Successful Distal Urethral Stone Removal in the Emergency Department

Nephrolithiasis is a common pathology encountered in the primary care and emergency department (ED) setting. In 2009 alone, there were over one million ED visits related to nephrolithiasis Higa et al. (2017) [1]. Emergent treatment options range from non-invasive pain control and patient education to lithotripsy and other invasive urologic procedures depending on stone location and related pathology. Urethral calculi are estimated to represent 0.3% of all urinary stone diseases Verit et al. (2006) [2]. There are very few case reports documenting distal urethral stone removal in the ED. Here we present a case of distal urethral stone impaction and the removal of this stone by ED providers, leading to expedited care and prevention of consultation and possible admission.     

Lack of fetal effect from adenosine administration in a pregnant patient

Supraventricular Tachycardias are the most common cardiac rhythm disturbances in pregnant patients. Adenosine is the recommended medication to treat these arrhythmias in part because the medication is projected to be metabolized prior to crossing the placenta and producing any fetal effects. Reported here is a case of a pregnant patient treated with adenosine in which the fetal heart activity was monitored through point of care ultrasonography with documentation of no fetal impact from this medication. This is the first documentation of a lack of fetal effect from adenosine.     

Emergency physician care of family members,friends, colleagues and self

Emergency Physicians are frequently called upon to treat family members, friends, colleagues, subordinates or others with whom they have a personal relationship; or they may elect to treat themselves. This may occur in the Emergency Department (ED), outside of the ED, as an informal, or “curbside” consultation, long distance by telecommunication or even at home at any hour. In surveys, the vast majority of physicians report that they have provided some level of care to family members, friends, colleagues or themselves, sometime during their professional career. Despite being common, this practice raises ethical concerns and concern for the welfare of both the patient and the physician. This article suggests ethical and practical guidance for the emergency physician as to how to approach these situations.     

Transesophageal echocardiography identification of aortic dissection during cardiac arrest and cessation of ECMO initiation

Cardiac arrest is a challenging clinical presentation that emergency medicine providers often encounter. Aortic dissection is an uncommon etiology in all-comers presenting in cardiac arrest. The use of bedside point of care echocardiography to aid in resuscitative efforts is expanding, particularly with the increasing use of transesophageal echocardiography (TEE) by emergency medicine providers. Additionally, emergency department initiation of extracorporeal membrane oxygenation (ECMO) is a relatively newer development in emergency department practice. We report the case of a 64-year old male presenting to the emergency department in cardiac arrest with TEE identification of aortic dissection as the etiology resulting in discontinuation of ECMO initiation attempts.