Archives

Massive Hematochezia from Ascending Colonic Varices

Volume 16, Issue 4, July 2015.
Christian, MD, et al.

A 54-year-old man with a history of alcohol use presented with hematochezia and syncope. Upon arrival to the hospital, his bleeding had stopped. He was hemodynamically stable with hemoglobin of 11g/dL, international normalized ratio of 1.8 and platelets of 37K/mcL. Nasogastric aspirate found bilious gastric contents without blood.

Read More

Esophageal Intubation of an Infant

Volume 16, Issue 4, July 2015.
Anderson, MD, et al.

A 68-day-old former 30-week infant presented with listlessness, apnea and bradycardia. The patient was intubated for airway protection. After intubation, breath sounds were auscultated bilaterally and a Pedi-Cap carbon dioxide detector had color change from purple to yellow. A nasogastric tube (NGT) was placed and a post-procedural chest radiograph was obtained.

Read More

Prochlorperazine-Induced Hemidystonia Mimicking Acute Stroke

Volume 16, Issue 4, July 2015.
Coralic, PharmD, et al.

Prochlorperazine is frequently used in the treatment of refractory nausea and migraines. Known side effects include extrapyramidal symptoms such as akathisia and dystonia. We report a pregnant patient taking prochlorperazine for hyperemesis gravidarum who developed hemidystonia, which
triggered an acute code stroke response from prehospital, emergency medicine and neurology providers. We suspect this report to be the first case of prochlorperazine-induced hemidystonia as a stroke mimic.

Read More

Psychiatric and Medical Management of Marijuana Intoxication in the Emergency Department

Volume 16, Issue 3, May 2015
Quan M. Bui, BS, et al.

We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation.

Read More

Pediatric Urinary Retention and Constipation: Vaginal Agenesis with Hematometrocolpos

Volume 16, Issue 3, May 2015
Rebekah Heckmann, MD, et al.

An 11-year-old healthy female presented to the emergency department with three days of worsening suprapubic pain, urinary retention, and constipation. She was afebrile with normal vital signs. Her physical examination was notable for suprapubic distention and bulging pink vaginal tissue at the introitus. Bedside ultrasound suggested a distended bladder.

Read More

Rectus Sheath Hematoma: An Unfortunate Consequence of Novel Anticoagulants

Volume 16, Issue 3, May 2015
Kimberly Stillman, DO, et al.

A 76-year-old male presented to the emergency department complaining of intense abdominal pain. He reported one week earlier an upper respiratory illness with violent coughing spells. Past medical history included recent percutaneous coronary intervention for a myocardial infarction 6 months prior where he received three drug-eluting stents and was subsequently discharged home on Prasugrel (Effient) and Aspirin.

Read More

Unusual Placement of a Central Venous Catheter: Left Pericardiophrenic Vein

Volume 16, Issue 3, May 2015
Karim El-Kersh, MD, et al.

A 62-year-old man presented to the emergency department with hypotension and diarrhea secondary to Clostridium difficile infection. Due to poor peripheral access, a left internal jugular vein triple lumen central venous catheter (CVC) was inserted for fluid resuscitation. The CVC was placed under real-time ultrasound guidance, which revealed normal anatomy, with no resistance during placement.

Read More

Vaginal Bulge

Volume 16, Issue 3, May 2015
Kubwimana M. Mhayamaguru, MD, et al.

A 61-year-old female presented to the emergency department complaining of constipation and vaginal bulge with valsalva 89 days after a robotic-assisted hysterectomy. The patient had intercourse three days prior to presentation and experienced postcoital abdominal discomfort with vaginal bleeding. She denied any other trauma. She had no other complaints and denies fevers, chills, nausea, vomiting, abdominal distension, or constipation. Physical exam revealed exposed bowel protruding through the vaginal cavity.

Read More

Rare Radiological Pattern of Diffuse Esophageal Spasm

Volume 16, Issue 3, May 2015
Demis N. Lipe, MD, MSc, et al.

A 42-year-old man with history of esophageal strictures and esophageal dilation presented to the emergency department with 12 hours of dysphagia and non-bloody emesis. His symptoms started upon waking and included sharp retrosternal pain during each attempt at swallowing. Dysphagia occurred with both solids and liquid. He denied difficulty initiating swallowing, pain with eating the previous night, halitosis and hematemesis.

Read More

Horner’s Syndrome after Superficial Cervical Plexus Block

Volume 16, Issue 3, May 2015
Stefan Flores, MD, et al.

Ultrasound-guided nerve blocks are becoming more essential for the management of acute pain in the emergency department (ED). With increased block frequency comes unexpected complications that require prompt recognition and treatment. The superficial cervical plexus block (SCPB) has been recently described as a method for ED management of clavicle fracture pain. Horner’s syndrome (HS) is a rare and self-limiting complication of regional anesthesia in neck region such as brachial and cervical plexus blocks.

Read More

Emergent Presentation of Decompensated Mitral Valve Prolapse and Atrial Septal Defect

Volume 16, Issue 3, May 2015
Jessie Kang, BSc, et al.

Mitral valve prolapse is not commonly on the list of differential diagnosis when a patient presents in the emergency department (ED) in severe distress, presenting with non-specific features such as abdominal pain, tachycardia and dyspnea. A healthy 55-year-old man without significant past medical history arrived in the ED with a unique presentation of a primary mitral valve prolapse with an atrial septal defect uncommon in cardiology literature. Early recognition of mitral valve prolapse in high-risk patients for severe mitral regurgitation or patients with underlying cardiovascular abnormalities such as an atrial septal defect is crucial to prevent morbid outcomes such as sudden cardiac death.

Read More

Anaphylaxis Due to Head Injury

Volume 16, Issue 3, May 2015
Heather C. Bruner, MD, et al.

Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury.

Read More

Morel-Lavallee Lesion Initially Diagnosed as Quadriceps Contusion: Ultrasound, MRI, and Importance of Early Intervention

Volume 16, Issue 3, May 2015
Nicholas A. Weiss, DO, et al.

Morel-Lavallee lesions (MLL) are rare, closed degloving injuries caused by trauma that delivers a shearing force to the soft tissue most commonly of the hip. If not treated in the acute and subacute setting these lesions are often complicated by re-accumulation of fluid, infection, or chronic pain. We present a unique case of a recurrent, massive medial knee/thigh MLL in which proper treatment was delayed due to initial diagnosis of a quadriceps contusion.

Read More

Diagnosis of Pneumoperitoneum with Bedside Ultrasound

Volume 16, Issue 2, March 2015
Alice Chao, MD et al.

An 86-year-old female was brought in by ambulance for severe abdominal and back pain. She was hypotensive en route and appeared to be in distress upon arrival to the emergency department. Her abdomen was tense and distended with diffuse tenderness to palpation present.

Read More

Jaguar Attack on a Child: Case Report and Literature Review

Volume 16, Issue 2, March 2015
Kenneth V. Iserson, MD, MBA et al.

Jaguar attacks on humans rarely occur in the wild. When they do, they are often fatal. We describe a jaguar attack on a three-year-old girl near her home deep in a remote area of the Guyanese jungle. The patient had a complex but, relatively, rapid transport to a medical treatment facility for her life-threatening injuries. The child, who suffered typical jaguar-inflicted injury patterns and survived, is highlighted. We review jaguar anatomy, environmental status, hunting and killing behaviors, and discuss optimal medical management, given the resource-limited treatment environment of this international emergency medicine case.

Read More

Die Another Day

Volume 16, Issue 2, March 2015
Pablo Aguilera, MD et al.

A 22-year-old healthy male university student presented to the emergency department (ED) complaining of syncope. He had five episodes of loss of consciousness from 10 to 40 seconds in length, with loss of postural tone and full recovery without intervention in the last month.

Read More

Descending Necrotizing Mediastinitis in an Infant

Volume 16, Issue 2, 2015
Michael Butterfield, MD et al.

A nine-month-old girl was brought to the emergency department because of right neck swelling. She had recently been discharged from the same hospital after a brief admission for pneumonia that had followed influenza.

Read More

Left Flank Pain

Volume 16, Issue 2, March 2015
Thomas M. Nappe, DO et al.

An 18-year-old female presented to the emergency department with three days of worsening left flank pain. Past medical history included asymptomatic bacteriuria. She denied prior similar episodes or inciting events, and was currently being treated with trimethoprim sulfamethoxazole by an urgent care center for a urinary tract infection, although she denied having any urinary symptoms.

Read More

Cecal Diverticulitis: A Diagnostic Conundrum

Volume 16, Issue 2, March 2015
Kristof Nemeth, MD et al.

We report an unusual presentation of a 63-year-old female who presented with a five-day history of right-sided loin to groin pain. On assessment she was afebrile and her observations were stable. She had right iliac fossa pain and tenderness in the right renal angle.

Read More

Silent Killer: Case Report of Acute Gastrostomy Tube Erosion

Volume 16, Issue 2, March 2015
Allen D. Chang, MD et al.

An 87-year-old male with multiple medical problems and percutaneous endoscopic gastrostomy (PEG) tube placement presented to the emergency department for recurrent dysphagia, constipation, and concern for stool appearing in his PEG tube.

Read More

Penile Foreskin Avulsion from Parrot Fish Bite

Volume 16, Issue 2, March 2015
Sow A. Kobayashi, MD et al.

A healthy, uncircumcised 34-year-old male presented to an emergency department (ED) in Tinian (Commonwealth of the Northern Mariana Islands) after a parrot fish bite. The patient was spearfishing in the Philippine Sea and impaled a 15-pound parrot fish. As the patient was attempting to grasp the speared fish it bit him in the groin exterior to his swimming trunks.

Read More

Spontaneous Pneumomediastinum on Bedside Ultrasound: Case Report and Review of the Literature

Volume 16, Issue 2, March 2015
Sybil Zachariah, MD et al.

Spontaneous pneumomediastinum is a rare disease process with no clear etiology, although it is thought to be related to changes in intrathoracic pressure causing chest pain and dyspnea. We present a case of a 17-year-old male with acute chest pain evaluated initially by bedside ultrasound, which showed normal lung sliding but poor visualization of the parasternal and apical cardiac views due to significant air artifact, representing air in the thoracic cavity. The diagnosis was later verified by chest radiograph. We present a case report on ultrasound-diagnosed pneumomediastinum, and we review the diagnostic modalities to date.

Read More

Disaster Response Team FAST Skills Training with a Portable Ultrasound Simulator Compared to Traditional Training: Pilot Study

Volume 16, Issue 2, March 2015
Michael T. Paddock, DO, MS et al.

Pre-hospital focused assessment with sonography in trauma (FAST) has been effectively used to improve patient care in multiple mass casualty events throughout the world. Although requisite FAST knowledge may now be learned remotely by disaster response team members, traditional live instructor and model hands-on FAST skills training remains logistically challenging. The objective of this pilot study was to compare the effectiveness of a novel portable ultrasound (US) simulator with traditional FAST skills training for a deployed mixed provider disaster response team.

Read More

13-Year-Old with Cryptic Abdominal Pain

Volume 16, Issue 1, January 2015
Stephanie Spring, DO et al.

A 13-year old female patient presented to the emergency department (ED) with four days of intermittent non-radiating, left upper quadrant pain, associated with non-bloody, non-bilious emesis and decreased appetite. The patient had been evaluated by a gastroenterologist three months prior for abdominal pain.

Read More

Complications of New Medications

Volume 16, Issue 1, January 2015
Carlos J. Roldan, MD et al.

Numerous mandibular pathologies are diagnosed in the emergency department (ED). We present the case of a woman with severe right-sided mandibular pain who was found to have a pathological fracture and osteonecrosis of the jaw (ONJ).

Read More

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

CC-BY_icon.svg

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.