Curēus
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We report a renal laceration identified on a point-of-care ultrasound (POCUS) performed in the emergency department on a 58-year-old female presenting after blunt trauma. Emergency workup demonstrated a right flank abrasion with tenderness to palpation, hematuria, and decreasing hematocrit. ⋯ A computed tomography (CT) scan established a diagnosis of isolated right renal hematoma arising from a Grade IV laceration, with no collecting duct involvement. This report reviews the sonographic distinction between a renal hematoma and a positive FAST exam, and emphasizes the vital role ultrasound plays in the evaluation of the trauma patient.
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A Web-based Decision Tool to Estimate Subarachnoid Hemorrhage Risk in Emergency Department Patients.
Subarachnoid hemorrhage (SAH) from a leaking aneurysm is a neurological emergency. SAH patients often present with headache-a common chief complaint among emergency department patients. If unrecognized, 70% of the patients with re-bleeds die and one third are left with neurological deficits. ⋯ Despite this, lumbar puncture is still commonly performed in the emergency department, exposing patients to unnecessary procedural risks. The objective of this research study is to develop a web-based risk calculator that estimates the risk of SAH based on time to emergency department presentation after symptom onset, physical findings and imaging characteristics with the goal of reducing unnecessary lumbar punctures in the emergency department. In this technical report, we describe the prototype calculator, the mathematical basis of the model and provide a link to the web-based prototype. In the future, we will refine the prototype, make it user-friendly to physicians, staff and patients and study its benefits in the emergency department.
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Introduction Podcasts and blog posts have gained popularity in Free Open Access Medical education (FOAM). Previous work suggests that podcasts may be useful for knowledge acquisition in undergraduate medical education. However, there remains a paucity of research comparing the two mediums. ⋯ The podcast group tended to engage in multiple activities while using the learning materials (e.g. at least two to three of the following: driving, eating, chores, taking notes, exercising/walking), while the blog readers tended to do fewer activities (e.g. only one of the following: note taking, eating). Conclusion This study suggests that podcasts and blog posts are useful for extracurricular knowledge acquisition by undergraduate medical students with no significant difference between the two modalities. The usage conditions for each type of media differ.
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Case Reports
Two Cases of Myiasis Associated with Malignancies in Patients Living in the Continental United States.
Myiasis is the infestation of humans with dipterous larvae. Traditionally, myiasis was thought to affect individuals living in tropical regions, however, several cases in temperate zones have been reported. We encountered two patients with histories of malignancies that presented with complaints of myiasis, in Chicago, in the spring and summer of 2016. ⋯ Second of all, for patients with accidental myiasis, a sample of the larvae should be sent for analysis to help guide the treatment. Third of all, myiasis has been associated with new or recurrent malignancies, and therefore a biopsy of the affected tissue should be sent for analysis. Finally, we learned that myiasis can serve as a form of tissue debridement; this coinciding benefit should not prevent the treatment of accidental myiasis.
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Objective To compare hospital-wide code rates and mortality before and after the implementation of a rapid response team (RRT). Study design A prospective cohort design with historical controls. Place of study This study was conducted at Shifa International Hospital, Islamabad, from January 21, 2016, to January 20, 2017. ⋯ The total number of mortality events before the implementation of the RRT was 1470 (3.725%) and after the implementation of the RRT was 1529 (3.805%), which was not significantly different (P = .576). The total number of code blues before the implementation of the RRT was 146 (0.369%) and after the implementation of RRT was 148 (0.368%), which was not significantly different (P = .929). Conclusion In this large single-institution study, rapid response team implementation was not associated with significant reductions in either hospital-wide code blue or mortality.