J Emerg Med
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Comparative Study
Emergency ultrasound of the gall bladder: comparison of a concentrated elective experience vs. longitudinal exposure during residency.
It is unknown how an intensive emergency ultrasound (EUS) experience compares with comparable exposure done over the course of residency training. ⋯ Physicians who participated in a 2-week, semi-structured EUS elective demonstrated EUS accuracy for biliary disease that was comparable with those who performed the same number of examinations over a longer period of time.
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Injuries caused by the TASER(®) (TASER International, Inc., Scottsdale, AZ) have been well documented, and both direct and indirect ocular injuries have been reported. We present a case of severe perforating injury to the globe from a TASER dart with central cornea penetration. ⋯ This is a case of a severe TASER-related ocular injury resulting in significant vision loss. Although mechanical trauma seemed to be the main etiology for vision loss, electrical shock injury may also be contributory. Direct injury to the eye from a TASER dart is similar to other perforating projectile injuries and can have a devastating visual outcome.
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Although cardiac dysrhythmia is common in patients with thyrotoxic periodic paralysis (TPP), high-degree atrioventricular (AV) block complicated by cardiogenic shock, even under KCl supplementation, is rarely described. ⋯ A paradoxical fall in serum K(+) concentration with potentially life-threatening complication is still underappreciated in patients with TPP on KCl supplementation. Early recognition and prompt therapy prevent untoward consequences.
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Diverticulosis and diverticulitis of appendix vermiformis is a rare diagnosis. Clinical and laboratory examinations do not show a difference between a progressing diverticulitis and simplex appendicitis. But this entity has a higher mortality rate than common appendicitis. ⋯ It is not easy to document this entity preoperatively. When diagnosed either preoperatively by imaging studies or intraoperatively, the only choice is appendectomy to prevent its serious complications.
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Prehospital ultrasound has been shown to aid in the diagnosis of multiple conditions that do not generally change prehospital management. On the other hand, the diagnoses of cardiac tamponade, tension pneumothorax, or cardiac standstill may directly impact patient resuscitation in the field. ⋯ Paramedics were able to perform the PAUSE protocol and recognize the presence of pneumothorax, pericardial effusion, and cardiac standstill. The PAUSE protocol may potentially be useful in rapidly detecting specific life-threatening pathology in the prehospital environment, and warrants further study in existing EMS systems.