J Emerg Med
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In this case, a mobile medical ID was used to inform an off-duty clinician of highly relevant medical history when attending a pedestrian during a medical emergency. Mobile medical IDs are available on all major smartphone operating systems and provide information including, but not limited to, medical history, current medications, and allergy status. These can be accessed from lock screens, allowing access for off-duty clinicians to improve the quality of care they could provide while awaiting assistance.
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Patellar dislocations are a common orthopedic emergency with several variants. The rarer variants include rotational dislocations. These often require open reduction in the operating room. ⋯ We report on a case of a combined rotational and lateral patellar dislocation in a young female. We suspected and made the diagnosis of a rotational dislocation after initial unsuccessful attempts at reduction under sedation. With the assistance of our orthopedic colleagues, we were able to perform a reduction of this patient's patella under sedation in the emergency department. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Awareness of uncommon patellar dislocations is an important area of knowledge for the emergency physician. A thorough understanding of indications and contraindications to closed reduction is important for efficient and safe management and disposition. Collaboration with orthopedic surgery colleagues is another important step in the evaluation of these patients.
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Shockwave lithotripsy (SWL) is a common procedure, which can result in rare, life-threatening complications, such as splenic rupture, perinephric hematoma, sepsis, and ureteral colic from retained stone. Being able to identify these complications can result in successful diagnosis and expedited management. ⋯ We describe the case of an 82-year-old female presenting to the emergency department (ED) for hypotension and vomiting. The patient had undergone SWL for a kidney stone earlier in the day. On initial evaluation, the patient was hypotensive and reported mild abdominal pain. Although initially evaluated and treated for presumed sepsis, thorough testing was able to diagnose splenic rupture and hemoperitoneum. Splenic rupture is a rare complication of SWL and the patient's initial symptoms of hypotension and fever, with a potential source of infection, suggested a common presentation of sepsis and made this case a unique diagnostic challenge. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Diagnosis is always a challenge in the ED, due to the variability of patients that can be seen. Often times, a patient's medical and surgical history will provide guidance. For this reason, it is important to know what complications exist with outpatient procedures, how they may present, and what patient risk factors may lead to an increased incidence.
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Emergency Medical Services (EMS) is an important resource that interacts with our most vulnerable patients during transport home after hospital discharge. EMS providers may be appropriately situated to support the transition of care to the home environment. ⋯ The study findings suggest that transport home via ambulance after hospital discharge could be predictive of a high risk of recidivism independent of established readmission risk factors. Programs that expand the role of EMS to include post-transport interventions may warrant further exploration.