The American journal of emergency medicine
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Traumatic dissection of the aorta is a well-documented entity with poor prognosis and broad spectrum of clinical presentations. We report a rare case of an asymptomatic late presentation of aortic dissection after a high-speed vehicle accident. This case highlights the importance of high clinical suspicion for the diagnosis of aortic dissection.
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Many of critically ill patients receive medical care for prolonged periods in emergency department (ED). This study is the evaluation of efficiency of Acute Physiology and Chronic Health Evaluation (APACHE) III scoring system in predicting mortality rate in these patients. ⋯ The APACHE III score and ED lengths of stay were higher in this study compared with other studies. This could be ascribed to more critical patients presenting to the study center and also limited ICU bed availability. This study was indicative of applicability of APACHE III scoring system in evaluating the quality of care and prognosis of ED patients in need of ICU.
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In pediatric ankle injury, radiography is the current standard used to differentiate fracture from ligamentous injury; however, the associated cost, increased time, and radiation exposure pose a significant downside to this imaging modality. Point-of-care ultrasound may be an attractive alternative in this setting, as illustrated by this patient case. ⋯ The results of a formal radiograph confirmed this diagnosis. This case report presents the successful use of point-of-care ultrasound for detection of a Salter-Harris I ankle fracture, describes a stepwise approach for this new diagnostic technique in detail, and discusses its value in the setting of pediatric ankle injury.
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Adults older than 50 years are at greater risk for death and severe disability from influenza. Persons in this age group, however, are frequently not vaccinated, despite extensive efforts by physicians to provide this preventive measure in primary care settings. We performed this study to determine if influenza vaccination of older adults in the emergency department (ED) may be cost-effective. ⋯ Vaccination of older adults against influenza in the ED setting is cost-effective, especially for those older than 65 years. Emergency departments may be an important setting for providing influenza vaccination to adults who may otherwise have remained unvaccinated.
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Case Reports
Bruns-Cushing nystagmus due to hypertensive unilateral paramedian pontine base infarction.
Bruns-Cushing nystagmus is unusually rare and is known to be related with cerebellopontine angle tumor. A 32-year-old male patient came to our emergency department 3 times because of dizziness, right upper limb ataxia, hypertension, and Bruns-Cushing nystagmus. Magnetic resonance imaging demonstrated left paramedian pontine infarction. In conclusion, Bruns-Cushing nystagmus not only indicates a cerebellopontine angle tumor but may also be associated with pontine infarction.