J Emerg Med
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Core content in Emergency Medicine Residency Programs is traditionally covered in didactic sessions, despite evidence suggesting that learners do not retain a significant portion of what is taught during lectures. ⋯ When these techniques are incorporated, sessions can be effective in delivering core knowledge, contextualizing content, and explaining difficult concepts, leading to increased learning.
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Review Case Reports
Acute Hematogenous Osteomyelitis of the Rib Identified on Bedside Ultrasound.
Osteomyelitis is a challenging and commonly considered diagnosis in the emergency department. Early recognition and treatment with appropriate antibiotic therapy is crucial to prevent complications. ⋯ Bedside ultrasound holds great promise in investigating osteomyelitis when suspicion is high and traditional initial testing is nondiagnostic. Further study is required to quantify this benefit in the emergency department setting and explore utility of negative results.
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Review Case Reports
Eye on Children: Acute Work-up for Pediatric Horner's Syndrome. Case Presentation and Review of the Literature.
Ptosis and anisocoria in a child may be subtle indications of occult pathology, and making the observation acutely in the emergency department (ED) is important in guiding patient management and treatment. Emergency physicians must evaluate patients to exclude serious or life-threatening emergencies and ensure correct disposition of patients. Horner syndrome in children may be considered congenital or acquired and may be from benign or malignant causes. When an isolated, acquired Horner syndrome is suspected in a pediatric patient, physical examination of the neck and abdomen for masses, as well as spot urine catecholamines, vanillylmandelic acid and homovanillic acid, and varying degrees of imaging are recommended as part of the initial evaluation. These evaluations may be performed in the ED or may require hospitalization, depending on the suspected anatomical localization and diagnostic considerations. ⋯ A 21-month-old, normally developed girl presented to the University Hospital ED with a 2-h history of right-sided eyelid drooping in the setting of a febrile illness. An eventual diagnosis of Horner syndrome from cervical lymph node compression was made on the basis of history, examination, and imaging findings. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ED evaluations of pediatric patients differ from adults. Evaluation and work-up of Horner syndrome in children can be challenging and can require varying degrees of assessment and evaluation, depending on the diagnostic considerations. This article will address the common pathologies responsible for isolated pediatric Horner syndrome and the recommended ED evaluation.
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Considering current limitations in known treatment options and the significant disability associated with headache disorders, investigation of additional options is needed. Although occipital nerve blocks (ONBs) are currently being utilized frequently in specialty settings, the potential role of ONBs as an alternative to opioids for the management of acute headache episodes in primary and emergency care settings is not yet understood. ⋯ Interest in the use of ONBs in acute care settings is increasing. Current evidence supports that ONBs can be delivered safely in an outpatient setting by providers who have been trained in and have practiced this procedure. Although additional research is needed, current evidence supports that ONBs can be useful in treating acute headaches in an emergency care setting.