J Emerg Med
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Tongue lacerations provide a challenge for emergency physicians, especially in the case of pediatric patients. Traditional wound closure typically involves local anesthesia or procedural sedation in children, which is time consuming and often anxiety provoking for providers, patients, and parents. 2-Octyl cyanoacrylate (Dermabond(®); Ethicon, Inc., Sommerville, NJ) has been used in the context of the emergency department for successful repair of lacerations, however, is not marketed for use on mucosal or intraoral surfaces. This case report describes an alternative manner of tongue laceration repair by the use of 2-octyl cyanoacrylate. ⋯ Tongue lacerations and other intraoral lacerations are challenging to repair, especially in pediatric patients. The use of tissue adhesives such as 2-octyl cyanoacrylate is very likely safe and may provide an expedient manner in which to repair such lesions with good cosmetic results.
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Case Reports
Severe Subarachnoid Hemorrhage Associated with Cerebral Venous Thrombosis in Early Pregnancy: A Case Report.
Cerebral venous thrombosis (CVT) rarely induces subarachnoid hemorrhage (SAH). During late pregnancy and puerperium, CVT is an uncommon but important cause of stroke. However, severe SAH resulting from CVT is extremely rare during early pregnancy. ⋯ A rare case of severe SAH due to CVT is reported, with emphasis on the potential pitfalls of CVT diagnosis in early pregnancy.
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Munchausen syndrome is a psychiatric disease characterized by pathological lying and malingering. Patients who are affected can set up such complex and compelling clinical scenarios that they can lead to a bias in the diagnostic process and even to unnecessary surgery. ⋯ Retrospective analysis of the clinical events and the diagnostic process suggests that a confirmation bias played a major role in determining the misdiagnosis. The same mistake is likely to have occurred in the only other case reported in the literature.
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Computed tomography (CT) signs of hypovolemic shock have been reported previously. Whether these signs can be used to clinically predict hypovolemic shock remains unclear. ⋯ MSCT can provide useful information for predicting hyovolemic shock in severe multiple-injury patients. An IVC flatness index > 3.02 suggests the presence of hypovolemic shock in severe multiple-injury patients.
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A National Board of Medical Examiners examination does not exist for Emergency Medicine (EM) students. To fill this void, the Clerkship Directors in Emergency Medicine tasked a committee with development of an examination for 4th-year (M4) EM students, based on a published syllabus, and consisting of questions written according to published question-writing guidelines. ⋯ A national group of EM educators developed an examination to assess a published clerkship syllabus. The examination contains questions written according to published item-writing guidelines, and exhibits content validity, appropriate difficulty levels, and adequate question discriminatory ability.