J Emerg Med
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Review Case Reports
Fever, abdominal pain, and leukopenia in a 13-year-old: a case-based review of meningococcemia.
The presenting symptoms of meningococcemia are protean, and the illness is rapidly progressive and often fatal, making it simultaneously one of the most dangerous and most important illnesses the Emergency Physician can encounter. It attacks the young and it is highly contagious. This report uses one of the many unusual presentations of meningococcemia as a framework for discussing the epidemiology, presentation, diagnosis, and treatment of meningococcal disease.
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Existing guidelines for the number of ultrasounds required before clinical competency are based not on scientific study but on consensus opinion. The objective of this study was to describe the learning curve of limited right upper quadrant ultrasound. This was a prospective descriptive study. ⋯ Inclusion of all required images increased after 25 ultrasounds. Sonographers who had performed over 25 ultrasounds showed excellent agreement with the expert over-read, with only two disagreements, both from a single individual. It was concluded that clinicians are clinically competent after performing 25 ultrasounds of the gallbladder.
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Among the causes of non-accidental head injury (NAHI), shaken baby syndrome (SBS) is difficult to diagnose and is associated with retinal hemorrhages (RH). ⋯ SBS remains a difficult cause of NAHI to diagnose. Ophthalmologic examination can provide critical diagnostic and prognostic information in cases of suspected SBS. Child abuse should be highly suspect in children with RH and a parental explanation of accidental head injury, especially if the RHs are found to be bilateral, flame-shaped, or to extend through to all layers of the retina.
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Disasters or hazardous incidents, either natural or man-made, continue to increase in frequency and affect more and more citizens of the world community. Many of these are published in the medical literature, each being a "case report" of a single event. In clinical medicine, a common nomenclature and uniform reporting of data enables the collection of similar cases to series studies, with clinical conclusions being drawn. ⋯ The death toll was 7 people, 5 of whom died at the scene and 2 who died in hospitals. We recommend this method as a standard for scientific reporting of hazardous incidents. Accumulation of data, reported in a similar standardized fashion, would enable comparison and reporting of series, improving our understanding regarding the optimal medical response to various events.