SAEM Clinical Image Series: Strange Eyes
A 3-month-old boy, born full-term via normal spontaneous vaginal delivery to a gravida 2 para 1 mom with negative prenatal labs, presents with abnormal eye movement and position. His parents report 2 days of an increase in bulging of the soft spot, head size, and abnormal eye movement. He has not been able to look at his mother “like he used to.” This is associated with an increase in fussiness, poor feeding, and non-bilious, non-bloody vomiting. He also had increased sleepiness and difficulty waking up for feedings overnight. The patient has normal urination with no [+]
SAEM Clinical Image Series: An Incidental Finding
A middle-aged man presented after a motor vehicle collision with a logging truck at 55 miles per hour with low back pain. A computed tomography scan (CT) of the abdomen and pelvis at an outside facility showed a burst fracture of the third lumbar vertebra (L3). The patient had no other complaints. Given the fracture, additional CT imaging was done and the above finding was discovered. After the incidental finding was found, the patient reported a nail gun accident three years prior where he thought it had just recoiled and struck him in the lip [+]
Ultrasound for the Win! 18M with Acute Shoulder Injury #US4TW
Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series, where bedside ultrasound changed the management or aided in a diagnosis. In this case, an 18-year-old man presents with acute shoulder pain after an injury. Learning Objectives List the differential diagnosis for a patient presenting with shoulder pain.Discuss the role of the shoulder point-of-care ultrasound (POCUS) and how to correctly perform the scan using a posterior approach. Discuss the prevalence, diagnostic approach, sonographic findings, ED management, and disposition of a shoulder subluxation.Discuss recent literature regarding shoulder POCUS and its utility and value in the ED, particularly [+]
ACMT Toxicology Visual Pearls: Case of a Toxic Tea
The plant pictured is used as a tea, powder, or capsule by individuals looking to self-treat pain or opioid use disorder. Patients may develop nausea, vomiting, hallucinations, or other serious clinical effects after ingestion. What compound is contained in this plant? Arecoline from Areca catechu Kava lactone from Piper methysticum Mitragynine from Mitragyna speciosa Salvinorin from Salvia divinorum Answer 3 – Mitragynine from Mitragyna speciosa also known as Kratom What is Kratom? [1-6] Kratom is an herbal product that derives from the tree Mitragyna speciosa, native to Southeast Asia, where it has been historically used as a stimulant. [+]
Education Theory Made Practical (Volume 3): An ALiEM Faculty Incubator eBook Project
The ALiEM Team is delighted to announce another eBook publication: the third volume in the Education Theory Made Practical series. This book was a labor of love written by the 2018-19 Faculty Incubator class. We are very proud of all our Faculty Incubator alumni who made this happen. Their hard work has been compiled in this FREE, peer-reviewed eBook. We sincerely feel that it will be useful for all the educators out there, wrestling with the issue of integrating theory into practice. Special shout-out to the incredible Dr. David Sklar (former Editor-in-Chief of Academic Medicine) for providing us a thought-provoking foreword. [+]
SplintER Series: Punched a Wall
A 27-year-old male presents to the ED with left hand pain after punching a wall. He has pain and swelling on the ulnar side of the dorsal hand. The above hand radiographs were obtained (image courtesy of Mark Hopkins). This patient has a fracture of the 5th metacarpal neck, otherwise known as a Boxer’s fracture. It is so named because a majority of these fractures come from punching an object [1]. Pearl: Unlike most hand and wrist fractures, metacarpal fractures are more likely to occur from axial loading than from a fall onto an outstretched hand (FOOSH) [1]. [+]
SAEM Clinical Image Series: Eye Injury
An 11-year-old male presented to a pediatric trauma center following a motor vehicle collision (MVC). He was the restrained front-seat passenger when his vehicle was struck head-on, causing frontal airbag deployment. His primary complaint was pain around his right eye with associated blurry vision. He denied diplopia, pain with extraocular movements, flashers, floaters, or curtains in his vision. [+]
How I Stay Healthy in EM: Keith Henry
Image 1: Prepping for a shift! This month on our “How I stay Healthy” series, we’re featuring Dr. Keith Henry, director of medical student education at Regions Hospital in St. Paul, Minnesota. Dr. Henry tells us about his pre-shift rituals, his on-shift prioritization schema, and his new favorite exercise tool! [+]
SplintER Series: Pain in the Snuff Box
A 16-year-old male presents to the ED after injuring his wrist during a track meet. The patient was running hurdles when he fell forward, planting his wrist into the ground. The imaging is shown below (courtesy of Dr. Hani Makky ALSALAM, Radiopaedia.org). Scaphoid fracture (Image 2). Pearl: The scaphoid is the most frequently fractured carpal bone [1,2]. Pearl: Fractures occur at the waist, proximal third, and distal portion: 65%, 25%, and 10% respectively [3]. Image 2. Fracture of scaphoid. Case courtesy of Dr. Hani Makky ALSALAM, Radiopaedia.org, rID: 10398 (arrow added by authors). Occurs when [+]
IDEA Series: Virtual “Faux-tation” Rotation for 4th Year Medical Students Interested in Emergency Medicine
Visiting clerkships have traditionally offered the opportunity for extended contact among medical student applicants and residency program representatives, allowing for enhanced assessment of mutual compatibility. Accordingly, visiting clerkships are consistently rated as an essential consideration among residency program leadership when reviewing applications, and among medical students, as they determine “fit” [1,2]. The COVID-19 pandemic has resulted in institutional restrictions on visiting clerkships. Despite the now limited opportunities for medical students to see residency programs of interest in-person, demand for these experiences remains high. Opportunities that allow for increased interaction among medical student applicants and residency programs that maintain compliance with [+]