The American journal of emergency medicine
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Bowel obstruction is rare in pregnancy, and delay in recognition can lead to serious maternal and fetal complications. Most reported causes of bowel obstruction in pregnancy (adhesions, intussusception, hernia, and carcinoma) require surgical intervention. Sigmoid volvulus is an acute surgical cause that can now be managed successfully without surgery. We report the case of 33-year-old lady who presented with a sigmoid volvulus that was successfully managed with urgent endoscopic decompression.
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There is controversy regarding needle aspiration for primary spontaneous pneumothorax (PSP), with contradictory recommendations between the American College of Chest Physicians consensus statement (2001), which suggests that needle aspiration has little place in the management of PSP, and the British Thoracic Society guidelines (2010), which recommend that needle aspiration be attempted first for all cases of PSP where drainage is deemed necessary. Studies have shown that there is no significant difference between needle aspiration and tube thoracostomy with regard to safety, rates of immediate success, and early failure and has the advantages of decreasing pain and reducing rates of hospital admission and duration of hospital stay compared with tube thoracostomy. Point-of-care ultrasound (US) can facilitate needle aspiration by decreasing the risk of complications and detect pneumothorax resolution during or re-expansion after the procedure. ⋯ This technique allows the determination of pneumothorax resolution or re-expansion in real time. Point-of-care US may assist in the evaluation and management of spontaneous pneumothorax in the pediatric ED. Ultrasound-assisted needle aspiration may be a safe and less painful option for pediatric ED patients with PSP.
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Case Reports
De Garengeot hernia: the ultrasound and computed tomographic findings in an 81-year-old woman.
The presence of appendix within a femoral hernia is a rare condition in an incarcerated femoral hernia. It has a characteristic groin mass, and the diagnosis of appendicitis is mainly made intraoperatively. A specific imaging appearance (ultrasonography, computed tomography [CT]) allows accurate prospective diagnosis. ⋯ We report a case of an 81-year-old woman who present with painful and nonreducible groin mass. The ultrasonography and CT characteristic imaging features successfully diagnosed de Garengeot hernia. To our knowledge, this is the first description of a combination of CT and ultrasound in the preoperative diagnosis.
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Comparative Study
Senior patients with moderate to severe pain wait longer for analgesic medication in EDs.
Delayed pain treatment is a common problem in emergency departments (EDs). The objective of this study was to examine the effect of age on time to ED patients receiving the first analgesic dose for moderate to severe pain. ⋯ Seniors with moderate to severe pain wait 1.1 hours (55.2%) longer than younger patients to receive analgesics. Physicians and nurses (32 and 35 minutes, respectively) contributed to this disparity.