J Emerg Med
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The use of anticoagulant medications leads to a higher risk of developing traumatic intracranial hemorrhage (tICH) after a mild traumatic brain injury (mTBI). The management of anticoagulated patients can be difficult to determine when the initial head computed tomography is negative for tICH. There has been limited research on the risk of delayed tICH in patients taking direct oral anticoagulant (DOAC) medications. ⋯ This systematic review confirms that delayed tICH after mTBI in patients on DOACs is uncommon. However, large, multicenter, prospective studies are needed to confirm the true incidence of clinically significant delayed tICH after DOAC use. Due to the limited data, we recommend using shared decision-making for patients who are candidates for discharge.
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Case Reports
Delayed Symptomatic Pulmonary Embolism Secondary to Bone Cement After Percutaneous Vertebroplasty.
Percutaneous vertebroplasty (PVP) is a common procedure performed on patients suffering from osteoporotic compression fractures. Complications of the bone cement escaping both locally as well as systemically into pulmonary circulation leading to pulmonary embolism (PE) have been reported in ≤26% of patients. ⋯ A 57-year-old woman presented to the emergency department with complaints of chest pain, fever, and cough. The patient had a history of an outpatient PVP from compression fractures of T5 and T7 performed 25 days before her presentation. She was in moderate respiratory distress and placed on bilateral positive airway pressure with improvement of her respiratory status. Laboratory results were remarkable for an elevated D-dimer, normal B-type natriuretic peptide, and decreased pH on venous blood gas. Pulmonary computed tomography angiography demonstrated bone cement PE in both the left lower lobe and a right middle lobe pulmonary artery. She was admitted to the hospital with improvement of her respiratory status with supportive treatment only. She was discharged after a 4-day hospital stay but died unexpectedly in her sleep 38 days after discharge. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: PVP is a common procedure that carries a risk of PE from bone cement embolization. Most of these events occur during the procedure, making the diagnosis obvious. However, delayed presentations from weeks to years have been reported. The emergency physician should consider bone cement embolization in the differential diagnosis in any patient with chest pain and shortness of breath that also has a history of PVP.
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Ultrasonography (US) is highly dependent on operators' skills. It is not only a matter of correct scan techniques; there are anatomical structures and variants, as well as artifacts, which can produce images difficult to interpret and which, if not properly understood, can be causes of errors. ⋯ We present possible anatomic pitfalls and artifacts that may affect correct interpretation of US images in patients with abdominal trauma and suggest how to avoid or to clarify them during the examination. Knowing their existence, their appearances, and the reasons why they are produced is important for proper use of this diagnostic technique.