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SAEM Clinical Image Series: Foreign Body Ingestion

[Click for larger view] Chief complaint: Foreign Body Ingestion History of Present Illness: A 4-year-old male presents to the Pediatric ED for evaluation of swallowed foreign body. The mother reports the patient was at his grandmother’s house playing near a cabinet when they witnessed him put a small unknown object in his mouth [...]

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SAEM Clinical Image Series: Young Woman with a Headache

[Click for larger view] Chief complaint: Headaches for 1 year History of Present Illness: A 31-year-old woman with no significant past history presents with a dull headache. She notes the headache is generalized, has been almost daily for a year and is worsened by bending over. She denies nausea, vomiting, photophobia, trauma, seizures, [...]

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SplintER Series: Funny Looking Finger

Figure 1: Terminal extensor tendon avulsion at distal interphalangeal joint of 5th digit A 17-year-old baseball player presents complaining of finger pain and difficulty straightening his finger after a baseball game. You obtain x-rays and see the following fracture (photo credit). What is your diagnosis and emergency department management? [...]

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Differentiating pericardial effusion from pericardial tamponade on ultrasound

Tamponade physiology, in which a pericardial effusion impedes cardiac output, is a medical emergency and requires prompt diagnosis and intervention before cardiovascular collapse ensues. However, not every fluid collection in the pericardial sac results in tamponade physiology. A clinical diagnosis of tamponade (Beck’s triad) has poor sensitivity and will occur only in the late stages [...]

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SAEM Clinical Image Series: Hip Pain

[Click for larger view] Chief complaint: Left hip pain History of Present Illness: A healthy right leg-dominant 13-year-old male athlete presents with left hip pain after kicking a soccer ball. He states that he kicked the ball awkwardly and experienced hip pain immediately afterwards. He did not feel a pop or cracking sensation [...]

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The Leader’s Library | Radical Candor: Be a Kick-Ass Boss Without Losing Your Humanity

We proudly announce the second installment of ALiEM’s career development book club, The Leader’s Library, with Kim Scott’s bestseller Radical Candor [Amazon link]. Your colleague and friend plops down next to you at a meeting. She’s extra excited because she’s going to give an important presentation to hospital administration about her new quality improvement project, [...]

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Building Equipment Kits for Streamlined Care

In the setting of emergent care, the ability to access equipment rapidly and reliably can be a deciding factor in patient outcome. Poor stocking, inconsistent organization, and dispersal of equipment throughout a large geographic area are realities of practice as well as barriers to rapid and effective patient care. Equipment kits are a great way [...]

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First UNMC genetic counseling class shares about first week

by Emily Toering | First-Year Student, Genetic Counseling In 1969, the first genetic counseling program was started at Sarah Lawrence College in New York. The director described the first class of ten students as “a most unusual bunch” because they were motivated, driven to serve, and highly intelligent. Now, 50 years later, UNMC has welcomed their own similarly unusual bunch of genetic counseling students with... Continue Reading

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Welcome new PA staff: Kailee Strawmier

Kailee Strawmier, AA,  is the new office associate in the Division of Physician Assistant Education. Here’s more about Kailee in her own words: “I grew up in Omaha, Nebraska, and attended Iowa Western Community College where I received an associate degree in Education. Before coming to UNMC, I was the Director of a Child Care Center in Bellevue. I have always loved the education field... Continue Reading

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SAEM Clinical Image Series: Corneal Foreign Body

[Click for larger view] Chief complaint: Eye pain History of Present Illness: A 41-year-old man presents with pain and a foreign body sensation in the right eye since welding 4 days ago. The patient wore eye protective gear; however, he explains that he only wore sunglasses. A spark flew in from above his [...]

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SAEM Clinical Image Series: Tea & Toast | A Case of an Abdominal Rash

[Click for larger view] Chief complaint: Abdominal pain, nausea, and vomiting History of present illness: A 46 year-old female with a past history of fibromyalgia, irritable bowel disease, and chronic abdominal pain presented to the emergency department with abdominal pain, nausea, and vomiting. She reported a one-year history of similar symptoms but states [...]

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Fascia iliaca nerve block: A hip fracture best-practice

An 82-year-old woman presents with left hip pain after a mechanical fall while cleaning the kitchen floor. When EMS arrived, the left leg was foreshortened and externally rotated. The paramedics administered 10 mg of IV morphine, but she is still writhing in pain on arrival. The AP pelvic x-ray demonstrates a left femoral neck fracture [...]

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SAEM Clinical Image Series: Facial Swelling in a 2 Year Old

[Click for larger view] Chief complaint: Left-sided facial swelling History of Present Illness: A 2-year-old male presents to the emergency department in January after waking up with left-sided facial swelling. Mother states her son has had cough and congestion for the past 4 days for which she has been giving Tylenol and a [...]

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AMCT Toxicology Visual Pearls: Mushroom Mania

After eating the mushroom pictured, a 15-year-old patient arrives to the emergency department agitated, diaphoretic, and hallucinating, and then acutely becomes more somnolent and less responsive. Which neurotransmitter systems are affected by the toxins contained in this mushroom? Acetylcholine and histamine Dopamine and norepinephrine Gamma-aminobutyric acid (GABA) and N-methyl-D-aspartate (NMDA) Glycine and serotonin Answer: 3 [...]

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Ultrasound for the Win! 18M with dysphagia #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clinical case where bedside ultrasound changed the management or aided in the diagnosis. In this case, an 18-year-old man presents with a sore throat. Learning Objectives: Review the differential for a [...]

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PEM Pearls: 5 Tips to Demystify Amoxicillin in Pediatric Infections

Amoxicillin is a penicillin derivative antibiotic against susceptible gram positive and gram negative bacteria. It has reasonable coverage for most upper respiratory infections and is used as prophylaxis for asplenia and bacterial endocarditis. This post aims to demystify amoxicillin treatment for common pediatric infections. Susceptible Bacteria Susceptible Bacteria to AmoxicillinAssociated ConditionEnterococcusUrinary tract infection, bacteremiaGroup A [...]

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Welcome new faculty: Stacie Christensen

Stacie Christensen, PT, DPT, recently joined our Division of Physical Therapy Education as assistant professor. Here’s more about Stacie in her own words: I grew up in rural Nebraska always knowing I wanted to go into healthcare. After spending hours upon hours shadowing the health professions, I decided physical therapy was the perfect fit. I received my undergraduate degree from Chadron State College in 2006,... Continue Reading

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What is palliative emergency medicine and why now?

The skilled and rapid resuscitation of critically ill patients is a central premise in the specialty of emergency medicine (EM). A paradox for providers often arises when in the midst of resuscitating a patient with advanced chronic illness, the question of risks versus benefits arises. For this patient, we may successfully stabilize vital signs, but [...]

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SAEM Clinical Image Series: Rash After a Sore Throat and Ibuprofen Use

[Click for larger view] Chief complaint: Rash History of Present Illness: The patient is an 18 year-old male who presents with a rash that appeared 7 days ago. The rash is located on his torso, back, and lower lip. It is pruritic. Three days prior to the appearance of the rash, he had [...]

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SAEM Clinical Image Series: Another Heart Attack?

[Figure 1: Click for larger view] Chief Complaint: Chest pain History of Present Illness: An 89-year-old female with a past medical history of coronary artery disease and with recent admission for myocardial infarction that was medically managed, presented with chest pain and shortness of breath. She reports worsening midsternal chest pain that occasionally [...]

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SAEM Clinical Image Series: Flu-like symptoms, oral ulcers, and rash

[Click for larger view] Chief Complaint: Flu-like symptoms, lip pain/swelling, mouth pain, eye redness, and rash History of Present Illness: Patient is a 35-year-old transgender male with a history of bipolar disorder (taking seroquel/lamotrigine) who presents with 2 days of: Flu-like symptoms Progressive lip pain/swelling Mouth pain Oral ulcers Eye redness New erythematous rash [...]

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PEM Pearls: Ultrasound for Diagnosing Occult Supracondylar Fractures

Supracondylar humerus fractures are the most common type of elbow fracture in pediatric patients, most often seen in a fall on an outstretched hand (FOOSH) or a fall on a hyper-extended elbow.​1,2​ If there is no obvious fracture on x-rays, the patient may have an occult fracture; look for secondary radiographic signs including a posterior fat [...]

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ALiEM AIR | Orthopedics Upper Extremity 2019 Module

Welcome to the AIR Orthopedics Upper Extremity 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 orthopedics upper extremity emergencies. 5 blog posts within the past 12 months (as of March 2019) met our standard of [...]

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Revise and Resubmit: Responding to peer reviewer comments about your journal manuscript

As part of the ALiEM Faculty Incubator Program, Dr. Anthony Artino, Deputy Editor of the Journal of Graduate Medical Education (JGME) and Assistant Editor for Academic Medicine participated in a Google Hangout with Drs. Antonia Quinn and Teresa Chan in which he provided expert advice for responding to editor and peer reviewer comments on your [...]

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Trick: Peritonsillar abscess drainage 3.0 | All the steps with added variations

A 25-year-old medical student comes in with a muffled voice, sore throat and trismus. You look at the back of her throat and you see the uvula deviated to the right. You astutely diagnosed a peritonsillar abscess (PTA). You consider aspirating and want to check for tips on how to successfully do this.Dr. Michelle Lin [...]

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UNMC students, faculty in Kearney offer free sports screenings Sept. 7 for Special Olympics athletes

Physical assessments allow athletes to compete in the Special Olympics Students and faculty from the University of Nebraska Medical Center College of Nursing Kearney Division and UNMC College of Allied Health Professions in Kearney, are offering free sports screenings for current and new athletes who plan to compete in the Special Olympics. The event, called West Central MedFest, is open to athletes from the Kearney,... Continue Reading

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Welcome new faculty: Mariah Dougherty

Mariah K. Dougherty, MMN, RDN, LMNT, recently joined the Medical Nutrition program faculty. Here’s more about Mariah in her own words: “I grew up in Ames, Iowa and completed my BS in Dietetics at Iowa State University. After graduating, I moved to Omaha and completed a combined Dietetic Internship and Masters program at the University of Nebraska Medical Center. After working for about a year... Continue Reading

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SAEM Clinical Image Series: Fishing in Papua New Guinea

[Click for larger view] Chief Complaint: Right lower extremity injury while spear fishing History of Present Illness: A 33-year-old male went river fishing with a homemade spear and diving mask in Papua New Guinea. He felt sudden pain and tugging to the right lower extremity. He was near shore and grabbed a tree root. [...]

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SAEM Clinical Image Series: Distended Bowels

[Click for larger view] Chief Complaint: Abdominal distention History of Present Illness: A 36-year-old male with a history of cerebral palsy, gastrointestinal dysmotility, epilepsy, hypertension, gastroesophageal reflux disease, and insomnia presents to the ED after referral by his family physician for a 3-day history of abdominal distention. Due to the patient’s neurological disorder, he [...]

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