J Emerg Med
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Pregnancy after hysterectomy is an extremely rare event. However, if not diagnosed and managed properly, it may result in life-threatening consequences. ⋯ The possibility of pregnancy should be considered in the differential diagnosis of abdominal pain in women with intact ovaries despite a history of hysterectomy. A pregnancy test should be a part of the diagnostic work-up of these patients when they present in the emergency department.
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Resuscitation of any critically ill patient is aimed at restoration of oxygen delivery to maintain aerobic metabolism. Thus, "endpoints" of resuscitation have been sought after as a measure of evaluating the adequacy of resuscitation. This review article describes the most commonly used endpoints, central venous oxygen saturation (ScvO2) and lactate, and provides a clinically useful paradigm for utilizing these endpoints during resuscitation of critically ill patients in the emergency department (ED). ⋯ ScvO2 and lactate are useful endpoints of resuscitation, and when used together, provide a metabolic framework for guiding targeted therapy for critically ill patients in the ED with shock.
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Pyomyositis is a bacterial infection of skeletal muscle that often results in deep intramuscular abscesses. The absence of external dermatologic manifestations in the early stages of pyomyositis makes this a challenging diagnosis. In addition, physical examination findings can be difficult to distinguish from more common processes, such as soft-tissue cellulitis. Clinicians can fail to diagnose this serious disease in a timely manner, resulting in delayed treatment and potential clinical deterioration from sepsis. Although advanced imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI) provide excellent detail, ultrasound (US) can also be used to detect this disease. US can be performed expeditiously at the bedside and is less expensive than CT or MRI. It allows the clinician to examine the deeper tissue planes of muscle, in which purulent fluid collections will develop as pyomyositis advances. ⋯ Three patients presenting with leg pain were evaluated with point-of-care (POC) US and diagnosed with pyomyositis. The early diagnosis of this condition prompted rapid treatment with administration of appropriate antibiotics and involvement of orthopedic surgery. Aspiration of fluid allowed for detailed fluid analysis and bacterial cultures. Additional diagnostic imaging was performed, confirming the initial US diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POC US can be helpful in identifying and further delineating intramuscular abscesses and can subsequently lead to expedited and appropriate care in patients who present with extremity pain, but lack significant dermatologic changes.
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Evidence linking alcohol use to injury outcomes remains inconclusive, with prehospital and police department-based studies showing negative effects and hospital-based studies showing no effect or better outcomes. ⋯ A high alcohol level in the blood appears to be predictive of more unintentional injury, head injury, and Level I trauma activation and less injuries in extremities.
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The impact of the Certificate of Need (CON) law on Emergency Department (ED) care remains elusive in the academic literature. ⋯ This study provides a better understanding of the impact of CON law on ED care, which extends the previous literature that has mainly focused on CON effects on inpatient care.