J Emerg Med
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Retrocecal appendicitis may be challenging to find. We present the first case series in which retrocecal appendicitis was found on point-of-care ultrasound (POCUS). ⋯ In each of the five cases, appendicitis was found by a pediatric emergency physician in the right periumbilical region or right upper quadrant. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The POCUS practitioner should scan both the right upper and right lower quadrant of the abdomen in search of appendicitis, as well as in search of signs of perforation.
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Diabetic ketoacidosis (DKA) is a hyperglycemic emergency that presents commonly to the emergency department. Severe DKA has the potential for significant morbidity and mortality if not recognized early and treated appropriately. It is incumbent on the emergency clinician to be vigilant in the management of these critically ill patients. ⋯ DKA is a medical condition that has the potential for significant morbidity and mortality if not recognized and managed appropriately.
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Emergency departments (EDs) have experienced an increase in annual patient visits and length of stay over the past decade. Management of frequent-user patients with pain-related diagnoses are challenging in a time-limited setting. ⋯ Understanding characteristics of ED frequent users with pain-related diagnoses may inform community-based interventions designed to reduce episodic care and thereby improve care coordination and management.
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Falls into small water bodies can cause drowning and trauma. Such falls, especially into irrigation canals, and the subsequent trauma are common in Japan. However, few studies have investigated their characteristics, costs, and prognosis. ⋯ Trauma due to falls into irrigation canals can be severe and even fatal, and the related costs are high. Our study highlights the importance of implementing appropriate measures to prevent falls into irrigation canals and of promoting awareness among citizens.
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Case Reports
The Trouble with Swallowing: Dysphagia as the Presenting Symptom in Lateral Medullary Syndrome.
Posterior circulation strokes account for approximately one-fourth of all ischemic strokes, but are frequently misdiagnosed by emergency providers. Current standard stroke screening tools such as the National Institutes of Health Stroke Scale and the Cincinnati Prehospital Stroke Scale are weighted toward anterior circulation stroke diagnosis. Lateral medullary syndrome, a type of posterior circulation stroke, can be particularly challenging to diagnose due to nonspecific presenting symptoms, such as dysphagia. ⋯ This report describes a 65-year-old man who presented with dysphagia, dizziness, and hoarseness. An initial neurological examination did not reveal any gross deficits, and imaging to evaluate for posterior circulation stroke was not obtained. The patient presented the following day with worsening symptoms, prompting imaging that revealed a large cerebellar ischemic infarction. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although dysphagia frequently occurs in lateral medullary syndrome, it is rarely the presenting symptom in the emergency department. In patients with cerebrovascular risk factors who present with dysphagia, a complete neurological examination should be performed and noncontrast computed tomography (CT) of the head should be obtained if a neurological deficit is appreciated. Due to their poor sensitivity, CT scans can frequently miss posterior circulation strokes, therefore magnetic resonance imaging should be considered if provider suspicion remains high. Emergency providers are encouraged to have a high level of suspicion for this rare but debilitating stroke syndrome to avoid misdiagnosis and delayed care.