J Emerg Med
-
Focused cardiac ultrasound (FoCUS) can be extremely helpful in identifying unexpected diagnoses that can significantly alter treatment options. The diagnosis of Takotsubo cardiomyopathy (TCM) may be difficult to identify. ⋯ We describe a 47-year-old woman who presented to the emergency department (ED) with atypical features of TCM. Her clinical features included being a premenopausal woman with mild chest pain with a lack of identifiable emotional or physical stressors or significant electrocardiographic changes. Initial findings on FoCUS were consistent with TCM, with these findings replicated on repeat bedside echo performed in the ED by the cardiology fellow. A subsequent comprehensive echo showed marked improvement of the TCM pattern within 24 hours. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: TCM may present in younger women or men, without obvious preceding physical or emotional stressors and with nonspecific ECG findings. FoCUS performed in the ED may suggest a diagnosis of TCM in patients with chest pain or dyspnea of uncertain etiology. The performance of FoCUS, as highlighted by this case report, can lead to timely intervention and follow-up of a variety of cardiac conditions.
-
The majority of crashes cause "minor" injuries (i.e., treated and released from the emergency department [ED]). Minor injury crashes are poorly studied. ⋯ Driver-related risk factors are common in drivers involved in minor injury crashes, and drivers persist in taking risks after being involved in a crash. Despite their name, minor injury crashes are often associated with slow recovery and prolonged absenteeism from work.
-
In general, hematogenous spread of bacteria in children is uncommon. Bacteremia, however, is a known complication of dental procedures and severe caries, but is infrequently associated with primary, asymptomatic, non-procedural-related, dentoalveolar infection. ⋯ The patient is a 7-year-old previously healthy boy who presented to the Emergency Department (ED) with "fever, mottling, and shaking chills." In the ED, he appeared systemically ill with fever, mottling, delayed capillary refill, and rigors. Physical examination by three different physicians failed to reveal any focus of infection. Laboratory evaluation, including blood cultures, was obtained. The patient later developed unilateral facial swelling and pain, and a dentoalveolar abscess was found. He was started on antibiotics, underwent pulpectomy and eventually, extraction, prior to improvement in symptoms. Blood cultures grew two separate anaerobic bacteria (Veillonella and Lactobacillus). This is, to our knowledge, one of the first reported cases of pediatric sepsis with two different anaerobic organisms secondary to occult dentoalveolar abscess in a pediatric patient. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is imperative for emergency physicians to recognize the possibility of pediatric sepsis in the setting of acute maxillary or mandibular pain, as well as in patients for whom no clear focus of infection can be found. This is particularly important for those who appear ill at presentation or meet systemic inflammatory response syndrome criteria and would benefit from further laboratory evaluation, including blood cultures, and possibly antibiotic therapy.
-
Case Reports
Ultrasound-Guided Femoral Nerve Blockage in A Patellar Dislocation: An Effective Technique for Emergency Physicians.
Patellar dislocation is an orthopedic emergency and its reduction can be painful. The aim of this case is to show that the ultrasound-guided femoral nerve blockage can be effectively used in the pain management of patellar reduction in the emergency department (ED). ⋯ A 21-year-old man was admitted to our ED after suffering a fall down a flight of stairs. The initial physical examination and plain radiography showed a patellar dislocation in the right knee. We performed an ultrasound-guided femoral nerve blockage to provide a pain-free and comfortable patellar reduction. To our best knowledge, there is no manuscript except an old case series about use of the ultrasound-guided femoral nerve blockage in the management of patellar reduction in the medical literature. Procedural sedation is the preferred method used for this purpose in ED, but these medications need to be closely monitored because of their potential complications, such as nausea, vomiting, allergic reactions, and respiratory depression. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ultrasound-guided femoral nerve blockage gave rapid and effective pain control without any complication during the reduction in this patient. Therefore, we suggest this technique be used for pain management during the reduction of a dislocated patella in the ED.
-
A subluxation of the radial head (SRH) is a clinical condition that commonly occurs in children under 6 years of age. History and physical examination findings typically include a child who presents with an elbow held in extension and with forearm pronation, after having suffered significant longitudinal traction on the arm, or after a fall on an outstretched hand. The diagnosis is often clinically obvious. The injury responds dramatically to closed reduction, and usually no imaging is required. However, cases with atypical presentations and patients who do not respond favorably to a reduction maneuver present clinical challenges, because the initial diagnosis of SRH may seem to be questionable or erroneous. Point-of-care ultrasound (POCUS) can assist decision-making and clinical management for these patients. ⋯ We report three cases of SRH that were diagnosed and managed with POCUS in the emergency department. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS can assist in the diagnosis and management of patients with clinical suspicion of SRH, especially in cases of atypical presentations or cases in which the mechanism of injury is unknown. It is also an extremely valuable tool in determining postprocedure reduction success.