ACMT Visual Pearl: Necrosis in the Name of Anticoagulation
What anticoagulant medication can cause these skin changes? Apixaban Heparin Rivaroxaban Warfarin [Image courtesy of Herbert Fred, MD and Hendrik van Dijk via Wikimedia Commons] [+]
Natalie M. Rall, MD
Carolinas Medical Center
Latest posts by Natalie M. Rall, MD [+]
ALiEM AIR Series | OBGYN Module (2025)
Welcome to the AIR OBGYN Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to related to OBGYN emergencies in the Emergency Department. 3 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 1 AIR and 2 Honorable Mentions. We recommend programs give 1.5 hours of III credit for this module. AIR Stamp of Approval and Honorable [+]
SAEM Clinical Images Series: Tangled in the Toilet
An otherwise healthy 46-year-old male presented to the Emergency Department with 18 months of diarrhea and intermittent abdominal cramping that has acutely worsened in the past week. On the morning of presentation, he noticed a worm-like object in his stool, which he brought to the ED (See images), prompting his visit. Throughout these 18 months, he experienced 4-10 loose bowel movements per day. He tried dietary modifications, including the removal of dairy, gluten, and soy, all without relief. The patient frequently travels [+]
The Most Dangerous 10 Minutes of Your Shift: Mastering the ED Hand-Off
Handoffs are everywhere, from shift changes to trauma transfers. Each one is a chance for error. A standardized, structured sign-out protects patients, supports teamwork, and makes you a safer, more effective emergency physician. Why Sign-Outs Matter In emergency medicine, handoffs are constant and high-risk. Nearly a third of healthcare workers report an adverse event tied to a poor handoff. When communication falters, patients suffer: delayed results, missed diagnoses, duplicated work, or forgotten tasks. The stakes are higher in the ED, where the pace is quick, interruptions are constant, and boarding patients stretch the system thin. But there is good [+]
SAEM Clinical Images Series: A Case of Sudden Right Arm Pain and Deformity
A 73-year-old male presented to the Emergency Department with acute pain in his upper right arm. The pain began suddenly upon attempting to lift a 30-lb box that had been delivered to his house. He stated that as he began to lift the box, he felt a sudden pop coupled with the acute onset of pain. Since the injury, he had difficulty with flexion of his right upper extremity. He denied any other complaints. [+]
SAEM Clinical Images Series: First a Splash and then a Rash
The patient is a 25-year-old female with no significant past medical history who presents to the Emergency Department with a pruritic rash. She reported three days of progressive pruritus with an associated diffuse rash extending from the lower extremities to the proximal upper extremities with involvement of the chest and back. She denies fevers, chills, difficulty breathing, nausea, vomiting, or history of similar rash. She has no history of dermatologic or immunologic conditions. She has had no new exposures [+]
SAEM Clinical Images Series: Tongue Twisters
The patient is a 68-year-old male with a past medical history of hypertension who presents to the Emergency Department for evaluation of tongue swelling. The patient reports that his left tongue was swollen 3 weeks ago. He was evaluated, prescribed Levaquin, and was advised to gargle peroxide/salt water per his primary care provider. The swelling resolved after approximately 2 days. This morning, he awoke at 2 AM with swelling in the right side of his tongue. He denies any allergies or prior intubations. He denies any new foods, exposures, any other complaints at this time. [+]
Opportunities for Naltrexone: AUD and the Emergency Department
Take-Home Point: Naltrexone is a safe and effective medication for patients with alcohol use disorder that can improve morbidity by decreasing alcohol intake, and most importantly, can be initiated in the emergency department (ED). The Problem: Alcohol Use Disorder in the Emergency Department Alcohol use and its varied consequences, from trauma to withdrawal, are frequently encountered in the ED. Despite being ubiquitous in the ED, alcohol use disorder (AUD) often goes under-recognized and undertreated in the ED. The numbers are staggering-- approximately 29 million individuals across the country and 400 million across the globe meet criteria for AUD [1]. [+]
EM Match Advice 49: 5 Keys to Crush Your EM Residency Interview
It’s fall, which means goofy costumes, crisp apples, pumpkin spice latte, and the official start of the Residency Recruitment Season! Programs are furiously reviewing your applications right now, and this is a perfect time for you to start thinking about interviews. In this episode, Dr. Sara Krzyzaniak (Stanford University EM Program Director) provides insider tips on 5 things that you can do now to be prepared to crush your interviews! 1. Consider Your Strategy Do your homework and review programs’ social media and websites. Prioritize your program list. You will likely have more interview offers than you can accept, [+]
SAEM Clinical Images Series: Tuning In
The patient is an 85-year-old male with a history of anxiety/depression, hypertension, hyperlipidemia, and hearing loss who presents to the Emergency Department after having transient painful swallowing. He states he took several of his pills at once in one swallow this morning as prescribed, then shortly afterwards felt a sharp discomfort moving down his esophageal region. The pain seemed to migrate down to his stomach, then his pain resolved. He has since been pain free and is tolerating his secretions well, but he has not eaten or [+]