J Emerg Med
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The yield of urine culture testing in the emergency department (ED) is often low, resulting in wasted laboratory and ED resources. Use of a reflex culture cancellation protocol, in which urine cultures are canceled when automated urinalysis results predict that culture yield will be low, may help to conserve these resources. ⋯ These results suggest that a substantial reduction in urine culture testing might be achievable by implementing this protocol. Confirmation of these findings in a validation cohort is necessary.
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Heart failure (HF) emergency department (ED) visits are commonly due to HF self-care nonadherence. ⋯ Patients seeking ED care for decompensated HF had inaccurate HF beliefs and poor self-care adherence. Lack of association between HF beliefs and self care (and trend of an inverse relationship) reflects a need for predischarge HF education, including an explanation of what HF means and how it can be better controlled through self-care behaviors.
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Case Reports
Elevated Compartment Pressures from Copperhead Envenomation Successfully Treated with Antivenin.
Copperhead envenomation causes local soft tissue effects; however, associated compartment syndrome is rare. We report a case of a 17-month-old with significantly elevated compartment pressures successfully treated with antivenin and supportive care. ⋯ In this case, early and aggressive treatment with antivenin may have avoided invasive fasciotomy, and its use should be considered in patients with copperhead envenomation and significantly elevated compartment pressures.
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Eagle syndrome is a rare condition characterized by an elongated styloid process that occasionally irritates or disrupts adjacent anatomical structures. Although this is well known in the literature, it is rarely on the forefront of the clinician's mind. In the trauma patient, awareness of Eagle syndrome and knowledge of the anatomy associated with it may help differentiate symptoms secondary to acute injury from the chronic symptoms of this syndrome. ⋯ In the trauma patient, awareness of Eagle syndrome and knowledge of the anatomy associated with it may help differentiate symptoms secondary to acute injury from the chronic symptoms of this syndrome.
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Chest pain accounts for a significant number of visits to the Emergency Department. Lung herniation is an uncommon cause of chest pain, but one that is easily treated. Patients may complain of pain or present with ecchymosis or a visible bulge in the chest wall. Most lung herniations are located anteriorly or at the thoracic inlet, due to the lack of musculature in these areas. We present a unique case of a right lateral lung herniation and subsequent development of a spontaneous right-sided transdiaphragmatic hernia. ⋯ To our knowledge, this is the first reported case of a patient presenting with spontaneous right-sided lateral lung herniation and spontaneous right-sided transdiaphragmatic hernia. This case is unusual given the location of the hernias, and is unique in the spontaneous development of the hernias without any inciting history of trauma.