Needle decompression of a tension pneumothorax can be a lifesaving procedure. It requires an adequate needle length to reach the chest wall to rapidly remove air. With adult obesity exceeding one third of the United States population in 2010, we sought to evaluate the proper catheter length that may result in a successful needle decompression procedure. Advance Trauma Life Support (ATLS) currently recommends a 51 millimeter (mm) needle, while the needles stocked in our emergency department are 46 mm. Given the obesity rates of our patient population, we hypothesize these needles would not have a tolerable success rate of 90%.
A 51 year-old woman was found confused while crawling across a field. She had marked facial cyanosis and edema with cutaneous petechiae, subconjuctival hemorrhages, and echymosis across her anterior neck (image 1).
Author Affiliation Michael A. LaMantia, MD, MPH Indiana University Center for Aging Research and Regenstrief Institute, Indianapolis, Indiana Paul W. Stewart, PhD University of North Carolina, Department of Biostatistics, Chapel Hill, North Carolina Timothy F. Platts-Mills, MD University of North Carolina, Department of Emergency Medicine, Chapel Hill, North Carolina Kevin J. Biese, MD, MAT University […]
Author Affiliation Bruce M. Lo, MD Eastern Virginia Medical School, Sentara Norfolk General Hospital, Department of Emergency Medicine, Norfolk, Virginia A previously healthy 36-year-old male who was a restrained driver presented with bilateral hip pain after a motor vehicle collision (MVC) put his vehicle in a ditch. On examination, the patient was alert and oriented […]
Author Affiliation Corey Goldberg, MD University of Florida College of Medicine, Department of Emergency Medicine, Jacksonville, Florida Kathleen E. Carey, MD Mayo Clinic, Department of Radiology, Jacksonville, Florida Diagnosis A 34-year-old black man presented to the emergency department with right-sided pleuritic chest pain, productive cough, low grade fever, and dyspnea. He had a history of […]
Author Affiliation Kellee T. James, PharmD University of California San Francisco, Department of Clinical Pharmacy, San Francisco, California Alissa Detz, MD Robert Wood Johnson Foundation Clinical Scholar, University of California Los Angeles, Department of Medicine, Los Angeles, California Zlatan Coralic, PharmD University of California San Francisco, Department of Clinical Pharmacy, San Francisco, CaliforniaUniversity of California […]
Author Affiliation David I. Bruner, MD Naval Medical Center Portsmouth, Emergency Medicine Program, Portsmouth, Virginia Amy M. Pritchard, DO Naval Medical Hospital Camp Pendleton, Oceanside, California Jonathan Clarke, MD Naval Medical Center Jacksonville, Jacksonville, Florida Introduction Case report Discussion Conclusion ABSTRACT While complete molar pregnancies are rare, they are wrought with a host of potential […]
Author Affiliation Peter Hallas, MD Copenhagen University Hospital, Department of Pediatric Anesthesia, Rigshospitalet, Denmark Mikkel Brabrand, MD Hospital of Southwest Denmark, Department of Medicine, Esbjerg, Denmark Lars Folkestad, MD Hospital of Southwest Denmark, Department of Endocrinology, Esbjerg, Demark Introduction Methods Results Discussion Limitations Conclusion Abstract Introduction: Intraosseous access (IO) is indicated if vascular access cannot […]
Author Affiliation Forrest T. Closson, MD University of Maryland School of Medicine, Department of Pediatrics, Division of Pediatric Emergency Medicine, Baltimore, Maryland Richard Lichenstein, MD University of Maryland School of Medicine, Department of Pediatrics, Division of Pediatric Emergency Medicine, Baltimore, Maryland Introduction Case reports Discussion Recommendations ABSTRACT Vaginal foreign bodies are a complaint occasionally encountered […]
Author Affiliation Alexander J. Scumpia, DO, MSc Mount Sinai Medical Center, Department of Emergency Medicine, Miami, Florida Daniel A. Aronovich, DO Mount Sinai Medical Center, Department of Emergency Medicine, Miami, Florida Loredana Roman, BS Victor Babes University of Medicine and Pharmacy, Department of Medicine, Timisoara, Romania Vanitha Vasudevan, MD Ryder Trauma Center, Department of Surgery, […]
Author Affiliation Michael E. Nelson, MD, MS John H. Stroger Hospital of Cook County, Chicago, Illinois Toxikon Consortium, Illinois Poison Control Center, Chicago, Illinois Isam Nasr, MD John H. Stroger Hospital of Cook County, Chicago, Illinois Westlake Hospital, Melrose Park, Illinois Introduction Case reports Discussion Conclusion INTRODUCTION Many cases of hydrocarbon toxicity occur annually due […]
Author Affiliation Christopher J. Coyne, MD Los Angeles County + University of Southern California Health Network, Department of Emergency Medicine, Los Angeles, California Ashokokkumar Jain, MD, MPH Los Angeles County + University of Southern California Health Network, Department of Emergency Medicine, Los Angeles, California Case report Discussion ABSTRACT Pylephlebitis is a septic thrombophlebitis of the […]
Author Affiliation Matthew L. Mitchell, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan Elif Yucebey, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan Mitchell R. Weaver, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan A. Kathrin Jaehne, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan Emanuel P. […]
Author Affiliation Walter Geer, DO St. Luke’s University Hospital, Bethlehem, Pennsylvania Rebecca Jeanmonod, MD St. Luke’s University Hospital, Bethlehem, Pennsylvania Case Discussion Conclusion ABSTRACT Percutaneous endoscopic gastrostomy (PEG) is a relatively safe and effective method of providing nutrition to patients with neurologic deficits or proximal gastrointestinal pathology. Complications that follow this common procedure include dislodgement, […]
Author Affiliation Brent M. Felton, DO McLaren Greater Lansing Hospital, Department of Emergency Medicine, Lansing, Michigan Michigan State University, Department of Emergency Medicine, East Lansing, Michigan Josh M. White, MD McLaren Greater Lansing Hospital, Department of Emergency Medicine, Lansing, Michigan Michigan State University, Department of Emergency Medicine, East Lansing, Michigan Ryan A. Jones, MD McLaren […]
Author Affiliation Robert Bramante, MD North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York Marek Radomski, DO North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York Mathew Nelson, DO North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York Christopher Raio, MD North Shore University Hospital, Department of Emergency Medicine, […]
We present a case report of a patient who initially presented with altered mental status and significant urinary frequency. Over the course of her emergency department stay, she then developed tachycardia out of proportion to a new fever along with a respiratory alkalosis. Although each objective finding has a broad differential diagnosis, thyroid storm was the only unifying diagnosis when all findings were present.
A 20-year-old-female presented to the emergency department (ED) with a chief complaint of a persistent dull headache associated with a 7 mm dilated, non-reactive right pupil, and occasional blurry vision for 4 days. The patient had a past medical history significant for Noonan’s syndrome (NS).
Intro: Our objective was to compare the ability of SI, individual vital signs, and the systemic inflammatory response syndrome (SIRS) criteria to predict the primary outcome of hyperlactatemia (serum lactate ≥ 4.0 mmol/L) as a surrogate for disease severity, and the secondary outcome of 28-day mortality.
Conclusion: In this cohort, SI ≥ 0.7 performed as well as SIRS in NPV and was the most sensitive screening test for hyperlactatemia and 28-day mortality. SI ≥ 1.0 was the most specific predictor of both outcomes.
Primary meningococcal arthritis (PMA) is a rare infectious disease that occurs in as little as 1% of meningococcal infections. PMA is arthritis without meningitis, fever, rash, and hemodynamic instability. It is usually preceded by an upper respiratory infection in 50–55% of presentations, and patients may appear nontoxic, afebrile, and polyarthralgic. Despite definition they may have a rash.
A 15-year-old female presented to the emergency department (ED) with a 1-week history of fevers, vomiting, back pain and dysuria. Her primary care physician started her on cefdinir for a urinary tract infection. On initial evaluation she was febrile, tachycardic, and had an exam notable for tenderness of both the left costovertebral angle and suprapubic region.
A 41-day-old girl presented to the emergency department with a new dark red mass protruding from the umbilicus noted 3.5 hours prior to presentation. The patient’s mother reported the umbilical stump fell off at 4 days of life, but the patient continued to have intermittent clear green drainage from a small mass at the base of the umbilicus. The patient was born full-term with an otherwise unremarkable medical history.
A 46-year-old male with diabetes, hypertension, and a history of pulmonary embolism (status post placement of a retrievable Celect inferior vena cava [IVC] filter) presented to the emergency department with progressively worsening abdominal pain for 1 month.
Penetrating injuries to the face or neck can cause difficult airway issues. There is a relative dearth of literature to define the best approach to these patients. Impalement injuries are uncommon, and survivable injuries are most commonly confined to the abdomen or thorax. We report the case of a patient with an obviously difficult airway due to a facial impalement (Jael’s Syndrome) injured at a local construction site.
