SplintER Series: An Easily Missed Shoulder Injury
A 30-year-old male presents with right shoulder pain after a motorcycle accident. You obtain shoulder x-rays and see the following images (Image 1: AP, scapular Y, and axillary views of the right shoulder. Author’s own images). What is the most likely diagnosis, typical mechanism of injury, expected physical exam findings, appropriate imaging modalities, and management plan? [+]
Victor Huang, [+]
SAEM Clinical Image Series: An Oropharyngeal Mass
A fifty-year-old male presented to the emergency department (ED) unconscious with CPR in progress. Per EMS report, the patient was found down surrounded by emesis with no pulse or respirations. Fifteen minutes of CPR was performed prior to arrival in the ED with a King Tube in place. The King Tube was filled with emesis and increasingly difficult to bag. The King Tube was removed to attempt intubation and maximize oxygenation and ventilation. When the Mac 4 blade was placed in the mouth, a large, pink, fleshy, and vascularized structure was seen in the mouth [+]
The Leader’s Library: The Power of Moments | Sign Up for the Book Club
Thus far, 2020 has been a year of catastrophic events, some surprising and others disappointingly predictable, and many people are struggling to navigate the chaos, to grasp at some semblance of a routine in the face of an unpredictable near future. Time has become a blur, a coalescence of unremarkable (yet unprecedented) moments. What if we have the possibility to intentionally create these moments, for ourselves and those around us? What if, by reframing the way we view memory, experience, and time, we could be the powerful author of our own moments? [+]
SplintER Series: A Jammed Finger
A 50-year-old male presents to the emergency department with a new inability to extend his 5th digit of the left hand. He states he was playing a game of pick-up basketball last week when he jammed the finger while attempting to catch a pass from a teammate. An AP and lateral radiograph of the digit is obtained (Image 1 courtesy of Dr Alborz Jahangiri, Radiopaedia.org). What is your diagnosis? What causes this injury? What exam maneuver can help diagnose the underlying injury before the deformity is evident? What is the treatment/management of this injury? What [+]
Unlocking the MIC-KEY: Understanding and Troubleshooting Low-Profile Gastrostomy Tubes
You are working an overnight clinical shift at your community emergency department when a worried mother brings in her 15-year-old child with cerebral palsy due to their gastric tube “coming out.” As you begin to obtain a history of the patient’s gastric tube (when it was placed, where it was placed, why is it in place, etc.) you realize you will be the one replacing it tonight, and frankly you haven’t done this before. The following post serves as a refresher on the use, placement, and complications of gastrostomy tubes. [+]
How I Stay Healthy in EM: Christian Rose
We would be remiss to not acknowledge the unique challenges we as emergency providers have faced over the last few months. Prevention of burnout and active wellness management is more important now than ever. This month on our “How I stay Healthy” series, we’re featuring Dr. Christian Rose, clinical informatics fellow at Stanford University and staff physician at Kaiser Permanente. He shares some guiding principles when facing difficult clinical decisions, his belief in the power of connection, and his favorite noise machine! [+]
SplintER Series: Hip Pain Following an MVC
A 48-year-old female presents to the emergency department after a high-speed motor vehicle collision (MVC). She is complaining of left hip pain. Her radiographs are shown (Image 1 courtesy of Dr Ayaz Hidayatov, Radiopaedia.org, rID: 52760). What is your diagnosis? What is the likely mechanism of injury? What physical exam findings are expected? What is your management in the emergency department and when should you consult orthopedics? [+]
SAEM Clinical Image Series: The Cocaine Gut
A sixty-five-year-old male with a medical history of gastroesophageal reflux disease (GERD), hypertension, alcohol dependence, homelessness, and cocaine abuse presents to the emergency department with abdominal pain for three days. The patient describes his abdominal pain as knife-like, 9/10, located diffusely throughout his abdomen, with associated anorexia and nausea. He reports that he had one episode of coffee ground emesis this morning which provoked him to come to the ED. He reports frequent cocaine use with his last use three days ago. He endorses subjective fevers, chills, and no bowel movement for two days. He [+]
SAEM Clinical Image Series: Severe Cutaneous Lesions in an Immunocompromised Host
A thirty-one-year-old female presented to the emergency department with the complaint of a painful rash for 2 days. She has a history of HIV with a known CD4 count < 200 cells/µL. She states that the rash began two days ago and progressed to the current size. She describes the rash as burning and has never experienced these symptoms before. She has tried topical corticosteroids which did not alleviate the pain. [+]
HOT OFF THE PRESS: Free ALiEM MEdIC Series Book – Volume 5
This is a bittersweet moment for the MEdIC Editorial team – the launch of our 5th and final volume of our Medical Education in Cases ebook. We are very excited to showcase the compilation of our final season and hope that it serves you well as you all look to expand your online learning and teaching resources during this incredible time in medical history. We hope that you, your colleagues, and the greater FOAMed community enjoy this collaborative collection of high-quality cases and curated online commentary centered on educational, ethical, and professionalism-based quandaries. Your support, contributions, and enthusiasm for the [+]