J Emerg Med
-
Acute appendicitis can have various unusual presentations. Detection of this entity is often confounded by its presence in the company of symptoms consistent with distinctly different etiologies. ⋯ Appendicitis can sometimes be a challenging diagnosis. Thorough examination and maintenance of a wide differential diagnosis with common complaints can assist the emergency physician in reaching the correct diagnosis.
-
Mass sociogenic illness (MSI) is a rare occurrence involving a constellation of physical signs and symptoms in a group of individuals that are exhibited subconsciously and have no corresponding organic etiology. ⋯ Varying complaints with onset after removal from the church suggest MSI. The hazardous materials team reproduced the scenario and no toxic gases were detected. Escalation of symptoms and an increased number of persons being affected along with increasing ambulance presence are common in MSI. We suspect that field oximeter readings were either aberrant from an inexperienced operator or were false-positive COHb readings. Clinicians should consider MSI after mass outbreaks of illness, particularly with rapid onset, rapid resolution of symptoms, and normal physical examinations and laboratory analyses. However, the diagnosis of MSI should be entertained only after potential toxicologic etiologies have been excluded.
-
Blunt pancreatic injury is a rare type of abdominal trauma. It is a challenge to physicians due to difficulties in early diagnosis and associated complications. Most simple cases of pancreas contusion and hematoma can be safely treated conservatively. Nevertheless, the possibility of delayed mass effect and complications always exists. ⋯ A pancreatic hematoma after blunt abdominal trauma can be complicated by common bile duct obstruction with a delayed onset of obstructive jaundice. The application of ERCP with placement of a biliary stent was effective in this case. Conscientious follow-up and serial imaging studies should be utilized in patients with an initial presentation of an uncomplicated pancreatic head hematoma.
-
Community-acquired pneumonia (CAP) is a common reason for admissions in the emergency department (ED). However, patient disposition is not always standardized. ⋯ Incorporation of the PSI into the admission protocol for ED patients with CAP significantly reduced the admission rates and medical costs.