The American journal of emergency medicine
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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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We examined the impact of primary stroke center (PSC) certification on emergency department (ED) use and outcomes within an integrated delivery system in which EDs underwent staggered certification. ⋯ Stroke center certification was associated with significant changes in ED admission and radiographic utilization patterns, without measurable improvements in survival.
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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.
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An elderly Malay lady presented with lethargy and 2-day history of chest pain. Her electrocardiogram showed diffuse concave ST-segment elevation with depressed PR segments. ⋯ The left ventriculogram demonstrated apical akinesis with hyperdynamic contraction of the basal segments consistent with feature of Takotsubo cardiomyopathy. This case highlights an uncommon electrocardiogram presentation of Takotsubo cardiomyopathy.