The American journal of emergency medicine
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To analyze trends in admission rates and the proportion of admissions via the ED at rural hospitals in Pennsylvania and to identify factors that may impact admission rates. ⋯ Emergency departments are the gatekeepers of admissions at rural acute care hospitals in Pennsylvania. Many hospitals in rural Pennsylvania, including CAHs, are admitting most of their patients through the ED, concomitant with a significant decline in admissions and admission rates. This highlights the need to strengthen primary care practices serving rural Pennsylvania as well as the need to improve rural emergency and trauma systems. In the short to medium term, policy makers should explore innovative ways to fund smaller hospitals, especially CAHs, to develop level IV trauma center capabilities.
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Interstitial pregnancies are a rare form of ectopic pregnancy that occur when there is implantation of a fetus into the interstitial portion of the uterus. These can be particularly challenging to diagnose and have a high risk of morbidity and mortality due to the relatively late presentation compared to other ectopic pregnancies. ⋯ This case demonstrates the importance of ultrasound as a critical tool in the diagnosis of interstitial pregnancy and the sonographic findings. It is essential for emergency clinicians to be aware of this rare diagnosis.
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Laryngoscope blade shape may differentially facilitate first-attempt success in patients intubated in non-supine positions in the emergency department (ED). Therefore, we analyzed first-attempt success in ramped and upright positions stratified by hyperangulated or standard geometry video laryngoscopes (VL). ⋯ Hyperangulated and standard geometry VL had similar first-attempt success in ramped and upright position intubations in the ED.
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First-trimester bleeding and pregnancy loss are common reasons for presentation to emergency departments. Women of childbearing age frequently receive urine and serum pregnancy tests, which are thought to be reliable markers of pregnancy. ⋯ Physicians should consider the use of ultrasonography to assess for pregnancy or retained fetal products in the appropriate patient, even with negative serum or urine markers of pregnancy.
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Case Reports
Pyometra: Atypical cause of pediatric abdominal pain following complicated appendicitis.
This case is significant to the practice of emergency medicine and describes a unique post-operative infection that to my knowledge has not been described in this age group or under this set of circumstances before. Pyometra is a rare disease that is classically seen in an older cohort, and not commonly on the differential for pediatric patients presenting to the ED with vaginal discharge and fever. While post operative complications such as abscesses may be common following a surgery, intrauterine infections in this context are rare and the treatment is unique. It is important for emergency physicians to have knowledge of pyometra to keep on their differential for abdominal pain and fever after surgery, as well as be familiar with its management and which consultants may need to get involved.