J Emerg Med
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Adolescents and young adults account for about half of the annual diagnoses of sexually transmitted infections (STI) in the United States. Screening and treatment for STIs, as well as prevention, are needed in health-care settings to help offset the costs of untreated STIs. ⋯ One in 10 sexually active youth in the ED reported a prior diagnosed STI. Previous STI was significantly higher among females than males. ED providers inquiring about inconsistent condom use and previous STI among male and female adolescents may be one strategy to focus biological testing resources and improve screening for current STI.
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Case Reports
Dangers of Prehospital Cooling: A Case Report of Afterdrop in a Patient with Exertional Heat Stroke.
Exertional heat stroke is a potentially life-threatening disease with varying clinical presentations and severity. Given the severe morbidity that can accompany the disease, the immediate management often begins in the prehospital setting. It is important to have not only a comprehensive understanding of the prehospital cooling methods in addition to hospital management strategies, but an understanding of their potential complications as well. ⋯ A 32-year-old male presented to a San Antonio hospital in March 2014 with progressive confusion, nausea, nonbloody emesis, and ataxia. Initial presentation was concerning for exertional heat stroke, as the patient was recorded in the field to have a temperature of 42.1°C (106.2°F). The patient, on arrival to the emergency department, was found to have a core body temperature of 38.1°C (100.6°F). All active cooling measures were terminated and active rewarming was initiated. Despite adequate resuscitation and rapid identification of the patient's overcorrection in core body temperature, the lowest recorded temperature was 36.0°C (96.8°F). Why Should an Emergency Physician Be Aware of This? This case represents the dangers associated with exertional heat stroke, overcorrection of core body temperature, and the potentially lethal complication of afterdrop. It also represents the need for immediate recognition of the condition and initiation of appropriate medical care. Although this patient's clinical outcome was good, the event could have caused serious morbidity or could have potentially been fatal.
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Research indicates that licensed health care workers are less willing to work during a pandemic and that the willingness of nonlicensed staff to work has had limited assessment. ⋯ Improving care for dependent family members, worker protection, cross training, and job importance education may increase willingness to work during disasters.
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Case Reports
Right Lower Quadrant Pain in a Young Female: Ultrasound Diagnosis of Rectus Abdominis Tear.
Right lower quadrant pain in young females presents a frequent diagnostic challenge for emergency physicians, with a broad differential and several important diagnoses. Using an "ultrasound first" imaging strategy can help decrease the use of computed tomography scans, with associated savings in radiation exposure, cost, and other resource use. ⋯ We report a case of right lower quadrant pain in a young woman. After her initial history and physical examination, appendicitis was the leading differential. A bedside ultrasound was performed, leading to the uncommon diagnosis of rectus abdominis muscle tear. The sonographic findings of a muscle tear include increase in size, loss of linear, homogeneous architecture, and decreased echogenicity. Making this diagnosis at the bedside using ultrasound obviated the need for further imaging, avoiding unnecessary radiation exposure, and decreasing emergency department length of stay and overall cost, while leading to a tailored treatment plan. Why Should an Emergency Physician Be Aware of This? Rectus abdominis tear is a cause of right lower quadrant pain that may mimic appendicitis and should be considered in patients with this complaint. The ability to make this diagnosis with bedside ultrasound may assist in several important patient-oriented outcomes.
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The size, speed, and unpredictable nature of horses present a significant risk for injury in all equine-related activities. ⋯ The majority of equine-related injuries occur while pursuing recreational activities and are due to falls. Our patients experienced more severe injuries to the trunk and head and required more surgical intervention for pelvic, facial, and brain injuries than previously reported. Failure to use safety equipment contributes to the risk of severe injury. Education and injury prevention is essential. The need for complex surgical intervention by multiple specialties supports transfer to Level I trauma centers.