A 41-year-old Guatemalan woman with a history of remote uterine cancer presented to an urban community Emergency Department complaining of a pruritic, initially painful rash on her chest, eyelids, thighs, and elbows for three weeks.
A 55-year-old Hispanic male had a pacemaker placed in Mexico approximately one year prior to presenting to the Emergency Department. He noticed minor discomfort in his left chest one month earlier but did not see a physician.
An 11-month-old Hispanic male was brought to the emergency department (ED) by paramedics after being struck in his stroller by a full-size pickup truck. Witnesses told medics on the scene that the stroller was pushed 20 feet but did not tip over, and the patient was not ejected.
Author Affiliation David T. Schwartz, MD Associate Professor of Emergency Medicine, New York University School of Medicine In a recent review published in the New England Journal of Medicine, DJ Brenner and EJ Hall, professors of Radiation Biology at Columbia University, analyzed the current trend to increased use of computed tomography (CT) scanning, the attendant […]
Author Affiliation Sean O. Henderson, MD Keck School of Medicine of the University of Southern California Over the past 12 to 18 months I have heard from numerous sources that emergency physicians are using too much diagnostic radiation. The federal government (Biological Effects of Ionizing Radiation VII), the radiology community and several subspecialty groups […]
This case study describes a pregnant patient with vaginal bleeding who had a bedside endovaginal ultrasound in the emergency department (ED). The emergency physician identified a live intra-uterine pregnancy (IUP) with another structure that appeared to be a second gestational sac. The patient subsequently had an endovaginal ultrasound in the radiology department 46 minutes later. The attending radiologist described one live IUP and a subchorionic hemorrhage. Comparison of the ED and radiology ultrasound showed that the second structure, identified as a subchorionic hemorrhage, had significantly decreased in size. Endovaginal ultrasound in the evaluation of possible ectopic pregnancy is a useful bedside tool in the ED. We discuss a pitfall that can occur with endocavitary ultrasound when a twin gestation is presumed.
This case report describes a sternoclavicular infection in an IV drug user. The history and physical exam suggested an abscess. In the emergency department (ED) the patient refused incision and drainage but did consent to simple needle aspiration. Subsequent culture of the aspirate revealed Pseudomonas aeruginosa. He was admitted for IV antibiotics. After admission, a bone scan suggested the presence of osteomyelitis. The patient refused operative débridement, but ultimately did consent to bedside incision and drainage. By day five, the fever had resolved and the patient signed out AMA. He was given a prescription for Ciprofloxacin. The patient had an unscheduled follow up in the ED five months later for an unrelated heroin overdose. Physical examination demonstrated complete resolution of the infection.
Takotsubo cardiomyopathy (TCM) is an unusual form of acute cardiomyopathy showing left ventricular apical ballooning. It is often triggered by intense physical or emotional distress. We report here four cases of TCM and a review of the literature on the topic.
Author Affiliation Gus M. Garmel, MD Stanford University School of Medicine/Kaiser Permanente, Santa Clara INTRODUCTION Patients who present with electrocardiograms (ECGs) demonstrating wide complex tachycardias (WCTs) are often challenging to clinicians. Not only may the patient present with (or be at risk for) hemodynamic compromise, but their treatment may result in hemodynamic collapse if […]
With regard to sedative agents used in procedural sedation and analgesia (PSA), such as etomidate, the focus has been on variables usually related to side effect profile and the success rates of various procedures, with both variables specifically taking place during the patients’ stay in the emergency department (ED). There have been no extensive data on the functional status of patients after they leave the ED following PSA.
Author Affiliation Claudia A. Santucci, MD Kern Medical Center, Department of Emergency Medicine Thomas B. Purcell, MD Kern Medical Center, Department of Emergency Medicine Carlo Mejia Kern Medical Center, Department of Emergency Medicine ABSTRACT Introduction: The objective of this study was to determine if the white blood cell count can predict severity of injury […]
Decision-support tools (DST) are typically developed by computer engineers for use by clinicians. Prototype testing DSTs may be performed relatively easily by one or two clinical experts. The costly alternative is to test each prototype on a larger number of diverse clinicians, based on the untested assumption that these evaluations would more accurately reflect those of actual end users.