J Emerg Med
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Emergency departments (EDs) around the world are facing a crippling crisis of overcrowding, a complex problem caused by a variety of factors. One contributing factor is the overutilization of EDs by patients with frequent visits. ⋯ The prevalence rate of high utilizers was found to be 3.9% in our study, falling within the range based on literature. Due to the parallel issues raised by many studies, the importance of developing convenient corrective strategies and conducting further national-based studies to get better insight of high utilizers is required.
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Gastrointestinal bleeding (GIB) is a common condition in the emergency department (ED) with high incidence and mortality. ⋯ In this manuscript, we present a case series of ED patients with upper GIB in whom emergency physicians (2 fellowship-trained attendings and 2 senior residents facile with point-of-care ultrasound) performed GUS. As a supplement to the clinical examination, this sonographic "lavage" (i.e., using GUS in patients with upper GIB) helped predict aspiration risk, support diagnostic reasoning, and expedite early goal-directed management and appropriate disposition. We also provide a step-by-step tutorial using high-quality media, as well as a novel algorithm for translation of this technique to the bedside for emergency physicians.
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Lyme disease is the most common tick-borne illness in the United States, and cases of Lyme disease have nearly doubled since the early 2000s. Symptoms and presentation vary based on severity of illness, with more serious complications of disease consisting of neurologic and cardiac dysfunction. Testing is often unreliable, which can lead to delayed diagnosis and management. ⋯ A 38-year-old woman presented to the Emergency Department with left-sided facial droop and was subsequently diagnosed with Lyme carditis. This case depicts a classic but unique triad of symptoms caused by Lyme disease: high-degree atrioventricular (AV) blockade, Bell's palsy, and erythema migrans. The patient was promptly treated with empiric i.v. antibiotics pending serology testing for Lyme disease, and her high-degree AV block improved. Initial polymerase chain reaction testing for this patient was negative, but diagnosis was later confirmed with a positive two-tiered test. Intravenous ceftriaxone therapy improved this patient's heart block, allowing for discharge on oral antibiotics. Why Should an Emergency Physician Be Aware of This? It is important to recognize potential cases of Lyme disease early so that appropriate treatment can be initiated. Lyme disease is difficult to diagnose given the wide variety of symptoms and clinical presentations coupled with routine testing that has relatively low sensitivity. Lyme cases have been increasing over the last several years, even in areas in which Lyme disease is not generally endemic. Testing limitations make obtaining a definitive diagnosis difficult, which the emergency physician should be aware of.