The American journal of emergency medicine
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Numerous pathologies diagnosed in the emergency department (ED) are treated with invasive procedures involving anesthetic and surgical risks. Retropharyngeal abscess is a serious condition requiring emergent treatment, often in need of trans-oral incision and drainage under general anesthesia. A misdiagnosis, especially after surgical treatment, might generate undesirable consequences, more so if the final diagnosis is a non-surgical pathology such as longus colli (LC) tendonitis. ⋯ Longus colli tendonitis is a rare condition that mimics emergent surgical conditions. Emergency physicians are qualified to make a clinical and radiological diagnosis. While CT scan can provide a diagnosis, the primary evaluation tool is an adequate medical interview and physical exam.
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Ambulance response time is a major factor associated with survival in out-of-hospital cardiac arrests (OHCAs); the fast emergency vehicle pre-emption system (FAST™) aids response time by controlling traffic signals. This eight-year observational study investigated whether FAST™ implementation reduced response times and improved OHCA outcomes. ⋯ The FAST™ implementation significantly reduced ambulance response times and improved OHCA outcomes in Kanazawa city.
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Observational Study
"Sick" or "not-sick": accuracy of System 1 diagnostic reasoning for the prediction of disposition and acuity in patients presenting to an academic ED.
System 1 decision-making is fast, resource economic, and intuitive (eg, "your gut feeling") and System 2 is slow, resource intensive, and analytic (eg, "hypothetico-deductive"). We evaluated the performance of disposition and acuity prediction by emergency physicians (EPs) using a System 1 decision-making process. ⋯ EPs are able to accurately predict the disposition of ED patients using system 1 diagnostic reasoning based on minimal available information. However, the prognostic accuracy of acuity prediction was limited.
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Case Reports
The pelvic digit anomaly in a patient with multiple fractures: does it mimic the fracture?
Pelvic digit is a rare congenital anomaly where bone develops in the soft tissue adjacent to normal skeletal bone. Pelvic digits are most often associated with the ilium but may also pseudoarticulate with other pelvic bones or the abdominal wall. ⋯ In this article, we present a case of pelvic digit with multiple fractures. To avoid unnecessary investigation methods and treatment, this entity should be kept inmindwhen an atypical bone structure is noted around the pelvis.
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Ultrasonography (US) has gained popularity in the emergency medicine to assess intravascular volume status in critically ill patients. However, there are a limited number of studies on the interrater reliability of US examination of the inferior vena cava (IVC) by emergency residents. ⋯ The measurement of the IVC is moderately reliable by emergency residents. The interrater reliability of measurements in patients with profound and superficial located IVC is higher than that of measurements in patients with moderate-depth located IVC.