Posts Tagged ‘emergency medicine’

Twenty-Seven Overnight Shifts: Lessons Learned from Indian Health Service Providers

Posted by • August 2nd, 2016

The morning after I arrived in New Mexico was beautiful and warm, a pleasant change from the Northeast winter. I was entering my second year of emergency ultrasound fellowship and about to teach a point-of-care ultrasound course to health care providers working for the Indian Health Service (IHS). On that first day, as my colleagues and… Read More…

A Woman with Dyspnea

Posted by • June 10th, 2016

Bronchiolitis is a disease of the small airways, which are defined as airways less than 2 mm in diameter and without cartilage. The bronchioles are especially vulnerable to infectious or inhalational insults because of their narrow diameter. A 60-year-old woman was seen in a pulmonary clinic because of increasing dyspnea. Chest imaging revealed bronchiectasis and mild,… Read More…

The Hidden Lesion

Posted by • June 3rd, 2016

The repeated occurrences of clots involving the veins in the proximal left leg raise suspicion for the May–Thurner syndrome (compression of the left iliac vein by the overlying right iliac artery). A 24-year-old woman presented to the ED with pain in the left leg. She had been training for a 5-km race when, 2 days before presentation,… Read More…

Eye of the Beholder

Posted by • May 6th, 2016

Dermatomyositis, polymyositis, and necrotizing autoimmune myopathy all cause proximal muscle weakness. Proximal weakness is often progressive, with patients reporting difficulty in raising their arms above their head, climbing stairs, or standing from a seated position. Clinically, dermatomyositis is distinguished from polymyositis and necrotizing autoimmune myopathy by its distinctive dermal findings. A 47-year-old man presented to an… Read More…

Violence against Health Care Workers

Posted by • April 28th, 2016

Health care workplace violence is an underreported, ubiquitous, and persistent problem that has been tolerated and largely ignored. According to the Joint Commission, a major accrediting body for health care organizations, institutions that were once considered to be safe havens are now confronting “steadily increasing rates of crime, including violent crimes such as assault, rape,… Read More…

A Man with Dyspnea and Chest Pain

Posted by • March 25th, 2016

In every patient with a large pulmonary embolus, one may consider the possibility that the embolus is caused by a benign cardiac tumor, primary cardiac cancer, or a metastasis to the heart. A 29-year-old man presented with severe dyspnea and chest pain on the right side. Computed tomographic angiography revealed a filling defect in the main and… Read More…

Mesenteric Ischemia

Posted by • March 11th, 2016

Although mesenteric ischemia is an uncommon cause of abdominal pain, accounting for less than 1 of every 1000 hospital admissions, an inaccurate or delayed diagnosis can result in catastrophic complications; mortality among patients in whom this condition is acute is 60 to 80%. Although mesenteric ischemia is uncommon, it can be life-threatening, and its recognition is… Read More…

Uncomplicated Skin Abscess

Posted by • March 4th, 2016

Between 1993 and 2005, annual emergency department visits for skin and soft-tissue infections in the United States increased from 1.2 million to 3.4 million, primarily because of an increased incidence of abscesses. The primary treatment of a cutaneous abscess is drainage. Whether adjunctive antibiotics lead to improved outcomes in patients with uncomplicated abscesses or just… Read More…

A Woman with a Skin Ulcer

Posted by • February 12th, 2016

Ulceroglandular tularemia is one of several clinical presentations of Francisella tularensis infection. In patients with ulceroglandular tularemia, an ulcer develops at the site of inoculation and is followed by fever, systemic symptoms, and regional lymphadenopathy. Although tularemia can occur year-round, it predominantly occurs during the summer months. The diagnosis of tularemia is quite rare; in… Read More…

Viral Bronchiolitis

Posted by • January 8th, 2016

Few diseases have a greater effect on the health of young children than viral lower respiratory tract illness. Approximately 800,000 children in the United States, or approximately 20% of the annual birth cohort, require outpatient medical attention during the first year of life because of illness caused by respiratory syncytial virus (RSV). This review article… Read More…