An 11-year-old female presented to the emergency department with fever of 1 day’s duration and sore throat. Her family described a 3-week history of cough with fever, trouble breathing, and wheezing.
We report the case of a 22-year-old Marine who presented to the emergency department, after a martial arts exercise, with transient weakness and numbness in all extremities. Computed tomography cervical spine radiographs revealed os odontoideum. Lateral flexion–extension radiographs identified atlanto-axillary instability. This abnormality is rare and can be career ending for military members who do not undergo surgical fusion.
Although pneumomediastinum (PM) is a cause of chest pain, which can be diagnosed on a plain chest radiograph, emergency physicians frequently miss the diagnosis. As follows a description of findings of PM on a chest radiograph.
A 40-year-old male with human immunodeficiency virus (currently, CD4 171) presented to our emergency department (ED) with pain and swelling in the left third digit of 3 to 4 weeks’ duration. He noticed the swelling after a fist fight that resulted in compression of his ring on the finger.
Infants with food protein-induced enterocolitis syndrome (FPIES) may present to the emergency department (ED) with vomiting and hypotension. A previously healthy, 5-month-old male presented with vomiting and hypotension 2 to 3 hours after eating squash. The patient was resuscitated with intravenous fluids, antibiotics, and admitted for presumed sepsis.
Identifying fever can influence management of the emergency department (ED) patient, including diagnostic testing, treatment, and disposition. We set out to determine how well oral and tympanic membrane (TM) temperatures compared with rectal measurements.
A 35-year-old man presented to the emergency department complaining of right hip pain after being struck by a car while crossing the road. His vital signs were stable, and he complained of right hip pain. He had no other comorbidity. On examination, tenderness and reduced abduction were noted in his right hip, but the gait was normal.
We review the advantages and disadvantages of these therapies and recommend Three Factor PCC with small doses of rFVIIa and with vitamin K in life-threatening situations if Four Factor PCC is unavailable.
Tattoos and piercings are increasingly part of everyday life for large sections of the population, and more emergency physicians are seeing these body modifications (BM) adorn their patients. In this review we elucidate the most common forms of these BMs, we describe how they may affect both the physical and psychological health of the patient undergoing treatment, and also try to educate around any potential pitfalls in treating associated complications.
Prophylactic antibiotics have not been found to have a benefit in the setting of uncomplicated lacerations. We evaluated the proportion of patients with uncomplicated lacerations who are prescribed prophylactic antibiotics in the emergency department (ED), factors that physicians considered when prescribing antibiotics, and factors associated with patient satisfaction.
The treatment of acute coronary syndrome (ACS) includes the administration of aspirin. Current guidelines recommend chewing aspirin tablets to increase absorption. While this is intuitive, there are scant data supporting this recommendation. The purpose of this study is to assess which of 3 different aspirin formulations is most rapidly absorbed after ingestion.
We discuss a case of a 64-year-old male with a history of liver failure presenting with altered mental status, initially diagnosed with hepatic encephalopathy but ultimately diagnosed with nonconvulsive status epilepticus (NCSE) by electroencephalogram (EEG). NCSE is a difficult diagnosis to make, given no clear consensus on diagnostic criteria. Especially in the intensive care unit setting of persistent altered mental status with no clear etiology, NCSE must be considered in the differential diagnosis, as the consequences of delayed diagnosis and treatment can be substantial. EEG can be useful in the evaluation of patients with hepatic encephalopathy who have persistently altered levels of consciousness despite optimal medical management.
The purpose of our study was to describe the evaluation and outcome of patients with ileus and bowel obstruction admitted to an emergency department (ED) observation unit (OU) and to identify predictors of successful management for such patients.
This study describes deep sedations performed for painful procedures completed in the emergency department at an academic tertiary care hospital during an 18-month period. One hundred consecutive cases were retrospectively reviewed to describe indications, complications, procedural lengths, medication dosing, and safety of these sedations. Propofol and etomidate were the preferred agents. We found that there were relatively few complications (10%), with only 2 of these (2%) being major complications. All complications were brief and did not adversely affect patient outcomes. This data further demonstrate the safety profile of deep sedation medications in the hands of emergency physicians trained in sedation and advanced airway techniques.
We hypothesized that a geriatric chief complaint–based didactic curriculum would improve resident documentation of elderly patient care in the emergency department (ED).
The objective of this study was to evaluate emergency medicine physician and nurse acceptance of nonnurse, nonphysician screening for geriatric syndromes.
We compared the immediate cosmetic outcome of metallic foreign-body removal by emergency medicine (EM) residents with ultrasound guidance and conventional radiography.
To assess characteristics, satisfaction, and disposition of emergency department (ED) patients who successfully received ultrasound (US)-guided peripheral intravenous (IV) access.
A 41-year-old man presented twice to the ED with history of abdominal pain and was diagnosed with primary cardiac angiosarcoma with point-of-care ultrasound.
Acalculous cholecystitis is thought to occur in patients with a severe systemic illness or during long periods of intravenous nutrition. We discuss a case of acalculous cholecystitis secondary to Epstein-Barr virus detected by bedside ultrasound. We hope to alert clinicians who are actively using bedside ultrasound of an important, yet not commonly discussed, association.
Incidental findings during ultrasound examinations occur frequently with live models in training sessions. Because of the broad scope of training sessions available, the ethics and guidelines of dealing with incidental findings in live models need to be discussed.
Reliable and accurate Web-based health information is extremely valuable when applied to emergency medical diagnoses. With this update we seek to build upon on the 2004 study by determining whether the completeness and accuracy of emergency medical information available online has improved over time.
The study objective was to determine the accuracy of answers to clinical questions by emergency medicine (EM) residents conducting Internet searches by using Google. Emergency physicians commonly turn to outside resources to answer clinical questions that arise in the emergency department (ED).
Our aim in this article is to perform a retrospective review of the current literature, studying simulation use in EM medical student clerkships. Studies have demonstrated the effectiveness of simulation in teaching basic science, clinical knowledge, procedural skills, teamwork, and communication skills.
The objective of this study is to identify (1) the current role of simulation in medical student emergency medicine (EM) education; (2) the challenges to initiating and sustaining simulation-based programs; and (3) educational advances to meet these challenges.