J Emerg Med
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Lingual abscess is a rare clinical entity, with posterior involvement being much less common than anterior involvement. Typical inciting events include trauma or direct inoculation to the area. The clinical diagnosis can be difficult, and early imaging and specialist consultation should be pursued to make a definitive diagnosis and to prevent patient deterioration. ⋯ We present a case of posterior lingual abscess in a 62-year-old man after he received antibiotic injections to the lower molars for periodontal disease. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Lingual abscess is a rare condition that is difficult to diagnose clinically. Misdiagnosis or delayed diagnosis can lead to acute airway compromise and increased morbidity.
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Injury secondary to epileptic seizure is widely documented in the literature. In particular, uncontrolled muscular contractions generated during a seizure can lead to a variety of musculoskeletal injuries. ⋯ We present the case of a 16-year-old male who presented on two separate occasions after a tonic-clonic seizure with hip pain, an antalgic gait, and marked discomfort on hip flexion. Radiologic investigation revealed an acute isolated fracture of the lesser trochanters. Such fractures in adolescents are normally secondary to athletic injury and in adults are mainly associated with the presence of metastatic bone disease. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We present this case with its previously undocumented mechanism to highlight the injury to frontline emergency medical teams, create awareness of its presentation, and to discuss its potential mechanism and treatment.
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Case Reports
Bilateral Quadriceps Femoris Tendon Rupture in a Patient With Chronic Renal Insufficiency: A Case Report.
Simultaneous bilateral quadriceps femoris tendon rupture is a relatively rare occurrence. As such, patients frequently experience a delay in receiving an accurate diagnosis. It is often associated with significant morbidity and loss of function. We report a case of simultaneous bilateral quadriceps tendon ruptures in a patient with chronic renal insufficiency. ⋯ A 46-year-old white man presented to the Emergency Department (ED) via ambulance, reporting sudden onset of bilateral lower limb weakness. He had a medical history of renal insufficiency due to immunoglobulin-A-induced glomerulopathy, with secondary hyperparathyroidism and gout. Examination of his lower limbs revealed significant swelling in his distal thighs anteriorly and suprapatellar defects at the insertion of the quadriceps tendon. No other palpable deficits were identified. The patella was in a normal position and there was minimal tenderness on palpation. He had complete loss of active knee extension. Bilateral patella reflexes were absent. Lower-limb sensation was intact bilaterally and no other neurovascular deficits were elicited. Thompson test was negative and the rest of the clinical examination was unremarkable. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The inability to walk is a common ED presentation. The differential diagnosis is vast and includes but is not limited to: spinal cord injury, Guillain-Barré syndrome, myopathies, and even malingering. This case report details an uncommon cause for a common ED presentation. Furthermore, this case illustrates the importance of a detailed clinical history and physical examination, which narrowed the differential diagnosis and ultimately led to the clinical diagnosis. Knowledge of the patient's past medical history combined with simple imaging modalities permitted a prompt clinical diagnosis of an uncommon condition, which facilitated early operative management.
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Renal colic caused by stone(s) is common in the emergency department. Often, urinalysis reveals white blood cells, but it is unknown how frequently pyuria is sterile or infectious. ⋯ Pyuria was found in 14.2% of patients with renal colic. Patients with pyuria had 36.4% positive cultures compared to 3.3% of patients without pyuria. The degree of pyuria or leukocyte esterase was significantly associated with the risk of a positive culture. Urine cultures are recommended for all patients with renal colic and pyuria.
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In 1998, emergency medicine-pediatrics (EM-PEDS) graduates were no longer eligible for the pediatric emergency medicine (PEM) sub-board certification examination. There is a paucity of guidance regarding the various training options for medical students who are interested in PEM. ⋯ EM-PEDS graduates found combined training to be an asset in their career. They felt that it provided flexibility in job searches, and that it was ideal training for the skill set required for the practice of PEM. EM-PEDS graduates' practices varied, including mixed settings, free-standing children's hospitals, and community emergency departments.