Volume 16 Issue 2 Archives - The Western Journal of Emergency Medicine

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.

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Headache in Pregnancy: An Approach to Emergency Department Evaluation and Management

Volume 16, Issue 2, March 2015
Jessica C. Schoen, MD, MS et al

Headache is a common presenting complaint in the emergency department. The differential diagnosis is broad and includes benign primary causes as well as ominous secondary causes. The diagnosis and management of headache in the pregnant patient presents several challenges.

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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.

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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.

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Long-term Neurological Outcomes in Adults with Traumatic Intracranial Hemorrhage Admitted to ICU versus Floor

Volume 16, Issue 2, March 2015
Daniel K. Nishijima, MD, MAS et al.

The objective of this study was to compare long-term neurological outcomes in low-risk patients with traumatic intracranial hemorrhage (tICH) admitted to the ICU (intensive care unit) versus patients admitted to the floor.

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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.

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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.

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Characteristics of Patients That Do Not Initially Respond to Intravenous Antihypertensives in the Emergency Department: Subanalysis of the CLUE Trial

Volume 16, Issue 2, March 2015
Caroline E. Freiermuth, MD et al.

Hypertensive emergency has a high mortality risk and the treatment goal is to quickly lower blood pressure with intravenous (IV) medications. Characteristics that are associated with non-response to IV antihypertensives have not been identified. The objective is to identify patient characteristics associated with resistance to IV antihypertensives.

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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.

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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.

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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.

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Young Patients with Suspected Uncomplicated Renal Colic are Unlikely to Have Dangerous Alternative Diagnoses or Need Emergent Intervention

Volume 16, Issue 2, March 2015
Elizabeth M. Schoenfeld, MD et al.

In the United States there is debate regarding the appropriate first test for new-onset renal colic, with non-contrast helical computed tomography (CT) receiving the highest ratings from both Agency for Healthcare Research and Quality and the American Urological Association. This is based not only on its accuracy for the diagnosis of renal colic, but also its ability to diagnose other surgical emergencies, which have been thought to occur in 10–15% of patients with suspected renal colic, based on previous studies.

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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.

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Change in Intraocular Pressure During Point-of-Care Ultrasound

Volume 16, Issue 2, March 2015
Cameron Berg, MD et al.

Point-of-care ocular ultrasound (US) is a valuable tool for the evaluation of traumatic ocular injuries. Conventionally, any maneuver that may increase intraocular pressure (IOP) is relatively contraindicated in the setting of globe rupture. Some authors have cautioned against the use of US in these scenarios because of a theoretical concern that an US examination may cause or exacerbate the extrusion of intraocular contents. This study set out to investigate whether ocular US affects IOP. The secondary objective was to validate the intraocular pressure measurements obtained with the Diaton® as compared with standard applanation techniques (the Tono-Pen®).

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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.

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Bedside Ultrasound Identification of Infectious Flexor Tenosynovitis in the Emergency Department

Volume 16, Issue 2, March 2015
Kevin Padrez, MD et al.

Infectious flexor tenosynovitis (FTS) is a serious infection of the hand and wrist that can lead to necrosis and amputation without prompt diagnosis and surgical debridement. Despite the growing use of point-of-care ultrasound (POCUS) by emergency physicians there is only one reported case of the use of POCUS for the diagnosis of infectious FTS in the emergency department setting. We present a case of a 58 year-old man where POCUS identified tissue necrosis and fluid along the flexor tendon sheath of the hand. Subsequent surgical pathology confirmed the diagnosis of infectious FTS.

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Asking for a Commitment: Violations during the 2007 Match and the Effect on Applicant Rank Lists

Volume 16, Issue 2, March 2015
H. Gene Hern, MD, MS et al.

Applicants to residency face a number of difficult questions during the interview process, one of which is when a program asks for a commitment to rank the program highly. The regulations governing the National Resident Matching Program (NRMP) match explicitly forbid any residency programs asking for a commitment.

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Can Emergency Physicians Perform Common Carotid Doppler Flow Measurements to Assess Volume Responsiveness?

Volume 16, Issue 2, March 2015
Lori A. Stolz, MD et al.

Common carotid flow measurements may be clinically useful to determine volume responsiveness. The objective of this study was to assess the ability of emergency physicians (EP) to obtain sonographic images and measurements of the common carotid artery velocity time integral (VTi) for potential use in assessing volume responsiveness in the clinical setting.

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Virtual Alternative to the Oral Examination for Emergency Medicine Residents

Volume 16, Issue 2, March 2015
Jillian McGrath, MD et al.

The oral examination is a traditional method for assessing the developing physician’s medical knowledge, clinical reasoning and interpersonal skills. The typical oral examination is a face-to-face encounter in which examiners quiz examinees on how they would confront a patient case. The advantage of the oral exam is that the examiner can adapt questions to the examinee’s response. The disadvantage is the potential for examiner bias and intimidation. Computer-based virtual simulation technology has been widely used in the gaming industry. We wondered whether virtual simulation could serve as a practical format for delivery of an oral examination. For this project, we compared the attitudes and performance of emergency medicine (EM) residents who took our traditional oral exam to those who took the exam using virtual simulation.

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Non-thrombotic Abnormalities on Lower Extremity Venous Duplex Ultrasound Examinations

Volume 16, Issue 2, March 2015
Srikar Adhikari, MD, MS et al.

Emergency physician-performed compression ultrasonography focuses primarily on the evaluation of the proximal veins of the lower extremity in patients with suspected deep venous thrombosis (DVT). A detailed sonographic evaluation of lower extremity is not performed. The objective of this study was to determine the prevalence of non-thrombotic findings on comprehensive lower extremity venous duplex ultrasound (US) examinations performed on emergency department (ED) patients.

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Structured Communication: Teaching Delivery of Difficult News with Simulated Resuscitations in an Emergency Medicine Clerkship

Volume 16, Issue 2, March 2015
Sangeeta Lamba, MD et al.

The objective is to describe the implementation and outcomes of a structured communication module used to supplement case-based simulated resuscitation training in an emergency medicine (EM) clerkship.

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Residency Applicants Prefer Online System for Scheduling Interviews

Volume 16, Issue 2, March 2015
Charlotte Wills, MD et al.

Residency coordinators may be overwhelmed when scheduling residency interviews. Applicants often have to coordinate interviews with multiple programs at once, and relying on verbal or email confirmation may delay the process. Our objective was to determine applicant mean time to schedule and satisfaction using online scheduling.

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The Social Media Index: Measuring the Impact of Emergency Medicine and Critical Care Websites

Volume 16, Issue 2, March 2015
Brent Thoma, MD, MA et al.

The number of educational resources created for emergency medicine and critical care (EMCC) that incorporate social media has increased dramatically. With no way to assess their impact or quality, it is challenging for educators to receive scholarly credit and for learners to identify respected resources. The Social Media index (SMi) was developed to help address this.

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Inferior Vena Cava Filter Fracture: Potential Liability for Emergency Physicians

Volume 16, Issue 2, March 2015
Richard M. Pescatore, DO et al.

A 58-year-old female presented to the emergency department complaining of low back pain following a motor vehicle crash.

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Emergency Medicine Residency Boot Camp Curriculum: A Pilot Study

Volume 16, Issue 2, March 2015
Ramsey Ataya, BS et al.

Establishing a boot camp curriculum is pertinent for emergency medicine (EM) residents in order to develop proficiency in a large scope of procedures and leadership skills. In this article, we describe our program’s EM boot camp curriculum as well as measure the confidence levels of resident physicians through a pre- and post-boot camp survey.

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This article corrects: “Correlation of the NBME Advanced Clinical Examination in EM and the National EM M4 exams”

Volume 16, Issue 2, March 2015
Katherine Hiller, MD, PH et al.

In the Original Research article entitled “Correlation of the National Board of Medical Examiners Advanced Clinical Examination in Emergency Medicine and the National Emergency Medicine M4 Exams,” published in the January 2015 issue of the Western Journal of Emergency Medicine (2015;16(1):138-142. DOI: 10.5811/westjem.2014.11.24189), there were the following errors in the published article:

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