The American journal of emergency medicine
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Clinical Trial Controlled Clinical Trial
Does a physician visual assessment change triage?
A prospective comparative trial was conducted to determine the effect of a physician's visual assessment of emergency patients on triage categorization and ability at triage to predict admission. The setting was a university, county, referral center and residency training site. Participants were a consecutive sample of emergency department patients presenting between the times of 0700 and 2300 hours for 5 weeks. ⋯ When physician visual assessment was done, agreement between physicians and nurses decreased by more than half. Physicians who included visual assessment in patient triage were less likely to agree with RN categorization. A visual assessment by the physician improved the sensitivity for predicting admission with an only small cost in specificity.
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Case Reports
Obstructive ileus caused by a swallowed foreign body (a "press-through" package) and preexisting adhesions.
A "press-through" package (PTP), because it is large and square-shaped, tends to be caught in the esophagus when swallowed. A rare case of obstructive ileus induced by a PTP that was swallowed by 54-year-old man with a history of diabetes mellitus and acute appendectomy is reported. The PTP was 19 mm x 18 mm and was lodged in the cecum, which was stenosed because of preexisting intestinal adhesions; consequently, the PTP obstructed the ileus. The PTP was surgically removed.
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Case Reports
Traumatic thrombophlebitis of the superficial dorsal vein of the penis: an occupational hazard.
Several cases of thrombophlebitis of the superficial dorsal vein of the penis (TSDVP) have been reported in the literature. Etiologies may include any of the following: trauma associated with vigorous sexual intercourse; penile strangulation caused by a multitude of entities; penile injection; infection; neoplasm; or surgery. We report a rare case of traumatic TSDVP in a cab driver following repeated injury to the penis by a coin-filled pouch. We review the etiologies, mechanism, and treatment of traumatic TSDVP, and attempt to identify men who may be at similar occupational risk.
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Case Reports
Spontaneous cervicothoracic epidural hematoma following prolonged valsalva secondary to trumpet playing.
Spontaneous spinal epidural hematoma is an uncommon clinical entity. Patients with this disease may present with devastating neurological deficits that can mimic other diseases. Emergency physicians should be familiar with this condition to assure appropriate therapy in a timely manner. A typical case of spontaneous spinal epidural hematoma is presented with review of appropriate differential diagnosis and management.
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An unusual case of multiple impalement by chain-link fence posts is presented in which facial, thoracic, and abdominal injuries were sustained following a rollover motor vehicle crash. Torso impalement injuries are briefly reviewed and guidelines for the management of such injuries are described.