The American journal of emergency medicine
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Dengue fever is an acute febrile viral disease caused by the bite of Aedes aegypti mosquito. It is a major health problem especially in tropical and subtropical areas including South East Asia and Pakistan. In the past few years, dengue fever has been endemic in Northern Punjab. ⋯ Rectus sheath hematoma is an uncommon and often clinically misdiagnosed cause of abdominal pain. It is the result of bleeding into the rectus sheath from damage to the superior or inferior epigastric artery or their branches or from a direct tear of the rectus muscle. It can mimic almost any abdominal condition (See Fig.) (See Table).
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Although a diagnosis of acute myocardial infarction (AMI) that mandates emergency reperfusion therapy requires ST-segment elevation greater than 1 mm in at least 2 contiguous leads, some of the early electrocardiogram (ECG) changes of AMI can be subtle. Any ST-segment depression or T-wave inversion in lead aVL may be implicated in left anterior descending artery lesion or early reciprocal changes of inferior wall myocardial infarction, particularly when the clinical context suggests ischemia. Early recognition of reciprocal changes and serial ECG help initiate early appropriate intervention. Heightened awareness of ST segment and T-wave changes in lead aVL is of paramount importance to quickly identifying life-threatening condition.
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Although electronic health record systems (EHRs) and emergency department information systems (EDISs) enable safe, efficient, and high-quality care, these systems have not yet been studied well. Here, we assessed (1) the prevalence of EHRs and EDISs, (2) changes in efficiency in emergency medical practices after introducing EHR and EDIS, and (3) barriers to and expectations from the EHR-EDIS transition in EDs of medical facilities with EHRs in Japan. ⋯ To attract EDs to EDIS from EHR, systems focusing on decreasing the time required to produce medical records and establishing appropriate clinical guidelines for residents are required.
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Case Reports
Ogilvie syndrome: a potentially life-threatening phenotype of immobilization hypercalcemia.
Ogilvie syndrome, also known as acute colonic pseudo-obstruction, is characterized by the clinical presentation and imaging evidence of acute colonic obstruction in the absence of a mechanical cause. Several comorbidities and serious associated medical or surgical conditions have been described to be relevant to this syndrome. ⋯ Although disrupted electrolyte homeostasis may induce impaired colonic motility, hypercalcemia secondary to immobilization as a major culprit in this syndrome has rarely been studied. In this report, we profiled radiographic features, therapeutic strategies, and pathogenetic hypothesis of this clinical entity and highlighted the need for clinicians to maintain awareness of this distinct manifestation.
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Randomized Controlled Trial
Randomized trial of tourniquet vs blood pressure cuff for target vein dilation in ultrasound-guided peripheral intravenous access.
Ten percent of the time, peripheral intravenous access (PIV) is not obtained in 2 attempts in the emergency department. Typically, a tourniquet is used to dilate the target vein; but recent research showed that a blood pressure (BP) cuff improves dilation, which may translate to increased PIV success. ⋯ Tourniquet is superior to BP cuff for target vein dilation in ultrasound-guided PIV.