye. She has [+]
SAEM Clinical Images Series: No, I Am Not Diabetic!
The patient is a 72-year-old male with a history of CAD, hypertension, and BPH who presents to the Emergency Department for sinus congestion and right-sided facial pain. The patient reports progressively worsening darkening crusting around his nose for 3 weeks. He has also had a right-sided temporal and retrobulbar headache, blurry vision in right eye, diminished sense of smell, and right sided numbness to the roof of his mouth for the past week. He was prescribed amoxicillin and nasal steroid spray four [+]
SAEM Clinical Images Series: Snorkeling Gone Wrong!
The patient is a 30-year-old female who presents to the Emergency Department with severe left foot pain after snorkeling in shallow water off the coast of Phuket, Thailand. She reports a sudden onset of pain as she was kicking her legs while swimming. She describes the pain as burning in nature across the top of her foot, which worsens with weight bearing, though she can bear weight. She also complaints of multiple discolorations on the dorsum [+]