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1.
Lisa Mills Eric J. Morley Zachary Soucy Gary M. Vilke Samuel H.F. Lam 《The Journal of emergency medicine》2018,54(2):215-220
Background
This review provides practicing emergency physicians updated information regarding point-of-care ultrasound (POCUS) imaging of patients with suspected urolithiasis.Methods
A PubMed literature search was conducted for articles published between January 1, 1996 and May 31, 2017 and limited to human clinical trials written in English with relevant keywords. High-quality studies identified then underwent a structured review. Recommendations herein are made based on the literature review.Results
Two hundred seventy-two abstracts fulfilling the search criteria were screened and 10 appropriate articles were rigorously reviewed in detail. There were 8 prospective studies and 2 retrospective studies. Only 1 of them was a multi-institutional randomized trial. POCUS performed in the emergency department (ED) is moderately sensitive and specific in making the diagnosis of urolithiasis in symptomatic patients. Suspected urolithiasis patients evaluated initially with ED POCUS have complication rates compatible with those evaluated initially with computed tomography.Conclusions
POCUS has moderate accuracy in making the diagnosis of urolithiasis. Nevertheless, it may be safely used as a first line of imaging in ED patients with suspected symptomatic urolithiaisis. 相似文献2.
Background
A subluxation of the radial head (SRH) is a clinical condition that commonly occurs in children under 6 years of age. History and physical examination findings typically include a child who presents with an elbow held in extension and with forearm pronation, after having suffered significant longitudinal traction on the arm, or after a fall on an outstretched hand. The diagnosis is often clinically obvious. The injury responds dramatically to closed reduction, and usually no imaging is required. However, cases with atypical presentations and patients who do not respond favorably to a reduction maneuver present clinical challenges, because the initial diagnosis of SRH may seem to be questionable or erroneous. Point-of-care ultrasound (POCUS) can assist decision-making and clinical management for these patients.Case Reports
We report three cases of SRH that were diagnosed and managed with POCUS in the emergency department.Why Should an Emergency Physician Be Aware of This?
POCUS can assist in the diagnosis and management of patients with clinical suspicion of SRH, especially in cases of atypical presentations or cases in which the mechanism of injury is unknown. It is also an extremely valuable tool in determining postprocedure reduction success. 相似文献3.
Background
Infant lumbar punctures (LPs) are common procedures performed in the emergency department. However, 10% to 35% of these LPs are unsuccessful or grossly bloody, which can lead to increased hospitalization, increased costs, and prolonged exposure to antibiotics or antivirals. Point of care ultrasound (POCUS) may help to surmount the intrinsic causes of LP failure by providing a visual guide of the vascular structures in the needle path before a LP is performed.Case Report
We report two cases where color flow Doppler POCUS was used to identify vascular structures around the spinal canal in infants before attempting a LP.Why Should An Emergency Physician Be Aware of This?
Color flow Doppler POCUS directly visualizes the spinal vascular structures in infants and may help guide the physician in the decision-making process of what intervertebral space and stylet placement to use for a LP. 相似文献4.
Shawn Farrokhi Brittney Mazzone Susan Eskridge Kaeley Shannon Owen T. Hill 《Archives of physical medicine and rehabilitation》2018,99(2):348-354.e1
Objective
To describe the incidence of overuse musculoskeletal injuries in service members with combat-related lower limb amputation.Design
Retrospective cohort study.Setting
Military treatment facilities.Participants
Service members with deployment-related lower limb injury (N=791): 496 with a major lower limb amputation and 295 with a mild lower limb injury.Interventions
Not applicable.Main Outcome Measures
The outcomes of interest were clinical diagnosis codes (International Classification of Diseases–9th Revision) associated with musculoskeletal overuse injuries of the lumbar spine, upper limb, and lower limb regions 1 year before and 1 year after injury.Results
The overall incidence of developing at least 1 musculoskeletal overuse injury within the first year after lower limb amputation was between 59% and 68%. Service members with unilateral lower limb amputation were almost twice as likely to develop an overuse lower or upper limb injury than those with mild combat-related injury. Additionally, service members with bilateral lower limb amputation were more than twice as likely to develop a lumbar spine injury and 4 times more likely to develop an upper limb overuse injury within the first year after amputation than those with mild combat-related injury.Conclusions
Incidence of secondary overuse musculoskeletal injury is elevated in service members with lower limb amputation and warrants focused research efforts toward developing preventive interventions. 相似文献5.
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6.
Background
Insect venom anaphylaxis is a potentially life-threatening disorder. Transient coagulopathy in insect venom anaphylaxis is a rare phenomenon.Case Report
A 41-year-old man presented to the Emergency Department (ED) with hypotension after a run in a park. History and examination revealed signs of anaphylactic shock. A deranged coagulation profile with a normal platelet count led to the diagnosis of wasp sting anaphylaxis.Why Should an Emergency Physician Be Aware of This?
Transient deranged coagulation profile with a normal platelet count may arise from insect venom anaphylaxis. This specific finding may aid the emergency physician in making a diagnosis of anaphylactic shock in an otherwise healthy patient presenting with shock with no apparent cause. 相似文献7.
Background
Elbow dislocations are one of the most common large joint dislocations and they require urgent reduction in the emergency department. Posterior dislocations are the most common type, with anterior dislocations occurring in rare cases.Discussion
Reduction techniques include traction–countertraction, patient-assisted countertraction, the leverage approach, and the modified Stimson technique. Complications can include nerve injury, vascular injury, and compartment syndrome.Conclusions
It is important for emergency physicians to be familiar with several different reduction techniques for elbow dislocations in case the initial reduction attempt is unsuccessful. This article reviews the current evidence for reduction of elbow dislocations and any variations on these approaches. 相似文献8.
9.
Yasutaka Kuniyoshi Azusa Kamura Sumie Yasuda Makoto Tashiro Yoichiro Toriyabe 《The Journal of emergency medicine》2017,52(4):e145-e148
Background
Serious isolated laryngeal injuries are uncommon in children.Case Report
We describe the case of an 8-year-old boy with laryngeal injury and pneumomediastinum due to minor blunt neck trauma. He presented to the emergency department complaining of odynophagia and hoarseness, but without respiratory distress. Emphysema was seen between the trachea and vertebral body on initial cervical spine x-ray study, and flexible laryngoscopy revealed erythema and mild edema of both the right vocal cord and the arytenoid region. He recovered with conservative management only.Why Should an Emergency Physician Be Aware of This?
We conclude that it is important to recognize subtle evidence of laryngeal injury secondary to blunt neck trauma to ensure early diagnosis. Initial cervical spine x-ray assessment should exclude both cervical spine fracture and local emphysema after blunt neck trauma. If patients with blunt neck trauma have evidence of a pneumomediastinum, the clinician should consider the possibility of aerodigestive injury. 相似文献10.
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11.
Background
Patients with acute anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries from sport-related activities are frequently seen in the emergency department (ED). However, knee instability tests are known to show variable sensitivity and specificity. These tests would also have limited functionality in patients with severe pain and swelling in the knee.Case Report
A 19-year-old female judo player presented to the ED with severe left knee pain. She had abruptly twisted her left knee while she was shoulder-throwing her opponent. She complained of severe pain and refused physical examination of the knee injury; as a result, evaluation of knee instability could not be performed. However, a point-of-care ultrasound helped in making a prompt and accurate diagnosis of simultaneous, complete rupture and partial ruptures of the ACL and PCL, respectively. The ultrasound findings correlated well with the magnetic resonance imaging images in the assessment of the combined ACL-PCL ruptures. The patient underwent simultaneous arthroscopic ACL and PCL reconstruction with a hamstring tendon autograft and was discharged.Why Should an Emergency Physician Be Aware of This?
Point-of-care ultrasound imaging of the knee in trauma patients may be helpful for diagnosis of ACL and PCL injuries by augmenting findings of physical examinations in patients with severe pain and swelling in the knee. Ultimately, it may lead to more accurate diagnosis and treatment plans in knee trauma patients. 相似文献12.
Margaret J. Lin Mark Neuman Rachel Rempell Michael Monuteaux Jason Levy 《The Journal of emergency medicine》2018,54(1):96-101
Background
Point-of-care ultrasound (POCUS) is increasingly being used to differentiate cellulitis from abscess in the pediatric emergency department (ED). POCUS has also been shown to decrease length of stay (LOS) for other applications among adult patients.Objective
We sought to determine if ED LOS differed for children presenting with skin and soft tissue infections who received POCUS versus radiology-performed ultrasound.Methods
We performed a retrospective cohort study of children presenting to an urban pediatric ED between January 2011 and June 2013 with a diagnosis of cellulitis or abscess who underwent soft tissue ultrasound. Patients who received a surgical consult, had significant medical comorbidities, or had a lesion located on the face, hands, feet, or groin were excluded. We compared ED LOS among children who received radiology-performed ultrasound to children who received POCUS, adjusting for relevant clinical variables.Results
Among 3094 children with a diagnosis of cellulitis or abscess, we identified 202 who underwent a POCUS and 118 who underwent radiology-performed ultrasound. The POCUS group had a shorter median LOS than the radiology-performed ultrasound group (adjusted median difference –73 min; 95% confidence interval –93.6 to –52.4 min). In the subset of patients discharged from the ED, this difference was more pronounced (adjusted median difference –89 min; 95% confidence interval –109.9 to –68.1 min).Conclusion
Among children presenting to a pediatric ED with superficial skin and soft tissue infections, children receiving POCUS experienced shorter LOS compared to children receiving radiology-performed ultrasound. 相似文献13.
Background
Ovarian torsion is a rare but serious cause of pelvic pain in females. Making the diagnosis is important because misdiagnosis can lead to an ischemic ovary and subsequent infertility.Objective
Although all emergency physicians are aware of ovarian torsion, there are several myths regarding its epidemiology, diagnosis, and treatment. This article attempts to review some of these myths to improve emergency diagnosis and evaluation.Discussion
Ovarian torsion is not an easy diagnosis to make and it is commonly missed. Signs and symptoms often mimic other disorders such as appendicitis, pyelonephritis, and nephrolithiasis. The diagnosis becomes more challenging in that torsion can occur in female patients of all ages, including infants and the elderly. Normal arterial blood flow on ultrasound does not rule out ovarian torsion and not every patient will have a mass on imaging or a palpable mass on examination. Patients may have symptoms for several hours or days, and thus, ovarian torsion may be present even with a longer duration of symptoms. Surgery is the definitive treatment and may still be effective after several hours of symptoms.Conclusions
Although ovarian torsion is a challenging diagnosis, understanding myths surrounding the disorder may help emergency physicians consider it in unusual populations. If there is any clinical concern for ovarian torsion, a gynecologic consult may be helpful, even if imaging findings are not conclusive. Surgery remains the standard method for definitive diagnosis and treatment. 相似文献14.
Morgan K. Boes Rachel E. Bollaert Richard M. Kesler Yvonne C. Learmonth Mazharul Islam Matthew N. Petrucci Robert W. Motl Elizabeth T. Hsiao-Wecksler 《Archives of physical medicine and rehabilitation》2018,99(3):484-490
Objective
To determine whether a powered ankle-foot orthosis (AFO) that provides dorsiflexor and plantar flexor assistance at the ankle can improve walking endurance of persons with multiple sclerosis (MS).Design
Short-term intervention.Setting
University research laboratory.Participants
Participants (N=16) with a neurologist-confirmed diagnosis of MS and daily use of a prescribed custom unilateral passive AFO.Interventions
Three 6-minute walk tests (6MWTs), 1 per footwear condition: shoes (no AFO), prescribed passive AFO, and portable powered AFO (PPAFO). Assistive devices were worn on the impaired limb.Main Outcome Measures
Distance walked and metabolic cost of transport were recorded during each 6MWT and compared between footwear conditions.Results
Each participant completed all three 6MWTs within the experimental design. PPAFO use resulted in a shorter 6MWT distance than did a passive AFO or shoe use. No differences were observed in metabolic cost of transport between footwear conditions.Conclusions
The current embodiment of this PPAFO did not improve endurance walking performance during the 6MWT in a sample of participants with gait impairment due to MS. Further research is required to determine whether expanded training or modified design of this powered orthosis can be effective in improving endurance walking performance in persons with gait impairment due to MS. 相似文献15.
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16.
Arjun Lakshman Charanpreet Singh Manphool Singhal Sanjay Jain Navneet Sharma Savita Kumari Subhash Varma 《The Journal of emergency medicine》2017,52(3):e61-e63
Background
Takayasu arteritis, also known as “pulseless disease,” causes proximal occlusion of the lumen of large arteries of the neck and arm, leading to impalpable pulses and “pseudohypotension.” This may misdirect the management plan for a patient in the emergency setting if the presence of vascular occlusion is not previously known.Case Report
We describe a young woman who presented to the emergency department (ED) with fever. On evaluation, she had shock, which was not responsive to a fluid bolus. Bedside Rapid Diagnostic Test was positive for Plasmodium vivax, and a diagnosis of severe vivax malaria was made. She was started on intravenous artesunate and vasopressors in view of her persistent hypotension in the face of a normal central venous pressure. A thorough examination at that time revealed palpable lower limb pulses with feeble upper limb pulses. Vasopressors were tapered while monitoring lower limb blood pressure. Computed tomographic angiogram confirmed the diagnosis of Takayasu arteritis.Why Should an Emergency Physician Be Aware of This?
Hypotension and shock are regularly encountered in the ED. Occlusive arterial disease involving upper limbs can mimic refractory shock, leading to potentially harmful and unnecessary interventions. Emergency physicians should be aware of this possibility. A simple routine of quickly checking all peripheral pulses would help them avoid this pitfall. 相似文献17.
Ilufredo Y. Tantoy Bruce A. Cooper Anand Dhruva Janine Cataldo Steven M. Paul Yvette P. Conley Marilyn Hammer Fay Wright Laura B. Dunn Jon D. Levine Christine Miaskowski 《Journal of pain and symptom management》2018,55(3):808-834
Context
Studies on multiple dimensions of the symptom experience of patients with gastrointestinal cancers are extremely limited.Objective
Purpose was to evaluate for changes over time in the occurrence, severity, and distress of seven common symptoms in these patients.Methods
Patients completed Memorial Symptom Assessment Scale, six times over two cycles of chemotherapy (CTX). Changes over time in occurrence, severity, and distress of pain, lack of energy, nausea, feeling drowsy, difficulty sleeping, and change in the way food tastes were evaluated using multilevel regression analyses. In the conditional models, effects of treatment group (i.e., with or without targeted therapy), age, number of metastatic sites, time from cancer diagnosis, number of prior cancer treatments, cancer diagnosis, and CTX regimen on enrollment levels, as well as the trajectories of symptom occurrence, severity, and distress were evaluated.Results
Although the occurrence rates for pain, lack of energy, feeling drowsy, difficulty sleeping, and change in the way food tastes declined over the two cycles of CTX, nausea and numbness/tingling in hands/feet had more complex patterns of occurrence. Severity and distress ratings for the seven symptoms varied across the two cycles of CTX.Conclusions
Demographic and clinical characteristics associated with differences in enrollment levels as well as changes over time in occurrence, severity, and distress of these seven common symptoms were highly variable. These findings can be used to identify patients who are at higher risk for more severe and distressing symptoms during CTX and to enable the initiation of preemptive symptom management interventions. 相似文献18.
Anthony H. Lequerica Christian Lucca Nancy D. Chiaravalloti Irene Ward John D. Corrigan 《Archives of physical medicine and rehabilitation》2018,99(9):1811-1817
Objective
To test the feasibility and validity of an online version of an established interview designed to determine a lifetime history of traumatic brain injury (TBI).Design
Cross-sectional.Setting
General community.Participants
A volunteer sample of individuals (N= 265) from the general population across the United States.Interventions
Not applicable.Main Outcome Measure(s)
Online version of the Ohio State University Traumatic Brain Injury Identification Method, Rivermead Postconcussion Symptoms Questionnaire (RPQ), Patient-Reported Outcomes Measurement Information System Cognitive Concerns Scale.Results
The measure was completed by 89.4% of the sample with most participants completing the measure in <8 minutes. After controlling for age, sex, psychiatric history, drug or alcohol history, and history of developmental disability, worst TBI severity was significantly associated with scores on the RPQ, F(2,230)=4.56, P=.011, and having a TBI within the past 2 years was associated with higher scores on the cognitive factor subscale of the RPQ, F(1,75)=7.7, P=.007.Conclusions
The online administration of the Ohio State University Traumatic Brain Injury Identification Method appears to be feasible in the general population. Preliminary validity was demonstrated for the indices of worst TBI severity and time since most recent TBI. 相似文献19.
Simon Décary Pierre Frémont Bruno Pelletier Michel Fallaha Sylvain Belzile Johanne Martel-Pelletier Jean-Pierre Pelletier Debbie Feldman Marie-Pierre Sylvestre Pascal-André Vendittoli François Desmeules 《Archives of physical medicine and rehabilitation》2018,99(4):607-614.e1
Objective
To assess the validity of diagnostic clusters combining history elements and physical examination tests to diagnose or exclude patellofemoral pain (PFP).Design
Prospective diagnostic study.Settings
Orthopedic outpatient clinics, family medicine clinics, and community-dwelling.Participants
Consecutive patients (N=279) consulting one of the participating orthopedic surgeons (n=3) or sport medicine physicians (n=2) for any knee complaint.Interventions
Not applicable.Main Outcome Measures
History elements and physical examination tests were obtained by a trained physiotherapist blinded to the reference standard: a composite diagnosis including both physical examination tests and imaging results interpretation performed by an expert physician. Penalized logistic regression (least absolute shrinkage and selection operator) was used to identify history elements and physical examination tests associated with the diagnosis of PFP, and recursive partitioning was used to develop diagnostic clusters. Diagnostic accuracy measures including sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios with associated 95% confidence intervals (CIs) were calculated.Results
Two hundred seventy-nine participants were evaluated, and 75 had a diagnosis of PFP (26.9%). Different combinations of history elements and physical examination tests including the age of participants, knee pain location, difficulty descending stairs, patellar facet palpation, and passive knee extension range of motion were associated with a diagnosis of PFP and used in clusters to accurately discriminate between individuals with PFP and individuals without PFP. Two diagnostic clusters developed to confirm the presence of PFP yielded a positive likelihood ratio of 8.7 (95% CI, 5.2–14.6) and 3 clusters to exclude PFP yielded a negative likelihood ratio of .12 (95% CI, .06–.27).Conclusions
Diagnostic clusters combining common history elements and physical examination tests that can accurately diagnose or exclude PFP compared to various knee disorders were developed. External validation is required before clinical use. 相似文献20.
Sergey Motov Reuben Strayer Bryan D. Hayes Mark Reiter Steven Rosenbaum Melanie Richman Zachary Repanshek Scott Taylor Benjamin Friedman Gary Vilke Daniel Lasoff 《The Journal of emergency medicine》2018,54(5):731-736