SmilER 102: Dental Trauma

By |Sep 22, 2021|Categories: ALiEMU, Dental, SmilER|

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

By |Sep 20, 2021|Categories: Ophthalmology, SAEM Clinical Images|

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

By |Sep 18, 2021|Categories: Cardiovascular, Critical Care/ Resus, EM Pharmacy Pearls|

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

By |Sep 15, 2021|Categories: ALiEMU, Dental, SmilER|

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

By |Sep 13, 2021|Categories: Genitourinary, Pediatrics, SAEM Clinical Images|

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, [+]

The 1440 Doctor: Working From Home (WFH) | 3 Strategies for Being Productive

By |Sep 8, 2021|Categories: 1440 Doctor|

Physicians have practiced medicine in a variety of practice settings in the past. Some in rural environments, others in austere conditions on a mountain top in Nepal. The recent pandemic has created even a new practice environment in the field of medicine: our own homes. The idea of working from home (WFH) is not a new concept. It’s been gaining momentum for several decades in other fields but healthcare has been slow to embrace this trend. COVID19 changed that. There are many benefits of this new practice environment (basically a 0-minute commute, being able to see family/furry friends during the [+]

EMRad: Can’t Miss Adult Traumatic Hip and Pelvis Injuries

By |Sep 3, 2021|Categories: Orthopedic, Radiology, SplintER, Trauma|

  Have you ever been working a shift at 3 AM and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify injuries that ideally should not be missed. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your [+]

EMRad: Radiologic Approach to the Traumatic Hip/Pelvis

By |Sep 1, 2021|Categories: EMRad, Orthopedic, Radiology, Trauma|

This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department [1]. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. Next up: the hip. [+]

SAEM Clinical Image Series: Pulseless and Painful Blue Leg

By |Aug 30, 2021|Categories: Cardiovascular, COVID19, SAEM Clinical Images, Ultrasound|

A 57-year-old male who works as a truck driver with a history of hypertension, type 2 diabetes, and recent COVID-19 infection presents with right lower extremity pain for two hours. He reports experiencing one day of dull aching of the right leg, then being suddenly awakened with the abrupt onset of severe right leg pain and shortness of breath. He denies chest pain. EMS reports a pulseless and painful blue leg en route. The patient denies any history of trauma, irregular heartbeat, or anticoagulation.     Vitals: T 97.5°F; BP 120/78; HR 102; RR 20; oxygen [+]

  • Preexcited Rapid Atrial Fibrillation

Diagnosis on Sight: “I have a rapid heart rate”

By |Aug 25, 2021|Categories: Cardiovascular, Diagnose on Sight, ECG|

A 31-year-old male presented to the emergency department with palpitations. The patient stated that he thinks his symptoms began "last night" and felt like he had “a rapid heart rate.” He said that prior to last night he felt fine. He did admit to drinking alcohol with his friends 2 nights prior. The patient estimated that he "must have drunk about 30 beers." On review of systems, he reported feeling anxious. He denied illicit drug use, headache, chest pain, cough, shortness of breath, fevers, nausea, vomiting, abdominal pain, dysuria, or increased urinary frequency. He reported that he was unaware of [+]