Volume 15, Issue 4, July 2014
Mark I. Langdorf, MD, MHPE et al.
Cost and radiation risk have prompted intense examination of trauma patient imaging. A proposed decision instrument (DI) for the use of chest computed tomography (CT), (CCT) in blunt trauma patients includes thoracic spine (TS) tenderness, altered mental status (AMS) and distracting painful injury (DPI) as potential predictor variables. TS CT is a separate, costly study whose value is currently ill-defined. The objective of this study is to determine test characteristics of these predictor variables alone, and in combination, to derive a TS injury DI.
Volume 15, Issue 4, July 2014
Landon A. Jones, MD et al.
Traumatic brain injury (TBI) is a significant health concern. While 70–90% of TBI cases are considered mild, decision-making regarding imaging can be difficult. This survey aimed to assess whether clinicians’ decision-making was consistent with the most recent American College of Emergency Physicians (ACEP) clinical recommendations regarding indications for a non-contrast head computed tomography (CT) in patients with mild TBI.
Volume 15, Issue 4, July 2014
Victoria L. Thornton, MD, MBA et al.
Patients with sickle cell disease (SCD) often seek care in emergency departments (EDs) for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1) explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA) in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made) for patients with SCD, and 2) report the failures of these care processes in each ED.
Volume 15, Issue 4, July 2014
Michael A. Yokell, ScB et al.
Emergency department (ED) screening and counseling for alcohol misuse have been shown to reduce at-risk drinking. However, barriers to more widespread adoption of this service remain unclear.
Volume 15, Issue 4, July 2014
Kenneth Deitch, DO et al.
The incidence of respiratory depression in patients who are chemically sedated in the emergency department (ED) is not well understood. As the drugs used for chemical restraint are respiratory depressants, improving respiratory monitoring practice in the ED may be warranted. The objective of this study is to describe the incidence of respiratory depression in patients chemically sedated for violent behavior and psychomotor agitation in the ED.
Volume 15, Issue 4, July 2014
Maya Subbarao Iyer, MD et al.
The Pediatric Emergency Department (PED) provides medical students with learning in a high-volume, fast-paced environment; characteristics that can be stressful for new students. Shadowing can improve transitioning, yet this alone does not facilitate students’ development of independent medical care competencies. This study evaluates if third-year medical students’ deliberate apprenticeship with senior residents increases students’ comfort and patient exposure in the PED.
Volume 15, Issue 4, July 2014
Kristi H. Grall, MD, MHPE et al.
The standard letter of recommendation in emergency medicine (SLOR) was developed to standardize the evaluation of applicants, improve inter-rater reliability, and discourage grade inflation. The primary objective of this study was to describe the distribution of categorical variables on the SLOR in order to characterize scoring tendencies of writers.
Volume 15, Issue 4, July 2014
Taher Vohra, MD et al.
The Department of Health and Human Services and Food and Drug Administration described guidelines for exception from informed consent (EFIC) research. These guidelines require community consultation (CC) events, which allow members of the community to understand the study, provide feedback and give advice. A real-time gauge of audience understanding would allow the speaker to modify the discussion. The objective of the study is to describe the use of audience response survey (ARS) technology in EFIC CCs.
Volume 15, Issue 4, July 2014
Joshua N. Burkhardt, BS et al.
The purpose of this study was to determine cardiopulmonary resuscitation (CPR) knowledge of hospital providers and whether knowledge affects performance of effective compressions during a simulated cardiac arrest.
Volume 15, Issue 4, July 2014
David A. Wald, DO et al.
The emergency medicine clerkship director serves an important role in the education of medical students. The authors sought to update the demographic and academic profile of the emergency medicine clerkship director.
Volume 15, Issue 4, July 2014
Wesley Eilbert, MD et al.
Mesenteric venous thrombosis is a rare cause of abdominal pain, which if left untreated may result in bowel infarction, peritonitis and death. The majority of patients with this illness have a recognizable, predisposing prothrombotic condition. Oral contraceptives have been identified as a predisposing factor for mesenteric venous thrombosis in reproductive-aged women. In the last fifteen years new methods of hormonal birth control have been introduced, including a transdermal patch and an intravaginal ring. In this report, we describe a case of mesenteric venous thrombosis in a young woman caused by a vaginal contraceptive ring.
Volume 15, Issue 4, July 2014
Tarina L. Kang, MD et al.
A 36 year-old man with a history of a complicated oral surgery from a complex mandibular fracture months prior presented with traumatic right eye swelling, tearing, and redness.
Volume 15, Issue 4, July 2014
Kashyap Tadisina, BS et al.
Fireworks are used to celebrate a variety of religious, patriotic, and cultural holidays and events around the world. Fireworks are common in the United States, with the most popular holiday for their use being national Independence Day, also known as July Fourth.
Volume 15, Issue 4, July 2014
Maryam Kia, MD et al.
A 55-year-old woman with a 3-month history of abdominal pain presented to the emergency department with chief complaints of worsening abdominal pain and per os intolerance since 3 days ago. Her medical history was noteworthy for watery diarrhea without fever, loss of appetite, weight loss, and nausea and vomiting.
Volume 15, Issue 4, July 2014
Vu Huy Tran, MD et al.
Ketamine associated urinary dysfunction has become increasingly more common worldwide. Point-of-care ultrasound (POCUS) is an established modality for diagnosing hydronephrosis in the emergency department. We describe a case of a young male ketamine abuser with severe urinary urgency and frequency in which POCUS performed by the emergency physician demonstrated bilateral hydronephrosis and a focally thickened irregular shaped bladder. Emergency physicians should consider using POCUS evaluate for hydronephrosis and bladder changes in ketamine abusers with lower urinary tract symptoms. The mainstay of treatment is discontinuing ketamine abuse.
Volume 15, Issue 4, July 2014
William Hurley, MD et al.
We describe a case series of seven patients presenting to an emergency department with symptoms of paralytic shellfish poisoning. They developed varying degrees of nausea, vomiting, diarrhea, weakness, ataxia and paresthesias after eating mussels harvested from a beach near their resort. Four patients were admitted to the hospital, one due to increasing respiratory failure requiring endotracheal intubation and the remainder for respiratory monitoring. All patients made a full recovery, most within 24 hours. The ability to recognize and identify paralytic shellfish poisoning and manage its complications are important to providers of emergency medicine.
Volume 15, Issue 4, July 2014
Jean Chin-Yu Lo, MD et al.
Rivaroxaban is a newer anticoagulant initially approved by the Food and Drug Administration to treat nonvalvular atrial fibrillation. Rivaroxaban has several characteristics that are more favorable than warfarin. One of the characteristics is decreased risk of hemorrhage. We report one of the first case reports of severe intracranial hemorrhage associated with rivaroxaban in an elderly patient with decreased renal function. We aim to alert emergency medicine providers regarding the likelihood of encountering these patient as newer anticoagulants rise in popularity.
Volume 15, Issue 4, July 2014
Jared Sutton, MD et al.
A 2 year old fully immunized male with no personal history of chicken pox presented to the emergency department with a chief complaint of a rash for one week after returning from a hiking trip in a remote island in Canada. After initially being diagnosed with contact dermatitis, a diagnosis of herpes zoster was made by confirmatory viral polymerase chain reaction testing. The purpose of this case report is to examine the literature for the incidence and etiology of shingles in children without a prior history of a primary varicella rash outbreak.
Volume 15, Issue 4, July 2014
Daniel M. Aronovich, DO et al.
A 44 year-old Caucasian male was found floating in the sea for an unknown duration of time and was pulled out by fire rescue paramedics. He was unconscious, pulseless, and in asystole as determined by emergency medical services. Cardio-pulmonary resuscitation (CPR) was commenced immediately.
Volume 15, Issue 4, July 2014
Serpil Yaylaci, MD et al.
An 11-year-old boy was admitted to emergency department with abdominal pain, bilious vomiting and rectal bleeding one day after falling from bicycle. He stated that he landed directly onto the handlebar through his left lower quadrant of the abdomen.
Volume 15, Issue 4, July 2014
Caleb P. Canders, MD et al.
A 42-year-old woman presented with a left lower extremity ulcer. Three weeks prior, she had been struck by a motor vehicle and developed bullae on her thigh, the main area of impact. She could not afford to see a primary doctor, and had been applying a low-cost, over-the-counter topical antiseptic solution to the site since the accident.
Volume 15, Issue 4, July 2014
Jesse Kellar, MD et al.
A 19-year-old man presented to the emergency department complaining of two days of right arm pain and swelling. The pain started while lifting weights. He did not experience a pop or pulling sensation. He stated his arm felt a little cold but otherwise denied numbness or tingling. He denied chest pain, neck pain or shortness of breath.
Volume 15, Issue 4, July 2014
Danielle D. Campagne, MD et al.
A restrained 20 year old male driver presents after a rollover motor vehicle collision. He is repetitive after sustaining a loss of consciousness, but is a Glasco Coma Scale of 15 on arrival. He is complaining of left ear and shoulder pain. He has no focal findings other than a ruptured left tympanic membrane
Volume 15, Issue 4, July 2014
Ozlem Bilir, MD et al.
A 60 year old female, with a history of atrial fibrillation who was on warfarin therapy, presented to our emergency department with chief complaint of the most severe headache that she ever had. Her vital signs, systemic and neurological examinations were normal.
Volume 15, Issue 4, July 2014
Jiro Tamura, MD et al.
A 59-year-old man had been admitted to our hospital three times with tarry stool, hematemesis, and abdominal discomfort. His medical history included no abdominal operation. Repeated upper endoscopy, colonoscopy, and computed tomography (CT) had been negative.
Volume 15, Issue 4, July 2014
Michael R. Minckler, MD et al.
A 51-year-old male with a history of chronic obstructive pulmonary disease and obstructive sleep apnea presents to the emergency department complaining of 48 hours of progressive right eye pain and swelling after he ran into his dresser while sleep-walking. He does not know which surface of the dresser contacted his eye. He denies changes in visual acuity, flashes, or floaters.
