J Emerg Med
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Hemorrhage from ruptured ectopic pregnancy is the leading cause of first trimester mortality in North America. ⋯ ED patients with a ruptured ectopic pregnancy who received a PoCUS first had shorter times to diagnosis, obstetric consultation, and OR arrival compared with those who received RADUS.
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Cortical hand strokes affect the 'hand knob' of the motor cortex, resulting in isolated distal upper limb or hand weakness. They are rare and can be easily misdiagnosed for peripheral lesions. ⋯ Case 1: A 59-year-old man presented to the Emergency Department (ED) after noticing left hand weakness while driving. There was no sensory deficit noted. A full neurological examination suggested an upper motor neurone rather than a peripheral nerve lesion. This was confirmed by a magnetic resonance imaging scan of his brain. Case 2: An 88-year-old man presented to the ED after developing sudden-onset left hand weakness while completing a newspaper puzzle. Power returned gradually over approximately 4 h, with no sensory symptoms being noted. A transient ischemic attack leading to cortical hand was diagnosed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Cortical hand strokes are a rare, but important, differential for wrist drop. They are often first strokes and embolic in nature. Therefore, correct diagnosis is vital to enable initiation of secondary prevention.
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Radial arterial line placement is commonly performed in various clinical settings, including the emergency department. However, learners are successful on the first attempt only half of the time. Simulation can provide learners with procedure practice opportunities outside of clinical practice to increase confidence and chances of success. ⋯ Our inexpensive trainer can help physicians and physicians in training conceptualize, practice, and troubleshoot the pitfalls of arterial line placement. Training programs looking to help learners understand the mechanics of arterial line placement may find it a useful tool.
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Occam's razor instructs physicians to assume one single cause for multiple symptoms, whereas Hickam's dictum encourages them to suspect multiple concurrent pathologies. Although the general practice is to follow Occam's razor, occasionally Hickam's dictum reigns supreme. Here we present one such case, where the concurrent presence of two life-threatening pathologies posed clinical challenges in diagnosis and management. ⋯ Although cardiac tamponade and pulmonary embolism (PE) are known complications of malignancy, their concomitant existence is rare. Here we report a patient who presented with shortness of breath found to have both cardiac tamponade and submassive PE. Although the cardiac tamponade was initially diagnosed in the Emergency Department by bedside ultrasound and treated with pericardiocentesis, only a few hours later, when she deteriorated, the submassive PE was diagnosed, which was treated with heparin infusion and subsequently transitioned to a newer oral anticoagulant. The patient was later diagnosed as having primary breast cancer and metastatic lung adenocarcinoma. Why Should an Emergency Physician Be Aware of This? This raised unique diagnostic challenges, as both cardiac tamponade and PE present with obstructive shock. The increased right heart pressure from the PE could have paradoxically protected the patient from the tamponade effects of the pericardial effusion. Furthermore, the presence of cardiac tamponade may also mask the typical echocardiographic features of PE. The concurrent presence of two pathologies raised challenges and dilemmas in management. This case shows that physicians should maintain a high degree of suspicion of two pathologies when the patient deteriorates after the first pathology has been appropriately treated.
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Political rhetoric from the former U.S. president influences Latinx adults' feelings of safety and their decisions to seek care in the emergency department (ED). ⋯ Most parents heard statements against undocumented immigrants by the former U.S. president and most believed measures were being enacted. This rhetoric had a substantial negative impact on ULF parents in terms of safety concerns for their child and fear of accessing health care.