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Tactical Medicine News

SAEM Clinical Image Series: An Uncommon Cause of Shortness of Breath

by Marimer Rivera-Nieves, MD
Feb 28, 2022
A 102-year-old female presents with intermittent epigastric abdominal pain for the last two days. Episodes have no relieving or exacerbating factor...
Tactical Medicine News

SAEM Clinical Image Series: I Have a Stomachache

An 18-year-old male with no significant past medical history presents with diffuse abdominal pain and multiple episodes of non-bloody, non-bilious ...
Tactical Medicine News

SAEM Clinical Image Series: Vomiting in the Pediatric Patient

A 2-year-old boy with a past medical history of Hirschsprung disease presents to the emergency department (ED) with vomiting, abdominal distension,...
Tactical Medicine News

Trick of the Trade: Persistent Paracentesis Leakage 2.0

You’re seeing a patient returning to the ED after a recent diagnostic paracentesis. The patient is complaining of persistent peritoneal fluid leaka...
Tactical Medicine News

PEM POCUS Series: Intussusception

Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric intussusception. Then test your skills on the ALiEMU course pa...
Tactical Medicine News

ALiEM AIR Series | Gastroenterology 2020 Module

Welcome to the AIR Gastroenterology Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM...
Tactical Medicine News

SAEM Clinical Image Series: Distended Abdomen after ROSC

A 64-year-old female presented to the emergency department (ED) in cardiac arrest. Her family members heard her fall in the bathroom and started ...
Tactical Medicine News

SAEM Clinical Image Series: An Oropharyngeal Mass

A fifty-year-old male presented to the emergency department (ED) unconscious with CPR in progress. Per EMS report, the patient was found down sur...
Tactical Medicine News

Unlocking the MIC-KEY: Understanding and Troubleshooting Low-Profile Gastrostomy Tubes

You are working an overnight clinical shift at your community emergency department when a worried mother brings in her 15-year-old child with cereb...
Tactical Medicine News

Diagnose on Sight: Scrotal Swelling

Case: A 58-year-old male with no past medical history presents to the emergency department for evaluation of right lower quadrant abdominal pain a...
Tactical Medicine News

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...
Tactical Medicine News

IDEA Series: Just-in-Time Training for Diagnostic Paracentesis

According to the National Health And Nutrition Examination Survey, approximately 630,000 adults in the United States have cirrhosis of the live...
Tactical Medicine News

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...
Tactical Medicine News

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 c...
Tactical Medicine News

SAEM Clinical Image Series: Mysterious Blood Sample

34-year-old female with a history of hypertension, diabetes mellitus, and pancreatitis presents for epigastric and left upper quadrant abdominal ...
Tactical Medicine News

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 fo...
Tactical Medicine News

Trick of Trade: Topical lidocaine jelly to make constipation relief less painful

Severe constipation, requiring fecal disimpaction and rectal enemas, can be excruciatingly painful for patients. Administering sedatives and ...
Tactical Medicine News

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,...
Tactical Medicine News

Pediatric Point of Care Ultrasonography ALiEMU Course on Intussusception

Our ALiEMU learning management system, which currently houses the AIR series, Capsules series, and In-Training Exam Prep courses, is ready to s...
Tactical Medicine News

AIR Series: Gastrointestinal 2017

Welcome to the Gastrointestinal Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR...
Tactical Medicine News

ALiEM’s Greatest Hits for Interns: A Curated Collection of High-Yield Topics

Congratulations, you’ve made it! On July 1, thousands of medical students across the country made the transition to becoming Emergency Medicine re...
Tactical Medicine News

AIR-Pro: Gastroenterology

Welcome to the Gastroenterology AIR-Pro Module. Below we have listed our selection of the 10 highest quality blog posts related to 4 advanced level...
Tactical Medicine News

Ultrasound For The Win! – 46M with Diffuse Abdominal Pain #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 clini...
Tactical Medicine News

PEM Pearls: The nonvisualized appendix quandary on ultrasound

A 10-year old girl presents with progressively worsening right lower quadrant pain for the last 2 days. She reports having chills and feeling warm....
Tactical Medicine News

Trick of the Trade: Isopropyl Alcohol Vapor Inhalation for Nausea and Vomiting

Your triage nurse complains of numerous patients in the waiting room complaining of nausea, retching, and emesis. They ask you “why can’t we have a...
Tactical Medicine News

Trick of the Trade: Large volume paracentesis technique using gravity

Recall the last time you were sitting in a room doing a large-volume, therapeutic paracentesis in the ED. Were you stressing out because your other...
Tactical Medicine News

Ultrasound For The Win Case – 46F with Abdominal Pain #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win” (#US4TW) Case Series. In this peer-reviewed case series, we focus on...
Tactical Medicine News

PV Card: Focused Biliary Assessment Ultrasound

Have trouble finding the common bile duct? What’s the normal thickness of the gallbladder wall? What are common pitfalls in imaging the gallbladder...
Tactical Medicine News

Small bowel obstruction: Diagnosis by ultrasonography

A 64 year old man with an extensive history of abdominal surgeries presents to the emergency department with abdominal pain and vomiting. Because y...
Tactical Medicine News

Ondansetron: Has it reduced need for IV rehydration in vomiting kids?

A 3-year-old male presents to the emergency department (ED) complaining of vomiting and diarrhea that has been occurring for 2 days. The mother sta...
Tactical Medicine News

Upper Gastrointestinal Bleeding: Evidence-Based Treatment

Upper gastrointestinal bleeding remains a common reason for emergency department visits and is a major cause of morbidity, mortality, and medical c...
Tactical Medicine News

Amylase Level for Pancreatitis: Stop doing it

A patient actively vomiting is wheeled into your ED. Within minutes IV access is obtained, and your nurse asks what tests and medicines are wanted....
Tactical Medicine News

BISAP, EHMRG, ORT: 3 New Medical Scores You’ve Never Heard Of

Let’s face it. You’ve heard about the A-a gradient. And free water deficit. And even the APACHE-II score. But how useful are these in your daily pr...
Tactical Medicine News

52 Articles in 52 Weeks: Landmark EM Articles 2013

To provide a resource for evidence-based Emergency Medical education, this list of must-read landmark articles was created to supplement the Emerge...
Tactical Medicine News

NG Lavage: Indicated or Outdated?

Nasogastric lavage (NGL) seems to be a logical procedure in the evaluation of patients with suspected upper GI bleeding, but does the evidence supp...
Tactical Medicine News

Trick of the Trade: Persistent paracentesis leakage

Dr. Matt Borloz (Carilion Clinic) recently emailed me his recent trick in fixing a persistently leaking paracentesis site. Read about his experienc...
Tactical Medicine News

Paucis Verbis: Upper GI bleeding

Do you know what the Blatchford clinical prediction score is for upper GI bleeding? It can help you predict whether a patient with an upper GI ble...
Tactical Medicine News

Paucis Verbis: Blunt Abdominal Injury, Likelihood Ratios

This month’s issue of JAMA addresses the question “Does this patient have a blunt intra-abdominal injury?” as part of the always-popular Rational C...
Tactical Medicine News

Paucis Verbis: Diagnostic testing tips for acute abdominal pain

In the most recent EM Clinics of North America publication, Dr. Panebianco et al. discussed the evidence behind diagnostic tests for acute abdomin...
Tactical Medicine News

Paucis Verbis: NSAIDS and upper GI bleeds

Primum non nocere. Do no harm. We so often recommend and give NSAIDs to patients for various painful conditions. We also commonly administer ketor...
Tactical Medicine News

Paucis Verbis: Clostridium Difficile

I just finished taking the 2011 LLSA exam to remain eligible for recertification. The only good thing about this test is that it gives me interesti...
Tactical Medicine News

Paucis Verbis: Outpatient treatment for diverticulitis

The classic teaching for the treatment of diverticulitis includes: Hospital admission Bowel rest (NPO) IV fluids Broad spectrum IV antibiotics D...
Tactical Medicine News

Paucis Verbis: Strength of diagnostic tests for cholecystitis

You have a 40 year-old man who presents to the ED for persistent right upper quadrant abdominal pain for 12 hours after eating a fatty meal. He has...
Tactical Medicine News

Paucis Verbis card: Dysphagia

Dyphagia is a disorder of swallowing. It actually occurs in up to 10% of adults older than 50 years old. How can you determine the most likely caus...
Tactical Medicine News

Trick of the Trade: "Pour some sugar on me" | Reducing a rectal prolapse

Rectal prolapses are typically caused by weakened rectal muscles, continued straining, stresses during childbirth, weakened ligaments, or neurologi...
Tactical Medicine News

Paucis Verbis card: Ascites assessment with paracentesis

A paracentesis procedure is often performed in the Emergency Department to rule a patient out for spontaneous bacterial peritonitis (SBP). Do you ...
Tactical Medicine News

Paucis Verbis card: Appendicitis – ACEP Clinical Policy

Appendicitis is a common presentation in the Emergency Department. Dilemmas arise when deciding whether to image patients with equivocal symptoms a...
Tactical Medicine News

Tricks of the Trade: Low tech solutions to esophageal foreign bodies

Patients can present to Emergency Departments with esophageal foreign bodies. Recently, a patient presented with a doxycycline pill stuck in her es...
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