J Emerg Med
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Radial head subluxation (RHS) is a common complaint seen in the pediatric emergency department in children ages 6 months to 4 years. Classically, injury occurs due to axial traction on the arm, but this mechanism is not universal. Some patients will have recurrent RHS; some may undergo x-ray (XR) evaluation for alternative diagnosis. ⋯ RHS can result from a myriad of mechanisms. We found that recurrence was more likely in male patients. Factors associated with radiographic evaluation included atypical mechanism, older age, and unclear history, regardless of physician training background.
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Traumatic axilloaxillary arteriovenous (AV) fistulas are rare occurrences, with the predominance of AV fistulas in this region occurring as an alternative surgical intervention in patients who are undergoing hemodialysis. ⋯ We describe the case of a young man with this condition caused by a previous penetrating trauma who had a delayed diagnosis primarily because of the infrequency of the clinical presentation. This is one of a few documented cases of axilloaxillary AV fistulas in the setting of trauma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Axilloaxillary AV fistulas present with loud machinery like cardiac murmurs that can be similar to patients with coarctation of the aorta and patent ductus arteriosus; however, important clinical examination features can help distinguish the two conditions. Diagnosis is important in avoiding late-stage complications and more technically difficult surgical repairs.
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Renal colic results in > 1 million ED visits per year, yet there exists a gap in understanding how the majority of these visits, namely uncomplicated cases, are managed. ⋯ For patients with uncomplicated renal colic, there is variation in the management associated with nonclinical factors, namely insurance. No consensus guidelines exist yet to address when to admit or utilize inpatient urologic procedures.
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Case Reports
A Physician's Moral Dilemma in the Emergency Department: Going Against a Patient's Perceived Wishes.
We describe a case where a patient at the end of life with an advanced medical directive in place presents to the ED in distress. ⋯ We discuss the ethical and moral distress faced by ED physicians in such acute scenarios where a patient's perceived wishes are not in line with their families' pleas.
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Marchiafava-Bignami (MB) disease is a rare disorder that causes primary degeneration of the corpus callosum. It is associated with chronic alcohol consumption caused by either a toxic or nutritional etiology. ⋯ We report a case of a 54-year-old woman who presented to our emergency department with complete mutism caused by MB disease that completely resolved with intravenous thiamine and dextrose therapy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians frequently encounter patients with alcohol abuse and its complications. We report a rare presentation of a potential alcohol-related spectrum disease that may be encountered by an emergency physician. Early diagnosis and prompt management are critical to potentially reversing the disease, and this case shows the importance of including this disease in the differential diagnosis in patients with speech difficulty and alcohol abuse.