J Emerg Med
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Case Reports
Functional urinary outlet obstruction causing urosepsis in a male multiple sclerosis patient.
Detrusor-external sphincter dyssynergia (DESD) is a neuropathic disorder of micturition that exists when the simultaneous contractions of the detrusor muscle and external urethral sphincter oppose each other. When the external urethral sphincter contracts during a detrusor contraction, functional urinary outflow obstruction occurs by the increased urethral resistance. This loss of coordination between the bladder and its outlet is associated with a high risk for serious urologic complications, such as vesicoureteral reflux, hydronephrosis, and urosepsis. This report describes a male multiple sclerosis patient with DESD who developed functional outlet obstruction with urosepsis and discusses the diagnosis and treatment of this potentially life-threatening voiding dysfunction.
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A 27-year-old white female with a history of paroxysmal supraventricular tachycardia presented to the emergency department complaining of intermittent palpitations. Although no tachydysrhythmia was present, she was noted to have two distinct PR intervals during normal sinus rhythm while in the emergency department. ⋯ She was placed on flecainide for outpatient management of her dysrhythmia. Dual AV nodal pathways leading to AV nodal reentrant tachycardia is discussed.
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This is the 15th article in a continuing series of "off-service" goals and objectives for resident education in emergency medicine. Knowledge and skills in providing anesthesia and analgesia are essential in managing patients in the emergency department, critical care unit, and surgery. However, Anesthesiology off-service rotations are often limited to a 2-week rotation. Therefore, clear goals and objectives in Anesthesiology are essential for the resident in training.
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The use of a Fast Track system in the emergency department is becoming increasingly popular in order to provide fast and efficient service to patients with minor emergencies. In this paper we describe the one-year results of our system staffed by nurse practitioners. During the first year of operation, a total of 4468 patients were seen in Fast Track. ⋯ Fewer than 1% of patients required admission to the hospital. Overall, patients and medical staff were highly satisfied with the Fast Track system. Our experience demonstrates that nurse practitioners can effectively and efficiently staff a Fast Track in an academic emergency department.
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Emergency physicians often encounter covertly and overtly suicidal patients, and can thus play a key role in the prevention of suicide. The epidemiology and diverse presentations of suicidal behavior are reviewed. We then provide a detailed approach to the assessment of suicide risk, and criteria for safe discharge from the emergency department (ED). Finally, management considerations for the ED are discussed.