J Emerg Med
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Isolated distal deep vein thrombosis (DVT) is not traditionally viewed as a potentially life-threatening condition. There are conflicting recommendations regarding its evaluation and treatment, and wide variability in clinical practice. The presentation of this case highlights the fatal potential of this condition. ⋯ This is the report of a previously healthy young woman who presented to the emergency department with calf pain concerning for a DVT. She received two radiologist-performed duplex ultrasound examinations of the affected extremity, both of which were negative, but suffered a sudden cardiac arrest several hours after the second study. Autopsy attributed the death to DVT and pulmonary embolism. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the risk for fatal pulmonary embolization, even after normal serial ultrasound examinations to exclude DVT.
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Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the most reported diseases in the United States, and emergency departments (ED) serve a population presenting with increased infection risk. However, identifying patients for whom sexually transmitted infection (STI) screening is appropriate requires accurate sexual history reporting. ⋯ Given that reported sexual activity and age are the only criteria for routine female screening, and that homosexual activity is one of the few screening criteria for males, our results show that a substantial proportion of ED patients eligible for screening may not be identified by reliance upon general sexual history questions.
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Lower-extremity subcutaneous emphysema is an unusual presentation in the emergency department, and it is often associated with gas-forming bacterial infections that confer significant morbidity and mortality. Because the presence of subcutaneous emphysema in an extremity can be alarming, physicians often pursue aggressive diagnostic and therapeutic strategies to identify and treat the underlying cause. In some cases, however, subcutaneous emphysema does not represent a life-threatening medical condition. The source of the subcutaneous air may not always be immediately recognized and can lead to either over- or under-utilization of resources to direct patient care. ⋯ We describe a case of bilateral lower-extremity subcutaneous emphysema after recent robotic surgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As the role of minimally invasive surgery and the push for shorter hospitalizations continue to rise, we are likely to see an increase in patients with complications from such procedures in the emergency department setting. Familiarity with the potential complications of these procedures is essential to differentiating between life-threatening and non-life-threatening conditions.