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A patient with altered mental status and possible seizure reveals an atypical aortic dissection upon workup
In this report, we present the case of a 57-year-old woman who was transported to the emergency department with an acute episode of altered mental status, presenting as a possible stroke with possible seizures. The patient's only complaint was mild low back pain. Physical examination revealed disorientation to time with no other neurologic deficits or abnormal findings. Results from initial noncontrast head computed tomography, chest radiograph, and laboratory studies were all normal, except for an elevated d-dimer and serum creatinine. Chest computed tomography with contrast demonstrated a type A aortic dissection. The pa...
Source: The American Journal of Emergency Medicine - November 18, 2013 Category: Emergency Medicine Authors: Olufolahan J. Lawal, Harinder S. Dhindsa, Joshua W. Loyd Tags: Case Reports Source Type: research

Short answer question case series: a case of upper extremity oedema
Case vignette A right-handed man without past medical history presents with right upper extremity oedema for 4 days. He does not endorse any history of trauma, but was weight lifting and trampoline jumping 2 days prior to symptom development (see figures 1–4). Key questions Which visual findings are of notable concern? What are other important considerations on history? How should this patient be evaluated? How should this patient be treated? What should this patient's disposition be?Figure 1 depicts the forearms. The right arm is erythematous and oedematous compared with the left. Figures 2 and 3...
Source: Emergency Medicine Journal - September 16, 2014 Category: Emergency Medicine Authors: Tzvetkova, E., Jang, T. Tags: Fractures, Drugs: cardiovascular system, Pain (neurology), Stroke, Venous thromboembolism, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Trauma SAQs Source Type: research

The Case Files: When a Spade is Not a Spade
Turrin, Danielle DO; Sattler, Steven DO; Amodeo, Dana DO A 25-year-old Hispanic man presented to the emergency department with a complaint of three days of left-sided precordial chest pain. He described the pain as a constant 6/10 with pressure-like discomfort radiating to his left arm and the left side of his neck. He also experienced nausea, but denied any provocative or palliative factors. He said he had not experienced anything similar to this before. He had no family history of heart disease, acute myocardial infarction, or sudden cardiac death. He admitted to a 1.5 pack-per-day smoking history and social alcohol use,...
Source: The Case Files - August 26, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

A pain in the neck
A 41-year-old woman presented to the emergency department after developing severe neck pain while unloading groceries. The pain began at the base of her neck, radiated to the vertex of the skull, reached maximum intensity within 2–3 min, and was aggravated by head movement. Neurological examination was normal. Head CT showed focal hyperattenuation immediately anterior to the midbrain (figure 1) and angiogram showed no evidence of aneurysm (see online supplementary figure 1). Diagnosis: Perimesencephalic nonaneurysmal subarachnoid haemorrhage (PN-SAH). Originally described in 1985,1 PN-SAH has been reported in pa...
Source: Emergency Medicine Journal - October 17, 2014 Category: Emergency Medicine Authors: Lindor, R. A., Homme, J. L. Tags: Headache (including migraine), Pain (neurology), Stroke, Ethics Images in emergency medicine Source Type: research

Decreased facial expression variability in patients with serious cardiopulmonary disease in the emergency care setting
Conclusions With a single visual stimulus, patients with serious cardiopulmonary diseases lacked facial expression variability and surprise affect. Our preliminary findings suggest that stimulus-evoked facial expressions from emergency department patients with cardiopulmonary symptoms might be a useful component of gestalt pretest probability assessment.
Source: Emergency Medicine Journal - December 15, 2014 Category: Emergency Medicine Authors: Kline, J. A., Neumann, D., Haug, M. A., Kammer, D. J., Krabill, V. A. Tags: Editor's choice, Press releases, Pneumonia (infectious disease), TB and other respiratory infections, Pain (neurology), Stroke, Venous thromboembolism, Pneumonia (respiratory medicine), Pulmonary embolism Original article Source Type: research

Cost‐effectiveness of Quantitative Pretest Probability Intended to Reduce Unnecessary Medical Radiation Exposure in Emergency Department Patients With Chest Pain and Dyspnea
ConclusionsWidespread use of a combined qPTP for both ACS and PE has the potential to decrease costs by reducing diagnostic testing, while improving most long‐term outcomes in emergency patients with chest pain and dyspnea.
Source: Academic Emergency Medicine - April 21, 2015 Category: Emergency Medicine Authors: Jennifer L. Troyer, Alan E. Jones, Nathan I. Shapiro, Alice M. Mitchell, Ian Hewer, Jeffrey A. Kline Tags: Original Contribution Source Type: research

Cost-effectiveness of Quantitative Pretest Probability Intended to Reduce Unnecessary Medical Radiation Exposure in Emergency Department Patients With Chest Pain and Dyspnea.
CONCLUSIONS: Widespread use of a combined qPTP for both ACS and PE has the potential to decrease costs by reducing diagnostic testing, while improving most long-term outcomes in emergency patients with chest pain and dyspnea. PMID: 25899550 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - April 21, 2015 Category: Emergency Medicine Authors: Troyer JL, Jones AE, Shapiro NI, Mitchell AM, Hewer I, Kline JA Tags: Acad Emerg Med Source Type: research

Management of Apixaban-Associated Subdural Hematoma: A Case Report on the Use of Factor Eight Inhibitor Bypassing Activity
Conclusions: Factor VIII inhibitor bypassing activity may be a viable, nonspecific reversal agent for life-threatening bleeding associated with apixaban.
Source: Critical Care Medicine - May 16, 2015 Category: Emergency Medicine Tags: Online Case Report Source Type: research

Neurological disorders in the emergency centre of the Douala General Hospital, Cameroon: A cross-sectional study
Conclusion Neurological disorders are common in the emergency centre of the DGH. Aetiologies are diverse and in-hospital mortality is high. This highlights the need to organize neurologist calls at the EC and/or to improve the human resources capacity through regular training and evaluation.
Source: African Journal of Emergency Medicine - July 11, 2015 Category: Emergency Medicine Source Type: research

Raising the bar for exclusion of acute venous thromboembolism in the emergency department
Conclusion Retrospective application of an age adjusted d-dimer cut point for exclusion of VTE in ths cohort significantly increased specificity with limited impact on sensitivity. Caveats include those patients with longstanding symptoms and those with isolated distal deep vein thrombosis. UK centres should consider further local validation and trial adoption.
Source: Emergency Medicine Journal - November 23, 2015 Category: Emergency Medicine Authors: Horner, D., Wells, S., Bonnici, K., Reeves, N., Parris, R. Tags: Drugs: cardiovascular system, Pain (neurology), Stroke, Venous thromboembolism, Clinical diagnostic tests RCEM FREE PAPERS Source Type: research

Prehospital Helicopter Air Ambulances Part 1: Access, Protocols, and Utilization
Conclusion Most nationally certified EMS professionals had access to a medical helicopter service and used these resources mainly for trauma patients. About one third reported they did not have or were unsure if their agency had written protocols for HAA use.
Source: Air Medical Journal - November 24, 2015 Category: Emergency Medicine Source Type: research

Pediatric Homonymous Superior Quadrantanopia in the Presence of Acute Vertebral Artery Dissection
Conclusions: Most patients with vertebral artery dissection present with signs of posterior circulation ischemia consisting of neurological deficits, headaches, or neck pain. This case report highlights the unique clinical features and diagnostic imaging seen in the work-up of this rare disease process and exemplifies the importance of identifying acute visual symptoms in an emergency situation.
Source: Pediatric Emergency Care - December 1, 2015 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Short answer question: a distracting ECG
Part 1 A 76-year-old man with a past medical history of chronic obstructive pulmonary disease is brought to the emergency department (ED) with suspected sepsis. He is a smoker of 15 cigarettes per day who has an exercise tolerance of approximately 30 m. He saw his general practitioner who treated him with antibiotics and steroids. He has rung for an ambulance complaining of increasing shortness of breath and back pain. His initial vital signs were: BP 100/87 mm Hg, HR 120 bpm, RR 24 breaths per minute, oxygen saturations 100% on room air and normal temperature. He appeared sweaty and clammy, but his hea...
Source: Emergency Medicine Journal - December 23, 2015 Category: Emergency Medicine Authors: Lyddon, K., Thevendra, M., Jang Tags: Tachyarrhythmias, Cardiomyopathy, Drugs: infectious diseases, Pneumonia (infectious disease), TB and other respiratory infections, Echocardiography, Pain (neurology), Stroke, Hypertension, Acute coronary syndromes, Percutaneous intervention, Pain (palliat Source Type: research

Perceived Appropriateness of Shared Decision‐Making in the Emergency Department: A Survey Study
ConclusionsAcceptance of SDM among emergency physicians appears to be strong across management categories (diagnostic testing, treatment, and disposition) and in a variety of clinical scenarios. SDM is perceived by most EPs to be medicolegally protective.This article is protected by copyright. All rights reserved.
Source: Academic Emergency Medicine - January 25, 2016 Category: Emergency Medicine Authors: Marc A. Probst, Hemal K. Kanzaria, Dominick L. Frosch, Erik P. Hess, Gary Winkel, Ka Ming Ngai, Lynne D. Richardson Tags: Original Contribution Source Type: research

Perceived Appropriateness of Shared Decision-Making in the Emergency Department: A Survey Study.
CONCLUSIONS: Acceptance of SDM among emergency physicians appears to be strong across management categories (diagnostic testing, treatment, and disposition) and in a variety of clinical scenarios. SDM is perceived by most EPs to be medicolegally protective. This article is protected by copyright. All rights reserved. PMID: 26806170 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - January 25, 2016 Category: Emergency Medicine Authors: Probst MA, Kanzaria HK, Frosch DL, Hess EP, Winkel G, Ngai KM, Richardson LD Tags: Acad Emerg Med Source Type: research

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