Can D-Dimer in Low-Risk Patients Exclude Aortic Dissection in the Emergency Department?

Background: Aortic dissection (AD) is a challenging diagnosis associated with severe mortality. However, acute AD is a rare clinical entity and can be overevaluated in the emergency department. D-dimer, both alone and in combination with the Aortic Dissection Detection Risk Score (ADD-RS), has been studied as a tool to evaluate for AD.

Comparing two doses of intramuscular ketorolac for treatment of acute musculoskeletal pain in a military emergency department.

Study Objective: The goal of the study was to assess a low-dose versus a high-dose of intramuscular (IM) ketorolac for non-inferiority in adults with acute MSK pain in an emergency department (ED).

Methods: This was a single-blinded, randomized controlled, non-inferiority trial of adults presenting to an ED with a chief complaint of acute MSK pain. Patients were randomized to either a 15 mg or a 60 mg IM ketorolac dose.

A 61-year-old Female with Right Upper Abdominal Pain.

Case Presentation: A 61-year-old female presented to the emergency department with right upper quadrant abdominal pain following a cholecystectomy 18 days prior. Computed tomography (CT) of her abdomen demonstrated a large abscess in her post-hepatic fossa. She was admitted to the general surgery service and received an image-guided percutaneous drain placement with interventional radiology with immediate return of purulent material.

Oncologic Emergencies: Palliative Care in the Emergency Department Setting.

Background: Palliative care is an essential component of emergency medicine, as many patients with terminal illness will present to the emergency department (ED) for symptomatic management at the end of life (EOL).

Objective: This narrative review evaluates palliative care in the ED, with a focus on the literature behind management of EOL symptoms, especially dyspnea and cancer-related pain.

Discussion: As the population ages, increasing numbers of patients present to the ED with severe EOL symptoms.

An emergency medicine-focused review of malignant otitis externa.

Introduction: Malignant otitis externa (MOE) is a progressive infection of the external auditory canal (EAC). This disease is rare but has severe morbidity and mortality.

Objective: This narrative review provides an overview of malignant otitis externa for emergency clinicians.

55 year-old Female with Hematuria.

Case Presentation: A 55 year-old female presented to the emergency department with left sided abdominal pain and hematuria. Computed tomography scan of her abdomen and pelvis demonstrated a large left renal mass with extension into the left ureter, left renal vein, and inferior vena cava. She was admitted and treated for presumed renal cell carcinoma (RCC).

Emergency medicine misconceptions: Utility of routine coagulation panels in the emergency department setting.

Background: Coagulation panels are ordered for a variety of conditions in the emergency department (ED).

Objective: This narrative review evaluates specific conditions for which a coagulation panel is commonly ordered but has limited utility in medical decision-making.

Discussion: Coagulation panels consist of partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT), prothrombin time (PT), and international normalized ratio (INR).

An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction.

Introduction: Troponin is an integral component of the evaluation for acute coronary syndrome (ACS) and occlusion myocardial infarction (OMI). However, troponin may be elevated in conditions other than OMI.

Objective: This narrative review provides emergency clinicians with a focused evaluation of troponin elevation in patients with myocardial injury due to conditions other than OMI.

Clinical mimics: an emergency medicine focused review of pneumonia mimics.

Pneumonia is a common cause of morbidity and mortality in adults in the United States. While pneumonia classically presents with a fever, cough, and shortness of breath, the presentation can vary widely in adults. This review evaluates history and physical examination findings of pneumonia and several conditions that mimic pneumonia.

Prognosis of diffuse axonal injury with traumatic brain injury.

Background: Determine the prognostic impact of magnetic resonance imaging (MRI)-defined diffuse axonal injury (DAI) after traumatic brain injury (TBI) on functional outcomes, quality of life, and 3-year mortality.

Methods: This retrospective single center cohort included adult trauma patients (age > 17 years) admitted from 2006 to 2012 with TBI. Inclusion criteria were positive head computed tomography with brain MRI within 2 weeks of admission.