J Emerg Med
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Case Reports
Bilateral Hyphema - An Unexpected Complication of Exercise Resistance Band Use: A Case Report.
Resistance bands commonly used for strength training exercise come with an unexpected risk for ocular trauma. ⋯ In this report, we describe an unintended consequence of a 28-year-old man sustaining an unusual injury-bilateral hyphema-as a result of the use of elastic resistance bands. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Resistance bands are commonly used for strength training exercise and, in this case, a potentially severe, vision-threatening injury-traumatic hyphema-occurred. Traumatic hyphema occurs when blood pools in the anterior chamber of the eye, usually as the result of blunt force trauma or penetrating injury. Early recognition of this condition is imperative, as complications of traumatic hyphema, such as intraocular hypertension or rebleeding, can lead to permanent vision loss.
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Occam's razor instructs physicians to assume one single cause for multiple symptoms, whereas Hickam's dictum encourages them to suspect multiple concurrent pathologies. Although the general practice is to follow Occam's razor, occasionally Hickam's dictum reigns supreme. Here we present one such case, where the concurrent presence of two life-threatening pathologies posed clinical challenges in diagnosis and management. ⋯ Although cardiac tamponade and pulmonary embolism (PE) are known complications of malignancy, their concomitant existence is rare. Here we report a patient who presented with shortness of breath found to have both cardiac tamponade and submassive PE. Although the cardiac tamponade was initially diagnosed in the Emergency Department by bedside ultrasound and treated with pericardiocentesis, only a few hours later, when she deteriorated, the submassive PE was diagnosed, which was treated with heparin infusion and subsequently transitioned to a newer oral anticoagulant. The patient was later diagnosed as having primary breast cancer and metastatic lung adenocarcinoma. Why Should an Emergency Physician Be Aware of This? This raised unique diagnostic challenges, as both cardiac tamponade and PE present with obstructive shock. The increased right heart pressure from the PE could have paradoxically protected the patient from the tamponade effects of the pericardial effusion. Furthermore, the presence of cardiac tamponade may also mask the typical echocardiographic features of PE. The concurrent presence of two pathologies raised challenges and dilemmas in management. This case shows that physicians should maintain a high degree of suspicion of two pathologies when the patient deteriorates after the first pathology has been appropriately treated.
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Political rhetoric from the former U.S. president influences Latinx adults' feelings of safety and their decisions to seek care in the emergency department (ED). ⋯ Most parents heard statements against undocumented immigrants by the former U.S. president and most believed measures were being enacted. This rhetoric had a substantial negative impact on ULF parents in terms of safety concerns for their child and fear of accessing health care.
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The recent proliferation of electric standing scooters in major urban areas of the United States has been accompanied by injuries of varying severity and nature, representing a growing public health concern. ⋯ Patients presenting with e-scooter injuries have a high likelihood of injury to the radial head, nasal bone, and malleoli. Emergency physicians should be especially vigilant for injuries in these areas at presentation. Visceral injuries are uncommon but may be severe enough to warrant surgery.
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Collecting blood cultures from patients admitted from the emergency department (ED) with acute respiratory infection (ARI) is common, but the rate of secondary bacteremia in adult patients admitted from the ED with ARI associated with respiratory syncytial virus (RSV) is unknown. Indiscriminate collection of blood cultures can be associated with contaminated blood cultures and increased inappropriate antimicrobial use and health care costs. ⋯ Overall, 6.7% of adults hospitalized with RSV infections had secondary bacteremia, more commonly from nonrespiratory sources.