Ultrasound-guided nerve blocks are fast becoming a core part of opioid-sparing, multimodal, acute pain management in the emergency department (ED) setting. The ultrasound-guided erector spinae plane block (ESPB) has been shown to be effective in treating a variety of musculoskeletal and neuropathic painful conditions in the ED.
Tension hydrothorax is an uncommon emergent condition in which hemodynamic instability and respiratory compromise may occur. Emergency physicians may diagnose tension hydrothorax by point-of-care ultrasound.
A 57-year-old male veteran presented to the emergency department for recurrent fevers for 10 days. The patient was febrile but had an overall benign physical exam. This interesting case explores the broad differential diagnosis and evaluation in a patient who presents with fever of unknown origin.
Author Affiliation Samuel G. Rouleau, MD University of California Davis Health, Department of Emergency Medicine, Sacramento, California Martin A.C. Manoukian, MD University of California Davis Health, Department of Emergency Medicine, Sacramento, California Gordon X. Wong, MD University of California Davis Health, Division of Cardiovascular Medicine, Department of Internal Medicine, Sacramento, California David K. Barnes, MD […]
Author Affiliation Madison C. Winstead, University of Kentucky College of Pharmacy, Lexington, Kentucky Kimberly J. Wells, MD University of Kentucky HealthCare, Department of Emergency Medicine, Lexington, Kentucky Gavin T. Howington, PharmD University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, Lexington, Kentucky; University of Kentucky HealthCare, Department of Pharmacy Services, Lexington, Kentucky […]
Author Affiliation Nicholas Bielawa, MS, PA-C North Shore University Hospital, Manhasset, Department of Emergency Medicine, New York Allison Cohen, MD North Shore University Hospital, Manhasset, Department of Emergency Medicine, New York Milan Patel, DO North Shore University Hospital, Manhasset, Department of Emergency Medicine, New York Brendon Stankard, PA-C North Shore University Hospital, Manhasset, Department of […]
Author Affiliation Daniel Mitchell, BS The University of Vermont – Larner College of Medicine, Burlington, Vermont Quinn Self, MD The University of Vermont Health Network, Department of Otolaryngology Surgery, Burlington, Vermont Carolyn Orgain, MD The University of Vermont Health Network, Department of Otolaryngology Surgery, Burlington, Vermont Introduction Case report Discussion Conclusion ABSTRACT Introduction Unilateral nasal […]
Author Affiliation Alexander Piszker, DO, MS Michigan State University College of Osteopathic Medicine, Trinity Health Muskegon Emergency Medicine Residency, Muskegon, Michigan Nicholas McManus, DO Michigan State University College of Osteopathic Medicine, Trinity Health Muskegon Emergency Medicine Residency, Muskegon, Michigan Introduction Case report Discussion Conclusion ABSTRACT Introduction Psychosis associated with coronavirus disease 2019 (COVID-19) has been […]
Author Affiliation Daria Osipchuk, MD Keck School of Medicine of University of Southern California, Department of Emergency Medicine, Los Angeles, California Jeffrey Riddell, MD Keck School of Medicine of University of Southern California, Department of Emergency Medicine, Los Angeles, California Introduction Case report Discussion Conclusion ABSTRACT Introduction Infectious extensor tenosynovitis is a rare infection spreading […]
Author Affiliation Debayan Guha, MD Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Medical Centers, Bronx, New York Franz C. Mendoza-Garcia, MD Albert Einstein College of Medicine, Department of Emergency Medicine at the Jacobi and Montefiore Medical Centers, Bronx, New York Kathryn M. Millen, MD Albert Einstein College of […]
Author Affiliation Nicholas Valentini, MD University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan Madison Breeden, MD University of Michigan, Department of Internal Medicine, Division of Infectious Disease, Ann Arbor, Michigan Laura E. Felley, MD, PhD University of Michigan, Department of Internal Medicine, Division of Infectious Disease, Ann Arbor, Michigan Nathan B. Roberts, MD, […]
Author Affiliation Jonathan Henry Brewer, MD Vanderbilt University Medical Center, Department of Emergency Medicine, Division of Emergency Ultrasound, Nashville, Tennessee Noah Sanders, MD Highland Hospital, Department of Emergency Medicine, Oakland, California Alexander Ayala, MD Highland Hospital, Department of Emergency Medicine, Oakland, California Arun Nagdev, MD Highland Hospital, Department of Emergency Medicine, Oakland, California Introduction Technique […]
Author Affiliation Bryan P. McNeilly, MD University of Maryland Medical Center, Department of Emergency Medicine, Baltimore, Maryland Dominic M. Williams, DO CarolinaEast Medical Center, Department of Emergency Medicine, New Bern, North Carolina Laura J. Bontempo, MD, MEd University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland J. David Gatz, MD University of […]
Author Affiliation Shantal Tummings, BS Loma Linda University School of Medicine, Laboratory for Innovations in Medical Education, Loma Linda, California Sierra Garrett, BS Loma Linda University School of Medicine, Laboratory for Innovations in Medical Education, Loma Linda, California Ja’Neil G. Humphrey, BS Loma Linda University School of Medicine, Laboratory for Innovations in Medical Education, Loma […]
A 92-year-old female with past medical history of hypertension presented to the emergency department with pain in her right shoulder, right flank, and right upper quadrant of her abdomen. Point-of-care ultrasound (POCUS) and computed tomography imaging showed concerns for multiple large hepatic abscesses. Percutaneous drainage removed 240 millileters of purulent fluid that identified Fusobacterium nucleatum, a rare cause of pyogenic liver abscess.
A 22-year-old female presented to the emergency department with a dilated right pupil and mild blurry vision. Physical examination revealed a dilated, sluggishly reactive right pupil, without other ophthalmic or neurologic abnormalities. Neuroimaging was normal. The patient was diagnosed with unilateral benign episodic mydriasis (BEM).
This is a case report of an implanted penile prosthetic visualized during focused assessment with sonography for trauma (FAST) examination. The case represents a unique finding near the lateral bladder that may confound assessment of intraperitoneal fluid collections during initial assessment of trauma patients.
Late atrial arrhythmias after catheter ablation for atrial fibrillation occur in up to 30% of post-ablation patients and are increasingly encountered by emergency physicians. However, diagnosing the exact mechanism of the arrhythmia on the surface electrocardiogram (ECG) remains challenging due to atrial scarring leading to heterogeneous P-wave morphology.
Neuropathy of the lateral femoral cutaneous nerve, also known as meralgia paresthetica, causes pain and paresthesia to the anterolateral thigh. It commonly results from nerve irritation from extrinsic compression; however, it may occur spontaneously. Symptoms from this condition can be debilitating, and the pain may be ascribed to other conditions leading to delays in diagnosis. Peripheral nerve blockade can be useful both diagnostically and therapeutically for meralgia paresthetica.
We describe a case of left internal jugular central venous access with rare malpositioning into the internal mammary vein. Despite various confirmatory measures at the time of placement including ultrasonography of the internal jugular vein, as well as blood gas analysis consistent with venous blood by oxygen saturation and good venous flow in all three ports of the catheter, subsequent imaging confirmed misplacement into the internal mammary vein.
A 72-year-old female presented to the emergency department (ED) with exacerbation of chronic obstructive pulmonary disease and congestive heart failure. The patient required intubation for airway protection and hypercapnic respiratory failure. The ED team used a video laryngoscope, Macintosh 3 blade and bougie as the endotracheal tube delivery device. Despite a grade 2a Cormack-Lehane airway view, the bougie repeatedly missed left posterolateral to the airway. During these missed attempts, the emergency medicine (EM) resident’s shoulder was noted to be abducted. The EM resident then readjusted his technique by adducting the shoulder. which allowed the tip of the bougie to pass the vocal cords resulting in successful intubation.
Acute traumatic limb injury is a common complaint of patients presenting to the emergency department (ED). Ketamine is an effective analgesic administered via intravenous (IV), intranasal (IN), intramuscular (IM), and nebulized routes in the ED. It has also been used in the prehospital setting via IV, IM, and IN routes. Recent studies have proposed the prehospital use of nebulized ketamine via breath-actuated nebulizer (BAN) as a noninvasive and effective method of analgesic delivery, as well as an alternative to opioid analgesia.
An acute subdural hematoma is a collection of blood in the space between the dural and arachnoid membranes overlying the brain. Head trauma is the most common cause. Less frequently, low cerebrospinal fluid pressure, due to a spontaneous or iatrogenic cerebrospinal fluid leak can result in a subdural hematoma.
The Portuguese man o’ war, an aquatic invertebrate, is responsible for a large proportion of cnidarian stings worldwide. Cnidaria is a phylum that contains the genus Physalia. These injuries result in severe pain and skin irritation, which are often difficult to control. Traditionally, cnidarian stings have been treated by emergency physicians with warm water, vinegar and, in severe cases, opioids. However, no concrete guidelines have been established for pain management in man o’ war stings.
Popliteal artery aneurysms are in most cases asymptomatic but cause significant complications if ruptured. An acute popliteal aneurysm rupture is relatively rare, and few cases have been documented secondary to blunt trauma. Common presenting signs and symptoms include distal limb ischemia and absent dorsalis pedis pulses. Timely management and recognition of this rare presentation are crucial as this condition can result in limb loss or death if not treated in a timely manner.
