The American journal of emergency medicine
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Multiple myeloma (MM) and its complications carry a high rate of morbidity and mortality. ⋯ An understanding of the complications of MM can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Observational Study
Pragmatic evaluation of point of care lung ultrasound for the triage of COVID-19 patients using a simple scoring matrix: Intraclass-classification and predictive value.
The value of routine bedside lung ultrasound (LUS) for predicting patient disposition during visits to the Emergency Department (ED) is difficult to quantify. We hypothesized that a simplified scoring of bedside-acquired LUS images for the triage of acute respiratory symptoms in the ED would be associated with patient disposition. ⋯ A simplified scoring of bedside-acquired LUS images from patients with acute respiratory symptoms at the emergency department reliably predicts patient disposition.
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Ketamine is an NMDA receptor antagonist commonly used as a dissociative anesthetic and analgesic. Though it is conventionally administered via the intravenous, intramuscular, or intranasal route, use as a compounded analgesic cream is becoming increasingly common. This is a case report of a 61-year-old man who was detained by the police for erratic driving. ⋯ His clinical presentation was consistent with ketamine toxicity, and mass spectrometry demonstrated an elevated urine ketamine concentration (32,300 ng/mL). His symptoms resolved spontaneously within a few hours and he was discharged. This is a unique case of systemic toxicity following dermal application of a ketamine pain cream in a patient with impaired skin barrier function due to pyoderma gangrenosum.
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While use of point-of-care ultrasound (POCUS) has become widespread in emergency medicine, its adoption and usage among emergency clinicians is variable. In this study, we explored the barriers and facilitators to POCUS use among emergency medicine clinicians in a tertiary care emergency department in the United States by clinical role and perceived usability of POCUS. ⋯ Participants reported that POCUS facilitates patient disposition and clinical supervision enhances its use. Early POCUS education in professional school and continued POCUS training in clinical practice could facilitate POCUS use clinically. Structured POCUS courses and continued medical education programs may provide protected time to learn and practice POCUS. Moreover, accessible and standardized machines in the clinical environment could improve POCUS usage.
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Case Reports
Delayed diagnosis of pediatric bladder rupture with atypical presentation after a minor fall.
Pediatric bladder injuries, though uncommon, typically result from blunt trauma, often associated with motor vehicle collisions. While most bladder injuries are linked to pelvic fractures, this association may be less common in children due to anatomical differences. Bladder injuries are classified as extraperitoneal, intraperitoneal, or combined, with intraperitoneal injuries being rarer but more prevalent in children due to their higher abdominal bladder position. This case report discusses a rare instance of delayed intraperitoneal bladder rupture in a young child following a relatively minor fall, emphasizing diagnostic challenges. ⋯ A 4-year-old female presented with new onset abdominal pain, vomiting, and subjective fever three days after a minor fall. Initial evaluation revealed diffuse abdominal tenderness, elevated creatinine, and moderate ascites on ultrasound with no gross hematuria. Despite treatment for presumed acute kidney injury, the patient's condition worsened, leading to the identification of a large posterior dome bladder rupture via cystography. Surgical repair was performed, and the patient was discharged with a full recovery after sequential removal of urinary catheters. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Intraperitoneal bladder rupture can occur in healthy children after minor trauma and may not present acutely with the classic signs of gross hematuria and peritonitis. Emergency physicians should consider this diagnosis in young children with unexplained ascites, abdominal pain, hematuria, and renal failure, even with only a remote history of minor abdominal trauma.