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SAEM Clinical Images Series: A Rash You Don’t Want to Miss
by Ryan Schum, MD
Nov 28, 2022
A 54-year-old female with a past medical history of diabetes presented to the Emergency Department (ED) for evaluation of unresponsiveness. The pat...
Tactical Medicine News
SAEM Clinical Image Series: Eye Pain
A 59-year-old gentleman experiencing homelessness with a history of hepatocellular carcinoma, hepatitis C, alcohol use disorder, and tobacco depend...
Tactical Medicine News
Oral Antivirals for Treatment of Mild-Moderate COVID-19 Infection
Background Two new oral agents were given Emergency Use Authorization to be used in patients with mild-moderate COVID-19 at high risk of progressio...
Tactical Medicine News
Dose Order Matter? Which Antibiotic to Give First for a Bloodstream Infection
Background Early antibiotics are recommended for treatment of many infections, including patients with sepsis or septic shock [1]. Critically-ill p...
Tactical Medicine News
SAEM Clinical Image Series: Pediatric Rash
A previously healthy 8-year-old female presents to the pediatric emergency department due to a rash. Her symptoms started three days prior to prese...
Tactical Medicine News
SAEM Clinical Image Series: A Rapidly Spreading Rash
A 40-year-old male with a past medical history of HIV presented for evaluation of a non-pruritic rash. Six days ago, he suddenly felt a stinging se...
Tactical Medicine News
The Pneumonia Short Treatment Trial: Antibiotic Treatment for 3 days vs 8 days
Background:
In 2019 the World Health Organization listed “Antimicrobial Resistance” as a top 10 threat to global health. This was echoed in a 2021 ...
Tactical Medicine News
One-Time Vancomycin Doses in the Emergency Department
Background A previous ALiEM post from 2013 by an EM pharmacist colleague argued the case against one-time vancomycin doses in the ED prior to disch...
Tactical Medicine News
SAEM Clinical Image Series: Guess Who’s Back?
A 27-year-old male with no significant past medical history presented to the emergency department with one week of progressively worsening, non-p...
Tactical Medicine News
Doxycycline vs Azithromycin: Think Twice About the 2020 CDC Guideline Update on Treatment of Gonorrhea and Chlamydia
When the new Centers for Disease Control and Prevention (CDC) recommendations1 regarding the treatment of uncomplicated gonorrhea (and indirectly c...
Tactical Medicine News
SAEM Clinical Image Series: What Lies Beneath?
A 35-year-old male with a history of diabetes and pericarditis, status post pericardiectomy 3 years ago, presented with a painful lesion on his a...
Tactical Medicine News
SAEM Clinical Image Series: Left Ear Mass
A 25-year-old male who was previously healthy presents to the emergency department with a painful left posterior ear mass. The mass began as a “p...
Tactical Medicine News
COVID-19 Update: The ChAdOx1 (AstraZeneca) COVID-19 Vaccine
Background Information: With rising cases, an increasing death toll, and a significant strain on hospital systems globally, the COVID-19 pandemic ...
Tactical Medicine News
ALiEM AIR Series | Immunology 2020 Module
Welcome to the AIR Immunology Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR T...
Tactical Medicine News
SAEM Clinical Image Series: Severe Cutaneous Lesions in an Immunocompromised Host
A thirty-one-year-old female presented to the emergency department with the complaint of a painful rash for 2 days. She has a history of HIV with...
Tactical Medicine News
SAEM Clinical Image Series: Found Down with Altered Mental Status
A forty-nine-year-old male with a history of polysubstance abuse, including methamphetamine and intravenous (IV) drug use, rectal cancer, and hum...
Tactical Medicine News
Guideline Review: Pre-exposure prophylaxis (PrEP) for HIV prevention
While HIV medications receive much attention for the treatment of HIV infection, less attention has focused on the prophylaxis indications. In 2017...
Tactical Medicine News
Healthcare Providers in the COVID-19 Era: Keeping Clean When Coming Home
Given overcrowded hospitals and limited availability of personal protective equipment (PPE), showing up for work can feel like entering a battlegro...
Tactical Medicine News
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...
Tactical Medicine News
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 starte...
Tactical Medicine News
SAEM Clinical Image Series: Tick Bite
A 14 year old girl presenting from Mexicali with altered mental status. Her mother reports a rash about a week ago following a tick bite. She had...
Tactical Medicine News
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...
Tactical Medicine News
ALiEM AIR | Infectious Disease 2019 Module
Welcome to the AIR Infectious Disease Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the...
Tactical Medicine News
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 yea...
Tactical Medicine News
Guideline Review: 2018 IDSA Update on Influenza (Infographic)
Did you get your flu shot? We hope so. Influenza season is upon us again and it is always helpful to review the latest 2018 Infectious Disease ...
Tactical Medicine News
Measles 2019 Updates: The Comeback Kid
The child with a fever and rash in your Emergency Department (ED) may actually have measles. This year, there have been 1,182 cases of measles ...
Tactical Medicine News
SAEM Clinical Image Series: Bumps and Balls
A 31 year old African-American male, with a history of HIV, non-compliant with medications, presents with 3 months of painful “balls and bumps” o...
Tactical Medicine News
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 de...
Tactical Medicine News
Strep Pharyngitis in Children: Review of the 2012 IDSA Guidelines
Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cas...
Tactical Medicine News
Ultrasound Gel Warmers in the Emergency Department?
How many times have you told a patient “The gel will be cold?” How many times have you watched a patient retract from the transducer because of...
Tactical Medicine News
HiTEMP: Procalcitonin-Guided Antibiotic Therapy in the ED
Background: With CMS core measures requiring timely use of antibiotics in patients with fever and suspected sepsis, many patients receive antibioti...
Tactical Medicine News
ANDROMEDA-SHOCK: Peripheral Perfusion vs Serum Lactate in Septic Shock
Background: Based on the Surviving Sepsis Campaign, hemodynamic resuscitation of sepsis patients is done by repeating serum lactic acid levels ever...
Tactical Medicine News
The CENSER Trial: Early Norepinephrine in Septic Shock
Background: Standard management of septic shock has included, IV fluids until optimal intravascular volume is achieved, appropriate early antibioti...
Tactical Medicine News
Omadacycline, the NEJM and Non-Inferiority Studies
Introduction: The production and release of new antibiotics is rare and should be celebrated by clinicians. As antibiotic resistance continues to m...
Tactical Medicine News
Influenza Update: IDSA 2018 Guidelines Detailed Review
Symptomatic influenza A and B infections cause worldwide morbidity and mortality every year. Annual vaccination remains the greatest prophylact...
Tactical Medicine News
IDSA Guideline on Seasonal Influenza Management 2018
Article: Uyeki TM et al. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprop...
Tactical Medicine News
Algorithm for ED Evaluation and Management of Pediatric UTI
When should urinary tract infections (UTI) be included in the differential diagnosis for febrile infants and young children? The EM Committee on Q...
Tactical Medicine News
Baloxavir (Xofluza), a New Influenza Anti-Viral Medication is FDA Approved, But Does it Work?
Background: On October 24th, 2018, Roche, the maker of oseltamivir, announced that the US Food and Drug Administration (FDA) approved Xofluza (balo...
Tactical Medicine News
The Tamiflu Debacle
Background: Oseltamivir (Tamiflu), a neuraminidase inhibitor, was approved by the FDA in 1999. The majority of the evidence supporting the use of...
Tactical Medicine News
PECARN Study: Accuracy of Urinalysis for Febrile Infants ≤60 Days Old
The reported accuracy of the urinalysis (UA) for diagnosing urinary tract infections (UTI) is febrile infants ≤ 60 days has been widely variable. S...
Tactical Medicine News
Ultrasound guided peripheral IV: It’s time to clean up our act
Have you ever performed a procedure, when suddenly, you are overcome by a sinking feeling that something just is not right? A mix of fear, guilt, a...
Tactical Medicine News
Replace dolutegravir (Tivicay) with raltegravir (Isentress) for post-exposure prophylaxis
Post-exposure prophylaxis (PEP) of patients who may have been exposed to HIV includes a combination HIV nucleoside analog reverse transcriptase inh...
Tactical Medicine News
Ultrasound For The Win! Case – 64M with Fever and Scrotal Pain #US4TW
Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this series, we focus on a real clinical c...
Tactical Medicine News
Infographic: Sepsis and Septic Shock
The definitions of sepsis and septic shock continue to evolve, but the management, including resuscitation and early antibiotics, remains a core sk...
Tactical Medicine News
ALiEMU Capsules Module 10: Concepts in Infectious Disease
We are proud to present Capsules Module 10: Concepts in Infectious Disease, now published on ALiEMU. Here is a summary of the key points from a ste...
Tactical Medicine News
ALiEMU Capsules Module 9: Hospital Acquired Pneumonia
We are proud to present CAPSULES Module 9: Hospital Acquired Pneumonia (HAP), now published on ALiEMU. Here is a summary of the key points from a s...
Tactical Medicine News
Ultrasound for the Win! 53M with Right Index Finger Swelling #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
Little Patients, Big Medicine Podcast: Lactate in Pediatric Sepsis
The first recording from Little Patients, Big Medicine: the Pediatric Emergency Medicine (PEM) Podcast. This is an exciting interview with Dr. Hald...
Tactical Medicine News
PEM Pearls: Pediatric Sepsis Management – Understanding the Basics
Just as in adults, pediatric sepsis is a complex topic with continued research. In the United States, there are an estimated 75,000 cases per year ...
Tactical Medicine News
AIR Series: Infectious Disease Module (2016)
Welcome to the Infectious Disease Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index the ALiEM AI...
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