Alcohol-Related Metabolic Emergencies.

Patients with alcohol use disorders are commonly identified and managed in the emergency department. Although the alcohol-intoxicated patient has a high risk for significant injury and diseases, the majority will be allowed to sober in the emergency department and can be discharged without incident. However, there are metabolic derangements in these patients, such as alcoholic ketoacidosis, Wernicke-Korsakoff, and potomania that very commonly present similar to intoxication and can be misdiagnosed by emergency clinicians.

Don't Forget What You Can't See: A Case of Ocular Syphilis.

This case describes an emergency department (ED) presentation of ocular syphilis in a human immunodeficiency virus (HIV) infected patient. This is an unusual presentation of syphilis and one that emergency physicians should be aware of. The prevalence of syphilis has reached epidemic proportions since 2001 with occurrences primarily among men who have sex with men (MSM).

The "syringe" technique: a hands-free approach for the reduction of acute nontraumatic temporomandibular dislocations in the emergency department.

Background: The traditional intraoral manual reduction of temporomandibular joint (TMJ) dislocations is time consuming, difficult, and at times ineffective, and commonly requires conscious sedation.

Objectives: We describe a novel technique for the reduction of acute nontraumatic TMJ dislocations in the emergency department (ED).

Methods: This study was a prospective convenience sample population during a 3-year period at two university teaching-hospital EDs where acute nontraumatic TMJ dislocations were reduced utilizing our syringe technique.

Vascular pedicle width on chest radiograph as a measure of volume overload: meta-analysis.

Introduction: Vascular pedicle width (VPW), a measurement obtained from a chest radiograph (CR), is thought to be an indicator of circulating blood volume. To date there are only a handful of studies that demonstrate a correlation between high VPW and volume overload, each utilizing different VPW values and CR techniques. Our objective was to determine a mean VPW measurement from erect and supine CRs and to determine whether VPW correlates with volume overload.

The routine utilization of procedural pain management for pediatric lumbar punctures: are we there yet?

Background: The objective of this study was to assess the utilization of local anesthetics by emergency physicians (EP) and pediatric physicians (PP) who performed a lumbar puncture (LP) in pediatric patients from birth to 24 months of age.

Methods: We conducted a prospective study of children that received an LP at a university tertiary referring hospital. A convenience sample included children from birth to 24 months that received an LP for suspected meningitis in the ED or pediatric units during a one-year period.

Analysis of urobilinogen and urine bilirubin for intra-abdominal injury in blunt trauma patients.

Objective: To determine the point prevalence of urine bilirubin, urine hemoglobin and urobilinogen in blunt trauma patients, and to evaluate its utility as a screening tool for intra-abdominal injury.

Methods: Data analysis of 986 consecutive trauma patients of which 698 were adult blunt trauma patients. Five-hundred sixteen subjects had a urinalysis and a CT scan of the abdomen/pelvis or exploratory laparotomy.

Acute ischemic stroke in a pediatric patient.

Acute ischemic stroke in a pediatric patient is a complex disease with a variety of etiologies that differ from adults. Though rare, they are a real phenomenon with potentially devastating consequences. Some treating institutions are using anti-thrombotic drug therapy with unclear benefits.

Complications of MRSA Treatment: Linezolid-induced Myelosuppression Presenting with Pancytopenia.

Methicillin-resistant Staphylococcus aureus (MRSA) infections have grown to epidemic proportions in the United States. With the development of increasing drug resistance of MRSA to traditional antimicrobials, there has been a search for a more effective antibiotic treatment. Linezolid is one of the most effective oral medications used for outpatient treatment of MRSA infections.

A methicillin-resistant Staphylococcus aureus-positive holospinal epidural abscess.

Spinal epidural abscess is a rare debilitating disease that if left untreated may result in serious morbidity and mortality. Most cases involve the level of 3 or 4 vertebrae, but in very rare cases may affect the whole spine. The most common pathogen found in spinal abscesses is Staphylococcus aureus, which involves approximately two thirds of cases.

Under Utilization of local anesthetics in infant lumbar punctures.

Background: Lumbar Puncture (LP) is an invasive procedure frequently used to diagnose meningitis among the pediatric population. Neonates and infants have not routinely received local anesthesia prior to LP.

Study Objective: To determine whether emergency medicine physicians and pediatricians use local analgesics on neonates and infants prior to performing an LP and to identify which local anesthetics, if any, were used.

Conscious sedation and emergency department length of stay: a comparison of propofol, ketamine, and fentanyl/versed.

Study Objectives: Three of the most commonly used agents for conscious sedation in the Emergency Department (ED) are ketamine, fentanyl/versed, and propofol. In this study, we measured and compared the total times spent in the ED with each of these agents. Our objective was to determine whether the use of propofol for conscious sedation was associated with a shorter length of ED stay as compared to the other two agents.

Access to Firearms among Orange County Youth: A School-Based Study.

Objective: School-associated firearm violence among children and adolescents is a national public concern. The objective of this study was to determine the accessibility of firearms, methods of firearm access and firearm safety knowledge among middle and high school students in Orange County, California.

Methods: After permission from school officials and parents was obtained, a 24-question survey was distributed to 176 students in grades 6 through 12 at four schools in Orange County.

Analgesia and addiction in emergency department patients with acute pain exacerbations.

Introduction: There is ongoing controversy regarding the appropriate use of narcotic analgesia for patients presenting frequently to the emergency department (ED) with subjective acute exacerbations of pain. "Are we treating pain or enabling addiction?"

Objectives: To determine whether the presence of specific factors could be used to identify adults complaining of acute exacerbations of pain for suspected drug addiction, to estimate the percentage of drag addicted patients, to assess the physicians' ability to detect drug addiction and to evaluate Interrater reliability.

Methods: A Drug Abuse Screening Test (DAST-20) was administered to 76 ED patients who presented with acute exacerbations of pain and either multiple ED visits for similar pain complaints, specific narcotic requests, or "allergies" to non-narcotics.

A modified approach to supraclavicular subclavian vein catheter placement: the pocket approach.

Background: Central venous access is often necessary for the administration of fluids, blood products, and medications. Several approaches to supraclavicular subclavian venous access have been described. This study examines the effectiveness of central venous catheter placement utilizing an alternative set of anatomic landmarks for supraclavicular subclavian vein access.

Intimate partner violence among men presenting to a university emergency department.

Objective: We sought to investigate the one-year point prevalence for male intimate partner violence (IPV) in men presenting to a university emergency department, to identify types of violence, to examine differences in male IPV rates based on patient demographics, and to identify any differences in prevalence based on types of partnership.

Methods: This survey study was conducted from September 2001 until January 2002 at a tertiary, academic, Level I Trauma Center with an emergency department (ED) that has 40,000 visits per year. The anonymous written survey consisted of 16 questions previously validated in the Colorado Partner Violence Study, Index of Spouse Abuse and the Conflict Tactics Scale.

Intimate partner violence among women presenting to a university emergency department.

Objective: To establish point and one-year prevalence data regarding partner violence (PV) for women presenting to a university teaching hospital, University of California, Irvine Medical Center (UCIMC), one of 15 emergency departments in Orange County, and to determine differences in partner violence rates when comparing descriptive variables such as race, income and education.

Methods: An anonymous, written survey was administered to a convenience sample of 370 women presenting to University of California Irvine Emergency Department over a 12 month period.

Results: Partner violence has a point prevalence of 6.

Airway compromise after routine alpha-hydroxy facial peel administration.

High concentration alpha-hydroxy facial "peels" are widely used for cosmetic anti-aging purposes. We report a case of secondary burns to the neck and face resulting in airway compromise after a professionally applied citric acid facial treatment.