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Western Journal of Emergency Medicine

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https://www.readbyqxmd.com/read/27833700/point-of-care-ultrasound-to-diagnose-a-simple-ranula
#1
Ili Margalit, Ron Berant
In the following vignette we demonstrate the use of point-of-care ultrasound to diagnose a simple ranula.
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833699/point-of-care-sonographic-findings-in-acute-upper-airway-edema
#2
Michael Schick, Kendra Grether-Jones
We describe a case where a patient presented with acute angiotensin-converting enzyme inhibitor (ACE-I) induced angioedema without signs or symptoms of upper airway edema beyond lip swelling. Point-of-care ultrasound (POCUS) was used as an initial diagnostic test and identified left-sided subglottic upper airway edema that was immediately confirmed with indirect fiberoptic laryngoscopy. ACE-I induced angioedema and the historical use of ultrasound in evaluation of the upper airway is briefly discussed. To our knowledge, POCUS has not been used to identify acute upper airway edema in the emergency setting...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833698/role-of-ultrasound-in-the-identification-of-longitudinal-axis-in-soft-tissue-foreign-body-extraction
#3
Al Lulla, Taryn Whitman, Ricky Amii, Alan T Chiem
Identification and retrieval of soft-tissue foreign bodies (STFB) poses significant challenges in the emergency department. Prior studies have demonstrated the utility of ultrasound (US) in identification and retrieval of STFBs, including radiolucent objects such as wood. We present a case of STFB extraction that uses US to identify the longitudinal axis of the object. With the longitudinal axis identified, the foreign body can be excised by making an incision where the foreign body is closest to the skin. The importance of this technique as it pertains to minimizing surrounding tissue destruction and discomfort for patients has not been previously reported...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833697/point-of-care-ultrasound-to-locate-retained-intravenous-drug-needle-in-the-femoral-artery
#4
Blake Primi, Molly E W Thiessen
We describe the use of point-of-care ultrasound to localize a retained intravenous drug needle, and subsequent surgical removal without computed tomography.
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833696/ultrasound-detection-of-patellar-fracture-and-evaluation-of-the-knee-extensor-mechanism-in-the-emergency-department
#5
Kiersten Carter, Arica Nesper, Laleh Gharahbaghian, Phillips Perera
Traumatic injuries to the knee are common in emergency medicine. Bedside ultrasound (US) has benefits in the rapid initial detection of injuries to the patella. In addition, US can also quickly detect injuries to the entire knee extensor mechanism, including the quadriceps tendon and inferior patellar ligament, which may be difficult to diagnose with plain radiographs. While magnetic resonance imaging remains the gold standard for diagnostic evaluation of the knee extensor mechanism, this can be difficult to obtain from the emergency department...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833695/spermatic-cord-anesthesia-block-an-old-technique-re-imaged
#6
Jeffrey Gordon, Robert P Rifenburg
Spermatic cord anesthesia block (SCAB) is a useful technique for providing anesthesia to males with scrotal pain. This technique has been described and published in the urology and anesthesia literature for more than 40 years. Initially described as a blind injection, anesthesia of the spermatic cord provides pain control to the scrotal contents. The technique can easily be performed under ultrasound guidance by emergency physicians and should be considered a useful option when seeking to provide pain relief to male patients with scrotal pain...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833694/large-posterior-communicating-artery-aneurysm-initial-presentation-with-reproducible-facial-pain-without-cranial-nerve-deficit
#7
Stacie Zelman, Michael C Goebel, David E Manthey, Seth Hawkins
Unruptured posterior communicating artery (PCOM) aneurysms can be difficult to diagnose and, when large (≥ 7mm), represent a substantial risk to the patient. While most unruptured PCOM aneurysms are asymptomatic, when symptoms do occur, clinical manifestations typically include severe headache (HA), visual acuity loss, and cranial nerve deficit. This case report describes an atypical initial presentation of a large unruptured PCOM aneurysm with symptoms mimicking trigeminal neuralgia, without other associated cranial nerve palsies or neurologic deficits...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833693/e-cigarette-blast-injury-complex-facial-fractures-and-pneumocephalus
#8
Benjamin A Archambeau, Stephanie Young, Carol Lee, Troy Pennington, Christopher Vanderbeek, Dan Miulli, John Culhane, Michael Neeki
Electronic cigarettes (also known as e-cigarettes or e-cigs) are becoming a popular method of recreational nicotine use over recent years. The growth of new brands and devices has been outpacing the FDA's ability to regulate them. As a result, some of these devices fail without warning, most likely from malfunction of the lithium-ion batteries that are in close proximity to volatile compounds within the device. Failures have occurred during both use and storage of the devices or their components. The subsequent injuries from several of these events, including full thickness burns requiring grafting and blast injuries, have been observed at Arrowhead Regional Medical Center, a regional trauma and burn center in southern California...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833692/rapid-diagnosis-of-rhabdomyolysis-with-point-of-care-ultrasound
#9
Alicia Nassar, Richard Talbot, Ashley Grant, Charlotte Derr
It is important to rapidly diagnosis and treat rhabdomyolysis in order to decrease morbidity and mortality. To date there are no reports in the emergency medicine literature on the use of point-of-care ultrasound in the diagnosis of rhabdomyolysis. This unique case describes how ultrasound was used in the emergency department (ED) to quickly diagnose and treat rhabdomyolysis prior to confirmation with an elevated serum creatine kinase. When coupled with a high index of suspicion, ultrasound can be one of the most portable, readily available, low cost, and minimally invasive techniques for making a rapid diagnosis of rhabdomyolysis in the ED...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833691/opioid-dependent-malingerer-with-self-induced-sepsis
#10
Kelly A Kesler, Mark I Langdorf, Michael J Burns
A 21-year-old woman was admitted to the emergency department (ED) with severe sepsis. Both the mechanism of infection and organisms discovered were unusual.
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833690/impact-of-prior-therapeutic-opioid-use-by-emergency-department-providers-on-opioid-prescribing-decisions
#11
Adam C Pomerleau, Jeanmarie Perrone, Jason A Hoppe, Matthew Salzman, Paul S Weiss, Lewis S Nelson
INTRODUCTION: Our study sought to examine the opioid analgesic (OA) prescribing decisions of emergency department (ED) providers who have themselves used OA therapeutically and those who have not. A second objective was to determine if OA prescribing decisions would differ based on the patient's relationship to the provider. METHODS: We distributed an electronic survey to a random sample of ED providers at participating centers in a nationwide research consortium...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833689/hours-and-miles-patient-and-health-system-implications-of-transfer-for-psychiatric-bed-capacity
#12
Amy M O'Neil, Annie T Sadosty, Kalyan S Pasupathy, Christopher Russi, Christine M Lohse, Ronna L Campbell
INTRODUCTION: An increasing number of behavioral health (BH) patients are presenting to the emergency department (ED) while BH resources continue to decline. This situation-may lead to more external transfers to find care. METHODS: This is a retrospective cohort study of consecutive patients presenting to a tertiary care academic ED from February 1, 2013, through January 31, 2014. Patients were identified through electronic health record documentation of psychiatric consultation during ED evaluation...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833688/autoinjectors-preferred-for-intramuscular-epinephrine-in-anaphylaxis-and-allergic-reactions
#13
Ronna L Campbell, M Fernanda Bellolio, Megan S Motosue, Kharmene L Sunga, Christine M Lohse, Maria I Rudis
INTRODUCTION: Epinephrine is the treatment of choice for anaphylaxis. We surveyed emergency department (ED) healthcare providers regarding two methods of intramuscular (IM) epinephrine administration (autoinjector and manual injection) for the management of anaphylaxis and allergic reactions and identified provider perceptions and preferred method of medication delivery. METHODS: This observational study adhered to survey reporting guidelines. It was performed through a Web-based survey completed by healthcare providers at an academic ED...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833687/application-of-circumferential-compression-device-binder-in-pelvic-injuries-room-for-improvement
#14
Rahul Vaidya, Matthew Roth, Bradley Zarling, Sarah Zhang, Christopher Walsh, Jessica Macsuga, John Swartz
INTRODUCTION: The use of a noninvasive pelvic circumferential compression device (PCCD) to achieve pelvic stabilization by both decreasing pelvic volume and limiting inter-fragmentary motion has become commonplace, and is a well-established component of Advanced Trauma Life Support (ATLS) protocol in the treatment of pelvic ring injuries. The purpose of this study was to evaluate the following: 1) how consistently a PCCD was placed on patients who arrived at our hospital with unstable pelvic ring injuries; 2) if they were placed in a timely manner; and 3) if hemodynamic instability influenced their use...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833686/first-report-of-survival-in-refractory-ventricular-fibrillation-after-dual-axis-defibrillation-and-esmolol-administration
#15
Kevin M Boehm, Daniel C Keyes, Laura E Mader, J Michelle Moccia
There is a subset of patients who suffer a witnessed ventricular fibrillation (VF) arrest and despite receiving reasonable care with medications (epinephrine and amiodarone) and multiple defibrillations (3+ attempts at 200 joules of biphasic current) remain in refractory VF (RVF), also known as electrical storm. The mortality for these patients is as high as 97%. We present the case of a patient who, with a novel approach, survived RVF to outpatient follow up.
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833685/adapting-the-i-pass-handoff-program-for-emergency-department-inter-shift-handoffs
#16
James A Heilman, Moira Flanigan, Anna Nelson, Tom Johnson, Lalena M Yarris
INTRODUCTION: Academic emergency department (ED) handoffs are high-risk transfer of care events. Emergency medicine residents are inadequately trained to handle these vital transitions. We aimed to explore what modifications the I-PASS (illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by receiver) handoff system requires to be effectively modified for use in ED inter-shift handoffs. METHODS: This mixed-method needs assessment conducted at an academic ED explored the suitability of the I-PASS system for ED handoffs...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833684/use-of-physician-concerns-and-patient-complaints-as-quality-assurance-markers-in-emergency-medicine
#17
Kiersten L Gurley, Richard E Wolfe, Jonathan L Burstein, Jonathan A Edlow, Jason F Hill, Shamai A Grossman
INTRODUCTION: The value of using patient- and physician-identified quality assurance (QA) issues in emergency medicine remains poorly characterized as a marker for emergency department (ED) QA. The objective of this study was to determine whether evaluation of patient and physician concerns is useful for identifying medical errors resulting in either an adverse event or a near-miss event. METHODS: We conducted a retrospective, observational cohort study of consecutive patients presenting between January 2008 and December 2014 to an urban, tertiary care academic medical center ED with an electronic error reporting system that allows physicians to identify QA issues for review...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833683/why-the-watchdog-won-t-bite-u-s-food-and-drug-administration-challenges
#18
EDITORIAL
Joe Lex
No abstract text is available yet for this article.
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833682/u-s-food-and-drug-administration-review-for-the-emergency-physician-of-approval-process-and-limitations
#19
REVIEW
Nadia Zuabi, Bhavesh Patel, Mark I Langdorf
No abstract text is available yet for this article.
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27833681/pilot-point-of-care-ultrasound-curriculum-at-harvard-medical-school-early-experience
#20
Joshua S Rempell, Fidencio Saldana, Donald DiSalvo, Navin Kumar, Michael B Stone, Wilma Chan, Jennifer Luz, Vicki E Noble, Andrew Liteplo, Heidi Kimberly, Minna J Kohler
INTRODUCTION: Point-of-care ultrasound (POCUS) is expanding across all medical specialties. As the benefits of US technology are becoming apparent, efforts to integrate US into pre-clinical medical education are growing. Our objective was to describe our process of integrating POCUS as an educational tool into the medical school curriculum and how such efforts are perceived by students. METHODS: This was a pilot study to introduce ultrasonography into the Harvard Medical School curriculum to first- and second-year medical students...
November 2016: Western Journal of Emergency Medicine
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