Archives

Emergency Medicine Clerkship Directors: Current Workforce

Volume 15, Issue 4, July 2014
David A. Wald, DO et al.

The emergency medicine clerkship director serves an important role in the education of medical students. The authors sought to update the demographic and academic profile of the emergency medicine clerkship director.

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Acute Mesenteric Venous Thrombosis with a Vaginal Contraceptive Ring

Volume 15, Issue 4, July 2014
Wesley Eilbert, MD et al.

Mesenteric venous thrombosis is a rare cause of abdominal pain, which if left untreated may result in bowel infarction, peritonitis and death. The majority of patients with this illness have a recognizable, predisposing prothrombotic condition. Oral contraceptives have been identified as a predisposing factor for mesenteric venous thrombosis in reproductive-aged women. In the last fifteen years new methods of hormonal birth control have been introduced, including a transdermal patch and an intravaginal ring. In this report, we describe a case of mesenteric venous thrombosis in a young woman caused by a vaginal contraceptive ring.

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Facial Firework Injury: A Case Series

Volume 15, Issue 4, July 2014
Kashyap Tadisina, BS et al.

Fireworks are used to celebrate a variety of religious, patriotic, and cultural holidays and events around the world. Fireworks are common in the United States, with the most popular holiday for their use being national Independence Day, also known as July Fourth.

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Intestinal Obstruction Caused by Phytobezoars

Volume 15, Issue 4, July 2014
Maryam Kia, MD et al.

A 55-year-old woman with a 3-month history of abdominal pain presented to the emergency department with chief complaints of worsening abdominal pain and per os intolerance since 3 days ago. Her medical history was noteworthy for watery diarrhea without fever, loss of appetite, weight loss, and nausea and vomiting.

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Bilateral Hydronephrosis and Cystitis Resulting from

Volume 15, Issue 4, July 2014
Vu Huy Tran, MD et al.

Ketamine associated urinary dysfunction has become increasingly more common worldwide. Point-of-care ultrasound (POCUS) is an established modality for diagnosing hydronephrosis in the emergency department. We describe a case of a young male ketamine abuser with severe urinary urgency and frequency in which POCUS performed by the emergency physician demonstrated bilateral hydronephrosis and a focally thickened irregular shaped bladder. Emergency physicians should consider using POCUS evaluate for hydronephrosis and bladder changes in ketamine abusers with lower urinary tract symptoms. The mainstay of treatment is discontinuing ketamine abuse.

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Paralytic Shellfish Poisoning: A Case Series

Volume 15, Issue 4, July 2014
William Hurley, MD et al.

We describe a case series of seven patients presenting to an emergency department with symptoms of paralytic shellfish poisoning. They developed varying degrees of nausea, vomiting, diarrhea, weakness, ataxia and paresthesias after eating mussels harvested from a beach near their resort. Four patients were admitted to the hospital, one due to increasing respiratory failure requiring endotracheal intubation and the remainder for respiratory monitoring. All patients made a full recovery, most within 24 hours. The ability to recognize and identify paralytic shellfish poisoning and manage its complications are important to providers of emergency medicine.

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A Case of Rivaroxaban Associated Intracranial Hemorrhage

Volume 15, Issue 4, July 2014
Jean Chin-Yu Lo, MD et al.

Rivaroxaban is a newer anticoagulant initially approved by the Food and Drug Administration to treat nonvalvular atrial fibrillation. Rivaroxaban has several characteristics that are more favorable than warfarin. One of the characteristics is decreased risk of hemorrhage. We report one of the first case reports of severe intracranial hemorrhage associated with rivaroxaban in an elderly patient with decreased renal function. We aim to alert emergency medicine providers regarding the likelihood of encountering these patient as newer anticoagulants rise in popularity.

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Pediatric Patient with a Rash

Volume 15, Issue 4, July 2014
Jared Sutton, MD et al.

A 2 year old fully immunized male with no personal history of chicken pox presented to the emergency department with a chief complaint of a rash for one week after returning from a hiking trip in a remote island in Canada. After initially being diagnosed with contact dermatitis, a diagnosis of herpes zoster was made by confirmatory viral polymerase chain reaction testing. The purpose of this case report is to examine the literature for the incidence and etiology of shingles in children without a prior history of a primary varicella rash outbreak.

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A Purple Ulcer

Volume 15, Issue 4, July 2014
Caleb P. Canders, MD et al.

A 42-year-old woman presented with a left lower extremity ulcer. Three weeks prior, she had been struck by a motor vehicle and developed bullae on her thigh, the main area of impact. She could not afford to see a primary doctor, and had been applying a low-cost, over-the-counter topical antiseptic solution to the site since the accident.

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Thoracic Outlet Syndrome with Secondary Paget Schröetter Syndrome: A Rare Case of Effort-Induced Thrombosis of the Upper Extremity

Volume 15, Issue 4, July 2014
Jesse Kellar, MD et al.

A 19-year-old man presented to the emergency department complaining of two days of right arm pain and swelling. The pain started while lifting weights. He did not experience a pop or pulling sensation. He stated his arm felt a little cold but otherwise denied numbness or tingling. He denied chest pain, neck pain or shortness of breath.

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Ear Drainage After Trauma

Volume 15, Issue 4, July 2014
Danielle D. Campagne, MD et al.

A restrained 20 year old male driver presents after a rollover motor vehicle collision. He is repetitive after sustaining a loss of consciousness, but is a Glasco Coma Scale of 15 on arrival. He is complaining of left ear and shoulder pain. He has no focal findings other than a ruptured left tympanic membrane

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Incidental Finding in a Headache Patient: Intracranial Lipoma

Volume 15, Issue 4, July 2014
Ozlem Bilir, MD et al.

A 60 year old female, with a history of atrial fibrillation who was on warfarin therapy, presented to our emergency department with chief complaint of the most severe headache that she ever had. Her vital signs, systemic and neurological examinations were normal.

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“Whirl Sign” of Primary Small Bowel Volvulus

Volume 15, Issue 4, July 2014
Jiro Tamura, MD et al.

A 59-year-old man had been admitted to our hospital three times with tarry stool, hematemesis, and abdominal discomfort. His medical history included no abdominal operation. Repeated upper endoscopy, colonoscopy, and computed tomography (CT) had been negative.

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Chemosis from Trauma

Volume 15, Issue 4, July 2014
Michael R. Minckler, MD et al.

A 51-year-old male with a history of chronic obstructive pulmonary disease and obstructive sleep apnea presents to the emergency department complaining of 48 hours of progressive right eye pain and swelling after he ran into his dresser while sleep-walking. He does not know which surface of the dresser contacted his eye. He denies changes in visual acuity, flashes, or floaters.

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Giant Hydronephrosis

Volume 15, Issue 4, July 2014
Yalcin Golcuk, MD et al.

A 83-year-old man with a history of urinary stone disease presented to the emergency department with abdominal and right-sided flank pain. Examination demonstrated distended abdomen and right costovertebral angle tenderness.

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Man with Abdominal Distension

Volume 15, Issue 4, July 2014
Caleb P. Canders, MD et al.

A 63-year-old man presented with abdominal distension and shortness of breath for two days. He reported flatus and denied chest pain, anorexia, vomiting, or abdominal pain.

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Man with Altered Mentation after Trauma

Volume 15, Issue 4, July 2014
Landon A. Jones, MD et al.

A 37 year-old male presented after an altercation in which he was dragged by a vehicle. The patient was intoxicated and asking repetitive questions. He demonstrated significant facial trauma—including frank bloody discharge from both ears and dental trauma.

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Arm Weakness and Deformity

Volume 15, Issue 4, July 2014
Meghan Galer, MD et al.

A healthy 58-year-old man presented to the emergency department with right arm weakness first noticed while playing hockey that day. He could not recall the onset of injury, but endorsed several weeks of antecedent intermittent right shoulder discomfort.

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Critical Care

Continuous Hemodynamic Monitoring in Acute Stroke: An Exploratory Analysis

Volume 15, Issue 4, July 2014
Ayan Sen, MD, MSc et al.

Non-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED) stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements.

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
Suite 640
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.