J Emerg Med
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Point-of-care ultrasound (POCUS) is an optimal imaging modality for the risk stratification of patients presenting to the emergency department (ED) with inguinal and femoral hernias, allowing for better evaluation of clinical presentations and guiding appropriate treatment. The lack of ultrasound classification for inguinal and femoral hernias has led to inconsistent use and often underuse of POCUS in this patient population. Several groin hernia classifications are available, but most are complex and often targeted toward surgical management. ⋯ In the ED, POCUS can confirm the presence of a hernia sac and identify and predict surgical emergencies, such as bowel incarceration or strangulation, which are the most important elements in the management of patients presenting with possible inguinal or femoral hernias.
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Although vaccination against coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been proven generally safe, rare but potentially serious adverse reactions do occur. Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis that has been associated with other immunizations, but, to our knowledge, has not been previously reported in association with vaccines directed against SARS-CoV-2. ⋯ We report the case of a 22-year-old man with no known past medical history who presented to the Emergency Department with 2 days of migratory arthritis in his ankles and palpable purpura on his bilateral lower extremities, occurring 10 days after receiving the Johnson & Johnson SARS-CoV-2 vaccine. The patient's clinical presentation was suggestive of leukocytoclastic vasculitis, and this diagnosis was confirmed on skin biopsy. Why Should an Emergency Physician Be Aware of This? Recognition of vasculitides is important for timely treatment and prevention of complications. In a patient presenting with palpable purpura after immunization against SARS-CoV-2, LCV should be promptly considered and worked up by the Emergency Physician, though management is most often entirely outpatient and the clinical course is typically mild and self-resolving.
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In 2004, 2009, and 2014, we examined the number of endowed faculty positions in academic departments of emergency medicine (ADEMs). ⋯ Forty-six individual ADEMs (46%) reported having at least one endowed faculty position compared with only 30 in 2014 and only 19 in 2009. The total number of endowed faculty positions in ADEMs was 92 in the current study compared with 53 in 2014, 25 in 2009, and only 9 in 2004.
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Bottle gourd (Lagenaria siceraria) is sometimes used in complementary medicine practice for the treatment of chronic ailments. However, there have been reports of toxicity due to consumption of bottle gourd juice, leading to severe abdominal upset and upper gastrointestinal bleeding. ⋯ We present a case of a 41-year-old gentleman who presented to the Emergency Department with multiple episodes of vomiting, hematemesis, and diarrhea after consuming bottle gourd juice. The patient was resuscitated and stabilized with fluids, proton pump inhibitors, and antiemetics. He was subsequently admitted to the General Medicine ward for further management. He continued to receive symptomatic treatment in the ward and underwent esophagogastroduodenoscopy during his hospitalization stay. His symptoms improved and he was discharged stable 5 days later. Why Should an Emergency Physician Be Aware of This? Early recognition of this rare presentation of bottle gourd toxicity is important in our local context, especially where traditional medicine is widely prevalent nowadays. Treatment is supportive. Public awareness of dangerous effects from the consumption of bitter bottle gourd juice and complementary medicine without proper consultation with a practitioner plays a crucial role to prevent further cases. Physicians need to advise patients on the use of traditional medicine and their potential side effects.
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Human grayanotoxin poisoning is distinctly uncommon in North America, as the predominant source of human exposure is honey made by bees pollinating rhododendron species in the Mediterranean. We present a case of confirmed grayanotoxin poisoning from honey imported from Turkey. ⋯ A 61-year-old man developed nausea, lightheadedness, and lost consciousness. Onset was 30 min after the ingestion of honey that was brought to the United States from Turkey. Emergency medical services found him bradycardic, hypotensive, and unresponsive. He was treated with atropine, saline, and oxygen, at which point his heart rate and blood pressure improved, and he regained consciousness. A similar episode several days earlier was followed by a brief unrevealing hospitalization. He was again hospitalized, and had a normal echocardiogram, telemetric monitoring, and complete laboratory studies. Grayanotoxins I and III were subsequently identified in the patient's blood, urine, and honey. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Grayanotoxins are diterpenoids found in rhododendron species, whose clinical effects span multiple organ systems including gastrointestinal, cardiac, and neurologic. Treatment is largely supportive, and a good response to atropine and intravenous fluids has been described. Laboratory confirmation of grayanotoxins is not available in a short enough turnaround time to be clinically useful during immediate management, but confirmatory testing may obviate further unnecessary evaluation. Grayanotoxins are likely to remain a rare source of poisoning in North America, but recurrent bradycardia without alternative etiology should prompt a thorough exposure history, which may reveal, as in this case, a treatable toxicologic etiology.