J Emerg Med
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Emphysematous cholecystitis (EC) is a form of cholecystitis with high mortality rates more commonly seen in patients with medical histories such as diabetes, hypertension, and peripheral vascular disease. The common features of these medical diseases are impaired pain perception, particularly abdominal pain, due to advanced age and peripheral neuropathies. Accurate evaluation of characteristics observed at ultrasonography, the method of first choice in the diagnosis of EC, is therefore highly important in these patients. ⋯ This study reports a case of the champagne sign, rarely seen in EC, together with other EC findings. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The champagne sign is a little-known sonographic finding that is evidence of the presence of gas in the gallbladder. The champagne sign that will be detected while evaluating the hepatobiliary system on bedside ultrasound is one of the valuable findings in the diagnosis of emphysematous cholecystitis with high mortality.
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Lateral canthotomy is a vision-saving procedure. However, the low incidence of orbital compartment syndrome and the expense of simulators to practice this procedure can lead to low confidence and delays in the performance of the procedure by emergency physicians. ⋯ This simple task trainer is practical, inexpensive, quickly assembled, and useful as a tool for practicing emergency medicine providers.
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Randomized Controlled Trial
Video Laryngoscopy Improves Intubation Times With Level C Personal Protective Equipment in Novice Physicians: A Randomized Cross-Over Manikin Study.
The use of video laryngoscopes by novice physicians may improve first-pass success rates compared with direct laryngoscopy. ⋯ First-pass success and insertion time with the video laryngoscope were not affected by PPE donning. However, both were negatively affected with the Macintosh laryngoscope.
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Upper-extremity injuries are frequently seen in the emergency department (ED), yet traditional analgesic methods are often ineffective (e.g., hematoma blocks) or associated with prolonged ED duration and nontrivial risk (e.g., procedural sedation). Ultrasound-guided regional anesthesia of the infraclavicular brachial plexus offers dense anesthesia of the distal upper extremity. The Retroclavicular Approach to The Infraclavicular Region (RAPTIR) is an ultrasound-guided brachial plexus block that has only recently been described in both anesthesia and emergency literature. ⋯ We report use of the RAPTIR block in an elderly patient with a subacute angulated distal radius fracture that would otherwise require surgical management. The patient presented 11 days post injury and had no hematoma to block, and her age made her high risk for procedural sedation or operative management. Using the RAPTIR block, ED providers achieved dense anesthesia of her arm, allowing for appropriate reduction of a displaced fracture 11 days after injury. The patient followed with orthopedic surgery, never required additional manipulation, and had full return to activities of daily living. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In this case, the RAPTIR block safely and effectively anesthetized the distal upper extremity. This block provides clear visualization of neck and thoracic structures and has a simpler technique than traditional inferior brachial plexus blocks. It achieves dense anesthesia to allow for complex or repeat reduction attempts without the need for procedural sedation, opiates, or an operative setting. Our report details this patient, the RAPTIR technique, and the state of the current literature.