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 [+]
SAEM Clinical Images Series: There’s a Bird Stuck in Your Throat
The patient is a 61-year-old female with a past medical history of hypertension who presents to the Emergency Department for dysphagia. She states that for the past couple of months, she has experienced some discomfort in her chest as well as progressively worsening pain with swallowing. She was initially able to swallow thoroughly macerated solids and liquids, however over the past several days, she has been unable to tolerate either. She states whenever she eats or drinks something, she feels like the food gets [+]
SAEM Clinical Images Series: Tropical Rash
The patient is a 30-year-old female with no past medical history who presents to the Emergency Department with 2 months of non-healing ulcers on multiple parts of her body. She reports getting bitten by flies while traveling in wooded trails from Venezuela through Mexico. She reports the bites started as small scabs that have since enlarged, but they are non-painful or pruritic. She has ulcerative lesions on her left hand, right arm, back, and gluteal areas. She has taken multiple antibiotics from a doctor in Mexico including clindamycin, ceftriaxone, nitrofurantoin, flagyl, [+]
SAEM Clinical Images Series: When in Doubt, Swab It Out
A 26-year-old female with a history of atopic dermatitis presents with one week of rash that began on her lower lip but spread over her face, eyelids, and neck, plus one day of fevers and headache. She was seen at an urgent care and referred to the emergency department for evaluation and management of “impetigo.” On presentation, she endorsed nausea, headache, and mild neck pain. Vitals: Temp 100.7° F; BP 134/85; HR 121; SpO2: 100% General: Uncomfortable appearing. Cardiovascular: Tachycardia Neurological: AOx3. CN II-XII grossly intact. Moves all extremities [+]
ALiEM ACMT Toxicology Visual Pearl: Cookie Monster
What is most likely contained in this edible product that can cause somnolence and vomiting in a child? Lysergic acid diethylamide (LSD) Methamphetamines Psilocybin Tetrahydrocannabinol (THC) [Authors own image] [+]
Chloe Doris, MD
Carolinas Medical Center, Charlotte, NC
Latest posts by Chloe Doris, [+]
ACMT Toxicology Visual Pearl: Danger in the Shallows
In addition to local pain and dermal injury, stings from this marine animal can result in what systemic symptoms? Acute liver injury Hypotension, arrhythmia, and cardiac arrest Nausea, vomiting, and respiratory arrest Numbness, tingling, and muscle paralysis [Image courtesy of Guido Gautsch, Wikimedia Commons] [+]
Samuel Kerans, MD
Carolinas Medical Center
Charlotte, NC