J Emerg Med
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Herlyn Werner Wunderlich Syndrome (HWWS) is a congenital abnormality of the Müllerian duct system resulting in uterovaginal duplication, obstructive hemivagina, and ipsilateral renal agenesis. It typically presents shortly after menarche with gradual onset of progressive pelvic pain. ⋯ To the best of our knowledge abrupt onset of vaginal pain due to HWWS has not been reported previously. We present this case to increase awareness among emergency physicians of this rare and interesting entity.
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During natural and manmade disasters, the hospital is perceived as a central rallying and care site for the public, for both those with and without emergency medical needs. The expectations of the public may outstrip hospital plans and abilities to provide nonmedical assistance. ⋯ There is a high public expectation that hospitals will provide significant nonmedical disaster relief. Understanding these expectations is essential to appropriate community disaster planning.
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Review Case Reports
Acute rheumatic Fever: case report and review for emergency physicians.
Acute rheumatic fever (ARF), a consequence of group A streptococcal (GAS) pharyngitis, is characterized by nonsuppurative inflammatory lesions of the joints as well as subcutaneous and cardiac tissues. Although the overall incidence of ARF in the United States has declined in recent years, there have been reports of outbreaks in closed populations, as well as sporadic cases. Traditionally considered a disease of children, adults may also acquire the disease. Because of declining incidence and a presentation that may overlap with other conditions, ARF may not be considered in the differential diagnosis. Failure to recognize ARF may result in delayed diagnosis and recurrent disease. ⋯ Failure to recognize ARF may result in repeated ED visits, delayed diagnosis, and prolonged patient discomfort. Recognition of the condition is important to prevent recurrent disease.
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Colloids are widely used for fluid resuscitation in patients with sepsis. But the optimal type of fluid remains unclear. ⋯ There is no evidence that one colloid solution is more effective and safer than another for fluid resuscitation in sepsis. The severity score is improved in HES, but the confidence intervals are wide.
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Multiple studies illustrate the benefits of waveform capnography in the nonintubated patient. This type of monitoring is routinely used by anesthesia providers to recognize ventilation issues. Its role in the administration of deep sedation is well defined. Prehospital providers embrace the ease and benefit of monitoring capnography. Currently, few community-based emergency physicians utilize capnography with the nonintubated patient. ⋯ Capnography is a quick, low-cost method of enhancing patient safety with the potential to improve the clinician's diagnostic power.