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SAEM Clinical Image Series: Fever and Aches

A 62 year old female with no past medical history presented to the ED with fevers, generalized weakness, severe muscle aches, and a rash. She had returned home from the Philippines 3 days prior to evaluation. Twenty-four hours prior to arrival, the patient noticed a rash on her shins. She denied any nausea, vomiting, [...]

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EMRad: Can’t Miss Adult Wrist Injuries

Have you ever been working a shift at 3 AM 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 [...]

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ACMT Toxicology Visual Pearls – Look, Don’t Touch

What toxin is responsible for the most serious clinical effects experienced by patients bitten by the creature in this photo? latrotoxin Conotoxin Helothermine Tetrodotoxin Verrucotoxin Answer:  4 – Tetrodotoxin Tetrodotoxin The pictured creature is a blue-ringed octopus (Hapalochlaena lunulate Hapalochlaena maculosa), and it secretes tetrodotoxin in its saliva (1). Tetrodotoxin binds voltage-gated sodium [...]

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Introducing the 2020-2021 ALiEM Faculty Incubator Cohort!

We put the call out, and *wow* did the MedEd community respond! We were beyond excited this year about the quality of our applicants for the 2020-2021 ALiEM Faculty Incubator.  This next cohort will include educators from across the globe and from all arenas of medicine including pre-clinical educators and our first nurse practitioner! Please [...]

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Trick of the Trade: Directed Saline Irrigation for Nasal Suctioning

You are just starting out your mid-January evening shift, and you go to the room of an 8-month old male with nasal congestion. He is afebrile, and mildly tachycardic, but his lung exam is fairly benign and he’s breathing easily without retractions. You can clearly see he has congestion. You instruct the parents to use [...]

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Should the Trainee by Trusted? A User’s Guide to Assessment with EPAs

You are an attending working with a fourth-year medical student on their emergency medicine clerkship. The student sees a patient with the chief complaint of dizziness. After an initial assessment, the student says that there are no red flags in the history and the patient has a normal neurological exam. In the back of your [...]

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Grammer named director of physician assistant education

by Kalani Simpson, UNMC public relations | November 01, 2019 The UNMC College of Allied Health Professions has hired Shaun Grammer as director of the Division of Physician Assistant Education, effective today, Nov. 1. Grammer has served as associate professor in physician assistant education since July 2018. He came to UNMC from the College of Saint Mary (CSM), where he worked from 2013-18 and was... Continue Reading

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SAEM Clinical Image Series: A Multifactorial Skin Eruption

A 9-year-old male with no past medical history, brought in by his mother to the ER with a new rash on his face and torso. The rash began 10 days ago. On the day he developed the rash, the patient noted swimming in a newly chlorinated outdoor pool. That same day he also played [...]

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SplintER Series: A Rare Cause of Traumatic Thumb Pain

A 45 year-old male presents with right thumb pain and deformity after falling off his bicycle. You obtain hand x-rays and see the following images. What is the most likely diagnosis, differential diagnosis, and management plan? Figure 1. AP and oblique views of the hand. Author’s own images.     Dislocation [...]

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Teaming Tips 10: Resuscitate Your Meetings | ALiEM Faculty Incubator

Many of you are asked to take a leadership role in leading a team, whether it’s for research, administration, or even clinical. It is easy to feel unprepared for these roles, and there are many pitfalls waiting to sabotage your team’s productivity. The ALiEM Faculty Incubator has created a series of 10 case-based teaming problems [...]

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SplintER Series: The 2 minute ankle exam | Leg Day #5

Welcome to Leg Day #5 of the SplintER Series. The focused history and physical ankle exam of the patient with an acute ankle injury is a crucial tool often overlooked in the Emergency Department (ED). Our hope is that after enough practice, you will be able to complete your ankle exam within 2 minutes! [...]

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EMRad: Radiologic Approach to the Traumatic Wrist

This is EMRad, 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. Last post, we focused on the elbow. Now: the wrist. Learning [...]

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PECARN: Its relevance and importance in pediatric emergency care

Did you know that many of the landmark pediatric emergency medicine (EM) studies come from the Pediatric Emergency Care Applied Research Network (PECARN) collaborative? It works to address the challenging pediatric questions that only multicenter studies can. In this blog post, we highlight PECARN’s goal to translate, disseminate, and implement evidence to all providers of [...]

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ACMT Toxicology Visual Pearls: Painful Hand

What is the recommended treatment for a patient with this hand injury following a sting by the marine creature shown? Acetic acid (vinegar) Antivenom Cold water Hot water Hydrogen peroxide Answer: 4 Hot water Lionfish envenomation The pictured creature is a lionfish. The lionfish, which belongs to the subfamily Scorpaenidae, is native to the [...]

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EMRad: Can’t Miss Adult Wrist Injuries

Have you ever been working a shift at 3 AM 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 [...]

The post EMRad: Can’t Miss Adult Wrist Injuries appeared first on ALiEM.

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Grammer named director of physician assistant education

by Kalani Simpson, UNMC public relations | November 01, 2019 The UNMC College of Allied Health Professions has hired Shaun Grammer as director of the Division of Physician Assistant Education, effective today, Nov. 1. Grammer has served as associate professor in physician assistant education since July 2018. He came to UNMC from the College of Saint Mary (CSM), where he worked from 2013-18 and was... Continue Reading

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SAEM Clinical Image Series: A Multifactorial Skin Eruption

A 9-year-old male with no past medical history, brought in by his mother to the ER with a new rash on his face and torso. The rash began 10 days ago. On the day he developed the rash, the patient noted swimming in a newly chlorinated outdoor pool. That same day he also played [...]

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SAEM Clinical Image Series: Uncommon Cause of Right Groin Pain

A 48-year-old male presents with 2 weeks of severe right lower quadrant abdominal pain and inguinal pain. The patient had similar pain 2 weeks ago, was referred to a surgery clinic, but was lost to follow up. The pain has been progressively worsening over the last 2 days. It’s now severe, associated with nausea [...]

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SAEM Clinical Image Series: A Case of a Painful Facial Rash

A 65-year-old female without any significant past medical history presented to the emergency department with left eye pain and redness. She also reported a developing rash to left side of her face over the last 24 hours. Fluorescein exam of the left eye Skin: Vesicular rash over the medial aspect of [...]

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SplintER Series: The 2 minute ankle exam | Leg Day #5

Welcome to Leg Day #5 of the SplintER Series. The focused history and physical ankle exam of the patient with an acute ankle injury is a crucial tool often overlooked in the Emergency Department (ED). Our hope is that after enough practice, you will be able to complete your ankle exam within 2 minutes! [...]

The post SplintER Series: The 2 minute ankle exam | Leg Day #5 appeared first on ALiEM.

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Grammer named director of physician assistant education

by Kalani Simpson, UNMC public relations | November 01, 2019 The UNMC College of Allied Health Professions has hired Shaun Grammer as director of the Division of Physician Assistant Education, effective today, Nov. 1. Grammer has served as associate professor in physician assistant education since July 2018. He came to UNMC from the College of Saint Mary (CSM), where he worked from 2013-18 and was... Continue Reading

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Ultrasound for the Win! 3-year-old with abdominal pain #US4TW

A 3-year-old Hispanic female with no significant past medical or surgical history presents to the Emergency Department with her mother for a 3 day history of crampy abdominal pain, intermittent bloody diarrhea and fever. There has been no recent travel, admissions, or antibiotic use. Her older sister reports similar symptoms, which have resolved. The patient [...]

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SAEM Clinical Image Series: Rash and Headache in Acute Myeloid Leukemia

A 25 year old male with a history of acute myeloid leukemia (AML) after an allogeneic stem cell transplant, which has been in remission for 6 years. He presents with a headache and rash. 4 days ago the patient noticed a rash on the abdomen that was itchy, but not painful. Today, he noticed [...]

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Making Heads or Tails of the Flipped Classroom: Tips and Tricks for Students

Now more than ever, medical educators are excited about the flipped classroom, defined by Bishop and Verleger as “a new pedagogical method, which employs asynchronous video lectures and practice problems as homework, and active, group-based problem-solving activities in the classroom” [1]. The premise is that students will learn basic concepts during self-study, at their own [...]

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SplintER Series: Salter-Harris Fractures

A 6 year-old boy presents with left wrist pain after he fell off the monkey bars onto an outstretched hand. You obtain wrist x-rays and see an abnormality. What is the most likely diagnosis, differential diagnosis, and management plan? Figure 1. AP wrist radiograph. Courtesy of Mark Hopkins, MD. Figure 2. [...]

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SAEM Clinical Image Series: Bellybutton Mass

A 4 week-old female infant presents due to yellow discharge from her umbilicus and mom noticing a red mass coming from the umbilical area after changing her diaper today. She is a healthy infant born at 40 weeks by vaginal delivery without complications and weighed 6 lbs 1 oz at birth. She is feeding [...]

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Grammer named director of physician assistant education

by Kalani Simpson, UNMC public relations | November 01, 2019 The UNMC College of Allied Health Professions has hired Shaun Grammer as director of the Division of Physician Assistant Education, effective today, Nov. 1. Grammer has served as associate professor in physician assistant education since July 2018. He came to UNMC from the College of Saint Mary (CSM), where he worked from 2013-18 and was... Continue Reading

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Trick of Trade: Topical lidocaine jelly takes the tears out of skin tears and road rash

Skin tears are a common injury treated in the elderly in the emergency department (ED). Often the skin is paper thin, and the area involved can have a large flap. By the time the patient has arrived, the may blood have dried with a retracted and rolled-in skin flap. Often the surface area is too [...]

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Family Health History and the Holidays

By Elyssa Gray, genetic counseling student While families are gathering for the holidays, the Surgeon General encourages Americans to discuss and share information about their health. A detailed family health history is an invaluable tool to share with your provider and can be used to take control of your healthcare. This history can identify health concerns that you are at a higher risk for, and... Continue Reading

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Pilot grant sends PA students to Midwest Rural Agricultural Safety and Health Conference

Six UNMC PA students and two UNMC PA faculty recently attended the Midwest Rural Agricultural Safety and Health (MRASH) Conference in Marshalltown, IA as part of the CS-CASH Pilot Grant: Improving Agricultural Worker Health and Safety Awareness through Multimodal, Case-Based Physician Assistant Education. At the conference, PA faculty Carey Wheelhouse and Mia Hyde presented a poster on their research project. Student attendees, Chelsea Brinkman, Kiley... Continue Reading

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