Diagnostic Acumen

Bilateral Inferior Shoulder Dislocation

Volume 16, Issue 1, January 2015
Erica Cacioppo, MD et al.

A 42-year-old male with a history of multiple shoulder dislocations presented to the emergency department via emergency medical services with both arms locked above his head, stating that he had been jumped at a bar and had since been unable to move his arms.

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Acute Idiopathic Compartment Syndrome of the Forearm in an Adolescent

Volume 16, Issue 1, January 2015
Kelley Smith, MD et al.

Acute compartment syndrome (ACS) is a condition typically associated with long bone fractures or severe trauma; however, non-traumatic etiologies also occur. We describe a case of an otherwise healthy female pediatric patient presenting with unilateral forearm pain without an inciting injury.

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Necrotizing Fasciitis Caused by Hypermucoviscous Klebsiella pneumoniae in a Filipino Female in North America

Volume 16, Issue 1, January 2015
Daniel Ng, MD et al.

Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis.

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Achilles Tendon Rupture

Volume 16, Issue 1, January 2015
Sean P. Stickles, MD et al.

A 60-year-old man presented to the emergency department complaining of acute onset posterior ankle pain. He reported playing tennis earlier in the afternoon when he suddenly stopped and pivoted, noting a “pop” sensation and pain to the right posterior ankle.

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Hemi Orolingual Angioedema After tPA administration for Acute Ischemic Stroke

Volume 16, Issue 1, January 2015
Bryan Madden, MD et al.

As studies continue to demonstrate the efficacy of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke, the exclusion criteria continue to narrow, and the time-window continues to increase. The most dreaded adverse effect of tPA, hemorrhagic conversion of an ischemic stroke, is well known and well published.

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Herpes Zoster Ophthalmicus Extending to the Palate

Volume 16, Issue 1, January 2015
Todd Schneberk, MD, MA et al.

A 57-year-old female presented to the emergency department with left sided facial rash with associated pain, blurred vision and oral discomfort. Past medical history included hypertension, and remote scleroderma (untreated).

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Persistent Pain After Lithotripsy

Volume 16, Issue 1, January 2015
Ellen Jones, MD et al.

A 36-year old man presents to the emergency room five days after undergoing extracorporeal shock wave lithotripsy (ESWL) for a symptomatic 11mm left renal pelvis stone. The patient has persistent symptoms of severe left flank pain at presentation.

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Survival from Cervical Necrotizing Fasciitis

Volume 16, Issue 1, January 2015
Jeniffer S. Gausepohl, MD et al.

A 59-year-old Caucasian man with past medical history significant for hypertension and hyperlipidemia presented to the emergency department with a four-day history of increasing throat pain and bilateral neck swelling. Associated symptoms included voice hoarseness, shortness of breath, dysphagia, and odynophagia.

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Chikungunya Fever in Los Angeles, California

Volume 15, Issue 7, November 2014
Katherine R. Harter, MD, MPH et al.

We report the case of a 33-year-old woman returning from Haiti, presenting to our emergency department (ED) with fever, rash and arthralgia. Following a broad workup that included laboratory testing for dengue and malaria, our patient was diagnosed with Chikungunya virus, which was then reported to the Centers for Disease Control and Prevention for initiation of infection control.

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Sydenham Chorea: Rare Consequence of Rheumatic Fever

Volume 15, Issue 7, November 2014
Paul J. Myers, DO, et al.

Sydenham Chorea (SC) is an acute rheumatic fever complication. SC is the most common acquired childhood chorea, usually affecting children five to fifteen years of age.1 It occurs following an untreated group A streptococcal infection and a latent period of one to six months.1,2 Despite rheumatic fever diminishing, 18% to 36% of acute rheumatic fever patients develop SC.3 Full recovery often takes several months; some patients suffer permanent neurologic sequelae.1

An 11-year old male presented to the Emergency Department with two days of uncontrolled body twitching. The movements affected his right arm and leg, with occasional lip twitches; he experienced intermittent confusion and hyperactivity. The patient denied recent illness, but recalled a fever with headache and vomiting several months prior. Besides the above findings, his physical examination was normal.

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Old Man with Groin Bruising

Volume 15, Issue 7, November 2015
Basak Bayram, MD et al.

A 67-year-old man presented to the emergency department with abdominal pain and groin bruising. He had no history of any disease or drug use.

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Hip Pain Secondary to Small Bowel Fistula to Pelvis

Volume 15, Issue 7, November 2014
Chris Cruz, MD, et al.

A 26-year old man presented to the emergency department for two months of worsening right hip and thigh pain. He complained of radicular pain from his buttocks to his calf and has difficulty bearing weight on his right leg. He denies a history of trauma, fever, prior surgery, or arthritis. In addition, he was being evaluated by a gastroenterologist for recurrent diarrhea. In the middle of his encounter, the radiologist called to discuss a result of his computed tomography (CT) performed three days prior. CT images showed inflamed loops of bowel involving the distal ileum and rectum. A fistula is seen from the rectum, extending into the distal ileal loop and the posterior pelvis (Figures 1 and 2). An abscess was found between the piriformis and gluteus medius. He was admitted for intravenous antibiotic therapy, including a consultation with general surgery for Chrohn’s Disease (CD). He responded well to antibiotics and was discharged six days later.

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Intragastic Balloon Rupture

Volume 15, Issue 7, November 2014
George Lim, MD et al.

A 38 year old obese female presented to the emergency department with 1 hour of nausea and blue colored urine.

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Patellar Sleeve Fracture

Volume 15, Issue 7, November 2014
Scott Sullivan, MD et al.

A 10 year-old male presented to the ED with knee pain after falling off his bicycle. He landed on his flexed knee with an audible “pop.” He could not extend his knee or walk. Physical examination revealed an effusion and high riding patella with a palpable inferior pole defect. He was neurovascularly intact, and the remaining examination of his lower extremity was unremarkable.

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Egg Shell Sign: Rare Finding in Acute Aortic Dissection

Volume 15, Issue 7, November 2014
John Ashurst, DO et al.

A 77 year-old woman presented with a one day history of central chest pressure that radiated to the neck and right upper extremity. She had a history of hypertension and chronic obstruction pulmonary disease.

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

3800 W Chapman Ave Ste 3200
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: editor@westjem.org

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WestJEM
ISSN: 1936-900X
e-ISSN: 1936-9018

CPC-EM
ISSN: 2474-252X

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.