J Emerg Med
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Atypical hemolytic uremic syndrome (aHUS) is a complement-mediated disease manifesting in thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury. It has a higher incidence of extrarenal manifestations, including central nervous system findings like seizure or stroke, pancreatitis, and cardiac manifestations. ⋯ We present a case of an unimmunized 14-month-old girl presenting with generalized seizure and ultimately diagnosed with aHUS. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: These atypical neurological symptoms can cause the diagnosis to be commonly missed in the emergency department. The etiology of approximately 60% of patients with aHUS can be attributed to genetic mutations in complement regulators including factor H, membrane cofactor protein, factor I, activator factor B, or C3. Although previously treated with plasma transfusion and immunosuppressants, eculizumab is a newer treatment that has been changing prognosis and management of aHUS, but it should be administered within 48 h of symptom onset for best efficacy.
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Headache and monocular visual disturbance are worrisome pediatric presenting complaints in the emergency department. Appropriate and timely initial evaluation is critical. Most would opt for urgent computer tomography in such cases. Pediatric optic neuritis is a rare condition and is better evaluated by magnetic resonance imaging. With the increase in the use and scope of bedside ultrasound, there might be a potential role for transorbital ultrasound to be part of the emergency department evaluation of pediatric optic neuritis. ⋯ This is the first pediatric case report on the use of bedside transorbital ultrasound in the emergency department evaluation of a 15-year-old girl with optic neuritis who presented with unilateral headache and left visual disturbance. Transorbital ultrasound of her left eye revealed an irregularly enlarged optic nerve sheath with increased optic nerve sheath diameter (5.1 mm) and an elevated optic disc height (0.5 mm). Ultrasound examination of her right eye was contrastingly normal, showing an optic nerve sheath diameter of 3.8 mm and that the optic disc was not elevated. The ultrasound findings correlated well with her magnetic resonance imaging of her orbits. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The clinical findings and monocular ultrasound abnormalities facilitated the emergency department decision-making process and choice of neuroimaging. This highlights the use of transorbital ultrasound as a clinical adjunct and potential role in the emergency department clinical evaluation of a pediatric patient with optic neuritis. The finding of an irregularly enlarged optic nerve might be of potential clinical value but further studies are required.
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The number of allopathic emergency medicine (EM) programs has been progressively increasing over the years. In 2018, allopathic EM postgraduate year-1 spots, compared with 2012, increased by around 60% to reach 2278 positions. ⋯ Additionally, we tackle the combined emergency medicine residency programs, namely the combined EM-Family Medicine (FM), EM-Anesthesiology, EM-Internal Medicine (IM), EM-IM-Critical Care Medicine, and EM-Pediatrics residency programs. Finally, we explain the increased likelihood of matching with the single graduate medical education accreditation system expected to happen in the year 2020.