Emergency Department Point-of-Care Ultrasound Diagnosis of a Large Bowel Obstruction Due to Metastatic Rectal Cancer: A Case Report.

Large bowel obstruction (LBO) is a life-threatening condition seen most often in the geriatric population. LBO can present with nonspecific abdominal pain that can overlap with other pathologies, such as abdominal infection, acute aortic disease, intestinal perforation, and atypical acute coronary syndrome in the geriatric population. Delays in diagnosis of colonic obstruction result in significant mortality due to complications involving bowel necrosis, perforation, and sepsis.

Penetrating Aortic Ulceration With Pseudoaneurysm and Intramural Hematoma: Emergency Department Management and Point-of-Care Ultrasound Diagnosis.

Penetrating aortic ulcer (PAU) complicated by an intramural hematoma is a rare and potentially life-threatening emergency department (ED) presentation that is defined by progressive ulceration through the intima layer into the media layer of the aorta. Symptomatic PAUs can be clinically indistinguishable from other life-threatening pathologies such as aortic dissection, acute coronary syndrome (ACS), intrabdominal catastrophes as well as less lethal processes such as musculoskeletal back pain. Given the potential of PAUs to result in lethal aortic rupture and dissection, the emergency provider should maintain a high index of suspicion in patients with risk factors for aortic pathologies and utilize diagnostic modalities such as point-of-care ultrasound (POCUS) to expedite diagnosis.

Spontaneous Multivessel Coronary Spasm During Diagnostic Coronary Angiography.

Acute vasospastic angina, formerly known as Prinzmetal angina, is characterized by transient electrocardiographic changes that are not related to exertion. Its atypical presentation makes it difficult to establish the diagnosis, so it is probably underrecognized and therefore mismanaged. We treated a 49-year-old woman who presented with a 2-day history of chest pain associated with palpitations.

Not Just a Sore Throat: A Case of a Retropharyngeal Abscess Causing Midline Shift of the Nasopharynx.

A retropharyngeal abscess (RPA) is a deep neck space infection that can present with subtle symptoms. Although it is an uncommon diagnosis, an RPA can be life-threatening as it can result in airway compromise if not treated promptly. In this article, we report a case of a 21-month-old infant with a retropharyngeal abscess that required prompt recognition and treatment.

Physician-Perceived Barriers to Treating Opioid Use Disorder in the Emergency Department.

Objective We aimed to assess physicians' perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities. Methods This was a cross-sectional survey study of American emergency medicine (EM) physicians with a self-administered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs' listservs.

Anaphylaxis after Moderna COVID-19 vaccine.

The authors of this article report on a case of a patient who presented to the emergency department (ED) in anaphylaxis after receiving the Moderna® COVID-19 vaccine. The patient was hypoxic, with diffuse wheezing bilaterally to auscultation, flush skin, swollen face, and the feeling of her throat closing. Anaphylaxis can have wide range of presentation, the key is recognizing the symptoms and treating early.

Hand Hygiene and Hospital-Acquired Infections During COVID-19 Increased Vigilance: One Hospital's Experience.

Background: Hospital-acquired infections are associated with increased morbidity, mortality, costs and length of stay. Prior studies have linked increased hand hygiene compliance with reduced hospital-acquired infection rate. With the increased vigilance for personal and institutional hygiene practices during the COVID-19 pandemic, we hypothesized increased hand hygiene compliance and, as a result, decrease in hospital-acquired infections in our hospital.

AHORA: a Spanish language tool to identify acute stroke symptoms.

Objective: To develop a Spanish language tool for acute stroke identification.

Methods: A Spanish language translation of the Balance-Eyes-Face-Arm-Speech-Time tool was developed within our emergency medical services agency.

Results: The authors present a new prehospital stroke tool, Andar, Hablar, Ojos, Rostro and Ambos Brazos o Piernas (AHORA) (which means now in Spanish) to help combat the language barrier and reinforce the necessity to call 9-1-1 as soon as any stroke symptoms are noted.

Aortic Dissection as the Culprit for Seizure.

The authors present a case of syncope that was caused by aortic dissection. As the main artery to the system circulation, aortic dissection can manifest in numerous ways. This case reminds the clinician of the high index of suspicion necessary to diagnose this potentially life-threatening problem.

Rare Presentation of Deep Vein Thrombosis and Submassive Pulmonary Emboli Due to Hypercoagulable State With Supratherapeutic Anticoagulation.

We present a case of an elderly male with multiple co-morbidities, including atrial fibrillation on warfarin and recently diagnosed left lower extremity deep vein thrombosis (DVT), who presented to the emergency department for dyspnea. He was found to be hypoxic and mildly hypotensive. He was diagnosed with submassive pulmonary emboli (PE) despite having a supratherapeutic international normalized ratio (INR).

Omeprazole-induced Visual Hallucinations: A Case Report.

Proton pump inhibitors (PPIs) are medications that are frequently prescribed for gastroesophageal reflux disease. However, a few case reports have described neuropsychiatric symptoms following PPI use. In this report, we present a case of visual hallucinations secondary to PPI usage and propose possible mechanisms.

Abnormal Bedside Ultrasound Findings in a Complex Patient With Kawasaki Disease.

We herein report a case of an 18-year-old female with Kawasaki disease who presented to the emergency department with epigastric abdominal pain and was subsequently found to have free fluid present in her abdomen visualized on bedside Focused Assessment with Sonography for Trauma (FAST) exam. Kawasaki disease is an acute vasculitis syndrome that primarily affects children and can have serious complications such as coronary artery aneurysms. The use of ultrasound in emergency departments is rapidly increasing, with the FAST being one of the most commonly performed bedside ultrasound examinations.

Sex-Based Differences in the Presentation of Myocardial Infarction.

The authors report a case of a middle-aged female presenting with a chief complaint of shoulder pain. Workup revealed a non-ST-segment elevation myocardial infarction. The typical symptoms of myocardial infarction and the evaluation of a non-ST-segment elevation myocardial infarction are discussed.

The Power of an Active Shooter Simulation: Changing Ethical Beliefs.

Introduction: During a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. The Hartford Consensus survey of clinicians and the public demonstrated mixed feelings on the role of doctors and nurses in these situations. Our objective was to evaluate the effect of simulation on ethical dilemmas during a hospital-based AS simulation.

Bilateral Thalamic Stroke as a Cause of Decreased Responsiveness.

We report the case of a 77-year-old male with no prior history of stroke who came in as a stroke alert for right facial droop and speech slurring, but upon presentation he had decreased responsiveness. Initial imaging for stroke was negative. Laboratory evaluation revealed no abnormalities.

Weight Loss Outcomes following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in an Ethnically Diverse Bariatric Population: Which Is More Effective?

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have comparable weight loss outcomes in a general bariatric population.

Objectives: This study aimed to investigate whether similar outcomes can be observed in Hispanic and African American population. .

A Rare Presentation of Asymptomatic Spontaneous Pneumomediastinum.

Spontaneous pneumomediastinum is a rare condition characterized by interstitial air within the mediastinum without any obvious causative factors. It is most commonly found in young men, and the clinical presentation is typically associated with chest or neck pain and dyspnea. Objective findings can include subcutaneous emphysema of the neck and chest.

Supraventricular tachycardia with the use of phentermine: case report and review of literature.

: A 34-year-old woman with no significant past medical history presented to the hospital with sudden onset of palpitations with associated dyspnea and chest discomfort. She denied any similar previous episodes. Initial electrocardiogram (EKG) was consistent with a short R-P interval supraventricular tachycardia (SVT).

Gastric Ischemia Secondary to Abdominal Distension.

Gastric ischemia has been reported in the literature mainly as case reports and case series. It is uncommon because of its excellent blood supply. Patients with atherosclerosis and vascular insufficiency are at risk for gastric ischemia, especially with gastric distension.

A Rapid Diagnosis and Treatment of a Traumatic Aortic Transection: A Case of Survival to the ICU.

We present the case of a young man with traumatic aortic dissection secondary to a motor vehicle collision. While the differential diagnosis for traumatic injury after a motor vehicle collision can include commonly studied and trained for cases, such as pneumo/hemothorax, pulmonary contusion, splenic laceration, and pelvic fractures, for example, one of the more deadly and hence rare presentations of motor vehicle trauma is aortic transection. The fact that the diagnostic studies included as part of the initial Advanced Trauma Life Support (ATLS) trauma survey are not well equipped to diagnose such an injury is also a deadly factor.

Testicular Germ Cell Tumor Presenting to the Emergency Department.

The authors report on a case of a patient who presented to the emergency department (ED) and was ultimately diagnosed with stage IV testicular non-seminomatous germ cell tumor. The patient was cachectic with a tumor on the neck, abdomen, and scrotum. Germ cell tumors (GCTs) exhibit characteristic symptoms at different points in development.