Thoracic aortic syndromes in the emergency department: recognition and management.

Acute aortic syndromes include aortic dissection, penetrating atherosclerotic ulcer, and intramural hematomas, but aortic dissection is the most common and the deadliest. This review summarizes the latest evidence on developing a differential for aortic dissection when common complaints, such as chest pain, abdominal pain, and syncope are also present. Recent evidence on the optimal uses of emergency department imaging studies and risk stratification tools are reviewed, along with special considerations in the management of penetrating atherosclerotic ulcer and intramural hematoma.

Infective endocarditis: identification and management in the emergency department.

Recognition of infective endocarditis in the emergency department continues to be a challenge, as its signs and symptoms can be subtle, laboratory results are limited, and it can involve or lead to many other serious conditions. With the increase in use of medical access devices, implantable cardiac devices, and the rise of intravenous drug use, the epidemiology of infective endocarditis is changing. Diagnostic imaging has evolved, and the use of point-of-care ultrasound and transthoracic echocardiography are critical in making an early diagnosis.

To tPA or Not to tPA: Two Medical-Legal Misadventures of Diagnosing a Cerebrovascular Accident as a Stroke Mimic.

We present two recent successfully litigated malpractice cases in which patients with cerebrovascular accidents were misdiagnosed as stroke mimics. The first was diagnosed as a hemiplegic migraine, which occurs in only 0.01% of the population.

Headache with Aura: A case report of ocular melanoma.

Background: Headaches and visual complaints are common conditions encountered in the emergency department. While a patient's age, risk factors, and comorbidities often aid in risk stratification and guide emergency department evaluation, atypical presentations of serious disease may still occur in young otherwise healthy patients CASE: In this vignette we discuss a case of ocular (choroidal) melanoma in a 21 year-old female patient who presented with recurrent photopsia and headaches.

Discussion: Ocular melanoma is the most common non-skin melanoma and should be considered by the emergency physician for patients with visual deficits.

Eruptive xanthoma in the setting of hypertriglyceridemia and pancreatitis.

Background: Undifferentiated dermatologic complaints are often encountered in the emergency department. While a patient's exposures, risk factors, and comorbidities may help guide emergency department evaluation, the accurate diagnosis of dermatologic findings is critical to allowing rapid identification and treatment of disease.

Case: In this vignette we discuss a case of eruptive xanthoma in a 33-year-old male with diabetic ketoacidosis and pancreatitis.

Injuries Sustained During Modern Army Combatives Tournaments.

Introduction: Injuries sustained during Modern Army Combatives (MAC) tournaments can result in variable recovery time for involved competitors and unpredictable loss of readiness for military units. A paucity of MAC data is available to guide military medical providers and unit commanders on expected injuries or loss of readiness. Literature reviewing mixed martial arts competitions offers some insight but demonstrates variation in fight outcomes resulting in injuries ranging from 8.

Sudden onset flank pain: Spontaneous renal rupture.

Background: Undifferentiated abdominal pain is a common condition encountered in the emergency department. While a patient's age, risk factors, and comorbidities often aid in risk stratification and guide emergency department evaluation, atypical presentations of serious disease may still occur suddenly in young otherwise healthy patients.

Case Report: In this vignette we discuss a case of spontaneous, atraumatic renal rupture with large retroperitoneal hemorrhage (Wunderlich's Syndrome) in a 22year old male.