J Emerg Med
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We describe a modified string technique for ring removal from an edematous finger, a critical step in the initial treatment of a patient with upper-extremity trauma. ⋯ This multisuture technique adds to the armamentarium of methods for ring removal in the setting of upper-extremity trauma without reverting to alternate techniques for cutting or shattering the ring.
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Shoulder dislocation is one of the most frequent dislocations encountered by emergency physicians. Typical emergency care usually includes performing both prereduction and postreduction radiography. However, selective radiography has the potential benefits of reducing emergency department (ED) time and radiation exposure. ⋯ The refined Fresno-Quebec shoulder dislocation rule detected all clinically important prereduction fracture-dislocations and could have reduced prereduction films by 44%. Prospective validation is warranted.
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National guidelines recommend that prehospital and emergency department (ED) criteria identify patients who might benefit from trauma center triage and highest-level trauma team activation. However, some patients who are seemingly "stable" in the field and do not meet the standard criteria for trauma activation still die. ⋯ Despite apparent evidence of both prehospital stability and stability upon arrival to the ED, patients ≥60 years of age and with a history of CHF or CVA have a significantly increased risk of early mortality after blunt trauma. These patients are at risk for subsequent clinical deterioration and should be considered for early transfer to a trauma center with highest-level activation.
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Periodic paralysis is a rare complication of hyperthyroidism. Patients of East Asian descent are most commonly affected. Presentation is characterized by recurrent episodes of painless, abrupt-onset weakness, with laboratory evaluation characterized by profound hypokalemia. Underlying hyperthyroidism may not be clinically evident, but differentiation from the familial variant is critical due to differing treatment pathways. ⋯ We describe the presentation of a 22-year-old man with recurrent relapsing-remitting weakness with undiagnosed hyperthyroidism. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In patients with acute-onset paralysis with significant hypokalemia, or relapsing-remitting symptoms, hyperthyroidism should be suspected. Obese patients are at an especially increased risk due to underlying insulin resistance, which enhances basal sodium-potassium ATPase function. Hypokalemia is functional in nature. Nonselective β-blockers (such as propranolol) should be considered first line, as they simultaneously decrease ATPase activity, limit insulin secretion, and address the underlying disorder. Administration of > 50 mEq of exogenous potassium places patients at risk of dysrhythmias from rebound hyperkalemia.
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Case Reports
Right Lower Quadrant Abdominal Pain: Do Not Forget About Ovarian Torsion on the Computed Tomography Scan.
Abdominal pain is one of the most common chief complaints of patients presenting to emergency departments, and emergency physicians (EPs) often evaluate patients with right lower quadrant abdominal pain. Ovarian torsion is a rare cause of abdominal pain, but early diagnosis is essential for salvage of the affected ovary. The diagnostic study of choice for ovarian torsion is a pelvic ultrasound with color Doppler, but it is important for EPs and radiologists to be aware of findings of ovarian torsion that might appear on computed tomography (CT). ⋯ We present a case of a young female with right lower quadrant abdominal pain with CT evidence of ovarian torsion that was not recognized; the patient was discharged and then called back when the study was over-read as concerning for ovarian torsion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The presence of radiographic findings associated with ovarian torsion on a CT scan should encourage an EP to order a pelvic ultrasound with color Doppler (if available) and obtain an obstetrics/gynecology consult.