Abdominal pain is one of the most common presenting complaints to the emergency department. Mesenteric venous thrombosis represents an important cause to consider in patients with acute abdominal pain. The diagnosis is often delayed, and cases traditionally have been identified either at laparotomy or at autopsy. In this case, we describe a 21-year-old female with acute onset of right lower quadrant pain attributable to a hyperhomocysteinemia related non-occlusive superior mesenteric vein thrombosis. This case highlights how the use of computed tomography in select cases can lead to earlier recognition of this condition and increasingly allow for non-surgical treatment.
A 17-year-old male with symptoms of headache and diaphoresis presented to the emergency department. He had eight months of noted hypertension attributed to medications. On arrival his blood pressure was 229/117mmHg, and he was ill-appearing. His blood pressure was managed aggressively, and he was diagnosed with extra-adrenal pheochromocytoma by computed tomography. He eventually underwent resection of the mass. Children with severe, symptomatic hypertension should be evaluated for pheochromocytoma. Although rare, it is curable. Failure to diagnose carries a high risk of morbidity and mortality.
Academic emergency physicians (EPs) often feel that the demands of clinical productivity, income generation, and patient satisfaction conflict with educational objectives. The objective of this study was to explore whether the quality of faculty bedside teaching of residents correlated with high clinical productivity, measured by relative value units (RVUs). We also explored the strategies of high-performing faculty for optimal RVU generation and teaching performance.
To evaluate the test characteristics of the urine dipstick as a screening tool for elevated serum creatinine in patients with uncontrolled diabetes mellitus in the emergency department (ED).
Digital tourniquets used in the emergency department have been scrutinized due to complications associated with their use, including neurovascular injury secondary to excessive tourniquet pressure and digital ischemia caused by a forgotten tourniquet. To minimize these risks, a conspicuous tourniquet that applies the least amount of pressure necessary to maintain hemostasis is recommended.
We report a case of lingual ischemia and swelling in an elderly stroke patient from prolonged insertion of a FastrachTM Laryngeal Mask Airway ® following a failed Emergency Department intubation. Simple suggestions to mitigate such injury are provided.
Chilaiditi syndrome, symptomatic interposition of bowel beneath the right hemidiaphragm, is uncommon and usually managed without surgery. Morgagni hernia is an uncommon diaphragmatic hernia that generally requires surgery. In this case a patient with a longstanding diagnosis of bowel interposition (Chilaiditi sign) presented with presumed Chilaiditi syndrome. Abdominal computed tomography was performed and revealed no bowel interposition; instead, a Morgagni hernia was found and surgically repaired. Review of the literature did not reveal similar misdiagnosis or recommendations for advanced imaging in patients with Chilaiditi sign or syndrome to confirm the diagnosis or rule out other potential diagnoses.
A 54-year-old depressive woman was admitted to the emergency department with a Glasgow Coma Scale of six (E1V1M4) and hypothermia (34°C). A drug overdose was early suspected by history as the patient was treated by tricyclic antidepressants (TCA).
A 45-year-old male with a one-month history of dyspnea and cough presented with productive sputum consisting of bronchial casts for several days prior to admission.
A 61-year-old man presented to the emergency department (ED) with gradual onset shortness of breath exacerbated by lying flat three weeks after undergoing minimally invasive three-vessel coronary artery bypass grafting (CABG).
We are investigating the potential role for vibration response imaging (VRI) in the prompt emergency department (ED) evaluation of patients presenting with dyspnea to aid in differentiation between chronic obstructive pulmonary disease (COPD) and heart failure (HF).
To identify patients with risk for warfarin sensitivity among an ED population with VTE and to assess if the warfarin sensitivity mutations were of significant enough prevalence to be of clinical significance in customizing treatment of VTE. We sought in a pilot study to identify if testing for common CYP2C9 and VKORC1 single nucleotide polymorphisms (SNPs) in patients who were likely to begin warfarin treatment was feasible in an ED setting.
This study sought to investigate the patterns of injury resulting from a punch mechanism and to investigate the associated psychopathology present in patients with these injuries.
To compare the effectiveness of ondansetron and prochlorperazine to treat vomiting. Secondary objectives were the effectiveness of ondansetron and prochlorperazine to treat nausea and their tolerability.
A 61-year-old man with a history of diabetes, hypertension, hyperlipidemia and polysubstance abuse presented to the emergency department complaining of bony growths on his lower jaw. He had noticed these growths intermittently in the past. He reported pain only when his dentures were in place and food lodged against the growths.
A 38-year-old woman with insulin-dependent diabetes reported four-days of flank pain, dysuria, polyuria and urinary urgency. Vital signs included blood pressure 113/70mmHg, heart rate 135/min, respiratory rate 24/min, and temperature 102.5°F. Exam revealed right cerebral vascular accident and suprapubic tenderness without guarding or rebound.
A 59-year-old female with a history of diabetes mellitus presented to the emergency department complaining of three weeks of an enlarging pulsating mass to her left buttock. The patient denied any associated trauma, leg pain, back pain or previous episodes. Physical exam was remarkable for a bounding non-tender pulsatile mass over the lateral left buttock.
A 15-year-old Hispanic primigravid female at 12 weeks gestation presented to the Emergency Department (ED) complaining of vaginal bleeding for two days. The patient denied any abdominal pain, nausea, vomiting, or fever.
A 33-year-old man presented to the emergency department with two days of right-sided facial and submandibular swelling. He denied fevers, shortness of breath, difficulty swallowing or recent dental problems.
A two-year-old male presented to the emergency department (ED) with a four-day history of evening tactile fevers, measured to 38.1ºC at home, associated with a worsening cough, congestion, mild diarrhea, emesis, decreased oral intake and level of activity.
A 47-year-old Hispanic woman presented to the emergency department for evaluation of a left frontal head mass she reported noticing in the previous month, which caused her localized dull discomfort.
A 21-month-old male presented with a low impact fall striking his left eye against a metal stand at the market. On examination he was in no distress, had significant periorbital swelling, a dilated pupil with a sluggish pupillary response, and grossly normal extraocular movements.
A 17-year-old man presented with acute left lateral knee pain after “twisting” his knee during a soccer scrimmage. He denied trauma and prior injury to that knee.
