The American journal of emergency medicine
-
Alcohol and drug screening of adolescent trauma alert patients at a level 1 pediatric trauma center.
Adolescent trauma patients are reported to have increased incidence of alcohol and other drug (AOD) use, but previous studies have included inadequate screening of the intended populations. A Level 1 Pediatric Trauma Center achieved a 94% rate of AOD screening. We hypothesized that a positive AOD screening result is associated with males, increasing age, lower socioeconomic status, violent injury mechanism, higher Injury Severity Score (ISS), lower GCS, need for operation and increased hospital length of stay. ⋯ Prognostic.
-
The beneficial effect of the presence of an emergency physician in prehospital major trauma care is controversial. The aim in this study is to assess whether an emergency physician on scene can improve survival outcome of critical trauma patients. ⋯ Our results failed to show a difference in survival at discharge between non-physician-staffed ambulances and physician-staffed ambulances.
-
Case Reports
Emergency department presentation of 'delusional parasitosis by proxy'. Delusional parent, injured child.
We report a case of 'delusional parasitosis by proxy'. A sixyear old child was brought to the emergency department by a mother with concerns that her son had a skin and scalp infestation. Despite the absence of any clinical findings being found on exam, the mother remained disproportionately concerned. ⋯ We recruited the assistance of the maternal grandparents, child protective services and primary care pediatrics and the child was removed from the mother's custody and placed into the custody of the grandparents. Six weeks later with basic skin care and erythromycin ophthalmic ointment for the eyes, the child's hair, eyebrows and eyelashes grew had grown in, and the scalp irritation had resolved. The mother had sought and received psychiatric care and was improving.
-
We present the rare case of a small bowel obstruction secondary to pelvic organ prolapse (POP). A 77-year-old female presented with four days of abdominal pain, nausea, and vomiting. She had a history of abdominal hysterectomy with bilateral salpingo-opherectomy and a mildly symptomatic cystocele. ⋯ Prior case reports of small bowel obstructions secondary to POP required emergent surgical intervention. Post-menopausal women should be asked about symptoms or presence of pelvic organ prolapse and in the correct patient population, pelvic examination can be important for diagnosis and treatment of small bowel obstruction. If the enterocele is manually reduced non-operative management can be safe and effective.
-
Case Reports
Multiple boluses of alteplase followed by extracorporeal membrane oxygenation for massive pulmonary embolism.
Thrombolytics and extracorporeal membrane oxygenation (ECMO) are potential management options for massive pulmonary embolism (PE). There are early data supporting the use of repeated alteplase 50 mg bolus for massive PE. ⋯ We present the case of a patient with massive PE who received two boluses of alteplase for recurrent cardiac arrest, followed by initiation of ECMO. The patient stabilized with these interventions, and ultimately had a good outcome with normal neurologic and functional status.