J Emerg Med
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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.
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Urinalysis testing is frequently ordered in the emergency department (ED), but contamination of urine specimens limits the interpretation of results. The mid-stream, clean-catch (MSCC) procedure for urine specimen collection is recommended to decrease contamination rates, but without instructions this procedure has poor compliance. ⋯ A poster-based educational intervention with instructions on MSCC procedure failed to decrease contamination rates in this ED-based study. Possible explanations include poor compliance with MSCC technique in the ED, or poor efficacy of this technique at decreasing contamination rates. These results may indicate that other efforts are necessary to improve urine collection methods.
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Liver function test (LFT) abnormalities are a common problem faced by emergency physicians. This has become more common with the introduction of laboratory panels and automated routine laboratory testing. Fortunately, not all patients with irregularities in liver enzymes possess underlying pathology. This emergency medicine focused review provides a discussion of the various biochemical tests, their underlying biological basis, and an algorithmic approach to the interpretation of abnormalities. ⋯ By understanding the biochemical basis of each LFT, it is possible to correlate laboratory findings to a patient's clinical presentation. An algorithmic approach can be taken to help narrow the spectrum of a differential diagnosis. This may assist providers in ensuring appropriate management and evaluation of the patient with elevated LFTs.
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The differential diagnosis for a non-anion gap metabolic acidosis is probably less well known than the differential diagnosis for an anion gap metabolic acidosis. One etiology of a non-anion gap acidosis is the consequence of ileal neobladder urinary diversion for the treatment of bladder cancer. ⋯ We present a case of a patient with an ileal neobladder with a severe non-anion gap metabolic acidosis caused by a urinary tract infection and ureteroenterostomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Part of the ileal neobladder surgery includes ureteroenterostomy and predisposes patients to several clinically significant metabolic derangements, including a non-anion gap metabolic acidosis. These patients have an increased chronic acid load, bicarbonate deficit, and hypokalemia, which should be appreciated when resuscitating these patients.