Spontaneous Liver Rupture in the Setting of Autoimmune Disease and Periportal Edema.

Spontaneous liver rupture is a rare and life-threatening occurrence associated with high morbidity and mortality. We report a rare case of an elderly patient with a significant history of autoimmune disease who initially presented with cholestatic symptomatology that subsequently resulted in spontaneous liver rupture and hemorrhagic shock. An initial CT scan prior to the rupture showed periportal edema.

Radial Artery Pseudoaneurysm From a Squirrel Bite.

Radial artery pseudoaneurysm is a rarelimb-threatening complication that occurs from vascular procedures and direct trauma. We present a rare case of a 74-year-old female who presented to the emergency department with a squirrel bite to her right wrist. Although initially benign-appearing, computed tomography angiography of the right upper extremity showed a pseudoaneurysm at the distal radial artery.

Cannabinoid hyperemesis syndrome presenting with ventricular bigeminy.

The is a case of a 28-year-old male presenting to an emergency department (ED) via emergency medical services (EMS) with a chief complaint of "gastritis." He was noted to have bigeminy on the pre-arrival EMS electrocardiogram. He was ultimately diagnosed with cannabinoid hyperemesis syndrome (CHS).

Difficult Intravenous Access Requiring Ultrasound in the Emergency Department: Associations With Delays in Care and Areas for Quality Improvement.

Background Patients with difficult intravenous access (DIVA) requiring ultrasound-guided intravenous (USGIV) access have been associated with delays in treatment, imaging, and disposition in academic emergency department (ED) patient populations. Our objective in this study was to characterize differences in time to intravenous access, imaging, and disposition between patients with DIVA versus those without DIVA requiring USGIV access in a community ED while also assessing for DIVA-associated comorbidities. Methods A cross-sectional, observational analysis was performed on admitted ED patients evaluated from September 2 to September 31, 2022, at a community ED.

Hyperacute and Fulminant Guillain-Barré Syndrome Requiring Emergent Intubation.

Guillain-Barré syndrome (GBS) is an autoimmune-mediated acute polyneuropathy that can progress to life-threatening respiratory failure. The diagnosis and treatment of this pathology are complicated by the rarity of the disease and diversity in clinical presentation due to rarer, more dangerous subtypes of GBS. Understanding the time course of progression from onset to nadir of neurological deficits, maintaining a high index of suspicion, and close airway monitoring are essential in rapid diagnosis, securing the airway, and treatment.

Acute Upper Extremity Arterial Occlusion Diagnosed on POCUS in the Emergency Department.

Upper extremity acute limb ischemia (ALI) is a limb-threatening and potentially lethal pathology that is most commonly caused by vascular embolization. Outcomes of limb ischemia are time-sensitive due to the correlation between a longer time from symptom onset to intervention with a vastly higher risk of amputation. In this report, point of care ultrasound (POCUS) was utilized to rapidly diagnose a patient with a proximal right brachial artery embolic occlusion, prompting expedited surgical consultation and successful embolectomy.

Morel-Lavallée lesion of the distal thigh: Emergency department diagnosis with point-of-care ultrasound.

A Morel-Lavallée lesion (MLL) is a rare, closed traumatic soft-tissue degloving injury that is often misdiagnosed. The mechanism that results in this lesion involves a shearing force that separates the hypodermis from underlying fascia, thereby disrupting perforating vascular and lymphatic vessels and resulting in a hemolymphatic fluid collection prone to infection and pseudocyst formation. We describe a case of a 70-year-old male with an initially missed MLL despite CT imaging that was ultimately diagnosed on point-of-care ultrasound (POCUS) on a second emergency department visit.

Emergency department point-of-care ultrasound diagnosis of active bleeding into the intraluminal thrombus of an abdominal aortic aneurysm.

Rupture of an abdominal aortic aneurysm (AAA) is an immediately life-threatening phenomenon with substantial mortality. Although most AAAs are asymptomatic, an impending AAA rupture can be heralded by nonspecific symptoms and imaging findings on CT and point-of-care ultrasound (POCUS). In this report, we present a case of an 81-year-old male with an atypical presentation of an AAA with novel sonographic findings of imminent rupture on POCUS with Doppler that prompted successful emergent intervention.

Emergency Department Point-of-Care Ultrasound Diagnosis of a Large Bowel Obstruction Due to Metastatic Rectal Cancer: A Case Report.

Large bowel obstruction (LBO) is a life-threatening condition seen most often in the geriatric population. LBO can present with nonspecific abdominal pain that can overlap with other pathologies, such as abdominal infection, acute aortic disease, intestinal perforation, and atypical acute coronary syndrome in the geriatric population. Delays in diagnosis of colonic obstruction result in significant mortality due to complications involving bowel necrosis, perforation, and sepsis.

Dexmethylphenidate-Induced Rhabdomyolysis by Interaction With Aromatase Inhibitor.

Rhabdomyolysis secondary to prescription drug-drug interactions can be an overlooked life-threatening emergency. Amphetamines and similar substances have been associated with muscle lysis secondary to increased sympathetic activity that can cause myotoxicity, hyperthermia, and increased muscular activity. Anabolic steroids may also be a predisposing factor in developing rhabdomyolysis.

Penetrating Aortic Ulceration With Pseudoaneurysm and Intramural Hematoma: Emergency Department Management and Point-of-Care Ultrasound Diagnosis.

Penetrating aortic ulcer (PAU) complicated by an intramural hematoma is a rare and potentially life-threatening emergency department (ED) presentation that is defined by progressive ulceration through the intima layer into the media layer of the aorta. Symptomatic PAUs can be clinically indistinguishable from other life-threatening pathologies such as aortic dissection, acute coronary syndrome (ACS), intrabdominal catastrophes as well as less lethal processes such as musculoskeletal back pain. Given the potential of PAUs to result in lethal aortic rupture and dissection, the emergency provider should maintain a high index of suspicion in patients with risk factors for aortic pathologies and utilize diagnostic modalities such as point-of-care ultrasound (POCUS) to expedite diagnosis.

COVID-19 Vaccine Hesitancy Among Healthcare Providers.

Objective: Vaccine hesitancy among healthcare providers can compromise public confidence in vaccination during the ongoing COVID-19 global epidemic and increase susceptibility to life-threatening disease. We sought to investigate predictors of openness to vaccination among healthcare workers who choose not to be vaccinated against COVID-19 in order to explore potential solutions.

Methods: Physicians, physician assistants, and nurses who chose not to be vaccinated were surveyed to decipher reasons for vaccine refusal and personal loss due to the virus along with demographic variables.

The Burden of Hypercoagulability in COVID-19.

The novel coronavirus disease 2019 (COVID-19) infection has widespread impact on multiple organ systems, including damage to endothelial cells. Various studies have found evidence for direct mechanisms by which interaction between severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and endothelial cells lead to extensive damage to the latter, and indirect mechanisms, such as excessively elevated cytokines, can also result in the same outcome. Damage to the endothelium results in release of thrombotic factors and inhibition of fibrinolysis.

Life-Threatening Sublingual Hematoma in the Setting of Anticoagulation and Neck Trauma.

Sublingual hematoma is a rare and life-threatening emergency department presentation. The rich vascular supply of the tongue results in a predisposition for rapid hemorrhage secondary to lingual trauma and developing lethal upper airway obstruction. In the setting of a patient with neck trauma, assessment of risk factors, such as the use of anticoagulation, and clinical signs of vascular injury are essential for rapid diagnosis and mobilization of resources for airway protection.

Spontaneous Spinal Epidural Hematoma: A Case of a Benign Presentation and Emergency Department Management.

Spontaneous spinal epidural hematomas (SSEHs) are neurological emergencies complicated by a wide array of presentations. In this study, we report a case of a patient who presented with neck pain and was diagnosed with an SSEH with computed tomography (CT) angiography with subsequent confirmation by magnetic resonance imaging (MRI). The high-risk location and size of the lesion guided management and surgical intervention.

Massive Spontaneous Pneumothorax.

Spontaneous pneumothorax (SP) is an abnormal occurrence in which air enters the pleural space, increasing pressure that pushes on the lung, causing it to collapse in part or full. Diagnosis is made by physical exam and can be confirmed by chest X-ray (CXR), chest computed tomography (CT), ultrasonography, and other forms of imaging showing a collapsed lung. We present the case of a 35-year-old male cannabis user presenting with sharp sudden pains in the right chest, who presented almost 12 hours after symptom onset and was diagnosed with a 90% pneumothorax of the right lung.

Smart Tourism Technologies' Ambidexterity: Balancing Tourist's Worries and Novelty Seeking for Travel Satisfaction.

Tourists deal with two intrinsic, uncertainty-driven attributes of travel, tourist worries and novelty seeking, that simultaneously affect their transaction and travel experience satisfaction. Rapid technological advances coupled with uncertainties caused by momentous events such as COVID-19 highlight the increasing significance of smart technologies in the tourism industry. This study explores the relationships between novelty and worries and travel satisfaction, as well as examines how tourists enhance their quality of trips with the use of smart tourism technologies.

Modularity maximization to design contiguous policy zones for pandemic response.

The health and economic devastation caused by the COVID-19 pandemic has created a significant global humanitarian disaster. Pandemic response policies guided by geospatial approaches are appropriate additions to traditional epidemiological responses when addressing this disaster. However, little is known about finding the optimal set of locations or jurisdictions to create policy coordination zones.

Hematemesis Secondary to Complex Incarcerated Pantaloon Hernia.

Hematemesis with concomitant small bowel obstruction is an uncommon emergency department presentation. We report the case of a patient who presented with hematemesis and an incarcerated pantaloon hernia. While the patient initially had intact bowel movements and flatus, he eventually developed complete obstruction that required open surgical repair.

Optimal Investment in Prevention and Recovery for Mitigating Epidemic Risks.

The worldwide healthcare and economic crisis caused by the COVID-19 pandemic highlights the need for a deeper understanding of investing in the mitigation of epidemic risks. To address this, we built a mathematical model to optimize investments into two types of measures for mitigating the risks of epidemic propagation: prevention/containment measures and treatment/recovery measures. The new model explicitly accounts for the characteristics of networks of individuals, as a critical element of epidemic propagation.