J Emerg Med
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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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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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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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Since the first heart transplant in 1967, there has been significant progress in this field of cardiac transplantation. Approximately 600 pediatric heart transplants are performed every year worldwide. With the increasing number of pediatric heart transplant patients, and given the few tertiary care pediatric transplant centers, adult and pediatric emergency department (ED) providers are increasingly engaged in the care of pediatric heart transplant recipients in the ED. ⋯ The unique immunological challenges in these patients, including rejection and medication side effects and opportunistic infections, make this population fragile, and the knowledge of these challenges is helpful for EM providers.
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This study was developed to provide insight into the effects of an i.v. opioid order set on prescribing of i.v. opioids in the emergency department (ED) for nontraumatic, unspecified abdominal pain. Research is needed in this area to catalyze more consistent and evidence-based i.v. opioid prescribing. ⋯ The restriction correlated with a decrease in i.v. opioids. Pain control was not diminished as a result of the restriction. The results of this study may be used to generate hypotheses for comparing different modes of pain management in the ED in this patient population and others. Future studies should continue to evaluate the impact of oral vs. i.v. opioids.