J Emerg Med
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There are no guidelines for the management of accidental insulin administration. We hypothesized that home monitoring of asymptomatic patients (pts) was safe following unintentionally insulin administration. ⋯ Based on a retrospective analysis of a single PCC's cases, home observation of asymptomatic patients after unintentional administration of a wrong insulin formulation appears safe.
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Approximately 2% of angioedema (AE) patients have a hereditary or an acquired deficiency of the complement 1 (C1) esterase inhibitor (C1 INH) gene. Some case reports indicate an association between angiotensin-converting enzyme inhibitor (ACEI) use and exacerbation of hereditary AE (HAE). ⋯ The risk of exacerbating HAE by ACEI might be present, but we did not find any association in this retrospective study. Further studies are needed to determine the existence of this association.
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Case Reports
Subcapsular liver hematoma after colonoscopy diagnosed by emergency department bedside ultrasonography.
Hepatic subcapsular hematoma is an uncommon cause of right upper quadrant pain in the Emergency Department. It must be recognized early, as large volumes of acute blood loss and rupture into the peritoneum carry significant morbidity and mortality. In the absence of gallbladder disease, the differential diagnosis should include liver pathology. Bedside ultrasonography can be used to identify such lesions. ⋯ In a patient with undifferentiated right upper quadrant abdominal pain, bedside ultrasonography is a rapid and effective modality in the diagnosis of liver masses, including subcapsular hematoma.
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There is growing interest among emergency physicians to seek additional training in Sports Medicine (SM) and to add it to their clinical practice. This presents unique training and practice management issues. The majority of Primary Care SM fellowship programs list that they will accept emergency physicians, and approximately one-third have already had an emergency physician as an SM fellow. ⋯ Sports Medicine is a viable career option for emergency physicians and may complement their skills set in the management of acute injuries. Practice and training opportunities will continue to evolve as this pathway into the practice of SM gains further recognition.
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Repeat users of Emergency Departments (ED), so-called "frequent visitors," place a substantial burden on limited ED resources. The illness features of frequent visitors have not been well defined, though chronic medical and psychiatric illness and substance abuse are implicated. ⋯ Although chronic hepatitis and psychiatric complaints are both implicated in frequent ED visits, patients with psychiatric complaints present to the ED more often. Patients with a "dual diagnosis" of psychiatric condition and alcohol abuse are likely to be frequent visitors. This population should be targeted for creative intervention strategies, both within and outside of the emergency system, that comprehensively screen for symptomatology and integrate mental health treatment with substance abuse interventions.