J Emerg Med
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Bedside ultrasonography performed by the Emergency Physician is a safe procedure for evaluating patients with trauma, hypotension, chest or abdominal pain, and dyspnea of unknown origin. ⋯ The use of ultrasound in emergency settings has improved the clinical evaluation of critical patients by Emergency Physicians, but the possibility of a false-positive diagnostic error always should be considered.
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Alteplase (tPA) is a United States (US) Food and Drug Administration-approved treatment for acute ischemic stroke, though there are significant barriers to thrombolytic use, including Emergency Physicians' (EPs') concern for level of supporting evidence. ⋯ tPA is an effective treatment for stroke when given in prepared stroke centers; EPs and hospitals treating stroke patients with tPA need to have the necessary resources in place and a specific plan for timely care of patients with acute stroke.
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Acute appendicitis continues to be a condition at high risk for missed and delayed diagnosis. It characteristically presents with right lower quadrant pain after vague epigastric or periumbilical discomfort. Left-sided appendicitis is an atypical presentation and has been reported rarely. The majority of these cases have been described to be associated with congenital midgut malrotation, situs inversus, or an extremely long appendix. We report a case of left-sided acute appendicitis occurring in a patient with a redundant and hypermobile ascending colon. ⋯ This case is presented to increase awareness among emergency physicians of this anatomical variant and atypical presentation of appendicitis.
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West Nile virus (WNV) has spread rapidly across the United States since 1999, causing epidemics of neurologic illnesses including meningitis, encephalitis, and acute flaccid paralysis. West Nile encephalitis can be fatal; recovery can be incomplete; and constitutional and neurological symptoms can persist for months to years. ⋯ Infection with WNV should be considered in patients presenting to emergency departments with fever and neurologic symptoms. Recommended evaluation includes serologic testing of cerebrospinal fluid and serum.
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Monitoring unscheduled return visits to the Emergency Department (ED) is useful to identify medical errors. ⋯ Old age, high-grade triage, and doctor-based factors were found to be significant predictors for URVA, whereas advanced staff experience and ED crowding were not.