J Emerg Med
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Case Reports
Emergency Department Diagnosis of Postprocedural Hemorrhagic Cholecystitis Utilizing Point-of-Care Ultrasoun.
Hemorrhagic cholecystitis is a rare cause of abdominal pain. Most often described in the setting of blunt abdominal trauma, anticoagulation use, coagulopathy (such as cirrhosis or renal failure), and malignancy (biliary angiosarcoma), this rare condition can be difficult to identify unless high on the differential. With point-of-care ultrasound becoming more commonplace in the emergency department (ED), this tool can be successfully used to make a timely diagnosis in the correct clinical context. ⋯ A 64-year-old man with a past medical history of paroxysmal atrial fibrillation status post ablation on rivaroxaban, myelodysplastic syndrome, nonalcoholic steatohepatitis, gastroesophageal reflux disease, clonal cytopenias of undetermined significance, hypertension, and chronic pain presented to the ED with complaints of right upper quadrant pain in the setting of a recent transjugular liver biopsy. Using point-of-care ultrasound, the patient was diagnosed with hemorrhagic cholecystitis. This is an incredibly rare entity, with 87 documented cases in the literature, only two of which are in the setting of transjugular liver biopsy. The patient was ultimately managed conservatively until he had worsening symptoms, and a laparoscopic cholecystectomy was performed. The patient tolerated the procedure well and recovered. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Hemorrhagic cholecystitis is a rare pathology that can be easily recognized during point-of-care ultrasound examination. This allows for rapid diagnosis and surgical consultation to provide the patient with timely definitive management.
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Musculoskeletal pain (MSK) affects one out of three adults and is the most common source of significant long-term pain, physical disability, and under-treatment in the emergency department (ED). ⋯ We demonstrated that administration of an oral combination of VTS-Aspirin and ketamine to adult ED patients with acute MSK pain resulted in clinically significant pain relief in 80% of enrolled subjects.
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Wilderness expeditions require extensive planning and the correct medical supplies to ensure clinical care is possible in the event of illness or injury. There are gaps in the literature regarding evidence-based methods for medical kit design. ⋯ The medical kit created using this method managed all medical events in the field. This report demonstrates the potential utility of using a tailored, evidence-based approach to design a medical kit for wilderness expeditions.
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Sickle cell disease (SCD) is a lifelong illness affecting many individuals in the United States. Proper management of SCD is imperative, however, the unpredictability of pain crises may lead to frequent emergency department (ED) visits. This SCD feature has led to health-related stigmatization via labels and other terminology within clinical settings, which may be translated through medical research. Thus, it is important for medical literature to adhere to person-centered language (PCL) to diminish such stigmas from transcending into the clinical setting. ⋯ Our study suggests a widespread adherence to PCL in recent SCD literature. However, findings suggest a major disconnect between education and practice, as recent publications document the use of non-PCL terminology within EDs. Health care providers should be aware of biases and institutional resources should be allocated toward raising awareness.
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Observational Study
Emergency Medicine Residency Does Not Reduce a Racial Minority-Based Test Performance Gap.
Health care inequity is corrected more readily when safe, high-quality care is provided by physicians who reflect the gender, race, and ethnicity of patient communities. It is important to train and evaluate racially diverse physicians involved in residency training. ⋯ In this study of the ABEM ITE, a test-taking performance gap identified early in residency for black physicians persisted into late residency.