The American journal of emergency medicine
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Computed tomography angiography (CTA) has been applied in imaging studies for the assessment of most abdominal and pelvic injuries in some trauma centers. However, in most institutions, CTA is not routinely performed as part of the computed tomography scan protocol. In this study, we aimed to assess the efficiency of CTA in the evaluation of patients with pelvic fractures. ⋯ In the management of patients with pelvic fractures, CTA provides limited benefits in the evaluation of the active arterial hemorrhage. The additional arterial phase may be helpful for distinguishing between arterial and venous hemorrhage. However, this study showed that subsequent treatment was not changed.
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A 17 year-old man presented to the emergency department with signs and symptoms of a peritonsillar abscess. His trismus was sopronounced that it was too difficult to drain the abscess under dynamic ultrasound guidance. It was suggested that localization of the abscess with ultrasound be used concurrently with video laryngoscopy. ⋯ The probe was then removed, and a needle attached to a syringe was used in its place. Drainage was facilitated using the video laryngoscope in the oral cavity. Seven milliliters of pus was removed, and the patient drastically improved after the procedure.
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Phenytoin has a narrow therapeutic window, and when managing cases of toxicity, clinicians are very wary of this fact. Typically, if patient presents with symptoms suggestive of phenytoin toxicity, total serum phenytoin is promptly ordered. ⋯ Herein, we describe a case of an elderly male patient who presented with drowsiness, gait changes, and elevated liver enzymes and a normal total serum phenytoin level of 18 ng/dL (normal, 10-20 ng/dL). After taking his albumin level into account, his free phenytoin level was calculated to be 27 ng/dL, and the phenytoin was discontinued leading to resolution of his symptoms as well as a return of his liver function panel values to baseline.
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Although ultrasound is regarded as the first choice imaging modality for evaluating a pediatric neck mass, neck computed tomography (CT) is necessary for urgent surgical conditions such as deep neck infections. Our aim was to evaluate the diagnostic effectiveness of and proper patient selection for neck CT as a method for the initial evaluation of pediatric neck masses in the emergency department. ⋯ Computed tomography could be considered as the first diagnostic modality when an urgent surgical condition such as a deep neck infection is highly suspected.
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Case Reports
An atypical misplacement of a temporary pacing catheter diagnosed and resolved by ultrasound.
Temporary transvenous pacing catheter placement is an important and critical procedure for emergency physicians. Ultrasound can be used to guide placement and to diagnosis correct or incorrect catheter placement. This case report discusses a patient with an acute ST elevation myocardial infarction leading to unstable arrhythmias requiring emergent transvenous cardiac pacing. ⋯ There was some difficulty placing the catheter, but successful capture with a left bundle-branch block pattern was obtained. However, ultrasonographic evaluation after placement showed the pacing wire curled in the Inferior Vena Cava (IVC) with the tip in the right ventricle. Ultrasound examination and guidance can prevent misplacement of the transvenous pacer catheter, which would not be apparent by electrocardiographic means.