Volume 16, Issue 1, January 2015
Zachary Smith, DO et al.
Bouveret syndrome is a rare presentation of gastric outlet obstruction caused by a gallstone in the proximal duodenum via a bilioenteric fistula. This is an infrequent although clinically significant cause of abdominal pain, almost exclusively in the elderly.
Volume 16, Issue 1, January 2015
Erica Cacioppo, MD et al.
A 42-year-old male with a history of multiple shoulder dislocations presented to the emergency department via emergency medical services with both arms locked above his head, stating that he had been jumped at a bar and had since been unable to move his arms.
Volume 16, Issue 1, January 2015
Katherine C. Wurlitzer, BS et al.
A 68-year-old woman presented with a pruritic, blistering rash. Three months prior, she had developed itchy lesions on her hands and feet, spreading to her chest and abdomen.
Volume 16, Issue 1, January 2015
Kelley Smith, MD et al.
Acute compartment syndrome (ACS) is a condition typically associated with long bone fractures or severe trauma; however, non-traumatic etiologies also occur. We describe a case of an otherwise healthy female pediatric patient presenting with unilateral forearm pain without an inciting injury.
Volume 16, Issue 1, January 2015
Daniel Ng, MD et al.
Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis.
Volume 16, Issue 1, January 2015
Sean P. Stickles, MD et al.
A 60-year-old man presented to the emergency department complaining of acute onset posterior ankle pain. He reported playing tennis earlier in the afternoon when he suddenly stopped and pivoted, noting a “pop” sensation and pain to the right posterior ankle.
Volume 16, Issue 1, January 2015
Bryan Madden, MD et al.
As studies continue to demonstrate the efficacy of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke, the exclusion criteria continue to narrow, and the time-window continues to increase. The most dreaded adverse effect of tPA, hemorrhagic conversion of an ischemic stroke, is well known and well published.
Volume 16, Issue 1, January 2015
Todd Schneberk, MD, MA et al.
A 57-year-old female presented to the emergency department with left sided facial rash with associated pain, blurred vision and oral discomfort. Past medical history included hypertension, and remote scleroderma (untreated).
Volume 16, Issue 1, January 2015
Ellen Jones, MD et al.
A 36-year old man presents to the emergency room five days after undergoing extracorporeal shock wave lithotripsy (ESWL) for a symptomatic 11mm left renal pelvis stone. The patient has persistent symptoms of severe left flank pain at presentation.
Volume 16, Issue 1, January 2015
Jeniffer S. Gausepohl, MD et al.
A 59-year-old Caucasian man with past medical history significant for hypertension and hyperlipidemia presented to the emergency department with a four-day history of increasing throat pain and bilateral neck swelling. Associated symptoms included voice hoarseness, shortness of breath, dysphagia, and odynophagia.
Volume 16, Issue 1, January 2015
James F. Kenny, MD et al.
A free-floating right heart thrombus is often a harbinger of a massive pulmonary embolism and must be diagnosed and treated rapidly in order to avoid significant adverse sequelae. We present the case of an 84-year-old female who presented with two days of dyspnea and was hypotensive on arrival.
Volume 16, Issue 1, January 2015
Shawna D. Bellew, MD et al.
Atrial fibrillation (AF) is the most common cardiac dysrhythmia. Current guidelines recommend obtaining thyroid-stimulating hormone (TSH) levels in all patients presenting with AF.
Volume 16, Issue 1, January 2015
Richard Amini, MD et al.
This report describes a patient with sub-massive pulmonary embolism (PE) who was successfully treated with half-dose thrombolytics guided by the use of point-of-care (POC) ultrasound. In this case, POC ultrasound was the only possible imaging since computed tomography was contraindicated.
Volume 16, Issue 1, January 2015
Christopher J. Coyne, MD et al.
The American Heart Association/American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG) times for patients with ST-segment elevation myocardial infarction (STEMI). Previous quality improvement research at our institution revealed that we were not meeting this benchmark for walk-in STEMI patients.
Volume 16, Issue 1, January 2015
Puneeta Ramachandra, MD et al.
Studies have demonstrated that variables other than duration of symptoms can affect outcomes in children with acute testicular torsion. We examined demographic and logistical factors, including inter-hospital transfer, which may affect outcomes at a tertiary pediatric referral center.
Volume 16, Issue 1, January 2015
Tracy E. Madsen, MD, ScM et al.
Previous literature has shown gender disparities in the care of acute ischemic stroke. Compared to men, women wait longer for brain imaging and are less likely to receive intravenous (IV) tissue plasminogen activator (tPA).
Volume 16, Issue 1, January 2015
Marian J. Vermeulen, MHSc et al.
A number of other studies have also suggested that Lean is beneficial in addressing the problem of ED wait times. As in White et al., the vast majority of these studies have been conducted in single centers and/or as before-after evaluations.
Volume 16, Issue 1, January 2015
Benjamin A. White, MD et al.
We very much appreciate the interest of our colleagues in this important topic, one that has yet to fully mature in the pantheon of emergency medicine literature. We also recognize and noted in our manuscript that the single-site nature of our work is a limitation. However, we disagree that this limitation makes scientific exploration and publication of this nature a fruitless endeavor as implied.
Volume 16, Issue 1, January 2015
Lori Stolz, MD et al.
New medical technology brings the potential of lawsuits related to the usage of that new technology. In recent years the use of point-of-care (POC) ultrasound has increased rapidly in the emergency department (ED).
Necrotizing fasciitis (NF) is a rare and lethal soft tissue infection that requires urgent surgical intervention. It is most often found in the extremities occurring with precipitating trauma or in immunocompromised states. Signs and symptoms are often vague or missing making early diagnosis very difficult. Our patient presented with flank pain and altered mental status but no known precipitating factors. Computed Tomography showed gas within and around the right paraspinous muscle suspicious for NF. Given NF’s high lethality, early suspicion by emergency physicians of NF in patients with soft tissue infections or with systemic findings of unknown etiology is necessary.
