J Emerg Med
-
There have been few case reports of patellar tendon rupture in patients with underlying systemic lupus erythematosus (SLE). ⋯ An 18-year-old man with SLE presented to the ED with pain, swelling, and inability to extend his left knee after a fall. Physical examination demonstrated a palpable defect over the patellar tendon, and plain radiographs showed patella alta. Patellar tendon rupture was diagnosed, and the patient underwent open surgical repair. Conclusion: In low-energy patellar tendon rupture, the effects of the pathophysiology and the treatment for SLE, which includes systemic corticosteroids, are currently unclear. However, it is important to establish prompt diagnosis and appropriate treatment in the ED to maximize recovery and minimize long-term disability.
-
Acute appendicitis is a common disease process in which timely diagnosis minimizes the risk of complications. ⋯ In the emergency department evaluation of these children with inguinal or scrotal complaints, we maintain that intra-abdominal processes should be included in the differential.
-
The finding of a unilaterally dilatated pupil in a patient who is otherwise alert and unimpaired can pose an interesting diagnostic problem. Algorithms have outlined the approach to evaluating anisocoria, but do not stress the importance of toxic exposures. ⋯ In the absence of neurologic deficits, clinical history should search for a toxic or pharmacologic etiology of abnormal mydriasis. A detailed physical examination and bedside diagnostic maneuvers can help distinguish benign causes of an abnormally dilatated pupil from more serious causes relating to central nervous system lesions, potentially sparing the patient from unnecessary neuroimaging.
-
Disruptive behaviors have been shown to have a significant negative impact on staff collaboration and clinical outcomes of patient care. Disruptive episodes are more likely to occur in high stress areas such as the Emergency Department (ED). Having the structure, process, and skills in place to effectively address this issue will lower the likelihood of preventable adverse events. ⋯ Disruptive behaviors in the ED have a significant impact on team dynamics, communication efficiency, information flow, and task accountability, all of which can adversely impact patient care. EDs need to recognize the significance of disruptive behaviors and implement appropriate policies and protocols to address this issue.