A 41-year-old Guatemalan woman with a history of remote uterine cancer presented to an urban community Emergency Department complaining of a pruritic, initially painful rash on her chest, eyelids, thighs, and elbows for three weeks.

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Pacemaker Extrusion Causing Chest Pain

A 55-year-old Hispanic male had a pacemaker placed in Mexico approximately one year prior to presenting to the Emergency Department. He noticed minor discomfort in his left chest one month earlier but did not see a physician.

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Left Atrial Myxoma

A 64-year-old white male presented to the Emergency Department with complaints of 24 hours of right lower quadrant abdominal pain.

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Traumatic Pneumocephalus

A six-year-old female was evaluated at the Emergency Department after being struck by an automobile driving 15–20 mph through a pedestrian crosswalk.

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Counter-Point: Are We Really Ordering Too Many CT Scans?

  Author Affiliation David T. Schwartz, MD Associate Professor of Emergency Medicine, New York University School of Medicine In a recent review published in the New England Journal of Medicine, DJ Brenner and EJ Hall, professors of Radiation Biology at Columbia University, analyzed the current trend to increased use of computed tomography (CT) scanning, the attendant […]

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Point: Diagnostic Radiation: Why Aren’t We Stopping (Or at least Slowing Down)?

  Author Affiliation Sean O. Henderson, MD Keck School of Medicine of the University of Southern California Over the past 12 to 18 months I have heard from numerous sources that emergency physicians are using too much diagnostic radiation. The federal government (Biological Effects of Ionizing Radiation VII), the radiology community and several subspecialty groups […]

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Subchorionic Hemorrhage Appearing as Twin Gestation on Endovaginal Ultrasound

This case study describes a pregnant patient with vaginal bleeding who had a bedside endovaginal ultrasound in the emergency department (ED). The emergency physician identified a live intra-uterine pregnancy (IUP) with another structure that appeared to be a second gestational sac. The patient subsequently had an endovaginal ultrasound in the radiology department 46 minutes later. The attending radiologist described one live IUP and a subchorionic hemorrhage. Comparison of the ED and radiology ultrasound showed that the second structure, identified as a subchorionic hemorrhage, had significantly decreased in size. Endovaginal ultrasound in the evaluation of possible ectopic pregnancy is a useful bedside tool in the ED. We discuss a pitfall that can occur with endocavitary ultrasound when a twin gestation is presumed.

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Chest Swelling and Fever in an Intravenous Drug User

This case report describes a sternoclavicular infection in an IV drug user. The history and physical exam suggested an abscess. In the emergency department (ED) the patient refused incision and drainage but did consent to simple needle aspiration. Subsequent culture of the aspirate revealed Pseudomonas aeruginosa. He was admitted for IV antibiotics. After admission, a bone scan suggested the presence of osteomyelitis. The patient refused operative débridement, but ultimately did consent to bedside incision and drainage. By day five, the fever had resolved and the patient signed out AMA. He was given a prescription for Ciprofloxacin. The patient had an unscheduled follow up in the ED five months later for an unrelated heroin overdose. Physical examination demonstrated complete resolution of the infection.

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Wide Complex Tachycardias: Understanding this Complex Condition Part 2 – Management, Miscellaneous Causes, and Pitfalls

  Author Affiliation Gus M. Garmel, MD Stanford University School of Medicine/Kaiser Permanente, Santa Clara INTRODUCTION Patients who present with electrocardiograms (ECGs) demonstrating wide complex tachycardias (WCTs) are often challenging to clinicians. Not only may the patient present with (or be at risk for) hemodynamic compromise, but their treatment may result in hemodynamic collapse if […]

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Patient Satisfaction and Return to Daily Activities Using Etomidate Procedural Sedation for Orthopedic Injuries

With regard to sedative agents used in procedural sedation and analgesia (PSA), such as etomidate, the focus has been on variables usually related to side effect profile and the success rates of various procedures, with both variables specifically taking place during the patients’ stay in the emergency department (ED). There have been no extensive data on the functional status of patients after they leave the ED following PSA.

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Leukocytosis as a Predictor of Severe Injury in Blunt Trauma

  Author Affiliation Claudia A. Santucci, MD Kern Medical Center, Department of Emergency Medicine Thomas B. Purcell, MD Kern Medical Center, Department of Emergency Medicine Carlo Mejia Kern Medical Center, Department of Emergency Medicine ABSTRACT Introduction: The objective of this study was to determine if the white blood cell count can predict severity of injury […]

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Comparison of the Evaluations of a Case-Based Reasoning Decision Support Tool by Specialist Expert Reviewers with Those of End Users

Decision-support tools (DST) are typically developed by computer engineers for use by clinicians. Prototype testing DSTs may be performed relatively easily by one or two clinical experts. The costly alternative is to test each prototype on a larger number of diverse clinicians, based on the untested assumption that these evaluations would more accurately reflect those of actual end users.

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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


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

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.