The American journal of emergency medicine
-
A modified subcutaneous single-injection approach to achieve digital block using a tumescent technique is described. ⋯ The tumescent technique in digits to achieve a single-injection digital nerve block is an easy, safe and effective method for digital anesthesia. These data confirm the applicability of the tumescent technique in digits for patients with finger and thumb injuries or tumors that require minor surgical procedures.
-
Patients with acute Achilles tendon injuries from sport related activities are frequently seen in the emergency department (ED). Missed or delayed diagnosis of an Achilles tendon rupture can result in significant patient morbidity. However, the diagnosis of an Achilles tendon rupture is not always clear clinically. ⋯ Her physical examination was limited by pain. However, a point-of-care ultrasound examination helped in making a prompt and accurate diagnosis of acute Achilles tendon rupture. This case demonstrates that point-of-care ultrasound can be a useful diagnostic tool in the assessment of patients with suspected Achilles tendon rupture, particularly when the physical examination is limited.
-
Case Reports
Acute myocardial infarction in a 56-year-old female patient treated with sulfasalazine.
Drug rash, eosinophilia, and systemic symptoms (DRESS) syndrome represents one pattern of the cutaneous involvement in type IV hypersensitivity reaction to drugs. It is a severe, delayed, idiosyncratic reaction presented as rash with fever, lymphadenopathy, and visceral involvement. There are several reported cases of sulfasalazine-induced DRESS syndrome, but myocardial involvement was rare. ⋯ We report a case of a 56-year-old woman treated with sulfasalazine for ankylosing spondylitis for 3 weeks, which was discontinued after development of DRESS syndrome. Despite treating her with high dose of steroid and cyclosporine, her symptoms persisted, and ultimately, she developed toxic myocarditis with a misleading presentation of acute ST-elevated myocardial infarction. The diagnosis was made based on postmortem histopathologic finding.
-
Vertigo is a common emergency department (ED) complaint with benign and serious etiologies with overlapping features. Misdiagnosis of acute stroke may result in significant morbidity and mortality. Magnetic resonance imaging (MRI) is superior to computer tomography (CT) for diagnosis of acute stroke but is costly with limited availability. ⋯ This study identified 2 variables associated with acute stroke that should be considered in the evaluation of ED patients with vertigo. Head CT was inadequate for diagnosing acute stroke in this patient population.
-
Physician screening is one of many front-end interventions being implemented to improve emergency department (ED) efficiency. ⋯ In addition to improving operational measures, the implementation of a physician screening program in the ED allowed for an incremental increase in patient care capacity leading to an overall positive financial impact.