J Emerg Med
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Over the last decades, dental implants have become increasingly popular in the prosthetic rehabilitation of patients. This has subsequently led to an increase of perioperative complications. Obstruction of the airway as a result of a floor of mouth hematoma after dental implant surgery is a rare but life-threatening complication. ⋯ A 62-year-old man presented to the emergency department with a compromised airway caused by a hematoma in the floor of the mouth that occurred during dental implant surgery in the edentulous anterior mandible. Computed tomography angiography images revealed an elevation of the floor of mouth with subsequent occlusion of the airway. In addition, a perforation of the lingual mandibular cortical plate was observed that was caused by two malpositioned dental implants. Awake fiberoptic intubation was immediately performed, the two malpositioned dental implants were subsequently removed, and the patient was extubated after 3 days. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Perforation of the lingual mandibular cortical plate during dental implant surgery can lead to life-threatening bleeding in the floor of the mouth. This condition can be successfully treated by awake fiberoptic intubation and, if necessary, the malpositioned dental implants can be subsequently removed.
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Almost 70% of hospital admissions for Medicare beneficiaries originate in the emergency department (ED). Research suggests that some of these patients' needs may be better met through home-based care options after evaluation and treatment in the ED. ⋯ Some Medicare beneficiaries could be referred to Home Health from the ED with a concomitant reduction in Medicare expenditures. Additional studies are needed to compare outcomes, develop the logistical pathways, and analyze infrastructure costs and incentives to enable Medicare Home Health options from the ED.
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Assessment practices in emergency medicine (EM) clerkships have not been previously described. Clinical assessment frequently relies on global ratings of clinical performance, or "shift cards," although these tools have not been standardized or studied. ⋯ There is substantial variability in assessment practices between EM clerkships, raising concern regarding the comparability of grades between institutions. CDs rely on shift cards in grading despite the lack of evidence of validity and inconsistent process variables. Standardization of assessment practices may improve the assessment of EM students.