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Education

Need for Injury-Prevention Education in Medical School Curriculum

Injury is the leading cause of death and disability among the U.S. population aged 1 to 44 years. In 2006 more than 179,000 fatalities were attributed to injury. Despite increasing awareness of the global epidemic of injury and violence, a considerable gap remains between advances in injury-prevention research and prevention knowledge that is taught to medical students. This article discusses the growing need for U.S medical schools to train future physicians in the fundamentals of injury prevention and control. Teaching medical students to implement injury prevention in their future practice should help reduce injury morbidity and mortality. Deliberate efforts should be made to integrate injury-prevention education into existing curriculum. Key resources are available to do this. Emergency physicians can be essential advocates in establishing injury prevention training because of their clinical expertise in treating injury. Increasing the number of physicians with injury- and violence- prevention knowledge and skills is ultimately an important strategy to reduce the national and global burden of injury.

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Critical Care

Luxatio Erecta Complicated By Anterior Shoulder Dislocation During Reduction

Luxatio erecta humeri is an uncommon form of glenohumeral dislocation, resulting in the inferior displacement of the humeral head. Treatment with traction-counter traction techniques is usually successful in reducing most cases. We describe an unusual complication of this condition where initial reduction attempts of a luxatio erecta humeri repositioned the shoulder to an anterior dislocation position. After a thorough search of the literature, we were unable to find a similar case report of this type of complication during the reduction of a luxatio erecta shoulder dislocation.

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Posterior Knee Dislocation

A 38-year-old male presented to the Emergency Department (ED) after a motorcycle crash. The patient was unable to walk because of isolated left knee pain.

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Fournier Gangrene

A 51-year-old male with hepatitis C and a history of intravenous (IV) drug use presented to the emergency department, reporting one day of worsening scrotal pain and swelling. He denied diabetes, trauma, or infection with HIV.

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Necrotizing Fasciitis of the Paraspinous Muscles

Necrotizing fasciitis (NF) is a rare and lethal soft tissue infection that requires urgent surgical intervention. It is most often found in the extremities occurring with precipitating trauma or in immunocompromised states. Signs and symptoms are often vague or missing making early diagnosis very difficult. Our patient presented with flank pain and altered mental status but no known precipitating factors. Computed Tomography showed gas within and around the right paraspinous muscle suspicious for NF. Given NF’s high lethality, early suspicion by emergency physicians of NF in patients with soft tissue infections or with systemic findings of unknown etiology is necessary.

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To identify factors associated with culture-proven serious bacterial infection (SBI) and positive emergency department septic screening (EDSS) tests in children with bronchiolitis and to identify factors associated with the performance of EDSS.

To identify factors associated with culture-proven serious bacterial infection (SBI) and positive emergency department septic screening (EDSS) tests in children with bronchiolitis and to identify factors associated with the performance of EDSS.

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Raccoon Eyes

A 31-year-old male presented to the emergency department with a chief complaint of headache after being assaulted with a baseball bat to the head. He denied loss of consciousness, nausea or vomiting.

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Wells Syndrome

A 31-year-old Caucasian female presented to the emergency department (ED) with chief complaint of a gradually progressive right extremity rash for past two days.

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Massive Pneumoperitoneum

An 82-year-old female presented to the emergency department with acute worsening of abdominal pain, which had been present for three months.

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Atypical Guillain-Barré in the Emergency Department

Guillain Barré Syndrome (GBS), although an uncommon diagnosis in the emergency department (ED), usually presents as one of the more common chief complaints—weakness. In this report we present an unusual case of weakness, initially seen in the ED and sent home only to return with worsening symptoms and ultimately found to be GBS.

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Small Bowel Obstruction from Capsule Endoscopy

Over the past decade, capsule endoscopy has become the accepted modality for small bowel imaging in the United States. It is very helpful in making the diagnosis of Crohn’s disease; however, this patient population is also at an increased risk of small bowel obstruction secondary to capsule impaction. We present the case of a 60-year-old female with undiagnosed Crohn’s disease who presented to the emergency department with small bowel obstruction after capsule ingestion. She was successfully disimpacted with diatrizoate upper gastrointestinal (GI) series with small bowel follow-through and intravenous steroids. Review of the endoscopic video images revealed findings consistent with Crohn’s disease.

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Fatal Dysrhythmia Following Potassium Replacement for Hypokalemic Periodic Paralysis

We present a case of fatal rebound hyperkalemia in a patient with thyrotoxic periodic paralysis (TPP) treated with potassium supplementation. Although TPP is a rare hyperthyroidism-related endocrine disorder seen predominantly in men of Asian origin, the diagnosis should be considered in patients of non-Asian origins presenting with hypokalemia, muscle weakness or acute paralysis. The condition may present as a life threatening emergency and unfamiliarity with the disease could result in a fatal outcome. Immediate therapy with potassium chloride supplementation may foster a rapid recovery of muscle strength and prevent cardiac arrhythmias secondary to hypokalemia, but with a risk of rebound hyperkalemia.

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The Physiologic Effects of Multiple Simultaneous Electronic Control Device Discharges

Law enforcement and military personnel use electronic control devices to control non-compliant and actively resistive subjects. The TASER® Shockwave is a new electronic control device designed specifically as an area denial device capable of delivering multiple simultaneous discharges. This is the first study to examine the effects of multiple simultaneous device discharges in humans.

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
Suite 640
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: westjem@gmail.com

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WestJEM
ISSN: 1936-900X
e-ISSN: 1936-9018

CPC-EM
ISSN: 2474-252X

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.