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 […]
Japan has a universal healthcare system, and this paper describes the reality of the healthcare services provided, as well as current issues with the system.
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.
Author Affiliation J. Toscano, MD San Ramon Regional Medical Center, San Ramon, CA To the Editor: When I first saw the title of the study by Julie Gorchynski et al in the February 2007 issue of the Western Journal of Emergency Medicine, I thought, “Eureka!” We surely have to reason our way through a great […]
A 22-year-old intoxicated male presented to the emergency department after jumping from a second-story window, landing on his right foot. He was able to ambulate with a great deal of pain across the dorsum of his foot. Physical examination revealed significant tenderness to palpation over the second metatarsal with minimal edema.
A 40-year-old female presented to the emergency department with a one-week history of URI symptoms and a one-day history of more severe throat pain and swelling.
A 62-year-old Asian male with a past medical history significant for diabetes mellitus, hypertension, and prior surgical correction of a retinal detachment of the right eye presented to the emergency department (ED) for further evaluation of an abnormal examination by his optometrist.
A 42-year-old patient presented with chest pain and shortness of breath. The pain was atypical for cardiac disease, started suddenly, occurred at rest and was non-radiating.
Author Affiliation Chris Feier, MD Department of Emergency Medicine, Keck School of Medicine University of Southern California INTRODUCTION “Clinical Emergency Medicine (EM) Algorithms” was born out of my frustration with the educational process in medicine. Throughout medical school, professors teach us by a disease-based system. We read textbooks and learn about Takayasu’s Arteritis andDiphyllobrohtium […]
A 19-year-old female with Systemic Lupus Erythematosus (SLE) presented with ischemia of her left hand following trauma. Medical therapy was initiated but failed to improve her symptoms, and revision amputation was ultimately performed. The patient’s final diagnosis was digital ischemia due to secondary Raynaud’s Phenomenon (RP). The authors discuss diagnosis, complications, and treatment of this relatively uncommon disorder. The authors report this case in order to discuss how secondary RP can be complicated by ischemia and the multidisciplinary approach that needs to take place to prevent the latter from occurring.
Author Affiliation Joseph Brownfield, MD Department of Emergency Medicine, Keck/USC School of Medicine, Los Angeles, CA Mel Herbert, MD Department of Emergency Medicine, Keck/USC School of Medicine, Los Angeles, CA INTRODUCTION Reading EKGs is an integral skill in Emergency Medicine, especially given the fact that determining the presence and amount of ST segment elevation […]
Author Affiliation Gus M. Garmel, MD Stanford University School of Medicine/Kaiser Permanente, Santa Clara INTRODUCTION Patients presenting to the emergency department (ED) with electrocardiograms (ECGs) indicating wide complex tachycardias (WCTs) are difficult to manage. Furthermore, these ECGs are often challenging to interpret.1,2 Patients typically have ongoing chest discomfort, with or without symptoms of dyspnea, lightheadedness, […]
Author Affiliation Robert W. Derlet, MD University of California, Davis School of Medicine, Department of Emergency Medicine John R. Richards, MD University of California, Davis School of Medicine, Department of Emergency Medicine INTRODUCTION Over the past decade, emergency department (ED) crowding has occurred and progressed. It has become a major topic of discussion at […]