The American journal of emergency medicine
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A 40-year-old female presented to the ED with a history of intermittent headaches since a vaginal delivery 8 days prior. Her pregnancy was unremarkable and was not complicated by pre-eclampsia. She did not present with signs or symptoms consistent with postdural puncture headache or pre-eclampsia. ⋯ First-line pharmacological treatment consists of high-dose corticosteroids and is effective in reducing pituitary size and improving endocrine insufficiency in 75% of cases. LH is a potential cause of postpartum headache that can be easily screened for with history and routine bloodwork and has good outcomes with early intervention. LH should be added to the differential for postpartum headaches presenting to the emergency department and routine blood work should be considered for all postpartum headaches.
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Influence of emergency department patient volumes on CT utilization rate of the physician in triage.
Physician in triage (PIT) has been used as a potential solution to emergency department (ED) overcrowding and to decrease ED length of stay (LOS). This study examined the relationship between computerized tomography (CT) utilization of PIT and ED patient volumes. We hypothesized that despite the pressure on PIT to improve throughput on the busiest days, they will continue to utilize CT at the same rate. ⋯ No difference was found in the rate at which the PIT ordered CT scans on high volume vs low volume days. The rate of CT scans without clinically relevant findings did increase slightly on high volume days. LOS was longer on high volume days and when a CT was ordered.
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The number of people in the world consuming chicha is constantly increasing. However, several studies have shown that regular shisha smokers, whether active or passive, are exposed to the same risks as tobacco smokers. Shisha is also responsible for acute carbon monoxide (CO) poisoning, which is often unknown to emergency doctors, leading to under-diagnosis of this pathology and inappropriate treatment. ⋯ The prehospital percentage carboxyhemoglobin level measured by the pulse CO-oximeter is 22 and 27% for active smokers and 10% for the passively intoxicated patient. The individual and societal consequences of CO intoxication are significant. We believe it is important to make all those involved in emergency medicine aware of this pathology in order to treat it correctly from the initial phase and thus reduce its morbi-mortality and the risks of long-term complications.
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The SARS-CoV-2 is a respiratory virus of the coronavirus family responsible for a global pandemic since December 2019. More than 35 million people have been affected with the novel coronavirus disease (COVID-19), with more than one million deaths worldwide. Michigan was one of the top three states in the United States that was severely affected by the SAR-CoV-2 pandemic with more than 7000 deaths in adults and greater than 145,000 confirmed infections. ⋯ These cases presented approximately three weeks after the peak of adult SAR-CoV-2 related deaths occurred in the state. While many children presented with clinical characteristics similar to incomplete Kawasaki disease (KD), they also exhibited certain unique features which differentiated MIS-C from KD. The information presented below will aid clinicians with early recognition, evaluation and management of MIS-C in the emergency department.
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Subgaleal hematoma is an uncommon, but potential sequela of birth trauma and instrument-assisted delivery of neonates, as well as head trauma in young children. A rare complication is an infection of the subgaleal hematoma, which typically happens due to concomitant scalp lacerations. Escherichia coli is the most common causative pathogen in peripartum cases, and Staphylococcus aureus predominates in trauma cases. ⋯ She responded well to antibiotic therapy and required no surgical intervention. Conclusion: Subgaleal hematoma infection should be suspected in a child who presents with increased hematoma swelling, irritability, fever, and local signs of infection. Early recognition and treatment with antibiotics can prevent further complications, such as abscess formation and skull osteomyelitis.