J Emerg Med
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Case Reports
Methicillin-resistant Staphyloccocus aureus heel abscess: an uncommon emergency department diagnosis.
Heel abscesses present as heel pain that progressively worsens, with associated tenderness and fullness at the heel pad. Radiological studies like computed tomography, magnetic resonance imaging, or ultrasound can help correctly diagnose a heel pad abscess. Generally, these patients require i.v. antibiotics and operative management to adequately drain the abscess. It is recommended to avoid incising the plantar aspect of the heel to minimize chronic post-drainage heel pain.
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Ultrasound has been suggested as a useful non-invasive tool for the detection of early blood loss. Two possible sonographic markers for hypovolemia are the diameter of the inferior vena cava (IVC) and the thickness of the left ventricle (LV). ⋯ In this study, serial changes in vital signs, IVC diameter, and LV wall thickness were clinically insignificant after approximately 500 cc of blood loss in healthy volunteers.
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Review Case Reports
Role of non-operative management of spleen injury in patients with hemophilia: report of two patients with review of literature.
The non-operative management (NOM) of hemodynamically stable patients with splenic trauma is currently well accepted, yet non-operative therapy has rarely been attempted in coagulopathic patients. Two cases of successful NOM of splenic trauma in patients with hemophilia are presented with a review of the English medical literature.
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Acute ischemic stroke remains largely a clinical diagnosis. ⋯ Biomarker testing with CRP and potentially MMP-9 and S100B, may add valuable and time-sensitive diagnostic information in the early evaluation of patients with suspected stroke in the ED. Future prospective evaluations are necessary to validate the diagnostic capability of these biomarkers for acute ischemic stroke in the ED before they should be considered for use in clinical practice.
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In the era of increased prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA), there have been a number of questions and several recent studies that address the clinical management of uncomplicated abscesses in the emergency department (ED). ⋯ In light of the data currently available, antibiotics and decolonization should be used selectively, not routinely, for treatment of most uncomplicated abscesses. Wound cultures are generally not necessary in the ED, and all patients should be given return precautions for worsening symptoms.