Traumatic Lingual Hematoma Resulting in Bilateral Temporal Mandibular Joint Dislocations.

Background: Lingual hematoma (LH) is a relatively uncommon entity seen after both medical and traumatic etiologies. Regardless of the cause, the feared complication is acute airway obstruction.

Case Report: Our case involves a 39-year-old man who presented to the Emergency Department via emergency medical services with an enlarging LH after an unwitnessed fall, suspected to be an alcohol withdrawal seizure.

Efficacy of platelet transfusion for acute intracerebral hemorrhage among patients on antiplatelet therapy.

Clinical questionIn patients taking antiplatelet therapy, does a platelet transfusion after acute spontaneous primary intracerebral hemorrhage reduce the risk of death or dependence?Article chosenBaharoglu MI, Cordonnier C, Al-Shahi Salman R, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral hemorrhage associated with antiplatelet therapy (PATCH): a randomized, open-label, phase 3 trial. Lancet 2016;387(10038):2605-13.

Comparison of ketorolac dosing in an emergency department setting.

Clinical questionDoes the analgesic effect of intravenous ketorolac differ if given in doses of 10, 15, or 30 mg to patients presenting to the emergency department with acute pain?Article chosenMotov S, Yasavolian M, Likourezos A, et al. Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med 2017;70(2):177-84.

Comparison of naproxen with cyclobenzaprine, oxycodone-acetaminophen, and placebo for the treatment of acute low back pain.

Clinical Question Does the addition of cyclobenzaprine or oxycodone with acetaminophen to naproxen result in improved functional outcomes at one week when compared to placebo in patients with acute low back pain? Article Chosen Friedman B, Dym A, Davitt, M, et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA 2015:20;314(15):1572-80.

Brainstem Monitoring in the Neurocritical Care Unit: A Rationale for Real-Time, Automated Neurophysiological Monitoring.

Patients with severe traumatic brain injury or large intracranial space-occupying lesions (spontaneous cerebral hemorrhage, infarction, or tumor) commonly present to the neurocritical care unit with an altered mental status. Many experience progressive stupor and coma from mass effects and transtentorial brain herniation compromising the ascending arousal (reticular activating) system. Yet, little progress has been made in the practicality of bedside, noninvasive, real-time, automated, neurophysiological brainstem, or cerebral hemispheric monitoring.

Early goal-directed therapy versus usual care in the management of septic shock.

Clinical question Does early goal-directed therapy decrease mortality when compared with usual care? Article chosen Angus DC, Barnato AE, Bell D, et al. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe Investigators. Intensive Care Med 2015;41(9):1549-60.

Comparison of Tamsulosin, Nifedipine, and Placebo for Ureteric Colic.

Clinical question Do calcium channel blockers or alpha blockers improve renal stone passage when compared with placebo? Article chosen Pickard R, Starr K, MacLennan G, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet 2015;386(9991):25-31, doi: 10.

Isolated bilateral abducens nerve palsy due to an inflammatory process within the sella and parasellar regions.

Isolated bilateral abducens nerve palsy raises concern about a serious intracranial condition. Abducens nerve palsy is a common isolated palsy due to its susceptibility to injury along its long course. Non-traumatic isolated abducens nerve palsy is often caused by a mass that indirectly stretches and compresses the nerve.

Idiopathic ovarian vein thrombosis: a rare cause of abdominal pain.

Ovarian vein thrombosis (OVT) is a rare but potentially serious condition that affects mostly postpartum women. It has also been associated with other conditions, such as pelvic inflammatory disease, malignancy, sepsis, inflammatory bowel disease, and recent pelvic or abdominal surgery. It is critical to recognize and treat this condition as early as possible to avoid the potential complications of the thrombosis and adverse sequelae such as infection and sepsis.

Point-of-care Ultrasound: A New Tool for the Identification of Gastric Foreign Bodies in Children?

Background: Point-of-care ultrasound (POCUS) has been used to identify ingested gastric foreign bodies. Our aim was to describe the sonographic findings of radiopaque and radiolucent gastric foreign bodies (FBs) in children.

Case Report: Three children ingested different FBs.

Multi-Institution Validation of an Emergency Ultrasound Image Rating Scale-A Pilot Study.

Background: As bedside ultrasound (BUS) is being increasingly taught and incorporated into emergency medicine practice, measurement of BUS competency is becoming more important. The commonly adopted experiential approach to BUS competency has never been validated on a large scale, and has some limitations by design.

Objective: Our aim was to introduce and report preliminary testing of a novel emergency BUS image rating scale (URS).

A rare case of an Essex-Lopresti injury secondary to a gunshot wound.

Background: Radial head fractures are one of the more common fractures of the body, and the most common fractures around the elbow.

Case Report: While these can present in isolation, concomitant injuries to the ulna, elbow joint and surrounding ligaments, interosseous membrane, proximal radioulnar joint, and distal radioulnar joint can also occur. It is imperative that the treating surgeon rules out any concomitant injuries when evaluating a patient with a radial head fracture as the treatment options vary greatly depending on the structures which are damaged.

Kikuchi disease presenting with aseptic meningitis.

Kikuchi disease is a self-limited disease characterized primarily by regional lymphadenopathy. Kikuchi disease was first described in 1972 as a lymphadenitis with specific histopathologic findings. Extranodal manifestations have been reported, including rare neurologic complications such as aseptic meningitis.

Tongue-type calcaneus fractures: a threat to skin.

Calcaneal fractures account for 60% of all tarsal bone fractures. Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. They are often superiorly displaced because of the insertion of the Achilles tendon and pull of the gastroc-soleus complex.

A gargantuan acetaminophen level in an acidemic patient treated solely with intravenous N-acetylcysteine.

The objective of this report is to describe an acidemic patient with one of the largest recorded acetaminophen ingestions in a patient with acidemia who was treated with supportive care and intravenous (IV) N-acetylcysteine. A 59-year-old female with a history of depression was found comatose. In the Emergency Department, she was obtunded with agonal respirations and immediately intubated.

Hypertensive nephropathy: prevention and treatment recommendations.

Importance Of The Field: A worldwide epidemic of chronic kidney disease (CKD) exists; hypertensive nephropathy is second only to diabetes as a leading cause of progressive CKD. Due to the increasing morbidity and mortality and escalating costs associated with end-stage renal disease (ESRD), novel therapeutic strategies are needed urgently to maximally reduce albuminuria, control blood pressure, and delay progression of hypertensive nephropathy to ESRD. In particular, rational use of renin-angiotensin-aldosterone (RAAS) blockers and achieving blood pressure targets are crucial to reduce cardiovascular and renal outcomes.

Caring for uninsured patients with diabetes: designing and evaluating a novel chronic care model for diabetes care.

Background: Safety net urban hospitals are being overwhelmed by an increasing number of patients with diabetes, who frequently only access the health system through visits to emergency departments and urgent care clinics. It is uncertain whether the chronic care model advocated for diabetes care would be feasible and effective for managing diabetes in an acute care setting.

Objective: Determine if redesigning the system of care for treating diabetic patients who do not have primary care doctors is feasible, acceptable to patients and effectively lowers patients' haemoglobin A1c, blood pressure and cholesterol levels.

Lepiota subincarnata J.E. Lange induced fulminant hepatic failure presenting with pancreatitis.

A 43-year-old woman with a medical history significant only for hepatitis B carrier status presented to an emergency department with generalized weakness, dizziness, nausea, and diarrhea 36 h after eating an estimated 170 g of sautéed Lepiota subincarnata J.E. Lange (basionym Lepiota josserandii).

Ethnic disparities in asthma morbidity in Chicago.

Rationale: The role of ethnicity and socioeconomic status in explaining variations in asthma morbidity is unclear.

Objectives: To describe the magnitude of ethnic disparities in asthma morbidity in Chicago and to determine whether differences in socioeconomic status explain these disparities.

Methods: We conducted a survey of 561 school-age children and 353 young adults with asthma and measured their self-reported ethnicity, socioeconomic status (using 11 variables), and asthma morbidity (symptom frequency, asthma-specific quality of life, and frequency of severe asthma exacerbations).

Parenteral ophthalmic tropicamide or cyclopentolate protects rats from lethal organophosphate poisoning.

We determine the efficacy of parenteral ophthalmic antimuscarinic agents (tropicamide ophthalmic 1% and cyclopentolate hydrochloride ophthalmic 1%) on survivability in a rat model of acute, lethal organophosphate pesticide (OP) poisoning. After obtaining an appropriate dose-response for study comparison, rodents were randomized to receive 1 of 4 intraperitoneal antidotes; (1) 0.3 mL normal saline, (2) atropine 10 mg/kg, (3) ophthalmic tropicamide 20 mg/kg, or (4) ophthalmic cyclopentolate 20 mg/kg.