J Emerg Med
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Observational Study
Analysis of Brush Cutter-Related Accidents: Describing an Extraordinary Kind of Agricultural Injury.
Brush cutter (BC)-related penetrating trauma, similar to other types of power saws, can cause serious injuries, especially to the extremities. Studies of this particular injury are limited. ⋯ BC-related accidents are often preventable but can result in severe disabilities or death. Therefore, health care facilities should be provided in regions at risk to reduce hazards.
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Trichomonas vaginalis (TV) is one of the most common sexually transmitted infections (STIs). Overall prevalence is reported to be 3.1%, with rates approaching 12.9-14.4% in high-risk female populations. Although there is a plethora of data on TV in the female population, the corresponding data for the male population are limited. ⋯ Rates of TV in male patients who receive STI testing in the ED are similar to rates published previously for female patients. We found higher rates among older and African-American male patients. TV among male patients is prevalent and testing should continue when evaluating for STIs.
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Ultrasound inferior vena cava (IVC) diameter has been shown to decrease in response to hemorrhage. IVC diameter cut points to identify moderate and severe blood loss have not been established. ⋯ An ultrasound IVCmax of ≤ 0.8 cm may be useful in identifying moderate and severe hemorrhage before vital sign abnormalities are evident.
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Psoas muscle abscess (PMA) is a collection of pus in the psoas muscle. It is considered a rare clinical entity and is often misdiagnosed due to highly vague symptoms. We report that point-of-care ultrasound (POCUS) serves as a useful and noninvasive tool for early detection of PMA. ⋯ Our patient was a 35-year-old man without any past medical illness who visited the emergency department due to right lower back pain and hematuria for 8 months. He denied fever, trauma, or recreational drug use. On arrival, the patient's vital signs were stable and had no fever. Laboratory tests showed white blood cell count 12,800/μL with neutrophil segment 83.2%, C-reactive protein 0.2 mg/dL, and normal renal function. Urine routine showed red blood cells > 100/high-power field. Kidney-ureter-bladder radiograph revealed a positive psoas sign on the right. POCUS showed a mixed echogenic mass adjacent to the right kidney. Subsequently, contrast abdominal computed tomography revealed T10-T11 collapsed vertebral bodies with disc erosion and right psoas muscle abscess at the right kidney level. The patient received open drainage of psoas muscle abscess and T11-T12 laminectomy. He was discharged 13 days post admission. Why ShouldanEmergency PhysicianBe Aware of This? Early and accurate diagnosis of PMA is important because, if left untreated, mortality rate can reach 100%. A potential pitfall in our case is the presence of hematuria with flank pain that could lead to incorrect diagnosis of renal calculi, a much more common condition. This case illustrates the importance of using POCUS in any patient with back or flank pain, with or without hematuria.