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1.
Caitlin McNamara Irina Mironova Erik Lehman Robert P. Olympia 《The Journal of emergency medicine》2017,52(6):793-800
Background
Thoracic injuries are a major cause of death associated with blunt trauma in children. Screening for injury with chest x-ray study, compared with chest computed tomography (CT) scan, has been controversial, weighing the benefits of specificity with the detriment of radiation exposure.Objective
To identify predictors of thoracic injury in children presenting as trauma activations to a Level I trauma center after blunt torso trauma, and to compare these predictors with those previously reported in the literature.Methods
We performed a retrospective chart review of pediatric patients (<18 years of age) who presented to the Emergency Department of a Level I trauma center between June 2010 and June 2013 as a trauma activation after sustaining a blunt torso trauma and who received diagnostic imaging of the chest as part of their initial evaluation.Results
Data analysis was performed on 166 patients. There were 33 patients (20%) with 45 abnormalities detected on diagnostic imaging of the chest, with the most common abnormalities being lung contusion (36%), pneumothorax (22%), and rib fracture (13%). Statistically significant predictors of abnormal diagnostic imaging of the chest included Glasgow Coma Scale score (GCS) < 15 (27% with abnormality vs. 13% without abnormality), hypoxia (22% vs. 5%), syncope/loss of consciousness (55% vs. 35%), cervical spine tenderness (12% vs. 3%), thoraco-lumbar-sacral spine tenderness (41% vs. 17%), and abdominal/pelvic tenderness (12% vs. 3%).Conclusions
Based on our data, predictors of thoracic injury in children after blunt torso trauma include GCS < 15, hypoxia, syncope/dizziness, cervical spine tenderness, thoraco-lumbar-sacral spine tenderness, and abdominal/pelvic tenderness. 相似文献2.
Background
Although subcutaneous emphysema resulting from maxillofacial surgery is well described in the literature, the association with maxillofacial trauma is less firm. Clinically evident subcutaneous emphysema from facial injury is uncommon and extension into the cervical and mediastinal tissues is exceedingly rare, with few reported cases.Case Report
An unusual case of extensive subcutaneous emphysema after facial trauma is presented. The case posed a diagnostic dilemma in our emergency department.Why Should Emergency Physicians Be Aware of This?
Facial fractures are a rare but important cause of surgical emphysema. Emergency physicians need to be aware of the diagnostic possibility and the need to avoid factors that may precipitate secondary injury. 相似文献3.
Background
Electronic cigarettes have seen a drastic increase in use. A lithium-ion battery is often used as the rechargeable battery of the electronic cigarette device and has recently received much attention in terms of safety. There are several recent case reports in the scientific literature of injuries due to electronic cigarette explosions that involved soft-tissue injuries.Case Report
We report a significant spinal fracture from an electronic-cigarette explosion in a 27-year-old male. The electronic cigarette exploded during use, sending the mouthpiece through the pharynx and into the first cervical vertebra and resulting in fractures of the first and second vertebrae. An x-ray study of the neck showed a foreign body in the neck at the level of C1. A computed tomography scan of the neck showed fractures of C1. The foreign body was removed in the operating room. The patient was discharged home without neurologic sequelae.Why Should an Emergency Physician Be Aware of This?
Our case report is the first case of a cervical spine injury due to the explosion of an electronic cigarette. This case demonstrates that an electronic cigarette explosion can cause potentially serious penetrating neck injury. Emergency physicians should be aware of the potential danger of electronic cigarettes and have a low threshold to obtain radiographic tests and surgical consultation in the case of electronic cigarette explosion in the oral cavity. As the use of electronic cigarettes continue to increase, it is likely that injuries associated with them will also increase. 相似文献4.
Abdul Shameer Neelam Pushker Gautam Lokdarshi Shabeer Basheerz Mandeep S. Bajaj 《The Journal of emergency medicine》2017,52(1):e9-e12
Background
Delayed presentation of orbital trauma as an acute subperiosteal hematoma.Case report
A 12-year-boy developed sudden painful abaxial proptosis of the left eyeball 15 days after blunt trauma over the forehead. On contrast-enhanced computed tomography, a heterogeneous, hypodense, non-enhancing mass with biconvex contour was seen adjacent to the orbital roof. Direct needle drainage was performed and about 10 mL dark blood was aspirated. Proptosis reduced immediately and resolved completely at 2 weeks follow-up.Why Should an Emergency Physician Be Aware of This?
Sudden proptosis with no immediate history of trauma can be alarming for the emergency physician. Familiarity with this clinical entity and early drainage can decrease morbidity. 相似文献5.
Minyoung Lee Sang Heon Lee TaeYeong Kim Hyun-Joon Yoo Sung Hoon Kim Dong-Won Suh Jaebum Son BumChul Yoon 《Archives of physical medicine and rehabilitation》2017,98(1):80-87
Objective
To explore the feasibility of a newly developed smartphone-based exercise program with an embedded self-classification algorithm for office workers with neck pain, by examining its effect on the pain intensity, functional disability, quality of life, fear avoidance, and cervical range of motion (ROM).Design
Single-group, repeated-measures design.Setting
The laboratory and participants' home and work environments.Participants
Offices workers with neck pain (N=23; mean age ± SD, 28.13±2.97y; 13 men).Intervention
Participants were classified as having 1 of 4 types of neck pain through a self-classification algorithm implemented as a smartphone application, and conducted corresponding exercise programs for 10 to 12min/d, 3d/wk, for 8 weeks.Main Outcome Measures
The visual analog scale (VAS), Neck Disability Index (NDI), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Fear-Avoidance Beliefs Questionnaire (FABQ), and cervical ROM were measured at baseline and postintervention.Results
The VAS (P<.001) and NDI score (P<.001) indicated significant improvements in pain intensity and functional disability. Quality of life showed significant improvements in the physical functioning (P=.007), bodily pain (P=.018), general health (P=.022), vitality (P=.046), and physical component scores (P=.002) of the SF-36. The FABQ, cervical ROM, and mental component score of the SF-36 showed no significant improvements.Conclusions
The smartphone-based exercise program with an embedded self-classification algorithm improves the pain intensity and perceived physical health of office workers with neck pain, although not enough to affect their mental and emotional states. 相似文献6.
Nathan F. Jarman Toby Brooks C. Roger James Troy Hooper Mark Wilhelm Jean-Michel Brismée Manuel A. Domenech Stanley J. Kotara Phillip S. Sizer 《PM & R》2017,9(10):969-975
Background
Deep neck flexor (DNF) muscles stabilize the neck and contribute to head acceleration control. The function of DNF in cervical spine dynamic stabilization has not been examined in athletes of any age group, including adolescents. This investigation was necessary prior to studying the DNF muscles’ role in cervical spine injury patterns.Objectives
The objectives of this study were (1) to determine average Deep Neck Flexor Endurance Test (DNFET) time scores in high school?aged and university-aged subjects (aged 14-22 years); and (2) to establish the relationship between gender and age for adolescent DNFET time scores.Design
Cross-sectional design.Setting
Public high school and private university.Participants
A total of 81 (40 male, 41 female) healthy high school and collegiate athletes.Intervention
DNFET time scores (in seconds) were collected and means values were calculated. Interrater reliability was established using the first 15 university-aged subjects enrolled in the study.Main Outcomes
Mean DNFET time (seconds) scores.Results
The DNF muscle endurance interrater reliability coefficient of reproducibility for 4 allied health clinicians was intraclass correlation coefficient (2,4) 0.712 (confidence interval, 0.24-0.85). The mean (± standard deviation) DNFET time score for females was 31.86 (±8.53) seconds versus 35.57 (±10.43) seconds for males. The DNFET performance demonstrated a significant but fair correlation with age (r = 0.401, P = .0001). No significant performance differences were found between male and female subjects in the 14- to 17-year-old group (U = 187.0, P = .285), the 18- to 22-year-old group (U = 145.0, P = .215), or the total male versus female subject groups (U = 653.0, P = .083).Conclusion
Our study establishes a normative data set available for the DNFET in the adolescent population. The fair correlation between DNFET time scores and age is consistent with other studies. These findings serve as a basis for clinician testing, objectifying, and monitoring DNF dysfunction in an adolescent athletic population.Level of Evidence
II 相似文献7.
Alexander J. Bajorek Chloe Slocum Richard Goldstein Jacqueline Mix Paulette Niewczyk Colleen M. Ryan Carla Tierney Hendricks Ross Zafonte Jeffrey C. Schneider 《PM & R》2017,9(1):1-7
Background
A significant proportion of burn injury patients are admitted to inpatient rehabilitation facilities (IRFs). There is increasing interest in the use of functional variables, such as cognition, in predicting IRF outcomes. Cognitive impairment is an important cause of disability in the burn injury population, yet its relationship to IRF outcomes has not been studied.Objective
To assess how cognitive function affects rehabilitation outcomes in the burn injury population.Design
Retrospective study.Setting
Inpatient rehabilitation facilities in the United States.Participants
A total of 5347 adults admitted to an IRF with burn injury between 2002 and 2011.Methods or Interventions
Multivariable regression was used to model rehabilitation outcome measures, using the cognitive domain of the Functional Independence Measure (FIM) instrument as the independent variable and controlling for demographic, medical, and facility covariates.Main Outcome Measurements
FIM total gain, readmission to an acute care setting at any time during inpatient rehabilitation, readmission to an acute care setting in the first 3 days of IRF admission, rate of discharge to the community setting, and length of stay efficiency.Results
Cognitive FIM total at admission was a significant predictor of FIM total gain, length of stay efficiency, and acute readmission at 3 days (P < .05). Cognitive FIM total scores did not have an impact on acute care readmission rate or discharge to the community setting.Conclusions
Cognitive status may be an important predictor of rehabilitation outcomes in the burn injury population. Future work is needed to further examine the impact of specific cognitive interventions on rehabilitation outcomes in this population.Level of Evidence
II 相似文献8.
Background
The oculocardiac reflex is a decrease in heart rate caused by ocular compression or traction upon the extraocular musculature. Multiple instances of this phenomenon have been described in anesthesia, trauma, craniofacial, and ophthalmology literature, but there is a sparsity of documentation in the emergency medicine literature.Case Report
We describe the observation and management of the oculocardiac reflex in a 26-year-old man with retrobulbar hematoma and intraocular trauma caused by a self-inflicted gunshot wound.Why Should an Emergency Physician Be Aware of This?
Prompt recognition of the oculocardiac reflex is important for the emergency physician given the common occurrence of craniofacial trauma and the potentially devastating consequences if not recognized and addressed. 相似文献9.
Igor Jeroukhimov Yehuda Hershkovitz Itay Wiser Boris Kessel Mohammed Ayyad Inbar Gatot Zahar Shapira Svetlana Jeoravlev Ariel Halevy Ron Lavy 《The Journal of emergency medicine》2017,52(5):609-614
Background
Lower rib fractures are considered as a marker of intra-abdominal organ injury. Abdominal computed tomography (CT) is the “gold standard” examination for patients with lower rib fractures. However, the reported incidence of concomitant intra-abdominal injuries (IAI) is 20%–40%.Objective
The purpose of this study was to evaluate the incidence of intra-abdominal organ injuries in blunt trauma patients with lower rib fractures.Methods
Medical charts and radiology reports of patients with lower rib (from the 8th to 12th rib) fractures admitted to our center during a 6-year period were retrospectively reviewed. Patients were divided into two groups. Group I included patients with intra-abdominal injury (IAI) diagnosed either by CT or on urgent laparotomy, and Group II included those with normal abdominal CT scans. Data included demographics, mechanism of injury, laboratory tests, radiology results including number and location of fractured ribs, and incidence of IAI.Results
Overall 318 patients were included in the study. Fifty-seven patients (17.9%) had 71 IAIs compared with 265 (82.1%) patients with no IAI. Logistic regression identified age younger than 55 years (relative risk [RR] = 7.2; 95% confidence interval [CI] 3.1–16.8; p = 0.001), bilateral rib fractures (RR = 3.9; 95% CI 1.1–13.5; p = 0.03) and decreased levels of hematocrit (RR = 2.4; 95% CI 1.2–4.8; p = 0.016) as independent risk factors for the presence of IAI.Conclusions
Abdominal CT should be considered in blunt trauma patients with lower rib fractures who are younger than 55 years of age and have bilateral rib fractures and decreased levels of hematocrit on admission. 相似文献10.
Background
Ideally, high-stakes examinations assess 1 dimension of medical knowledge to produce precise estimates of a candidate’s performance. It has not been reported whether the American Board of Physical Medicine and Rehabilitation Part 1 Certification Examination (ABPMR-CE-1) is unidimensional or not.Objective
To examine the ABPMR-CE-1 to measure how many dimensions it assesses.Design
Retrospective observational study.Setting
We assessed examination results from the 2015 ABPMR-CE-1.Participants
A total of 489 deidentified candidates taking the 2015 ABPMR-CE-1.Methods
A 1-parameter Item Response Theory (IRT) measurement model was utilized. A Principal Components Analysis (PCA) of standardized residual correlations was used to detect multidimensionality.Main Outcome Measure
Number of primary dimensions reflected in the 325 test questions.Results
The results of the dimensionality analysis indicated that the ABPMR-CE-1 examination is highly unidimensional from a psychometric perspective. Expert content review of the substantive content of small contrasting clusters of questions provided additional assurance of the unidimensional nature of the examination.Conclusions
The ABPMR-CE-1 appears indeed to measure a single construct, which suggests a sound structure of the examination. It closely approximates the assumption of statistical unidimensionality.Level of Evidence
Not applicable. 相似文献11.
Andreas Moritz Sebastian Heinrich Andrea Irouschek Torsten Birkholz Johannes Prottengeier Joachim Schmidt 《The Journal of emergency medicine》2017,52(1):8-15
Background
Single-use plastic blades (SUPB) and single-use metal blades (SUMB) for direct laryngoscopy and tracheal intubation have not yet been compared with reusable metal blades (RUMB) in difficult airway scenarios.Objective
The purpose of our manikin study was to compare the effectiveness of these different laryngoscope blades in a difficult airway scenario, as well as in a difficult airway scenario with simulated severe inhalation injury.Methods
Thirty anesthetists performed tracheal intubation (TI) with each of the three laryngoscope blades in the two scenario manikins.Results
In the inhalation injury scenario, SUPB were associated with prolonged intubation times when compared with the metal blades. In the inhalation injury scenario, both metal laryngoscope blades provided a quicker, easier, and safer TI. In the difficult airway scenario, intubation times were significantly prolonged in the SUPB group in comparison to the RUMB group, but there were no significant differences between the SUPB and the SUMB. In this scenario, the RUMB demonstrated the shortest intubation times and seems to be the most effective device.Conclusions
Generally, results are in line with previous studies showing significant disadvantages of SUPB in both manikin scenarios. Therefore, metal blades might be beneficial, especially in the airway management of patients with inhalation injury. 相似文献12.
Background
Posterior sternoclavicular dislocations can be challenging diagnostically, as traumatic force often happens to the lateral shoulder rather than directly to the sternoclavicular joint. Shoulder radiographs do not illustrate the sternoclavicular joint well, and can miss the diagnosis. This injury, however, has the potential for life-threatening complications due to proximity of mediastinal structures that might also be injured.Case Report
The following case illustrates a delayed diagnosis of posterior sternoclavicular dislocation. It also shows how point-of-care ultrasound can diagnose a dislocation, confirm persistence of a dislocation diagnosis when patients are transported from a referring facility, as well as educate the patient and family.Why Should an Emergency Physician Be Aware of This?
Point-of-care ultrasound can be used to rapidly diagnose posterior sternoclavicular dislocations and to provide patients education about their injury. 相似文献13.
Background
There is a growing interest in the use of biologic agents such as platelet-rich plasma and mesenchymal stem/stromal cells to treat musculoskeletal injuries, including meniscal tears. Although previous research has documented the role of diagnostic ultrasound to evaluate meniscal tears, sonographically guided (SG) techniques to specifically deliver therapeutic agents into the meniscus have not been described.Objective
To describe and validate SG injection techniques for the body and posterior horn of the medial and lateral meniscus.Design
Prospective, cadaveric laboratory investigation.Setting
Academic institution procedural skills laboratory.Subjects
Five unenbalmed cadaveric knee-ankle-foot specimens from 5 donors (3 female and 2 male) ages 33-92 years (mean age 74 years) with body mass indices of 21.1-32.4 kg/m2 (mean 24.1 kg/m2).Methods
A single, experienced operator completed SG injections into the bodies and posterior horns of the medial and lateral menisci of 5 unenbalmed cadaveric knees using colored latex and a 22-gauge, 38-mm needle. After injection, coinvestigators dissected each specimen to assess latex distribution within the menisci and identify injury to intra-articular and periarticular structures.Main Outcome Measures
Latex location within the target region of meniscus (accurate/inaccurate), and iatrogenic injury to “at risk” intra- and periarticular structures (present/absent).Results
Seventeen of 20 injections were accurate. Two of 3 inaccurate injections infiltrated the posterior horn of the medial meniscus instead of the targeted meniscal body. One inaccurate lateral meniscus injection did not contain latex despite sonographically accurate needle placement. No specimen exhibited injury to regional neurovascular structures or intra-articular hyaline cartilage.Conclusions
SG meniscus injections are feasible and can accurately and safely deliver injectates such as regenerative agents into bodies and posterior horns of the medial and lateral menisci. The role of SG intrameniscal injections in the treatment of patients with degenerative and traumatic meniscal disorders warrants further exploration.Level of Evidence
Not applicable. 相似文献14.
Rachel Rowlands James Rippey Sing Tie James Flynn 《The Journal of emergency medicine》2017,52(2):208-215
Background
Painful forearm injuries after a fall occur frequently in children. X-ray study is currently the gold standard investigation. Ultrasound (US) is a potential alternative that avoids exposure to ionizing radiation and may be less painful than x-ray study; and familiarity and skill with US is increasing among emergency physicians.Objectives
The primary aim of this study was to determine if a cohort of physicians with little or no previous experience with US could, after a short training program, safely exclude forearm fractures in children. Secondary aims were to compare any pain or discomfort associated with clinical examination, US, and x-ray study and to determine the acceptability of US as a diagnostic tool to parents and patients.Methods
A prospective, nonrandomized, interventional diagnostic study was performed on children between the ages of 0 and 16 years who had a suspected fracture of the forearm. US scanning was performed by a group of physicians, most with little or no previous US experience.Results
After the brief training program, a group of pediatric emergency physicians could diagnose forearm fractures in children with a sensitivity of 91.5% and a specificity of 87.6%. Pain associated with US was no better or worse than pain associated with x-ray study. Patients and parents preferred US over x-ray study as an investigation modality for suspected forearm fractures.Conclusion
A group of pediatric emergency physicians with limited previous experience could, after a short training program, diagnose forearm fractures in children. Pain associated with US was no better or worse than pain associated with x-ray study. 相似文献15.
Christopher Eric McCoy Angelica Loza-Gomez James Lee Puckett Samantha Costantini Patrick Penalosa Craig Anderson Carl Schultz 《The Journal of emergency medicine》2017,52(2):151-159
Background
The association between ambulation at the scene of a motor vehicle collision (MVC) and spinal injury has never been quantified.Objective
To evaluate the association between ambulation and spinal injury in patients involved in a MVC.Methods
Prospective analytical-observational cohort study. Inclusion: patients sustaining traumatic injury in a MVC. Exclusion: < 18 years old, pregnancy. Primary outcome: spinal injury defined as injury to the cervical, thoracic, or lumbar spinal cord, bones, or ligaments. Secondary outcome: Injury resulting in neurological deficit, need for surgery, or death. A generalized linear model was used to evaluate the association between outcome and predictor variables. Risk ratios [RR] were reported with a point estimate and 95% confidence interval (CI). A two-tailed alpha of < 0.05 was the threshold for statistical significance.Results
There were 704 patients analyzed. Nonambulatory patients were 2.29 times more likely to sustain a spinal injury, compared to ambulatory patients (RR 2.29, 95% CI 1.34–3.91). Patients ≥ 65 years of age were 3.27 times more likely to sustain a spinal injury (RR 3.27, 95% CI 1.66–6.45). Patients with a Glasgow Coma Scale score ≤ 8 were 4.93 times more likely to sustain a spinal injury (RR 4.93, 95% CI 1.86–13.10).Conclusion
In this prospective analytical-observational study evaluating the association between ambulatory status and spinal injury in patients involved in MVCs, we observed that those patients who were nonambulatory were more than two times as likely to have a spinal injury compared to those patients who were ambulatory at the scene. 相似文献16.
Pyong Wha Choi 《The Journal of emergency medicine》2017,52(4):e117-e122
Background
Although colonoscopy is generally a safe procedure, lethal complications can occur. Colonoscopic perforation is one of the most serious complications, and it can present with various clinical symptoms and signs. Aggravating abdominal pain and free air on simple radiography are representative clinical manifestations of colonoscopic perforation. However, unusual symptoms and signs, such as dyspnea and subcutaneous emphysema, which are less likely to be related with complicating colonoscopy, may obscure correct clinical diagnosis. We present two cases of pneumomediastinum, pneumothorax, and subcutaneous emphysema caused by colonoscopic perforation.Case Report
A 75-year-old woman and a 65-year-old man presented with dyspnea, and facial swelling and abdominal pain, respectively. In the first case, symptoms occurred during polypectomy, whereas they occurred after polypectomy in the second case. Chest radiograph and computed tomography scans revealed pneumomediastinum, pneumothorax, and subcutaneous emphysema in the neck. During both operations, an ascending colonic subserosa filled with air bubbles was observed, and laparoscopic right hemicolectomy was performed in the first case. In the second case, after mobilization of the right colon, retroperitoneal colonic perforation was identified and primary repair was performed. The postoperative course was uneventful.Why Should an Emergency Physician be Aware of This?
These cases show the unusual clinical manifestations of colonoscopic perforation, which depend on the mechanism of perforation. Awareness of these less typical manifestations is crucial for prompt diagnosis and management for an emergency physician. 相似文献17.
Background
Choroid detachment is a rare disease process that has a multitude of etiologies; usually related to recent ophthalmological surgery, eye trauma, corneal ulcers, or intraocular pressure-lowering agents. Point-of-care ocular ultrasound has high utility and accuracy in diagnosing pathology of the eye.Case Report
We present a case of a patient who presented with vision loss caused by a choroid detachment diagnosed on point-of-care ultrasound because fundoscopic examination was limited due to cataracts. Ultrasound findings based on location and appearance during both static and dynamic evaluation that help differentiate a choroid vs. a retinal detachment are also described.Why Should an Emergency Physician be Aware of This?
Choroid detachments have a different sonographic appearance, as well as management, compared to a retinal detachment. 相似文献18.
Background
Raynaud's phenomenon has multiple etiologies, ranging from occupational causes to systemic disease. Most occupational causes of Raynaud's phenomenon usually present with vascular compromise.Case Report
A 41-year-old Chinese woman presented to the emergency department with progressive pain and bluish discoloration over her right index finger after minor trauma. The clinical examination revealed discoloration over multiple fingertips on both hands. She was diagnosed with Raynaud's phenomenon with possible underlying systemic disease. Additional laboratory workup led to the diagnosis of systemic lupus erythematosus with complex regional pain syndrome.Why Should an Emergency Physician Be Aware of This?
It is rare for the emergency physician to diagnose Raynaud's phenomenon in the setting of minor trauma. It is important to diagnose this condition because of its potential complications. 相似文献19.
Maxine Inocencio Jeannine Childs Mikaela L. Chilstrom Kristin Berona 《The Journal of emergency medicine》2017,52(6):e217-e220
Background
Delayed recognition of tension pneumothorax can lead to a mortality of 31% to 91%. However, the classic physical examination findings of tracheal deviation and distended neck veins are poorly sensitive in the diagnosis of tension pneumothorax. Point-of-care ultrasound is accurate in identifying the presence of pneumothorax, but sonographic findings of tension pneumothorax are less well described.Case Report
We report the case of a 21-year-old man with sudden-onset left-sided chest pain. He was clinically stable without hypoxia or hypotension, and the initial chest x-ray study showed a large pneumothorax without mediastinal shift. While the patient was awaiting tube thoracostomy, a point-of-care ultrasound demonstrated findings of mediastinal shift and a dilated inferior vena cava (IVC) concerning for tension physiology, even though the patient remained hemodynamically stable.Why Should an Emergency Physician Be Aware of This?
This case demonstrates a unique clinical scenario of ultrasound evidence of tension physiology in a clinically stable patient. Although this patient was well appearing without hypotension, respiratory distress, tracheal deviation, or distended neck veins, point-of-care ultrasound revealed mediastinal shift and a plethoric IVC. Given that the classic clinical signs of tension pneumothorax are not uniformly present, this case shows how point-of-care ultrasound may diagnose tension pneumothorax before clinical decompensation. 相似文献20.