J Emerg Med
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Cervical artery dissection (CeAD) is an infrequent, yet potentially devastating, cause of stroke. While uncommon, CeAD is important for emergency physicians to quickly diagnose and treat because of the potential for cerebral ischemia, stroke, blindness, or death. To our knowledge, no review articles in the emergency medicine literature have been published on CeAD. A literature search of MEDLINE/PubMed, Embase, and other major abstracts in the English language was performed for the following terms: cervical artery, vertebral artery, and carotid artery dissection. The search included all titles from January 1, 2010 to February 28, 2015 and other relevant articles. ⋯ Overall, the prognosis of patients with CeAD is good, with relatively low death rates. However, the diagnosis should not be missed, because treatment may help prevent worsening or persistent ischemia, recurrent dissection, and death.
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In 2008, the Council of Emergency Medicine Residency Directors (CORD) developed a set of recruitment strategies designed to increase the number of under-represented minorities (URMs) in Emergency Medicine (EM) residency. ⋯ Less than half of EM programs have instituted two or more recruitment strategies from the 2008 CORD diversity panel. EM faculty diversity, active pipeline programs, and attention paid to applicants' URM status and extracurricular activities were associated with higher resident diversity.
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Emergency bedside point-of-care ultrasound provides an extremely fast and cost-effective diagnostic modality for the diagnosis of vascular abnormalities, such as pseudoaneurysms. The cost-benefit and timing advantages of ultrasound are increasingly apparent when compared to more conventional diagnostic tests, such as computed tomography angiography and magnetic resonance angiography scans. ⋯ A 33-year-old man with no medical history presented to our emergency department complaining of a constant, throbbing, left-sided headache over his temple with an associated mass. The physical examination revealed a 0.5-cm, tender, flesh-colored, pulsatile mass over his left temple. The tender mass was evaluated at the bedside by an emergency physician with a linear array L-14 probe on the ZONARE ultrasound system (ZONARE Medical Systems, Inc., Mountain View, CA). A small anechoic collection adjacent to the superficial temporal artery was identified with a sac containing flow in a prototypical "yin and yang" pattern. These findings were consistent with a superficial temporal artery pseudoaneurysm. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We present this case report because of the implications of missing the diagnosis. Emergency physicians should be aware of the possible diagnosis of pseudoaneurysm of the temporal artery because of the plethora of head injuries that we evaluate on a regular basis. Missing the diagnosis can lead to delayed neurologic sequela and potential life-threatening bleeding in patients presenting with what appears to be a minor complaint.
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Phosphodiesterase-5 (PDE-5) inhibitors enhance penile erection and have gained popularity not only for erectile dysfunction, but also in recreational settings. Nevertheless, adverse effects have been associated with their use, with nasal bleeding among them. PDE-5 inhibitor action is materialized through the inhibition of the cyclic guanosine monophosphate (cGMP) enzyme. cGMP is present at several sites of the human body in addition to the corpus cavernosum, leading to the adverse effects associated with its nonselective inhibition. ⋯ Two male patients with severe epistaxis who were taking PDE-5 inhibitors for erectile dysfunction or recreational purposes are discussed. Surgical intervention was required in both patients to control the nasal hemorrhage. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Nasal bleeding in patients who are taking PDE-5 inhibitors might represent an under-reported cause of epistaxis because of the unwillingness of most male patients to discuss issues pertaining their use without hesitation. Yet such episodes are rather profuse. This is especially true when the venous engorgement caused in the nasal mucosa by the smooth muscle relaxant effect of PDE-5 inhibitors is combined with a second event (e.g., specific drugs or blood dyscrasia). Emergency physicians should be also aware of the possibility that in the coming years the number of such cases might increase because of the increased use of these medications for erectile dysfunction or recreational purposes. It is likely that these patients could not be managed conservatively, but would rather require referral to an Ear, Nose, and Throat Department for surgical intervention.