Paucis Verbis card: Angioedema

Angioedema Lip

Recently, a patient presented with angioedema after starting taking an ACE-inhibitor. There was upper lip swelling, similar appearing to the case above. He also experience a hoarse voice. Before the advent of fiberoptic nasopharyngoscopy, it was assumed that there may be laryngeal edema. Fortunately, using technology, we were able to visualize a normal epiglottis and a grossly normal laryngeal anatomy.


By |2019-01-28T23:49:23-08:00Mar 26, 2010|ALiEM Cards, Allergy-Immunology, ENT|

Trick of the trade: Ear foreign body extraction

BeadsA 6-year old boy has placed a hard bead in his ear and presents to the ED for care. How do you remove this foreign body as painlessly as possible? You can just barely see the edge of the bead by just looking at the external ear.

By experience, you know that mini-Alligator clips and forceps will not be able to sufficiently grab the edges of the bead. Additionally it may push the bead in even further.


By |2019-02-19T18:08:04-08:00Mar 24, 2010|ENT, Tricks of the Trade|

Paucis Verbis card: Knee exam

Knee PainHow accurate is the clinical knee exam?

JAMA published a meta-analysis trying to answer this question. Although they include patients with acute and chronic knee pain, it’s a good general review of the knee anatomy, historical clues, and exam elements.

In the ED, the knee exam is challenging because we see very acute injuries where knee pain and swelling often preclude an accurate exam. For patients with an equivocal exam, be sure to refer for orthopedic follow-up. A repeat exam should be performed once the pain and swelling subside.


By |2019-01-28T23:48:53-08:00Mar 19, 2010|ALiEM Cards, Orthopedic|

Tricks of the trade: Chemical sedation options

 DilatedPupilsmYou walk into a room where a patient is screaming and thrashing about in his/her gurney from some stimulant abuse. PCP, cocaine, methamphetamine… or all of the above.

When the number of people (police officers, security guards, nurses) is greater than the patient’s pupil size, you KNOW that you’ll need some chemical sedation.

What intramuscular sedation regimen do you use?


By |2016-11-11T19:01:31-08:00Mar 17, 2010|Tricks of the Trade|
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