J Emerg Med
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Skin and soft-tissue infections (SSTIs) are common disease presentations to the emergency department (ED), with the majority of the infections attributed to community-acquired methicillin-resistant Staphylococcus aureus. Rapid and accurate identification of potentially serious SSTIs is critical. Clinician-performed ultrasonography (CPUS) is increasingly common in the ED, and assists in rapid and accurate identification of a variety of disease processes. ⋯ A 21-year-old female presented to the ED with chin swelling and "boils." Although her visual examination was benign, CPUS of her facial swelling quickly established a more concerning disease process, which was eventually confirmed by aspiration and bone biopsy to be mandibular osteomyelitis. The causative organism, Serratia odorifera, is rarely associated with infections, and we are aware of no previously reported cases of osteomyelitis due to this species. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In this case of mandibular osteomyelitis, CPUS rapidly and accurately identified abnormal bony cortex of the mandible and an associated fluid collection. CPUS of an otherwise benign presentation of a facial infection led to a maxillofacial computed tomography scan, aspiration and biopsy, and then elective debridement of the bone infection. Emergency physicians should be aware of the utility of CPUS and the need to carefully investigate SSTIs presenting to the ED.
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Concentrated laundry detergent packs are new products that may be more likely to cause adverse effects and serious medical outcomes among young children than traditional laundry detergent products. ⋯ Pediatric exposures to laundry detergent packs were more likely to be referred to health care facilities if the laundry detergent pack brand was Purex(TM), the exposure was ocular, or particular ocular, respiratory, dermal, or neurologic clinical effects were present.
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Analyses of patient flow through the emergency department (ED) typically focus on metrics such as wait time, total length of stay (LOS), or boarding time. Less is known about how much interaction a patient has with clinicians after being placed in a room, or what proportion of their in-room visit is also spent waiting. ⋯ Approximately 75% of a patient's time in a care area is spent not interacting with providers. Although some of the time waiting is out of the providers' control (eg, awaiting imaging studies), this significant downtime represents an opportunity for both process improvement efforts and innovative patient-education efforts to make use of remaining downtime.
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Adolescent patients comprise the highest rate of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) in the United States. These patients often initially present to the emergency department (ED) with vague symptoms. ⋯ The majority of adolescent women found to have GC or CT or both in the ED were not treated at presentation.
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Cerebral aneurysms most commonly present with subarachnoid hemorrhage (SAH), a catastrophic event. However, 11-15% of unruptured aneurysms are symptomatic, with presentations including seizures, unilateral cranial nerve deficits, visual loss, headache, and ischemia. Of patients presenting with seizures, the semiology described includes speech arrest, "feelings of dread," localized pins and needles, and tonic clonic episodes. We report the case of a patient who presented to the emergency department (ED) with complex partial seizures secondary to a cerebral aneurysm. ⋯ A 54-year-old woman presented to the ED after an episode where she had noticed a "bad smell" and sensations of nausea and dizziness. This was the third episode she had experienced in 2 weeks, and other than migraine, she had no significant medical or family history. Physical examination was normal, but a computed tomography (CT) scan of the brain revealed a 15-mm aneurysm of the right middle cerebral artery. The patient was subsequently transferred for urgent neurosurgical intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The emergency physician should strongly consider the use of head CT in the evaluation of adults presenting with a first unprovoked seizure, as rarely they can be caused by urgent pathologies including cerebral aneurysms. If a patient is found to have a possible symptomatic unruptured aneurysm, they should be referred for urgent neurosurgical consultation, as these lesions have an increased risk of rupture.