ALiEM AIR Series | Environmental Module (2025)
Welcome to the AIR Environmental Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to related to Environmental emergencies in the Emergency Department. 5 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 1 AIR and 4 Honorable Mentions. We recommend programs give 3 hours of III credit for this module. AIR Stamp of Approval and Honorable Mentions [+]
SAEM Clinical Images Series: I Cannot See My Rashes
A 37-year-old African-American transgender patient presented with progressive, bilateral painful vision loss. The symptoms began acutely in the right eye two weeks prior to presentation, eventually extending to the left eye. Symptoms were worse in the right eye and included headache, blurry vision, photophobia, and pain with eye movement. Additionally, the patient reported the appearance of a diffuse, generalized, non-pruritic, non-tender rash of unknown duration or timeline. The rash was hyperpigmented and located on the trunk, face, genitalia, palms, and soles. The patient denied any recent trauma, using eye drops, wearing glasses, recent new detergents, [+]
SAEM Clinical Images Series: I’m Plugged Up
A 56-year-old male with a history of crack cocaine and opiate drug use presented to the Emergency Department (ED) with concerns about a persistent dry cough for seven days. The cough started after smoking cocaine from a homemade glass pipe. The day before arrival, he developed sharp chest pain with coughing associated with shortness of breath and a sore throat. The patient denied fevers, chills, or shortness of breath. He denied hemoptysis, nausea, vomiting, and diarrhea. A chest x-ray was obtained with the findings seen below. Vitals: Temp: 36.6°C; HR: 78 [+]
ACMT Toxicology Visual Pearl: Turning Blue
What commercially available product can cause blue-grey discoloration of the skin and conjunctiva with long term use? Benzocaine, 20% oral gel Colloidal silver, 30 ppm liquid solution Ferrous sulfate, 325 mg tablet Methylene blue, 1% oral solution [Image from Herbert L. Fred, MD and Hendrik A. van Dijk via Wikimedia Commons] [+]
Brandon Friedman, MD
The First Pulse Check: How to set yourself up for success in EM residency
“Are you ok?” My wife asked as I flopped onto the bed, which was still just a mattress on the floor. I (KL) had just finished my first shift as a resident and was overwhelmed. We still had furniture to buy, boxes to unpack, and countless things to repair. The house we were so excited to move into had not lived up to our expectations when we saw it for the first time in person. Despite all the housework we had to do, I felt paralyzed by the incompetence I felt on my first shift. The mountain between myself [+]
SAEM Clinical Images Series: Weird Flex
A 29-year-old female with a history of depression, anxiety, and tobacco use disorder presented with worsening right index finger pain, swelling, and redness for the previous three days. Additionally, she reported that she was unable to further flex or extend her finger. She denied fevers, chills, rashes, or recent illness. There was no history of trauma, aquatic or other environmental exposures, insect bites, or intravenous drug use. She did note that she uses a copper brillo pad to clean her dishes at home which often causes small abrasions to her fingers. Vitals: [+]
SAEM Clinical Images Series: Ptosis? A Don’t Miss Diagnosis!
A 50-year-old female with no past medical history presented to the emergency department for a headache. She developed progressive dull, left-sided head pain with sinus pressure one week prior, associated with sleep disturbance. In addition, she described two days of left eyelid drooping. She had no fever, chills, cough, difficulty breathing, neck pain, jaw claudication, vision changes, dizziness, numbness, or recent weight loss. She also denied any recent trauma to the head or neck. Vitals: BP 119/59; PR 92; Temp 37°C; RR 16; SpO2 100% on RA General: Well-appearing, no acute [+]
SAEM Clinical Images Series: Case of Painless Vision Changes
A 62-year-old female presented to the emergency room with a chief complaint of atraumatic painless blurry vision. She reported a medical history of bilateral lens replacements in 1999 and a prior history of bilateral retinal detachments and expressed concern that she may have detached her retina again. The patient first noted floaters starting 3 days ago, that progressed yesterday to sudden onset blurry vision of her right eye. She denied any sensation of “a curtain falling. The patient clarified that this presentation is different in nature to her prior bilateral retinal detachments. [+]
Greater Occipital Nerve Block in the Emergency Department
Chief complaints of non-traumatic headaches represent approximately 2% of emergency department (ED) visits in the United States [1]. Headaches are classified as primary (standalone condition) or secondary (a symptom of another medical condition), with primary headaches being the more common type [2]. In the ED, it is critical to rule out life-threatening causes of headaches such as subarachnoid hemorrhages, stroke, or meningitis. Headaches such as migraines, occipital neuralgia, cervicogenic headaches, and cluster headaches while more benign may still be debilitating for patients (Figure 1). Figure 1. Headaches that may benefit from greater occipital nerve blockade [illustration by Dr. [+]
ACMT Toxicology Visual Pearl: A Toxic Tuber
Improper preparation of this food causes poisoning from which toxic compound? Atropine Cicutoxin Cyanide Oxalic acid Image from Wikimedia Commons [1] [+]
