"Breaking the Bleed" Spontaneous Hemorrhage in an Emphysematous Bulla Complicated by Anticoagulation: A Case Report.

We present a case of spontaneous hemorrhage in an emphysematous bulla, complicated by anticoagulation. Bullous emphysema is a well-recognized complication of chronic obstructive pulmonary disease (COPD), and a rare manifestation is hemorrhage into preexisting pulmonary bullae. A 69-year-old male patient presented to the emergency department with hemoptysis, shortness of breath, and productive cough.

High-Pressure Refrigerant Gas Injection Injury to the Hand.

High-pressure injection injuries, although rare, are commonly discussed orthopaedic surgical emergencies. In many cases, high-pressure injection injuries can have detrimental effects on the patient. However, there are rare instances where surgical intervention may be more harmful than helpful.

The RACE Scale for Large Vessel Stroke Diversion to a Comprehensive Stroke Center by Helicopter Air Ambulance: A Retrospective Cohort Study.

Objective: Acute ischemic stroke caused by large vessel occlusion (LVO) occurs frequently and benefits from endovascular therapies available at comprehensive stroke centers (CSCs). Prehospital stroke severity tools have been devised to detect LVO. The goal of this study was to assess the value of the Rapid Arterial Occlusion Evaluation (RACE) score in helicopter air ambulance (HAA) activation.

Effectiveness and Safety of Mechanical Thrombectomy in Large-Vessel-Occlusion Mild Stroke: Insights from the ASSIST Registry.

Background And Purpose: Mechanical thrombectomy (MT) is effective for acute ischemic stroke, yet its indication in mild stroke remains unclear. This study evaluates MT's effectiveness and safety in low NIHSS patients and assesses different MT strategies' impact on procedural success and clinical outcomes.

Materials And Methods: Data from the ASSIST Registry were analyzed, categorizing patients with large vessel occlusion of the anterior circulation into mild (NIHSS≤5) and moderate-severe (NIHSS>5) stroke groups.

Outcomes of Adjunct Emergent Stenting Versus Mechanical Thrombectomy Alone: The RESCUE-ICAS Registry.

Background: Underlying intracranial stenosis is the most common cause of failed mechanical thrombectomy in patients with acute ischemic stroke with large vessel occlusion. Adjunct emergent stenting is sometimes performed to improve or maintain reperfusion, despite limited data regarding its safety or efficacy.

Methods: We conducted a prospective multicenter observational international cohort study.

EXCELLENT Registry: A Prospective, Multicenter, Global Registry of Endovascular Stroke Treatment With the EMBOTRAP Device.

Background: The EXCELLENT registry aimed to evaluate the effectiveness of the EMBOTRAP Revascularization Device in an all-comer population in a real-world setting, with a focus on the composition of retrieved clots.

Methods: EXCELLENT is a prospective, global registry of patients with acute ischemic stroke treated with EMBOTRAP as the first-line mechanical thrombectomy device conducted at 34 sites (25 sites contributing clot) from September 2018 to March 2021, utilizing core imaging and central histology laboratories blinded to clinical data, independent 90-day modified Rankin Scale assessment and Clinical Events Committee.

Results: After screening 3799 patients, a total of 997 subjects (mean age, 70.

Complete Proximal Long Head Biceps Tendon Rupture in an Elite 17-year-Old Softball Pitcher: A Case Report.

Case: This case report describes the successful treatment of a year-round teenage softball pitcher who sustained a proximal biceps tendon rupture who underwent successful subpectoral tenodesis. To our knowledge, this is the only reported case of such an injury occurring in an underhand throwing teenage athlete.

Conclusion: This case highlights an unusual instance of a sport-related injury in an adolescent softball pitcher, suggesting that the softball pitch in elite athletes may put similar stress on the shoulder to overhead throwing athletes over time and further demonstrating that patients may continue to have success at elite levels of competition after tenodesis.

Dilemma of ST-Segment Elevation and Subarachnoid Hemorrhage: A Case Report and Literature Review.

Acute ST-segment elevation myocardial infarction (STEMI) occurs due to occlusion of one or more coronary arteries causing myocardial injury. It is a medical emergency and requires prompt diagnosis and intervention. Transient ST-segment elevation can occur due to coronary vasospasm, and their association has been reported with subarachnoid hemorrhage.

Placement of spinal cord stimulation paddle leads in the thoracic spine using en bloc laminoplasty: A technical note.

Objective: Spinal cord stimulation (SCS) has become a successful treatment option for managing chronic pain syndromes. Conventional methods for placing SCS leads include percutaneous insertion or open laminectomy in cases requiring better visualization. However, achieving accurate placement of paddle leads while minimizing surgical invasiveness remains a challenge in cases with anatomic constraints such as dural scarring.

Trans-Clot MAP gradient: A novel innovative technique during thrombectomy for acute ischemic stroke with potential applications for assessing collateral circulation, determining clot etiology, informing device selection, and predicting first-pass success.

Endovascular mechanical thrombectomy has significantly improved recovery in acute ischemic stroke (AIS). While traditional patient selection has relied on factors such as last known well and penumbra volume, emerging research highlights the importance of collateral circulation in influencing thrombectomy success. However, current methods to assess collateral circulation are often unreliable and lack standardization, limiting their integration into clinical decision-making and prompting the need for innovative approaches.

The Influence of Preimplant Balancing on Manipulation under Anesthesia Rates following Imageless Robotic-Assisted Total Knee Arthroplasty.

Acquired idiopathic stiffness (AIS) following total knee arthroplasty (TKA) often requires manipulation under anesthesia (MUA). Robotic-assisted TKA (RA-TKA) systems provide gap balance templates for objective correlation with the rate of AIS. The purpose of this study was to assess intraoperative balancing parameters that were associated with MUA utilizing an "anatomical" implant design.

Trevo 3 Mm and/or AXS Catalyst 5 for the Treatment of Medium Distal Vessel Occlusion Stroke-results from the ASSIST Registry.

Background: The effect of endovascular therapy (EVT) on the outcome of stroke patients with a medium distal vessel occlusion (MDVO) is unclear. We report the results of MDVO patients treated with the 3 mm Trevo stent retriever (SR) and/or the AXS Catalyst 5 distal access catheter.

Methods: Data was derived from a prospective, multicenter global registry (ASSIST registry) which enrolled patients treated with operator preferred EVT technique at 71 sites from January 2019 to January 2022.

Assessment tool items for addressing physician-patient communication and reducing health care risk factors across multiple enterprise risk management domains.

Expertise in physician-patient communication is a primary outcome measure for physicians. We evaluated residents' communication behaviors with clinic patients following an educational intervention as measured by the Communication Assessment Tool (CAT). Thirty-five internal medicine residents were assessed by patients using the CAT for 3 months before and after the educational intervention.

Minimally invasive technique for acute fixation and subtalar fusion of displaced intra-articular calcaneus fractures.

Displaced intra-articular calcaneus fractures (DIACFs) are difficult injuries to treat and are often encountered by orthopedic surgeons. For DIACFs treated nonoperatively or with open reduction internal fixation (ORIF), a common complication is painful subtalar arthritis and the need for a secondary subtalar fusion, which prolongs the overall recovery time. One treatment option to address this sequela involves ORIF with subtalar fusion as the primary treatment.

Traumatic Scapula Fracture with Intrathoracic Interposition: A Case Report and Review of Literature.

Introduction: Scapula fractures are infrequently operated on due to the high union rate and well-preserved motion despite a large degree of angular deformity. Scapula fractures with intrathoracic interposition are rare and typically require open reduction due to an increased risk of pleural injury from the interposed segment. While there are several reports of intrathoracic interposition of scapular fractures requiring open reduction, only one case involved subsequent fragment fixation in an adult.

Can USMLE and COMLEX-USA Scores Predict At-Risk Emergency Medicine Residents' Performance on In-Training Examinations?

Purpose: The United States Medical Licensing Examination (USMLE) and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) scores are standard methods used to determine residency candidates' medical knowledge. The authors were interested in using the USMLE and COMLEX part 2 scores in our emergency medicine (EM) residency program to identify at-risk residents who may have difficulty on the in-training exam (ITE) and to determine the cutoff values under which an intern could be given an individualized study plan to ensure medical knowledge competency.

Methods: The authors abstracted the USMLE and COMLEX part 2 scores and the American Board of Emergency Medicine (ABEM) ITE scores for a cohort of first-year EM residents graduating years 2010-2022, converting raw scores to percentiles, and compared part 2 and ABEM ITE scores with Pearson's correlation, a Bland-Altman analysis of bias and 95% limits of agreement, and ROC analysis to determine optimal the cut-off values for predicting ABEM ITE < 50 percentile and the estimated test characteristics.

Adult Development and Associated Health Risks.

Much has been learned about adult development in recent decades. Adults go through stages of development (emerging adulthood, young adulthood, middle adulthood, post-retirement, and very old age) with certain challenges at each stage. Viewing patients through a developmental lens is part of providing patient-centered care.

Bilateral Intertrochanteric Femur Fractures in a Paraplegic Patient: A Case Report.

Bilateral intertrochanteric (IT) femur fractures are rare, and appropriate evaluation and treatment can vary depending on concurrent patient comorbidities. Even less has been described for patients with bilateral IT fractures with pre-existing paraplegia. This case report describes the unique case of a 72-year-old paraplegic female who presented with bilateral IT femur fractures due to a wheelchair accident.

S2 alar-iliac screws are superior to traditional iliac screws for spinopelvic fixation in adult spinal deformity: a systematic review and meta-analysis.

Purpose: Spinopelvic fixation (SPF) using traditional iliac screws has provided biomechanical advantages compared to previous constructs, but common complications include screw prominence and wound complications. The newer S2 alar-iliac (S2AI) screw may provide a lower profile option with lower rates of complications and revisions for adult spinal deformity (ASD). The purpose of this study was to compare rates of complications and revision following SPF between S2AI and traditional iliac screws in patients with ASD.

Factors Affecting Selection of TraineE for Neurointervention (FASTEN).

Background And Importance: Neurointervention is a very competitive specialty in the United States due to the limited number of training spots and the larger pool of applicants. The training standards are continuously updated to ensure solid training experiences. Factors affecting candidate(s) selection have not been fully established yet.

Rivaroxaban Failure Presenting With Renal Infarction in a Patient With Persistent Atrial Fibrillation: A Case Report.

Direct oral anticoagulants (DOAC) are the preferred choice of anticoagulation for patients with atrial fibrillation. DOACs are always preferred over vitamin K antagonists due to their better safety profile in terms of life-threatening bleeding and decreased need for INR (international normalised ratio) monitoring. Although the most commonly used anticoagulation, failure to DOAC has been reported.