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1.
Tyler Snoap Matthew Jaykel Cayla Williams Jason Roberts 《The Journal of emergency medicine》2017,52(1):28-33
Background
Calcaneal fractures are commonly seen and treated in the emergency department. There are subsets of calcaneal fractures that pose a high risk to the adjacent soft tissue of the heel and can result in full-thickness tissue necrosis.Objective
To identify which calcaneal fractures need to be managed within hours and triaged to the orthopedic team and which can be temporized in a neutral or plantarflexed ankle splint and seen in an outpatient setting.Discussion
Tongue-type calcaneal fractures and tuberosity fractures must be triaged appropriately within the first few hours of presentation to prevent skin compromise. This requires the emergency physician to understand the radiographic morphology of the fracture as well as the clinical signs of skin compromise. Communication with the orthopedic surgery service is essential and splinting in a specific manner is important to stabilize the soft tissue envelope.Conclusion
Recognizing the calcaneal injury pattern and implementing the correct treatment strategy is paramount to having successful patient outcomes. A delay or error in treatment can turn a closed fracture into an open fracture. 相似文献2.
Mary P. Henman 《The Journal of emergency medicine》2017,52(1):117-120
Background
A suicidal person with a do-not-resuscitate (DNR) order presents an ethical dilemma to the emergency physician. Many believe that suicide is an irrational action, and therefore, all suicide attempts must be treated. Others believe a DNR order should be respected even in the setting of a suicide attempt.Case Report
An elderly woman with a known terminal illness presented to the emergency department after a suspected suicide attempt. She had a DNR order during her previous hospitalization. The emergency physician felt obligated to intubate the woman despite his recognition that she was terminally ill.Discussion
Reasons to both honor and not honor a DNR order after a suicide attempt are reviewed.Conclusion
Not all patients who attempt suicide are necessarily incapable of making a rational decision about their health care. In some cases it may be appropriate to withhold resuscitation attempts in suicidal patients who have a preexisting DNR order. Institutional policies are needed to provide guidance in this situation. 相似文献3.
Background
Pediatric foreign-body ingestions are commonly managed by emergency physicians. Risk assessment and specific intervention are dependent on the nature and location of the foreign body. Radiographic evaluation is usually necessary to help define the clinical situation.Case Report
We present an interesting case of presumed ingestion of several disk batteries by a toddler with an unexpected outcome, reviewing aspects of this clinical problem and highlighting potential pitfalls in medical decision making.Why Should an Emergency Physician Be Aware of This?
Pediatric foreign-body ingestions are commonly managed in the emergency department, and timely and accurate intervention is dependent on correct defining and localization of the foreign body. This case illustrates potential pitfalls in this evaluation. 相似文献4.
Daniel Kolinsky Samuel M. Keim Brian G. Cohn Evan S. Schwarz Donald M. Yealy 《The Journal of emergency medicine》2017,52(1):52-58
Background
The current standards for domestic emergency medical services suggest that all patients suspected of opioid overdose be transported to the emergency department for evaluation and treatment. This includes patients who improve after naloxone administration in the field because of concerns for rebound toxicity. However, various emergency medical services systems release such patients at the scene after a 15- to 20-min observation period as long as they return to their baseline.Objectives
We sought to determine if a “treat and release” clinical pathway is safe in prehospital patients with suspected opioid overdose.Results
Five studies were identified and critically appraised. From a pooled total of 3875 patients who refused transport to the emergency department after an opioid overdose, three patient deaths were attributed to rebound toxicity. These results imply that a “treat and release” policy might be safe with rare complications. A close review of these studies reveals several confounding factors that make extrapolation to our population limited.Conclusion
The existing literature suggests a “treat and release” policy for suspected prehospital opioid overdose might be safe, but additional research should be conducted in a prospective design. 相似文献5.
Chelsea A. Tafoya Matthew J. Tafoya Maxwell Osei-Ampofo Rockefeller A. Oteng Torben K. Becker 《The Journal of emergency medicine》2017,52(5):723-730
Background
Point-of-care-ultrasound (POCUS) is an increasingly important tool for emergency physicians and has become a standard component of emergency medicine residency training in high-income countries. Cardiopulmonary ultrasound (CPUS) is emerging as an effective way to quickly and accurately assess patients who present to the emergency department with shock and dyspnea. Use of POCUS, including CPUS, is also becoming more prevalent in low- and middle-income countries (LMICs); however, formal ultrasound training for emergency medicine resident physicians in these settings is not widely available.Objectives
To evaluate the feasibility of integrating a high-intensity ultrasound training program into the formal curriculum for emergency medicine resident physicians in an LMIC.Methods
We conducted a pilot ultrasound training program focusing on CPUS for 20 emergency medicine resident physicians in Kumasi, Ghana, which consisted of didactic sessions and hands-on practice. Competency was assessed by comparing pretest and posttest scores and with an Objective Structured Clinical Examination (OSCE) performed after the final training session.Results
The mean score on the pretest was 61%, and after training, the posttest score was 96%. All residents obtained passing scores above 70% on the OSCE.Conclusion
A high-intensity ultrasound training program can be successfully integrated into an emergency medicine training curriculum in an LMIC. 相似文献6.
Maura Sammon Alveena Dawood Scott Beaudoin Richard A. Harrigan 《The Journal of emergency medicine》2017,52(3):348-353
Background
One of the principal tasks of an emergency physician is identifying potentially life-threatening conditions in the undifferentiated patient; cardiac dysrhythmia is an example of such a condition. A systematic approach to a patient with atypical dysrhythmia enables proper identification of such-life threatening conditions.Case Report
We describe a 31-year-old man presenting to the emergency department with an undifferentiated dysrhythmia after naloxone reversal of an opiate overdose. A systematic approach to the electrocardiogram led to the rare diagnosis of Wolff-Parkinson-White (WPW) alternans. We review the differential diagnosis of this dysrhythmia and the initial evaluation of a patient with the WPW pattern present on their electrocardiogram.Why Should an Emergency Physician Be Aware of This?
Emergency physicians should be prepared to use a systematic approach to an undifferentiated dysrhythmia to identify potentially life-threatening conditions. 相似文献7.
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8.
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9.
Michael Dailey Sean P. Geary Stefan Merrill Marleen Eijkholt 《The Journal of emergency medicine》2017,52(4):588-592
Background
In light of the growing gap between candidates for organ donation and the actual number of organs available, we present a unique case of organ donation after cardiac death. We hope to open a discussion regarding organ procurement from eligible donors in the prehospital and emergency department setting.Case
This case study, involving an otherwise healthy man who, after suffering an untimely death, was able to successfully donate his organs, highlights the need to develop an infrastructure to make this type of donation a viable and streamlined option for the future.Discussion
Given the departure from traditional practice in United States transplantation medicine, we bring forth legal and ethical considerations regarding organ donation in the emergency department. We hope that this case discussion inspires action and development in the realm of transplant medicine, with the aim of honoring the wishes of donors and the families of those who wish to donate in a respectful way, while using our medical skills and technologies to afford candidates who are waiting for organs a second chance.Conclusions
We believe that this case shows that donation after cardiac death from the emergency department, while resource-intensive is feasible. We recognize that in order for this to become a more attainable goal, additional resources and systems development is required. 相似文献10.
Basem F. Khishfe 《The Journal of emergency medicine》2017,52(2):235-237
Background
Catamenial epilepsy is defined as an increase in the frequency of seizures during a particular phase of the menstrual cycle. The increased seizure frequency is attributed to the cyclic variation and neuroactive properties of endogenous steroid hormones. It is estimated that more than one-third of women with epilepsy experience catamenial seizure exacerbation.Case Report
We present the case of a young female patient who presented to the emergency department with an increase in seizure frequency that coincided with her menstrual cycle, despite complete medication compliance.Why Should an Emergency Physician Be Aware of This?
It is important for the emergency physician to consider catamenial epilepsy in the differential diagnosis for secondary causes of seizure to ensure appropriate follow-up, as well as improve the quality of life of patients suffering from uncontrolled seizures. 相似文献11.
Jan Van Keer Karel Van Keer Joachim Van Calster Inge Derdelinckx 《The Journal of emergency medicine》2017,52(6):e221-e223
Background
Endophthalmitis is a feared complication of pyogenic liver abscesses caused by hypervirulent Klebsiella pneumoniae strains. First described in East Asia in the 1980s, this invasive syndrome is only recently emerging in Europe and America.Case Report
We describe an 84-year-old man who presented to the emergency department with fever, orbital cellulitis, and bilateral visual loss. Although the patient had no overt abdominal symptoms, computed tomography scan revealed a pyogenic liver abscess. Blood cultures were positive for K. pneumoniae. Initial treatment consisted of intravenous ceftriaxone and intravitreal ceftazidime. A unilateral vitrectomy was performed. The patient survived with severe visual sequelae.Why Should An Emergency Physician Be Aware of This?
K. pneumoniae pyogenic liver abscess with metastatic endophthalmitis is a relatively new syndrome that should be considered in patients presenting with acute vision loss who appear septic, with or without abdominal complaints. Early recognition prohibits delays in lifesaving treatment. 相似文献12.
Background
Intractable bone pain is a notorious adverse effect of granulocyte-colony stimulating factors (G-CSFs), such as pegfilgrastim and filgrastim, which are given to help prevent neutropenia in patients who are undergoing chemotherapy. G-CSF–induced bone pain is surprisingly common and often refractory to treatment with conventional analgesics.Case Report
This article describes an emergency department case of opiate and nonsteroidal anti-inflammatory drug–resistant pegfilgrastim-induced bone pain that was successfully alleviated with 10 mg of oral loratadine, allowing for discharge home.Why Should an Emergency Physician Be Aware of This?
This case suggests that loratadine may be an easy to implement, safe, and effective therapy in the emergency department management of intractable bone pain caused by G-CSF use. Emergency physicians should be aware that loratadine may successfully relieve otherwise intractable G-CSF–induced bone pain and allow for discharge home. 相似文献13.
14.
Background
Rash is a common complaint in the emergency department. Many causes of rash are benign; however, some patients may have a life-threatening diagnosis.Objective
This review will present an algorithmic approach to rashes, focusing on life-threatening causes of rash in each category.Discussion
Rash is common, with a wide range of etiologies. The differential is broad, consisting of many conditions that are self-resolving. However, several conditions associated with rash are life threatening. Several keys can be utilized to rapidly diagnose and manage these deadly rashes. Thorough history and physical examination, followed by consideration of red flags, are essential. This review focuses on four broad categories based on visual and tactile characteristic patterns of rashes: petechial/purpuric, erythematous, maculopapular, and vesiculobullous. Rashes in each morphologic group will be further categorized based on clinical features such as the presence or absence of fever and distribution of skin lesions.Conclusions
Rashes can be divided into petechial/purpuric, erythematous, maculopapular, and vesiculobullous. After this differentiation, the presence of fever and systemic signs of illness should be assessed. Through the breakdown of rashes into these classes, emergency providers can ensure deadly conditions are considered. 相似文献15.
Noah Kondamudi Haamid Chamdawala Iona Monteiro 《The Journal of emergency medicine》2017,52(3):354-357
Background
Excessive or persistent crying is a common presentation to the pediatric emergency department, and often poses a diagnostic dilemma to emergency physicians. There are several reasons for excessive or persistent crying in children, ranging from benign causes like hunger, to life-threatening causes such as intussusception.Case Report
We report an interesting case of a toddler whose cause of excess crying, with no detectable clinical clues, was eventually attributed to a foreign body in the esophagus. A brief review of diagnostic approach to excess crying and management of ingested foreign bodies is presented.Why Should an Emergency Physician Be Aware of This?
Ingested foreign body is a potential cause of persistent crying, and early recognition can result in definitive treatment and prevention of potential mortality and morbidity. 相似文献16.
Background
Many emergency physicians gain familiarity with the laryngeal anatomy only during the brief view achieved during rapid sequence induction and intubation. Awake laryngoscopy in the emergency department (ED) is an important and clinically underutilized procedure.Discussion
Providing benefit to the emergency physician through a slow, controlled, and deliberate examination of the airway, awake laryngoscopy facilitates confidence in the high-risk airway and eases the evolution to intubation, should it be required. Emergency physicians possess all the tools and skills required to effectively perform this procedure, through either the flexible endoscopic or rigid approaches. The procedure can be conducted utilizing local anesthesia with or without mild sedation, such that patients protect their airway.Conclusion
We discuss two clinical scenarios, indications/contraindications, patient selection, and steps to performing two approaches to awake laryngoscopy in the ED. 相似文献17.
David Kanon Paige Skinner William A. Kennedy Angela R. Cirilli 《The Journal of emergency medicine》2017,52(5):e175-e177
Background
Foreign body (FB) impaction in the oropharyngeal region—and specifically the tongue—is a common problem in the emergency department that often requires specialty consultation and admission for operative intervention. Over the years, the use of point of care ultrasound (POCUS) has increased ease and success of FB removal in other anatomic regions, but is only rarely reported for extraction of FB from the tongue outside of the operating room.Case Report
This case demonstrates a unique case of ultrasound-guided removal of a fishbone from the tongue in the emergency department after blind attempts failed. Operative intervention and admission were initially avoided; however, because of initial failed attempts and blind dissection before the use of POCUS, the patient presented a day later requiring admission for postprocedural tongue swelling and edema.Why Should an Emergency Physician Be Aware of This?
Emergency physicians should be aware that POCUS may assist in FB localization in the tongue. 相似文献18.
Background
Nasal septal abscess (NSA) is a rare condition most commonly seen as a complication of nasal trauma. The diagnosis of NSA requires emergent treatment, because delayed management can result in significant morbidity. Typically, NSA presents as a purulent collection that can be managed with drainage, either surgically or at bedside.Case Report
We report an unusual presentation of a spontaneous NSA in a 7-year-old boy as a solid nasal mass eroding the nasal septum. The solid, tumor-like nature of the mass necessitated intervention beyond drainage and was ultimately excised. Imaging initiated in the emergency department revealed a partially cystic mass and erosion of the septum, which was key to the diagnosis.Why Should an Emergency Physician be Aware of This?
Given the ease with which a diagnosis of NSA may be missed and the need for urgent management upon diagnosis of a NSA, we aim to highlight the clinical, radiologic, and histopathologic aspects that aid in diagnosis of NSA. Imaging, obtaining culture results, and initiation of antibiotics are paramount in management. In addition, NSAs may also necessitate bedside drainage given their emergent nature. 相似文献19.
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20.
Alexander Beyer Beejal Ganti Allen Majkrzak Nik Theyyunni 《The Journal of emergency medicine》2017,52(4):e123-e127