J Emerg Med
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The litigious nature of the American medical environment is a major concern for physicians, with an estimated annual cost of $10 billion. ⋯ Testicular torsion is a delicate condition and requires expertise in evaluation and treatment. When emergency physicians choose not to consult an urologist for possible torsion, they leave themselves open to litigation risk. When an urologist is involved in torsion litigation, they are rarely unsuccessful in their defense. Finally, ultrasound is no guarantee for success against litigation.
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Review Case Reports
Acute Limb Ischemia: A Case Report and Literature Review.
Acute limb ischemia (ALI), although uncommon, can present with profound symptoms, including disabling pain in the setting of acute vascular and neurologic deficits. The most appropriate diagnostic and therapeutic strategy has evolved with emerging technologies inclusive of less-invasive endovascular diagnostic and therapeutic options. ⋯ We present a case of ALI to illustrate the diagnostic and therapeutic approach with a summary of the most current literature. Emergency physicians should be aware of optimized clinical outcomes with the use of time-sensitive enhanced endovascular therapies as a recommended option for the best outcomes for the treatment of ALI.
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Patients often present to the emergency department (ED) as "found down," with limited history to suggest a primary traumatic or medical etiology. ⋯ Acute medical diagnoses were common in undifferentiated ED patients "found down" in an institutional trauma registry. Clinicians should maintain a broad differential diagnosis in the workup of the undifferentiated "found down" patient.
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Emergency department (ED) and hospital crowding adversely impacts patient care. Although reduction methods for duration of stay in the ED have been explored, few focus on medical intensive care unit (MICU) patients. ⋯ A streamlined admission intervention from the ED to the MICU was associated with decreased ED and hospital duration of stay without altering mortality.
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Case Reports
Late Postpartum Eclampsia with Postpartum Angiopathy: An Uncommon Diagnosis in the Emergency Department.
Late postpartum eclampsia is defined as occurrence of eclampsia >48 h after delivery and is a rare clinical entity. The delayed onset and nonspecific symptoms at presentation make this entity a challenge to diagnose in patients presenting to the emergency department (ED); however, early recognition and timely interventions are the keys to reducing morbidity and mortality in patients with late postpartum eclampsia. ⋯ A 28-year-old woman presented to our ED with a chief complaint of headache of 4 days duration, 8 days after an uncomplicated, normal vaginal delivery. Her past medical history was unremarkable and her entire pregnancy was without medical incident. The patient's examination was within normal limits other than a blood pressure of 152/111 mm Hg and pulse of 54 beats/min. Given her undifferentiated headache and the possibility of preeclampsia, the patient was treated with magnesium sulfate, which was subsequently stopped due to worsening bradycardia. Hydralazine was administered for blood pressure control. Three hours after the magnesium was stopped, the patient reported blurry vision, which was immediately followed by a generalized tonic-clonic seizure. After the seizure, lorazepam was given for control of seizures, and the patient was admitted to the medical intensive care unit. The patient was transferred to the postpartum floor 6 days later in stable condition and without any further seizure activity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients with late postpartum eclampsia are infrequently encountered in the ED due to the rarity of this condition. Increased awareness of this entity among emergency physicians will lead to early interventions, which are crucial in decreasing morbidity and mortality in these patients.