Traditionally large-bore tube thoracostomy has been the standard of care for treating many acute intrathoracic pathologies [1]. However, the advent of less invasive small-bore chest tubes, also known as pigtail catheters, has gradually led to a paradigm shift. Pigtails provide a less invasive and often better tolerated alternative to traditional chest tubes and allow for adequate treatment of pneumothoraces and uncomplicated pleural effusions [1-5]. Unfortunately, these less invasive catheters are not without complications – both unique and similar to traditional chest tubes. Case A 48 year ..read more

What could cause this finding three days after ingestion of a concentrated household substance? Duodenal ulcer Gastric perforation Necrotizing enterocolitis Post-corrosive acute pancreatitis Reveal the Answer 4. Post-corrosive acute pancreatitis The above image shows Cullen’s sign, which appears as blotches of superficial ecchymoses in the skin surrounding the umbilicus and is associated with acute pancreatitis [1]. Acute pancreatitis is an unusual complication of corrosive ingestion and when present is generally associated with severe injury and necrosis in the gastrointestinal tract ..read more

A 23-year-old female with no known past medical history presented with a rash concentrated on her legs, with a few areas on her arms and chest. The rash began the day before presentation when she became overheated while wearing sweatpants in 104°F weather. The rash was mildly pruritic but not painful. She denied any prior reaction to her sweatpants that she has had for several months. She denied any new soap or cosmetic use, prior rash, allergy, or medication use. Her review of systems and past medical history were negative. Additional Images Physical Exam Vitals: Normal Skin: An ..read more

What is the primary cause of death following ingestion of the plant pictured? Acute liver failure Arrhythmia Disseminated intravascular coagulation Status epilepticus Reveal the Answer 2. Arrhythmia The primary cause of death from plants of the Aconitum spp (aka Monkshood, Wolfsbane) is refractory ventricular arrhythmia and asystole. Background: Aconitine and its related alkaloids, mesaconitine and hypaconitine, are extremely potent cardiotoxins and neurotoxins found in the Aconitum species of plants [1,2].  There are high levels of aconite alkaloids in all parts of the plant, with ..read more

A 53-year-old woman with no significant past medical history presented to the emergency department with a 3-day history of double vision on leftward gaze. She initially presented to urgent care with a chief complaint of chest heaviness and concern that her blood pressure was too high, but was sent to the emergency department for further cardiac and neurological evaluation after her urgent care provider noticed abnormal eye movement. She endorsed mild, intermittent headaches associated with diplopia when looking to the left. However, she denied any blurry vision when looking forward. She de ..read more

A 30-year-old female with a past medical history of Crohn’s Disease presented to the ED for evaluation of an acutely bruised right 4th finger. She stated she was typing on a computer keyboard approximately 10 minutes prior to presentation and she noticed a sudden popping sensation at the base of her right ring finger. After the popping sensation, she noticed a cool sensation of the finger and numbness to the entire finger. Shortly after that, the finger turned purple, so she came to the Emergency Department for evaluation. She denied pain in the hand and has had no problems moving the fing ..read more

A 28-year-old male presented to the ED for evaluation of an injury to his right eye. While working out with an exercise band, it snapped back, hitting the patient in the right eye. He experienced blurry vision and excess eye tearing immediately after the incident occurred. The patient also developed gross blood over the front of the eye. Physical Exam Vitals: Temp 98°F, HR 73, BP (135/77), RR 16, SpO2 99% HEENT: Gross blood in the anterior portion of the right eye (grade I). The right pupil is dilated with minimal responsiveness to light. Visual Acuity: OD 20/70, OS 20/10, Both 20/10 ..read more

In July 2022, a 32-year-old male with a past medical history of HIV (on antiretroviral therapy, CD4 390, viral load undetectable) presented to the emergency department with constitutional symptoms and a rash for 4-5 days. His symptoms included malaise, body aches, subjective fevers, a sore throat, tender, swollen neck glands, body rash, and irritation of his left eye. He also noticed fluid-filled vesicles on his face, neck, trunk, and extremities. He denied travel outside the U.S. but reported a recent trip to New Orleans. He denied any new sexual partners or known exposure to individuals ..read more

Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric renal and bladder ultrasonography. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU Quiz: Pediatric Renal and Bladder Ultrasound Module Goals List the indications for performing a pediatric renal/bladder point-of-care ultrasound (POCUS) Describe the technique for performing renal/bladder POCUS Identify hydronephrosis and its appearance at different severities List the limitations of renal/bladder POCUS A ..read more

Which medication can be derived from the bark of the pictured tree? Aspirin Atropine Colchicine Quinine Reveal the Answer 1. Aspirin Background The photo shows a weeping willow, a member of the Salix genus of trees. Willow tree bark contains salicin from which aspirin (acetylsalicylic acid) can be derived. For over 3500 years, willow bark has been used as a traditional medicine to treat fevers and pain [1]. The active compound, salicin, is metabolized to salicylic acid in the body providing analgesic and antipyretic effects [2]. In 1897, Dr. Felix Hoffman modified salicylic acid and cre ..read more