J Emerg Med
-
Pulmonary embolus (PE) can be fatal, but is often treatable if recognized early. Unfortunately, the clinical presentation of PE is often variable and misleading. The D-dimer assay has recently come into favor as a method to exclude PE; however, this test has an acceptable safety margin only in low-risk populations. ⋯ This report highlights the risk of misdiagnosing PE if relying solely on ELISA D-dimer for exclusion. The approach to PE should include a measure of clinical probability. This report documents the presentation of PE despite having two unremarkable ELISA D-dimer measurements, and highlights the importance of clinical suspicion.
-
The objective of this study was to analyze demographic and event characteristics of patients presenting to the Emergency Department (ED) for evaluation after sexual assault, using a Sexual Assault Nurse Examiner standardized database. Data were prospectively collected as part of the Sexual Assault Nurse Examiner program at an urban teaching hospital. This study reviewed all ED patient records with a complaint of sexual assault between January 1, 2000 and December 31, 2004. ⋯ Multivariate analysis showed that race, age, threats, and substance use during the event were independent risk factors for evident trauma on physical examination. Survivors of sexual assault who present to the ED are overwhelmingly female, relatively young, often know the perpetrator of the event, and are likely to be threatened and show signs of physical trauma. Differences between patients according to demographic and event characteristics may have important implications for ED management and treatment plans.
-
Penile constriction devices are used for the enhancement of sexual performance. These devices have the potential to become incarcerated, leading to necrosis and amputation if not removed promptly. ⋯ The technique described in this article is a valuable and relatively safe technique for the Emergency Physician to facilitate the timely removal of a hardened steel constriction device.
-
The initial management of distal radius fractures in children is part of the usual practice of Emergency Medicine. However, no data are available evaluating the outcome of pediatric forearm fractures that undergo closed reduction and casting by emergency physicians. ⋯ Our results suggest that emergency physicians may be able to successfully provide restorative care for distal forearm fractures using closed reduction technique. Care rendered by emergency physicians was associated with a shorter length of stay and lower facility charges.