SAEM Clinical Image Series: A Recurring Neck Mass

By |Aug 23, 2021|Categories: HEENT, SAEM Clinical Images|

A 30-year-old female with no significant past medical history presents to the Emergency Department with a six-day history of an enlarging, tender, red “bump” on her anterior neck. She reports similar swelling during bouts of pharyngitis. She also reports a recent upper respiratory infection one week ago that was marked by fever, cough, congestion, sore throat, and myalgia. She denies shortness of breath, neck trauma, travel, or animal exposures. Vitals: T 37°C; BP 122/78; HR 77; RR 17 General: Well-developed, well-nourished female in no acute distress HEENT: 2cm tender, fluctuant, mobile right anterior neck mass with surrounding [+]

INR reduction with FFP – How low can you go?

By |Aug 21, 2021|Categories: EM Pharmacy Pearls, Heme-Oncology|

Background Bleeding patients or those undergoing procedures that are at high risk of bleeding may require correction of their INR. Multiple products can be used to achieve this, including fresh frozen plasma (FFP). FFP contains many substances, including clotting factors, fibrinogen, plasma proteins, electrolytes, and anticoagulant factors. It is sometimes said that the intrinsic INR of FFP is approximately 1.6-1.7 and that it’s not possible to achieve a lower INR. This pearl will further explore these concerns. Evidence What is the INR of FFP? The mean INR of FFP appears to be ~1.1 (0.9-1.3) [1,2]. Reports that the intrinsic INR [+]

  • Talar Neck Fracture

SplintER Series: Pedal to the Metal

By |Aug 18, 2021|Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

A 32-year-old female presents to the emergency department with right ankle pain after a high-speed motor vehicle accident. On exam, she is noted to have ecchymosis and swelling over the distal foot, and pain with ankle dorsiflexion and plantarflexion. An x-ray is obtained as shown above (Image 1. Case courtesy of Dr. Charlie Chia-Tsong Hsu,, rID: 18235).   [+]

ALiEM AIR Series | Endocrine 2021 Module

By |Aug 17, 2021|Categories: ALiEMU, Approved Instructional Resources (AIR series)|Tags: |

Welcome to the AIR Endocrine Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to endocrine emergencies in the Emergency Department. 7 blog posts met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 4 AIR and 3 Honorable Mentions. We recommend programs give 3.5 hours (about 30 minutes per article) of III credit for this module. AIR Stamp of Approval and Honorable Mentions   In an [+]

Unleashing Creativity

By |Aug 13, 2021|Categories: Academic, Creative|

Creativity is at the core of process improvement necessary for the advancement of the medical profession. We need to unleash our creativity to meet the rapidly changing needs of graduate medical education.  Think of that one person in your department who always seems to be coming up with the newest trick for doing a procedure or a creative method of delivering medical education. What if there was a way for you to become that creative person? The good news is that creative thinking can be learned, and with practice, can become a habit to where it comes naturally.   Collect [+]

  • Achilles tendon rupture

SplintER Series: My Foot Doesn’t Work Right

By |Aug 11, 2021|Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

A 35-year-old male felt a painful “pop” in his posterior left lower leg while playing football. Afterward, his “foot didn’t work right anymore.” X-ray of the left ankle and tib/fib was normal but he was unable to ambulate. You plan an ultrasound over the area of maximal tenderness and discover the above image (Image 1.Ultrasound of the left posterior ankle 11cm proximal to the calcaneal insertion of the Achilles tendon.  Case courtesy of Robert Lystrup.) [+]

SAEM Clinical Image Series: Sudden Onset of Facial Petechiae in Kindergartener

By |Aug 9, 2021|Categories: Dermatology, HEENT, Pediatrics, SAEM Clinical Images|

A 6-year-old boy with no past medical history presented when his parents noticed facial petechiae after picking him up from school. He had a series of four recent upper respiratory infections within four months since starting public kindergarten. He occasionally also complains of leg pain.     General: Non-toxic, cooperative child Skin: Petechial rash in periorbital and infra-auricular areas HEENT: Normal; no lymphadenopathy Musculoskeletal: Normal strength and range of motion Hemoglobin: 12.6 g/dL White blood cell (WBC) count: 6.7x103/mL Platelets: 352,000/mL Increased pressure in the dermis from actions such as extended Valsalva maneuver, vomiting, [+]

SplintER Series: Fracture After a Fall From a Bunk Bed

By |Aug 6, 2021|Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

  A 6-year-old male presents to the ED after a fall from his 5 foot high bunk bed causing elbow trauma. On exam, there is significant focal swelling, ecchymosis, and tenderness at the lateral left elbow. The forearm, wrist, hand and shoulder are nontender. He is neurovascularly intact. You  suspect a fracture and obtain x-rays (Figures 1 and 2).   Figure 1: Initial radiographs in the ED with the elbow slightly flexed. Figure 2: AP and lateral radiographs of the elbow.     [+]

  • Felon

SplintER Series: Case of the Swollen Finger

By |Aug 4, 2021|Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

An 18-year-old male presents with a painful and swollen left thumb. He removed a splinter from his finger a few days ago however, 2 days after removal, he began to experience edema and pain that has progressively gotten worse. An image of his finger is shown above (Image 1. Picture courtesy of Rosh Review [1]).   [+]

SAEM Clinical Image Series: Facial Edema

By |Aug 2, 2021|Categories: Endocrine-Metabolic, HEENT, SAEM Clinical Images|

A 44-year-old female presents to the emergency department after noticing swelling of her tongue and face, specifically the cheeks and periorbital area. She states the swelling began two weeks ago and has progressively worsened. She also complains of redness. Vitals: T 38.6°C; BP 135/78; HR 90; RR 18 General: Lying in bed, somewhat anxious appearing HEENT: Significant edema of bilateral cheeks and periorbital areas Thinning of hair along scalp and lateral aspect of eyebrows Mild macroglossia Skin: Yellow tinge to patient’s skin Horizontal scar noted on the anterior aspect of the neck TSH: 31.27 mU/L Free [+]