J Emerg Med
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Post-traumatic, true aneurysm of the hand is a well-documented phenomenon. Hypothenar hammer syndrome is often a consequence of repeated blunt trauma to the palm, but a false aneurysm, or pseudoaneurysm, of the palm is much rarer. A pseudoaneurysm is often the result of focal penetrating trauma. ⋯ Although a rare phenomenon, pseudoaneurysm of the superficial palmar arch after local penetrating trauma remains an important item on the differential for patients presenting with palmar masses. Pseudoaneurysm can be effectively diagnosed and treated with excellent results.
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The Surviving Sepsis Campaign (SSC) guidelines recommend that broad-spectrum antibiotics be administered to severely septic patients within 3 h of emergency department (ED) admission. Despite the well-established evidence regarding the benefit of timely antibiotics, adoption of the SSC recommendation into daily clinical practice has been slow and sporadic. ⋯ Storing key antibiotics in an institution's severe sepsis antibiogram in the ED ADC can significantly reduce order-to-antibiotic times and increase the percentage of patients receiving antibiotics within the recommended 3 h of ED arrival.
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Endotracheal intubation remains the definitive skill needed for airway management of both medical and surgical patients treated in the prehospital and hospital arenas. Subsequently, rapid sequence intubation (RSI) protocols have been established for various first-line emergency service providers. Because RSI results in the paralysis of skeletal muscles, with a subsequent period of apnea and an increased potential for oxygen desaturation, the accuracy of pulse oximetry (SpO(2)) data is critical in guiding pre-oxygenation efforts and indicating abandonment of intubation attempts to avoid hypoxic injury. Latency of up to 120 s has been demonstrated in conditions producing peripheral vasoconstriction. The influence of peripheral oximetry on the decision-making process during the establishment of a definitive airway has not, to our knowledge, been previously investigated in the prehospital setting. ⋯ To avoid the possibility of mistaking oximetry signal latency for oxygen desaturation during pre-hospital RSI, we propose a conservative approach of aggressive pre-oxygenation to SpO(2) values≥94%, and the use of quantitative continuous capnometry for decision-making regarding whether the endotracheal tube is correctly placed. In cases of hypoxemia despite a properly placed tube, focus should be turned to other causes of post intubation hypoxemia.
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Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections commonly present as skin and soft-tissue infections (SSTIs). Treatment often includes incision and drainage with or without adjunctive antibiotics. Emergency department (ED) pharmacists wished to provide specific data to emergency physicians to better inform antibiotic choices for patients with SSTIs. ⋯ Cephalexin was often added to cover for potential cellulitis due to Streptococcus spp., however, the surrounding erythema may simply be an extension of the CA-MRSA infection. Department-specific antibiograms are useful in guiding empiric antibiotic selection and may help providers judiciously prescribe antibiotics only when necessary.
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Case Reports
Ultrasound diagnosis of acute thrombosis of an abdominal aortic aneurysm: a case report.
Point-of-care ultrasound is an effective and reliable method to diagnosis the presence of an abdominal aortic aneurysm. However, there has been limited literature regarding ultrasound diagnosis of acute aortic thrombosis. ⋯ Aortic thrombosis is a rare and devastating problem that can be diagnosed with point-of-care ultrasound.