The American journal of emergency medicine
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Aortic dissection (AD) is one of the most challenging diagnoses in emergency medicine. This is due, in part, to its variable presentation, ranging from abrupt tearing chest pain in a hemodynamically unstable patient to back pain in a stable patient, as well as its high mortality rates. (1) With the expanding role of ultrasound (U/S) performed by emergency physicians, it is possible to make the diagnosis of AD at the bedside before any other imaging modality has been accessed. (2) In this case report, we describe the use of emergency department (ED) bedside U/S and specifically highlight the use of the suprasternal view in the diagnosis of AD.
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Patients are often referred to the emergency department for further evaluation, yet the astute physician will maintain a broad differential to avoid anchoring on prior diagnoses. In this case, a 56-year-old man was referred to our emergency department from the radiology suite secondary to concerns for an “allergic reaction” to prior magnetic resonance imaging contrast. ⋯ A chest x-ray that demonstrated right mediastinal mass was ordered, and a computed tomographic scan confirmed compression of the superior vena cava. A brief discussion on the history, etiologies, presentation, and evaluation of superior vena cava syndrome is discussed.
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Recent work has shown that two-thirds of patients report functional disability 1 week after an emergency department (ED) visit for nontraumatic musculoskeletal low back pain (LBP). Nearly half of these patients report functional disability 3 months later. Identifying high-risk predictors of functional disability at each of these 2 time points will allow emergency clinicians to provide individual patients with an evidence-based understanding of their risk of protracted symptoms. ⋯ Patients in the ED with worse baseline functional impairment and a history of chronic LBP are 2 to 4 times most likely to have poor short- and longer-term outcomes.
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Carbon monoxide (CO) is a colorless, odorless, nonirritating, toxic gas produced by the incomplete oxidation of hydrocarbons. Common sources of CO include motor vehicles, house fires, furnaces/heaters, and wood-burning stoves. ⋯ In the present study, we discuss compartment syndrome caused by CO poisoning in a 15-year-old boy. To our knowledge, this is the first CO poisoning case causing compartment syndrome.
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The risks of intravenous (IV) lidocaine before rapid sequence induction (RSI) have become a great concern. No study has investigated the hemodynamic effects of IV lidocaine during endotracheal intubation in patients with severe traumatic brain injury. ⋯ Intravenous lidocaine in addition to RSI before endotracheal intubation was not associated with significant hemodynamic changes in patients with severe traumatic brain injury.