J Emerg Med
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Physicians deployed to austere environments often encounter the challenge of needing to make clinical decisions based upon rudimentary history and physical examination. These skills, however, can be difficult for many to rely on, with the many subtleties of examining the eye, when they are normally accustomed to relying on sophisticated modalities to establish diagnosis. ⋯ This case illustrates that even under austere conditions, a focused history and evaluation can reveal the likelihood of occult intraocular foreign body, thereby triaging the patient for emergency surgery.
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Return visits to the Emergency Department (ED) requiring admission are frequently reviewed for the purpose of quality improvement. Treating physicians typically perform this review, but it is unclear if they accurately identify the reasons for the returns. ⋯ Both returns and the subset of returns due to potential deficiencies in management are more common than previously estimated, rendering review of returns a valuable quality improvement tool. However, EDs should not rely exclusively on the treating physicians to identify the reason for returns, as they seem to underestimate the frequency of returns due to potential deficiencies in medical management.
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Pericardiocentesis is a rare but potentially life-saving procedure. Improper technique can lead to life-threatening complications. ⋯ This cadaveric model allows trainees to familiarize themselves with both proper landmark and ultrasound-based pericardiocentesis technique.
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Volvulus of the sigmoid colon is a potentially life-threatening condition rarely seen in younger age groups and is male predominant. ⋯ Sigmoid volvulus is rarely seen in developed countries. Clinical manifestations vary with disease progression, but it typically presents with a triad of constipation, progressive abdominal distension, and severe abdominal pain. Plain-film x-ray studies can demonstrate a coffee bean or "omega loop" (inverted-U sigmoid) sign in <60% cases, but it was reported as high as 86% in computed tomography. The whirl sign on computed tomography might also be observed. The cause is multifactorial and colonic length is the most important predisposing factor. Flexible colon fiberscopic decompression followed by elective definitive surgery is the treatment choice, but exploratory laparotomy is mandatory if any complicated entity occurs. The mortality rate is still >50% when bowel gangrene develops.
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Letter Case Reports
Unilateral mydriasis due to a topical "anti-sweat" preparation.