Background: In the emergency department (ED), pyelonephritis is a fairly common diagnosis, especially in patients with unilateral flank pain. Xanthogranulomatous pyelonephritis (XGP) is a rare type of pyelonephritis that is associated with unique features, which may lead to its diagnosis. Case Report: A 30-year-old male patient presented to the Emergency Department (ED) for evaluation of right sided

Background Acute compartment syndrome can be caused by any condition that increases the pressure of an intracompartmental muscular space resulting in ischemia, which is a limb-threatening emergency. This case report is the first known documented example of an exogenously injected peptide causing compartment syndrome. The use of natural supplements and holistic therapies are on the rise, specifically

Background Opioid overdose is a major cause of mortality in the United States. Despite efforts to increase naloxone availability, distribution to high-risk populations remains a challenge. Objective To assess the effects of multiple different naloxone distribution methods on patient obtainment of naloxone in the emergency department (ED) setting. Methods Naloxone was provided to patients in three 12-month

Background Interpretation of electrocardiogram (ECG) is fundamental in the practice and teaching of emergency medicine. Previous studies have shown that providers of all levels have expressed interest in additional education with ECGs1. Asynchronous learning has been shown to be beneficial for improving residents’ ability to recognize findings of acute myocardial ischemia2. Objectives The goal of the

Background Tracheal intubation is the gold standard for airway management in emergency medicine but more difficult to apply for inexperienced individuals than laryngeal mask airway (LMA). Objective The aim of our study was to investigate if inexperienced individuals are able to secure the airway with the help of LMA after a short introduction. A second aim was to evaluate Thiel-fixed specimens against

Background Metformin is a biguanide hyperglycemic agent used to manage non-insulin-dependent diabetes mellitus. Adverse reactions mainly include mild gastrointestinal side effects, but severe complications such as metformin-associated lactic acidosis (MALA) can occur. Metformin is renally excreted, and therefore, not recommended in patients with renal impairment. The reported incidence of metformin-associated

Background Calcific tendinitis is classically a painful condition that most commonly affects the rotator cuff, but may infrequently involve other tendons. Case Report We discuss a 57-year-old man who presented to the emergency department with a 4-day history of right hip pain, described as the “worst pain in (his) life.” The pain was first noticed at night and had progressively worsened. History, physical

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Background The optimal pain relief method for acute renal colic in the emergency department remains controversial. Objective We compared the safety and efficacy of intradermal sterile water injection (ISWI) to treatment with intramuscular (IM) diclofenac, intravenous (IV) opioids, and IV paracetamol in patients with acute renal colic. Methods This randomized, single-blind study included 320 patients

Background Although common in pediatric airway equipment, positive-pressure relief (“pop-off”) valves are also present on some adult resuscitator bags. These valves are designed to decrease barotrauma but, in doing so, limit the airway pressure provided during manual bag-assisted ventilation. In critically ill adult patients with high airway pressures, these valves can be detrimental and result in

Background A relative hypovolemia occurs during septic shock (SS) early phase clinically reflected by tachycardia and low-blood pressure. In the prehospital setting, simple objective tools, to assess hypovolemia severity are needed to optimize triaging. Objectives The aim of this study was to evaluate the relationship between shock index (SI), diastolic SI (DSI), modified SI (MSI), and age SI (ASI)

Background Sickle cell trait (SCT), the heterozygous form of sickle cell disease (SCD), is generally thought of as a benign condition. However, it is possible for those with SCT to have serious complications, especially when they are exposed to high altitudes where oxygen levels are low. Case Report We present a case of a 41-year-old male with a history of SCT who developed severe epigastric pain and

Background As emergency physicians are looking at handheld devices as alternatives to the traditional, cart-based systems, concerns center around whether they are forsaking image quality for a lower price point and if the handheld can be trusted for medical decision making. Objectives We aimed to determine the feasibility of using a handheld ultrasound device in place of a cart-based system during

Background Airway management is a defining skill that demands mastery by emergency medicine physicians. Airway emergencies pose significant morbidity and mortality risks. Familiarity with, and mastery of, a variety of airway management approaches and equipment can prove invaluable for management of anatomically and/or physiologically difficult airways. Case Report A 67-year-old female presented as

Background Sacroiliac joint (SIJ) dysfunction is a common but underrecognized source of low back pain (LBP). With provocative testing, emergency physicians can diagnose SIJ dysfunction and begin appropriate treatment in the emergency department (ED). Discussion For patients with significant pain from SIJ dysfunction, ultrasound-guided SIJ injection of anesthetic and corticosteroid can significantly

Background Transthoracic echocardiography (TTE) is an essential tool for risk stratifying pulmonary embolism patients, but its availability is limited often requiring hospitalization. Minimal research exists evaluating clinical and laboratory criteria to predict lack of abnormal TTE findings. Objective We aimed to identify predictors associated with abnormal TTE results in PE patients to potentially

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Background This case report describes a 34-year-old female who developed diplopia and strabismus two weeks after a vaginal delivery and epidural anesthesia. Case Report A 34-year-old female presented to the Emergency Department (ED) with continued headache and new onset diplopia after having undergone epidural anesthesia for a vaginal delivery two weeks prior. During that time, she underwent two blood

Background Whether integration of nurse practitioners (NPs) and physician assistants (PAs) into academic emergency departments (EDs) affects emergency medicine (EM) resident clinical learning opportunities is unclear. Objective We sought to compare EM resident exposure to more-complex patients, as well as patients undergoing ACGME-required procedures, at non-pediatric academic EDs with lower, moderate

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Background There is concern that the values provided by devices using infrared thermometry in emergency departments (ED) do not reflect body core temperature accurately. Objectives Evaluation of three commonly used thermometers in ED. Methods Two infrared ear thermometers and an infrared forehead thermometer were evaluated using 1) the Voltcraft IRS-350 calibration device, 2) comparing temperature

Background : Intracerebral hemorrhage (ICH) is a potential complication from traumatic brain injury with a 30-day mortality rate of 35-52%. Rapid diagnosis allows for earlier treatment, which impacts patient outcomes. A trauma activation (TA) is called when injury severity meets institutional criteria. The patient is immediately roomed, and a multispecialty team is present. A trauma evaluation (TE)

Background Conjunctivitis is a frequent complaint in pediatric emergency departments; however, the etiology of conjunctivitis is difficult to clinically differentiate. Objective Our study objective was to evaluate the test performance characteristics of leukocyte esterase (LE) test strips in diagnosing bacterial conjunctivitis. Methods Patients 3 months to 21 years presenting to an emergency department

Background As the prevalence of tramadol toxicity is increasing, managing these patients with the aim of treatment and complete recovery has become a major challenge for healthcare professionals. Objectives This study evaluates the short-term effects of intravenous lipid emulsion (ILE) administration in cases of tramadol poisoning. Methods In this double-blind, randomized controlled trial, 120 patients

Background Genitourinary tract fungus balls are a rare complication of urinary tract infections (UTI). They arise from dense aggregations of hyphae that combine with surrounding urothelial cells and debris. Symptoms can progress to urosepsis and systemic dissemination. Unfortunately, fungus balls may remain unrecognized without further imaging. Even with computed tomography (CT) and magnetic resonance

Background : Ocular emergencies comprise 2-3% of emergency department (ED) visits, with retinal detachment requiring emergency surgery. 2D ultrasound (US) is a rapid bedside tool but is highly operator dependent. Objective : We determined 3DUS feasibility, acceptability, and usability in eye pathology detection using the ophthalmologist exam as reference standard. Methods : We performed a prospective

Background Since the introduction of electric-scooter (e-scooter) mobile applications, there has been a marked increase in e-scooter related injury. On January 19th, 2022, the City of Miami revoked permits to five major mobile applications for violation of safety protocols. Objectives The purpose of our study was to assess the effects of this notice on the orthopedic patients seen at our corresponding

Background Spontaneous cerebrospinal fluid (CSF) leaks occur when there is leakage of CSF caused by a tear in the dura mater. Spontaneous CSF leaks are rare and often associated with conditions like intracranial hypertension, connective tissue disorders, or congenital defects in the dura mater. Case Report The patient was a 66-year-old woman who presented to the Emergency Department with clear, positional

Background Bleeding in the upper airways is an important cause of airway-related death. A higher incidence of airway management failure and complications after intubation attempts in the emergency department had been suggested. Airway management of patients with active oropharyngeal hemorrhage may be challenging, leading the clinician to modify the approach. Case Report A 57-year-old female presented

Background Financial relationships between physicians and the healthcare industry are common in the United States (U.S.). Yet, there is limited data on payments to emergency physicians since the 2014 launch of the Open Payments Database. Objectives To analyze the trends and characteristics of industry payments to U.S. emergency physicians from 2014 to 2022. Methods This retrospective study used the

Background Most cases of pediatric epistaxis are spontaneous and self-resolve. However, a subset of children may experience significant bleeding and require procedural or medical interventions. Objective We aim to identify risk factors associated with moderate and severe epistaxis in the emergency department (ED) and explore management outcomes. Methods We retrospectively reviewed all patients under

Background A cervical radiofrequency ablation is a procedure that can be performed to treat arthritis-related pain in the neck and upper back. There have been no large studies reporting complications after this procedure. We report a case of a 55-year-old female with iatrogenic vertebral artery dissection of C3-C4 with segmental occlusion leading to a posterior fossa stroke and lateral medullary stroke

Background Cardiac tamponade is associated with high mortality and making the diagnosis is a core skill of emergency medicine physicians. Proper diagnosis relies on specific clinical and echocardiographic findings. It is not known whether expert sonographers consistently recognize echocardiographic signs of tamponade. Objectives To assess whether expert sonographers agree on echocardiographic signs

Background Considerable variability exists in Emergency Physicians’ (EP) rates of resource utilization, which may cluster in distinct patterns. However, previous studies have focused on academic and tertiary care centers, and it is unclear if similar patterns exist in community practice. Objective To examine if EPs practicing in community EDs demonstrate similar practice patterns to academic EDs. Secondarily

Background Emergency Medicine (EM) physicians play a critical role in mitigating opioid epidemic in public health. Objectives To analyze the prescribing of EM physicians for opioids among Medicare beneficiaries enrolled in Part D program from 2013 to 2019. Methods We conducted a retrospective, cross-sectional, descriptive analysis of Medicare Part D prescriber data, focusing on opioid claims between

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Background Right upper quadrant abdominal pain along with elevated cholestasis blood tests is usually associated with bacterial calculous cholecystitis. However, viral infections such as Ebstein-Barr virus (EBV) can also manifest with a similar clinical picture and is an important differential diagnosis. Case report This case report discusses a young woman presenting to the emergency department with

Background Eye-related complaints are a common presentation in the emergency department (ED). The cases range from simple viral conjunctivitis to trauma-related eye injuries. One pathological condition that could lead to vision loss is retinal artery occlusion (RAO). Evaluation of a patient with an eye complaint requires thorough eye examination and, in certain instances, advanced imaging. Consultation

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Background Peripheral venous cannulation is one of the most common procedures in medicine. A larger cannula allows higher rates of fluid to be provided if neeed in deteriorating patient; however, it is also perceived that larger gauge cannula placement is associated with increased pain and procedural difficulty. Objective This study aimed to compare the pain and procedural difficulty experienced during

Background Due to the high rate of geriatric patient visits, scoring systems are needed to predict increasing mortality rates. Objectives In this study, we aimed to investigate the in-hospital mortality prediction power of the national early warning score 2 (NEWS2) and the laboratory data decision tree early warning score (LDT-EWS), which consists of frequently performed laboratory parameters. Methods

Background 2019 marked the emergence of the novel Coronavirus (COVID-19) pandemic. Public avoidance of healthcare facilities, including the Emergency Department (ED), has been noted prior pandemics. Objectives This study describes pandemic related changes in adult and pediatric Emergency Department (ED) presentations, acuity, and hospitalization rates during the pandemic in a major metropolitan area

Background ECG findings of T wave inversions in V1-V3, with or without accompanying epsilon waves, often raise concerns for the rare, but potentially lethal arrhythmogenic right ventricular cardiomyopathy (ARVC). However, this pattern may be found in pericardial agenesis, an even rarer pathology. Concomitant myocarditis can confuse this presentation further. Case Report We report a case of a previously

Background Patients with limited English proficiency seen in the emergency department (ED) experience lower quality of care and higher diagnostic resource utilization, unless they are evaluated in their own language. Despite a low rate of serious pathology identified and the availability of guidelines to direct its use, computed tomography (CT) is commonly used to evaluate atraumatic headache in the

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Background Page kidney is a rare condition in which an external compression of the kidney as a result of a hematoma or mass causes renal ischemia and hypertension. In a patient with flank pain, elevated blood pressure, and recent trauma, this condition should be considered. Since this condition was first described in 1939, more than 100 case reports have surfaced. Case Report We describe the case of

Background Pneumothorax is a common issue in the intensive care unit and emergency department and is often diagnosed using lung ultrasound. The absence of lung sliding and the presence of the lung point sign are characteristic findings for pneumothorax. We describe a case of left pneumothorax diagnosed incidentally through a new variant of the lung point sign while performing a cardiac ultrasound.

Background Orthopedic injuries are commonly managed in the emergency department (ED) setting. Fractures and dislocations may require reduction for proper management. There are a variety of analgesic and sedative strategies to provide patient comfort during reduction. Objective This narrative review evaluates hematoma block, intra-articular injection, intravenous regional analgesia (IVRA) (also known

Background: Patients present to emergency departments (EDs) from a variety of backgrounds, which may help inform decision-making. Objectives: This study investigated the clinical characteristics and outcomes of outpatient department (OPD)-referred patients and self-referred patients in the ED. Methods: We selected nontrauma ED adult patients from a tertiary teaching hospital in Taiwan between August

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Background: Workload in the Emergency Department (ED) fluctuates and there is no established model for measurement of clinician-level ED workload. Objective: Measure perceived ED workload and assess the relationship between perceived workload and objective measures of workload from the electronic medical record (EMR). Methods: This study was conducted at a tertiary care, academic ED from 7/1/2020–4/13/2021

Background Medical equipment can become scarce in disaster scenarios. Prior work has shown that four sheep could be ventilated together on a single ventilator. Others have shown that this maneuver is possible when needed, but no one has yet investigated if cross-contamination occurs in co-ventilated individuals. Objectives Our goal was to investigate if an infection could spread between individuals

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Background The Centers for Medicare and Medicaid (CMS) developed the SEP-1 metric to improve sepsis care but evidence supporting this bundle is limited and harms secondary to compliance have not been investigated. Objective This study investigates the effect of an Emergency Department (ED) sepsis quality improvement (QI) effort to improve CMS SEP-1 compliance, looking specifically at antibiotic overtreatment

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