J Emerg Med
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Multisystem inflammatory syndrome in children (MIS-C) is a newly recognized condition affecting children with recent infection or exposure to coronavirus disease 2019 (COVID-19). MIS-C has symptoms that affect multiple organs systems, with some clinical features resembling Kawasaki disease (KD) and toxic shock syndrome (TSS). ⋯ The diagnosis of MIS-C is based on clinical presentation and specific laboratory findings. In the emergency setting, a high level of suspicion for MIS-C is required in patients exposed to COVID-19. Early diagnosis and prompt initiation of therapy offer the best chance for optimal outcomes.
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Randomized Controlled Trial
Translating Violence Prevention Programs from Research to Practice: SafERteens Implementation in an Urban Emergency Department.
Youth violence is a leading cause of adolescent mortality, underscoring the need to integrate evidence-based violence prevention programs into routine emergency department (ED) care. ⋯ Implementing behavioral interventions such as SafERteens into routine ED care is feasible using remote delivery. Policymakers should consider reimbursement for violence prevention services to sustain long-term implementation.
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Point-of-Care Ultrasound For Differentiating Ileocolic From Small Bowel-Small Bowel Intussusception.
Intussusception is a common pediatric emergency. The two types of intussusception are ileocolic intussusception (ICI) and small bowel-small bowel intussusception (SB-SBI), and neither are easily distinguished clinically. ICI requires radiology personnel and potentially surgical assistance for its reduction. SB-SBI is managed expectantly, as many resolve spontaneously. Differentiating between ICI and SB-SBI through point-of-care ultrasound (POCUS) requires an understanding of their salient features. Identification of the correct type of intussusception immediately assists decision making and patient disposition. ⋯ ICI and SB-SBI can be identified and differentiated using several sonographic features. POCUS is capable of expeditiously aiding the emergency physician's decision making and disposition when managing intussusception.
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Case Reports
Point-of-Care Ultrasound Assisting in the Rapid Diagnosis of Acute Cholangitis 60 Years After Cholecystectomy.
Point-of-care ultrasound (POCUS) is used frequently to evaluate the right upper quadrant of patients with high suspicion for biliary pathology. In patients with a history of cholecystectomy, the utility of POCUS can be overlooked. ⋯ We report the case of an 83-year-old female patient who was ultimately diagnosed with cholangitis more than 60 years after undergoing cholecystectomy. POCUS demonstrated a dilated common bile duct (CBD), which was confirmed by computed tomography and magnetic resonance cholangiopancreatography to be due to a large stone. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Choledocholithiasis and cholangitis can still occur in patients with a remote history of cholecystectomy. POCUS can be used to rapidly evaluate the CBD for dilatation in patients post cholecystectomy.
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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.