J Emerg Med
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Point-of-care ultrasonography (POCUS) is increasingly used for both diagnostic and guided procedures. Increasingly, POCUS has been used for identification of pneumonia and to assist in the differentiation of pleural effusions, as well as to guide thoracentesis. As such, there is a need for training with ideally high-fidelity lung ultrasound phantoms to ensure ultrasound proficiency and procedural competency. Unfortunately, most commercial ultrasound phantoms remain expensive and may have limited fidelity. ⋯ Easily prepared, homemade high-fidelity ultrasound phantom models for instructions on identification of pleural effusions and ultrasound-guided pleural tap of parapneumonic effusion were made.
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Spontaneous spinal and intracranial subdural hematomas are rarely reported, especially occurring simultaneously. Anticoagulation use has been associated with spontaneous hemorrhages. Prompt diagnosis is required to prevent permanent neurological sequelae. In this case report, we describe a spontaneous spinal and intracranial subdural hematoma in a woman taking warfarin and initially presenting with severe vaginal pain. ⋯ A 42-year-old woman who had a history of mechanical valve replacement and was therefore taking warfarin, came to an emergency department for relief of severe vaginal pain. Mild concurrent lumbar pain increased concern about spinal pathology, so magnetic resonance imaging of her spine was performed. It revealed a subdural hematoma extending from L1-S1 with arachnoiditis, which suggested intracranial pathology, though the patient had no complaint of a headache. Computed tomography of her brain demonstrated a large right subdural hemorrhage with midline shift. Subsequent imaging revealed no aneurysm or source of the intracranial bleeding. We concluded that the patient experienced spontaneous anticoagulation-related intracranial hemorrhage resulting in lumbar subdural hematoma and arachnoiditis with referred vaginal pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pelvic, vaginal, or perineal pain may be the presenting symptom in patients with lower spinal pathology. It is important to consider causes other than gynecological ones in the differential diagnosis of these patients, as well as to be cognizant of the relationship between spinal and intracranial subdural hemorrhages. In patients with back pain or radiating lumbar pain, especially coupled with neurological effects, clinicians should consider spinal subdural hemorrhage and arachnoiditis to expedite imaging studies and treatment of these rare entities.
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Colonoscopy is a frequently performed medical procedure; complications associated with this procedure often present to the emergency department (ED). Splenic laceration is a rare but life-threatening complication of colonoscopy. We report the unique case of a patient with a splenic laceration who presented after a recent colonoscopy and had no history of trauma. ⋯ A 52-year-old man presented to our ED with abdominal pain and lightheadedness the day after a routine colonoscopy. Ultrasound demonstrated hemoperitoneum, and contrast-enhanced computed tomography of the abdomen revealed a large hemoperitoneum with active contrast extravasation from the laceration of the superior pole of the spleen. After resuscitation, the patient was managed with an emergency splenectomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Colonoscopy complications are frequently identified and managed in the ED. Splenic laceration should be on the differential for patients that present with abdominal pain or hypotension after colonoscopy. Splenic injury carries a high mortality risk, and prompt, accurate diagnosis can be lifesaving.
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Case Reports
Neutropenia, Hypoxia, and the Complexities of Emergency Medicine: A Case of Dapsone-Induced Methemoglobinemia.
Methemoglobinemia is a rare dyshemoglobinemia that can be difficult to diagnose due to its nonspecific symptomatology and infrequent occurrence. A number of commonly used medications have been known to contribute to this disease process that results in acute hypoxemia. ⋯ A 60-year-old man with history of acquired immunodeficiency syndrome presented to the Emergency Department (ED) with asymptomatic hypoxia. Supplemental oxygen proves to be ineffective in treating his low oxygen saturation. Numerous testing modalities are performed in the ED focused on an infectious versus pulmonary etiology prior to coming to the conclusion that the source is methemoglobinemia induced by dapsone therapy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This article discusses the basic pathophysiology of the disease and the expected clinical findings. Patient outcome is correlated with prompt identification and discontinuation of the offending agents leading to the excessive accumulation of methemoglobin in the circulatory system. This makes it crucial that emergency providers know the symptomatology of the disease to facilitate appropriate treatment therapy.
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The Emergency Department (ED) is a medical setting increasingly utilized by opioid users. In January 2016, our health system initiated a take-home naloxone education and distribution program. From July to August 2016, screening was performed in the ED to identify patients for take-home naloxone. ⋯ Routine screening for take-home naloxone can help identify patients at-risk for opioid overdose and increase naloxone access in the ED.