J Emerg Med
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Case Reports
The Concealment of Significant Pelvic Injuries on Computed Tomography Evaluation by Pelvic Compression Devices.
Fractures of the pelvis and acetabulum are relatively rare, with a reported incidence of 3% to 8% of all adult fractures, but occur in approximately 20% of all polytrauma cases. They have high associated morbidity (40% to 50%) and mortality (5% to 30%). It is recommended that an external compression splint be applied in the presence of a suspected pelvic fracture before transfer and definitive investigation and management. ⋯ Two cases are presented in which these recommendations were met and the patients underwent computed tomography (CT) scanning upon arrival to the emergency department at a major trauma center with the pelvic binder in situ. In both these cases, CT scanning failed to identify a significant pelvic injury, which was concealed by the pelvic external compression belt. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: When there is high clinical indication of pelvic injury, whether related to mechanism of injury or clinical findings, despite a CT scan where no bony injury is identified, obtaining plain pelvic x-ray studies out of the pelvic compression device to avoid overlooking or neglecting a significant pelvic injury would be prudent.
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We present the case of the youngest known patient diagnosed with surfer's myelopathy. Surfer's myelopathy is a rare nontraumatic myelopathy. The most likely etiology, presumably, is arterial insufficiency related to spine hyperextension. Symptoms consist of back pain, urinary incontinence or retention, paraplegia, and sensory loss. ⋯ A 7-year-old girl presented with back pain, urinary retention, and lower extremity weakness after doing backbends during a cheerleading practice the day prior to presentation. WHY SHOULD AN EMERGENCY MEDICINE PHYSICIAN BE AWARE OF THIS?: With the trend of children becoming increasingly active in competitive sports at a younger age, surfer's myelopathy is a diagnosis that should be considered when the symptoms are present and the history consists of hyperextending the back. As in our case, a seemingly benign trauma can lead to the diagnosis of surfer's myelopathy.
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Patients with medical conditions may present with psychiatric symptoms, which may lead to worse physical health care. Here we present the case of a patient with acute aortic dissection masked by psychiatric symptoms after a stressful event. ⋯ A 29-year-old female medical student presented to the Emergency Department (ED) complaining about the feeling of "hysteria" after an argument with her boyfriend earlier the same day. She did not report other symptoms or pain. Careful physical examination, initially impeded by the patient's agitation, revealed pulseless extremities. Blood gas analysis showed metabolic acidosis. Transthoracic echocardiography and computed tomography ultimately led to the correct diagnosis: Stanford Type-A aortic dissection. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Medical conditions requiring acute diagnostic work-up and therapy may present with psychiatric symptoms. Increased awareness and the use of standardized operating procedures in the ED may prevent fatal misdiagnoses in these patients.
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M-mode or "motion" mode is a form of ultrasound imaging that is of high clinical utility in the emergency department. It can be used in a variety of situations to evaluate motion and timing, and can document tissue movement in a still image when the recording of a video clip is not feasible. ⋯ A great deal of important information may be obtained with M-mode imaging through views and measurements that are relatively easy to obtain.