The American journal of emergency medicine
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Massive hemorrhage from the inguinal space is an indication for the use of the Femostop device in the emergency department. This case report describes a middle-aged male with metastatic and recurrent penile cancer status post inguinal lymph node dissection and chemoradiation with a nonhealing left groin wound with extension to the femoral vessels. ⋯ Direct pressure and pressure dressings were unable to control the bleeding present in the patient's left groin. The Femostop device was applied and hemostasis was immediately achieved.
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Identifying communities at high risk of stroke is an important step in improving systems of stroke care. Stroke is known to show spatial clustering at the state and county levels, but it is not known if clusters are present within city boundaries. ⋯ This is the first study to demonstrate that stroke shows clustering at the neighborhood level within many major cities in the United States and within all of the largest cities. Understanding where stroke clusters exist within cities can form the basis of optimizing emergency medical services deployment and improving systems of stroke care.
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Randomized Controlled Trial
Short versus long axis ultrasound guided approach for internal jugular vein cannulations: A prospective randomized controlled trial.
Ultrasound-guided internal jugular vein cannulation is a standard procedure performed in ICUs worldwide. According to the guidelines, the short-axis approach is recommended over the long-axis approach for IJV cannulation. Double-operator cannulation is more convenient for the said procedure. However, the guidelines favor single-operator cannulation due to limited trials. We hypothesized that double-operator long-axis cannulation will be faster and have fewer complications than double-operator short-axis cannulation. ⋯ The long-axis view for IJV cannulation has similar insertion and procedure timings to the short-axis view. However, the complication rate and number of needle punctures required were less with the long-axis view than with those with the short-axis view.
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Smartphones and connected devices allow patients to monitor their health in a variety of ways. We report the case of a patient presenting to the emergency department complaining of palpitations and syncope. ⋯ This case highlights the importance of proactively requesting such information from patients, though normal recordings may not preclude cardiac arrhythmia. Controlled clinical studies are needed to validate such practices.