SplintER Series: Delayed pain in an injured knee
Image 1. Case courtesy of Radswiki, Radiopaedia.org A 26 year-old male presents with new medial right knee pain after twisting his knee playing soccer 3 weeks ago. His initial pain has since resolved. What is your diagnosis? What examination findings should you expect? What associated diagnoses should you assess for? What is your management in the emergency department? [+]
Diagnose on Sight: Post-traumatic Finger Pain
Case: A 32-year-old male with a past medical history of diabetes presents with a 1 month history of finger pain after slamming his finger in a car door. 2 weeks after the initial incident he presented to the emergency department for worsening pain and received x-rays that were negative for acute fracture. Today he presents reporting pain radiating up the hand, arm, and into the shoulder, with associated chills. His labs are significant for hyperglycemia, hyponatremia, and an elevated erythrocyte sedimentation rate and c-reactive protein. His x-ray is seen here (figure 1 image courtesy of Daniel Rogan, MD). What is [+]
Future of ALiEM: Need YOUR Input
With the arrival of a new decade, the ALiEM team has gotten quite reflective. Our last readership survey was in 2015 and it’s time for another check-in. We can track many things through Google Analytics, but there’s nothing like hearing from you directly to help us shape the upcoming year, 5 years, and 10 years. Your input is incredibly helpful to help us. We want to tailor our priorities to what YOU want. We are a volunteer organization, made up of passionate, early-adopting educators. Help us stay focused on what makes ALiEM special, helpful, and meaningful to you. [+]
EMRad: Can’t Miss Adult Ankle and Foot Injuries
Have you ever been working at 3am 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 sensitivity for these potentially [+]
Case of a Blue, Painful Finger
A 37-year-old female presented to the emergency department for evaluation of numbness and discoloration to her left fourth finger, which had started the day before. The patient stated that she was gardening the previous day and afterward she noticed the discoloration and pain. The patient denied taking any medications. She reported recreational methamphetamine and heroin use. She denied any chest pain or difficulty breathing. She denied any history of Raynaud’s phenomenon, venous thromboembolism, or history of trauma. The patient was afebrile with normal vital signs. Physical exam revealed cyanotic discoloration to the left distal fourth finger. Sensation was intact to [+]
EM Fellowship Match Advice: Medical Education Fellowship
One of the more popular fellowships in Emergency Medicine (EM) is the Medical Education Fellowship. These fellowships come in 1- and 2-year formats and some also come with an advanced degree. What do typical medical education and medical education scholarship fellowships typically entail? What are the logistics and timing when you decide to apply? Hosted by Dr. Michael Gisondi (Stanford) and Dr. Michelle Lin (UCSF), this podcast with 3 esteemed fellowship directors help provide some much-needed guidance. Podcast Panelists Dr. Danielle E. Hart (Hennepin County Medical Center) Dr. Dmitri Papanagnou (Thomas Jefferson University) Dr. Jeffrey Riddell (LAC-USC Medical Center) Listen [+]
EMRad: Approach to the Traumatic Foot X-ray
Radiology teaching during medical school is variable, ranging from informal teaching to required clerkships [1]. Many of us likely received an approach to a chest x-ray, but approaches to other studies may or may not have not been taught. We can do better! Enter EM:Rad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. We recently covered the elbow, wrist, and ankle: now, the foot x-ray. [+]
EMRad: Radiologic Approach to the Traumatic Ankle
Radiology teaching during medical school is variable, ranging from informal teaching to required clerkships [1]. Many of us likely received an approach to a chest x-ray, but approaches to other studies may or may not have not been taught. We can do better! Enter EM:Rad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. We recently covered the elbow and wrist. Now: the ankle. [+]
IDEA series: REDman simulation for teaching resuscitation skills in low-resource settings
In many parts of the world, emergency medicine is just beginning to emerge as a specialty. In Pakistan, for example, it was introduced as recently as 2012. Hands-on training in the management of critically-ill medical and trauma patients is imperative for adequate preparation of board-certified emergency physicians, but accurate simulation can be hard to come by in developing nations. There are very few training programs and dedicated centers for healthcare professionals, and even fewer that have simulation [1]. High-tech simulation equipment is often cost-prohibitive; a mobile, low-tech simulation lab could potentially address the need for advanced training in resuscitation for [+]
Trick of the Trade: Deflate an Undeflatable Gastrostomy Tube
A 54-year-old female with a past medical history of throat cancer presents for gastrostomy tube (G-tube) replacement. The initial G-tube was placed 3 years ago. Most recently, the patient had the G-tube changed 7 months ago. She presents to the Emergency Department because the G-tube is leaking from the tubing that is external to the skin. When you attempt to deflate the cuff, you are unsuccessful. [+]