Annals of emergency medicine
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To develop a discrete event simulation of emergency department (ED) patient flow for the purpose of forecasting near-future operating conditions and to validate the forecasts with several measures of ED crowding. ⋯ By modeling patient flow, rather than operational summary variables, our simulation forecasts several measures of near-future ED crowding, with various degrees of good performance.
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A 54-year-old man with an inferior vena cava filter in situ presented to the emergency department (ED) by emergency medical services, with acute onset of severe abdominal, lower back, and leg pain. He had fallen from a ladder 3 days before admission. An abdominal computed tomography scan revealed a large retroperitoneal hematoma and evidence of occlusive thrombus in the inferior vena cava, extending beyond the inferior vena cava filter. ⋯ The patient underwent bilateral fasciotomies of the lower extremities within 3 hours. Postoperatively, he developed extensive tissue necrosis and gangrene, requiring bilateral above-the-knee amputations, and acute renal failure associated with severe rhabdomyolysis, requiring hemodialysis. This case highlights the importance of prompt recognition and treatment of inferior vena cava filter thrombosis.