ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group: 2023 Update.

This review focuses on the initial imaging in the reproductive age adult population with acute pelvic pain, including patients with positive and negative beta-human chorionic gonadotropin (β-hCG) levels with suspected gynecological and nongynecological etiology. For all patients, a combination of transabdominal and transvaginal pelvic ultrasound with Doppler is usually appropriate as an initial imaging study. If nongynecological etiology in patients with negative β-hCG is suspected, then CT of the abdomen and pelvis with or without contrast is also usually appropriate.

A Case of Childhood Severe Paroxysmal Cold Hemoglobinuria with Acute Renal Failure Successfully Treated with Plasma Exchange and Eculizumab.

We describe the case of a 4-year-old female who presented with sepsis and disseminated intravascular coagulation (DIC), developed ongoing intravascular hemolysis with acute renal failure from suspected pigment-induced acute tubular necrosis necessitating continuous renal replacement therapy (CRRT) for five days followed by four episodes of intermittent hemodialysis (iHD), and was subsequently diagnosed with paroxysmal cold hemoglobinuria (PCH). She was successfully treated with plasma exchange and eculizumab, a humanized monoclonal antibody targeting complement protein C5, and demonstrated significant improvement of hemolysis and recovery of renal function.

Sepsis in Special Populations.

Sepsis is recognized by the presence of physiologic and laboratory changes that reflect the inflammatory response to infection on cellular and systemic levels. Comorbid conditions, such as cirrhosis, end-stage renal disease, and obesity, alter patients' susceptibility to infection and their response to it once present. Baseline changes in vital signs and chronic medications often mask clues to the severity of illness.

Emergency department focused bedside echocardiography in massive pulmonary embolism.

Background: Massive pulmonary embolism (PE) is a common consideration in unstable patients presenting to the emergency department (ED) with chest pain, dyspnea, or cardiac arrest. It is a potentially lethal condition necessitating prompt recognition and aggressive management. Conventional diagnostic modalities in the ED, including chest computed tomography angiography and ventilation-perfusion scanning, require the unstable patient to leave the department, and raise concerns over renal injury.

Electrocardiographic differential diagnosis of narrow QRS complex tachycardia: an ED-oriented algorithmic approach.

The differentiation of narrow complex tachycardias is a common diagnostic conundrum encountered by emergency physicians. Although a number of published algorithms are available to assist the clinician in evaluating features of the 12-lead electrocardiogram (ECG), many of these are too cumbersome, requiring multiple decisions and introducing treatment suggestions within the diagnostic framework. To optimize the diagnosis of the narrow complex tachycardia, we propose 3 separate algorithms tailored to address varying levels of available clinical information.

Impact of the 12-lead electrocardiogram on ED evaluation and management.

Study Objective: This study was conducted to assess the impact (diagnostic, therapeutic, and disposition) of the 12-lead electrocardiogram (ECG) on emergency department (ED) patient evaluation and management.

Methods: This project was a prospective study of a convenience sample of 304 ED patients undergoing ECG analysis during their evaluation in the ED of a level 1 trauma center. The data collection for this study was divided into 4 parts.

Disagreement between transport team and ED staff regarding the prehospital assessment of air medically evacuated scene patients.

Study Objective: To determine the rate of disagreement in assessment of significant illness or injury between air medical transport team assessment and emergency department (ED) diagnosis in patients transferred from the scene of an incident to the ED.

Methods: Retrospective analysis was performed on 84 patients transported by medical flight teams from an accident scene to an ED.

Results: Results show transport team assessment concurred with ED diagnosis 96.

High resolution structure of the HDGF PWWP domain: a potential DNA binding domain.

Hepatoma Derived Growth Factor (HDGF) is an endogenous nuclear-targeted mitogen that is linked with human disease. HDGF is a member of the weakly conserved PWWP domain family. This 70-amino acid motif, originally identified from the WHSC1 gene, has been found in more than 60 eukaryotic proteins.