J Emerg Med
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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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Wounds, particularly chronic wounds, are a common presentation to the Emergency Department (ED), and in severe cases can contain maggots. Maggot debridement therapy is a popular technique for wound debridement, but is limited to the use of sterilized larvae due to concerns of contamination and invasion of "wild" maggots into healthy tissue. Wild maggots in chronic wounds, therefore, should be removed, yet there is no reported literature that describes a technique for their removal. ⋯ The technique described in this article is a simple, safe, and efficient way for the Emergency Physician to remove "wild" larvae from wounds.
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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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Cannabinoid hyperemesis syndrome (CHS) was initially described in 2004 and remains an under-recognized clinical entity that occurs in chronic heavy marijuana smokers. ⋯ Our report suggests that frequent habitual smoking of synthetic cannabinoids can cause cannabinoid hyperemesis syndrome.
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Ultrasonographic evaluation of the inferior vena cava (IVC) provides information on central hemodynamics and predicts fluid responsiveness during positive pressure ventilation. In spontaneously breathing patients, the correlations between IVC dynamics and the hemodynamic response to volume shifts remain to be described. ⋯ IVC-CI and IVCe did not correlate with the magnitude of hemodynamic response to early hemorrhage. The sensitivity of serial IVC measurements was approximately 80% for detecting early blood loss.