J Emerg Med
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Emergency medicine (EM) has its challenges, downsides, advantages, and accompanying lifestyle. Additionally, graduates of EM residency programs have abundant job opportunities. Accordingly, there is an increased interest in residency training in EM, even among residents with prior training. ⋯ Therefore, in this article, we elaborate on the transition process from another discipline to EM in light of changes in residency funding. We also explore the advantages and disadvantages of transitioning to EM with previous training in another specialty. Moreover, we expand on credit equivalencies for months already completed in another training programs, as well as the difficulties to be anticipated by transitioning physicians.
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Commonly used ultrasound-guided internal jugular vein (IJV) cannulation techniques, short axis out of plane and long axis in-plane, have significantly reduced complications but failed to eliminate them because of technical difficulties. ⋯ Anteroposterior short axis in-plane technique is relatively novel and could be alternatively used safely and effectively in place of existing techniques for IJV cannulation.
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The reported risk of delayed intracranial hemorrhage (ICH) in a trauma patient on warfarin is estimated to be between 0.6% and 6%. The risk of delayed ICH in trauma patients taking novel oral anticoagulants (NOACs) is not well-defined. ⋯ A fall from standing or less in anticoagulated geriatric patients is a significant mechanism of injury resulting in ICH. The absence of LOC does not eliminate the possibility of ICH. There is a significant risk of delayed ICH for patients on NOACs and repeat evaluations should be performed. A prospective multicenter evaluation of this finding is warranted.
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Case Reports
Point-of-Care Ultrasonography for Hernia Reduction: A Case of Incarcerated Umbilical Hernia.
Manual reduction of an incarcerated hernia is used to avoid emergency surgery, which comes with risks of complications and death, especially in patients with severe comorbidities. However, there are no established procedures for hernia reduction. ⋯ We present the case of an 82-year-old man with refractory ascites due to nephrotic syndrome and chronic heart failure who developed an incarcerated umbilical hernia. Color Doppler ultrasonography allowed us to detect clearly visible blood-flow signals in the incarcerated bowel and rule out necrosis, which is a contraindication for reduction. Several attempts at manual reduction failed; ultrasonography-guided reduction revealed that fluid collection within the hernia sac was blocking the manual pressure directly on the incarcerated bowel toward the hernia orifice. After sac paracentesis (draining the fluid from the sac), the incarcerated bowel became palpable, leading to a successful reduction. Four days later, once the patient was in a stable condition, an elective surgery was performed to prevent the recurrence of incarceration. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We believe that this is a useful report on the use of point-of-care ultrasonography for incarcerated hernia from the initial assessment of bowel viability to reasonable hernia reduction through hernia sac paracentesis according to real-time observation. An approach based on visualization by ultrasonography, and not on the operator's experience, would be rational, and we believe that this approach will be feasible for emergency physicians, who are responsible for the initial treatment of incarcerated ventral hernia.