J Emerg Med
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Acute gastrointestinal bleeding is a potentially life-threatening condition that requires rapid intervention. In critically ill patients who are refractory to other therapies, balloon tamponade devices can be lifesaving. ⋯ It is essential for emergency physicians to be familiar with balloon tamponade for acute gastrointestinal bleeding. We review the common balloon tamponade devices, and this article is intended to serve as a resource for those interested in expanding their knowledge of balloon tamponade. © 2022 Elsevier Inc.
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Skin and soft tissue infections are common emergency department (ED) presentations. These infections cover a wide spectrum of disease, from simple cellulitis to necrotizing fasciitis. Despite the commonality, a subset of skin and soft tissue infections known as necrotizing soft tissue infections (NSTIs) can cause significant morbidity and mortality. ⋯ NSTIs are associated with significant morbidity and mortality. Knowledge of the history, examination, evaluation, and management is vital for emergency clinicians.
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Case Reports
Ultrasound-Guided Superior Laryngeal Nerve Block Facilitates Anesthesia Management in Bariatric Surgery.
Patients with obesity usually have a narrow pharyngeal cavity. They are prone to exposure difficulties and intubation failure during endotracheal intubation, and even face mask oxygen supply difficulties and hypoxemia in severe cases. We described the successful completion of conscious endotracheal intubation with superior laryngeal nerve internal branch block (SLNi) in a patient with pathologic obesity. ⋯ A 29-year-old, nondiabetic man with severe obesity (weight 211 kg, height 186 cm, and body mass index [BMI] 60.99 kg/m2) was scheduled for a laparoscopic sleeve gastrectomy. The superior laryngeal nerve internal branch was blocked under ultrasound guidance to eliminate the cough induced by fiberscope during awake endotracheal intubation. Why Should an Emergency Physician Be Aware of This? The cough caused by fiberscope was completely suppressed and the awake endotracheal intubation was completed successfully.
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Ultrasonography is an effective diagnostic tool for testicular torsion (TT), which is typically characterized by the absence of blood flow in the affected testicle on color Doppler mode. However, there are a few reported cases of TT with symmetrical preserved flow. We report a case of TT with the preserved intratesticular flow on color Doppler ultrasound. ⋯ A 14-year-old boy was admitted due to sudden-onset right scrotal pain. Point-of-care ultrasound (POCUS) revealed that the right testicle was larger than the left. The intratesticular flow in both testicles was preserved. Radiology-performed ultrasound confirmed the preserved intratesticular flow observed on POCUS, but also demonstrated a whirlpool sign of the right spermatic cord. TT was confirmed surgically. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should investigate the presence of intratesticular blood flow and the whirlpool sign of the spermatic cord or other ultrasound features suggestive of TT, even if testicular blood flow is preserved. Suspicion of TT from POCUS findings warrants further evaluation to preserve the patient's fertility.
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Low back pain (LBP) causes 2.6 million visits to U.S. emergency departments (EDs) annually. These patients are often treated with skeletal muscle relaxants (SMRs). ⋯ Among patients in the ED with acute LBP treated with a nonsteroidal anti-inflammatory drug, SMRs do not improve outcomes more than placebo. Neither age, sex, nor baseline impairment impacts these results.