Emergency_Medicine RSS : Gourt

Government Job for Emergency Medicine physician in Arizona. Any state license will work. :: Arizona :: CompHealth Inc

Job 0072336-0040 Any active state license Flexible AM/PM/Weekend/Weekday shifts Board Certified or Board Eligible ACLS, ATLS, and PALS required Computer literacy required We offer competitive compensation

Ski In The Winter, Water Ski In Summer In The Northeast :: New York :: CompHealth Inc

Job 3112496 32,000 Volume Double Coverage RT ABEM, BE or GF 36 Hours Per Week $200,000 Salary + $10,000 Differential For Working Nights Only Part Time Available (PC Boards ok) Occurrence Malpractice

FORESTS AND LAKE SURROUND THIS FRIENDLY WISCONSIN ED :: Wisconsin :: CompHealth Inc

Job 3112408 Fresh air and outdoor exhilaration await when you join the ED team at this brand new hospital. This 13,500 Volume Level III Trauma center features modern appointments in a fast-growing community.

CHARMING NON-URBAN LOW-VOLUME COMMUNITY ED IN TEXAS :: Texas :: CompHealth Inc

Job 3112602 Energetic, compassionate ED physician sought for this single-coverage low volume-facility less than 90 minutes from a big Lone Star State metro. EM/IM/FP boards and well-rounded clinical

WISCONSIN ED DIRECTOR IN OUTDOOR SPORTS PARADISE :: Wisconsin :: CompHealth Inc

Job 3112404 BC/BE EM Physician leader sought for critical access facility in scenic Wisconsin. Enjoy the opportunity to build and shape the future of this 14,000 folume Level III Trauma ED. Competitive

Low Volume Fast Track in Northeastern Paradise :: New York :: CompHealth Inc

Job 3112380 12,000 Volume 36 Hours Per Week EM, PC, FP Boards Welcome Single Coverage 20% Peds, 60% Adult, 20% Geriatric Outdoor Paradise Part TIme Available, Professional Sports Occurrence Malpractice

Generous Income, Private Group, Full Benefits :: Wisconsin :: CompHealth Inc

Job 3112543 Commutable To Milwaukee Generous Salary, Full Benefits, Private Group Group Funded Retirement Plan $170 Per Hour Year One Mid-Volume Dept. CompHealth offers thousands of physician jobs

21st CENTURY ED OPPORTUNITY IN WISCONSIN :: Wisconsin :: CompHealth Inc

Job 3112406 Digital paperless ED and hospital with accredited chest pain center and extensive backup offers an outstanding opportunity for talented EM physicians in a state-of-the-art facility Competitive

High Paying Low Volume In Historical SW :: New Mexico :: CompHealth Inc

Job 3112731 8,000 yearly volume Level III RT ABEM, $244,000 pr yr PC Boards with 2,000 hrs EM exp. $217,000 5-24 hr shifts pr month Each additional 24 hr shifts paid at 1.5 Critical Care facility Relo

MODERN ED IN " TOP TEN PLACES TO LIVE" :: Wisconsin :: CompHealth Inc

Job 3112452 Join the low-volume ED at this modern hospital and surround yourself with hiking trails, pristine rivers and the glory of the great outdoors. Great opportunity to balance work and an enviable

Groovy EM Opportunity Near Bethel, NY :: New York :: CompHealth Inc

Job 3112570 Up To $150 per hour PC Boards accepted with 3 years experience Occurrence Malpractice with PRI Benefits including 4 weeks PTO CompHealth offers thousands of physician jobs nationwide--permanent

Live & Work 10 Minutes From the Ocean :: South Carolina :: CompHealth Inc

Job 3112557 Hospital Only 10 Minutes From The Ocean Resort Area, Fresh Seafood, Great Night Life, 1,800 Restaurants To Choose From Beautiful Year Round Weather, 13 Golf Courses In the Area Fishing,

Beautiful Western MA EM Opportunity :: Massachusetts :: CompHealth Inc

Job 3112270 $213K Salary Will see PC Boards Work 36 hours a week Full Benefits including Malpractice Great skiing nearby CompHealth offers thousands of physician jobs nationwide--permanent placement

Exceptional SE Coastal ED opening! :: South Carolina :: CompHealth Inc

Job 3112284 $135/hr. in a prime coastal location B/E or B/C EM or FP with EM experience Level 3 Trauma 35,000 Volume Independent Contractor Malpractice with Tail $5000 CME CompHealth offers thousands

Growing group adds a new contract :: Maryland :: CompHealth Inc

Job 3112537 Upscale Area In Maryland, Top ranked group has just added Department, Earn $1150$150/Hr, Plus RVU's & Profit Sharing, Complete benefit package Commutable to Baltimore, DC & Philadelphia

Directorship In Mid-Volume Dept. :: West Virginia :: CompHealth Inc

Job 3112285 Resort Area. Shopping, White Water Rafting, Snow Skiing, Hunting, Scuba & More. Mild Four Seasons Climate. Comfortable Year Round Life Style Primary Care Boards Welcome Mid-Volume Dept.

Directorship In Low Volume Dept. :: South Carolina :: CompHealth Inc

Job 3112446 Year-Round Festivals Beautiful Weather Area Lakes & Forrests Offer Boating, Fishing, Swimming, Camping & Hiking Plenty of Shopping & Dining & Cultural Activities Nearby Only 9,300 Patients

EM in Pennsylvania's Best :: Pennsylvania :: CompHealth Inc

Job 3112649 Lower Volume Community Teaching Hospital Outstanding compensation & benefits I-80 corridor in central PA Easy commuting to metro areas Safe family community in outdoor paradise Malpractice

Med Peds PEM Opportunity :: North Carolina :: CompHealth Inc

Job 3112650 Work PEM during the school year Work Urgent Care during the summers Stable environment High pay & good benefits Malpractice Health, disability Tax shelters CompHealth offers thousands

EM In Affluent DC Suburb :: Virginia :: CompHealth Inc

Job 3112677 Excellent family community in burbs All EM residency trained group Very competitive comp & benefits ED has designated Peds Comprehensive Health Pension + Tax Shelters PTO + CME CompHealth

Primary survey

Litigation, redress and making amends

Are current UK tetanus prophylaxis procedures for wound management optimal?

Tetanus is a potentially fatal disease that occurs after contamination of a wound with Clostridium tetani spores. The introduction of comprehensive infant vaccination programmes in the 1960s dramatically reduced the incidence of tetanus in the UK. To achieve comprehensive protection against tetanus, the World Health Organization guidelines recommend the administration of the five-dose childhood immunisation regimen and an additional sixth dose, after approximately 10 years, to ensure long-lasting immunity. To supplement these measures, tetanus prophylaxis with human tetanus immunoglobulin is considered essential for incompletely immunised individuals presenting with dirty wounds. However, identifying those individuals who are not fully immunised has, until recently, been problematical. The use of a new rapid, point-of-care immunoassay to assess tetanus immune status may facilitate the optimal management of patients with wounds.

Emergency Medicine Questions (EMQs): Theme: Chemical injury

An evidence-based guideline for children presenting with acute breathing difficulty

Objective: The aim of this study was to develop an evidence-based guideline for use primarily by junior clinicians to assist with the management of children presenting to the hospital with an acute breathing difficulty. Methods: An overview of the literature provided a framework of clinical questions for the management of a child with an acute breathing difficulty on which to base a systematic literature review. Relevant articles were appraised by the research fellow and graded according to their quality. A national panel of 50 clinicians was provided, by post, with the clinical questions, research papers, appraisals and the grades of recommendations generated. They were asked to check the grades allocated to the recommendations and the accuracy of the language used. They were also provided with all the clinical questions for which there was insufficient evidence to reach a conclusion but for which a consensus recommendation was required. A Delphi method was used to formalise the consensus process. For all recommendations, panel members were asked to rate their level of agreement on a 1–9-point Likert scale. The results of the first round were fed back, and appropriate alterations to the recommendations made or additional recommendations included. The process of rating was repeated, and the final guideline was developed based on the consensus reached. Results: Following two iterative rounds, the guideline was completed as a full technical document, with a series of key recommendations and an algorithm. It was based on 10 grade A (evidence from systematic review or meta-analyses), 5 grade B, 17 grade C and 31 grade D (consensus or expert opinion) recommendations. Conclusion: We have developed an evidence-based guideline that has subsequently been successfully implemented in the paediatric emergency departments and disseminated nationally. Results showing the effect of the guideline upon practice will be published separately.

Proximal interphalangeal joint hyperextension injuries in children

Background: Proximal interphalangeal joint (PIPJ) hyperextension injuries are common in children. There is a range of opinion on management but little evidence to suggest best practice. Aims: To determine from a convenient sample size, the overall and significant fracture rate. Whether significant injuries can be differentiated from the insignificant clinically and whether children get complications. Methods: Data were collected on all PIPJ hyperextension injuries (thumb excluded) presenting to a children’s emergency department between October and December 2006. Staff were trained to perform standardised assessment and documentation and all injuries were x rayed. The diagnosis was cross-referenced with x ray reports. All notes were reviewed for 4 months. Management, complications and unscheduled returns were noted. Results: From the population of 134 patients, there was a fracture rate of 55% (74/134). Of those, 57% (42/74) were defined as significant. Others included buckle (9/74), flake (14/74) and avulsion (9/74) fractures. Obvious deformity and inability to touch pulp to palm were significantly associated with a fracture. Except for those with clinical deformity requiring manipulation, all injuries were treated conservatively. There were no unscheduled returns with any complications 4 months post-injury. Conclusions: There is a significant risk of a fracture in children sustaining hyperextension injuries to the PIPJ. These results show that, except in those with an obvious deformity, it is difficult to differentiate clinically between those with a sprain, minor or significant fracture. Even those with a significant fracture were managed conservatively. Children appear not to have the complications seen in the adult population with similar injuries.

Atypical acute appendicitis

Accessibility versus confidentiality of information in the emergency department

Introduction: In the emergency department (ED), clinicians can benefit greatly from having access to information at the point of care. It has been suggested that using computerised information systems could improve the accessibility of information. However, making information accessible, while maintaining confidentiality, is one of the main challenges of implementing information systems. This article presents the ED staff perspectives about the accessibility and confidentiality of information in the ED. Method: The authors undertook a qualitative study in March–April 2007. Data were collected using in-depth semi-structured interviews with the ED staff of an ED located in Northern England. In total, 34 interviews were conducted and transcribed verbatim. Data were analysed using framework analysis. Results: The results showed that the ED staff had role-based access to the current information systems, and these systems met only a small part of their information needs. As a result, different sources were used to get access to the needed information. Although the ED staff believed that improving the accessibility of information could be helpful in emergency care services, there were concerns about the confidentiality of information. The confidentiality of information could be threatened—for example, by sharing passwords, misusing patient information or by unauthorised staff having access to patient information. Conclusion: To design a system, the accessibility and confidentiality of information should be addressed in parallel. A balance between these two is needed, as the failure of each of these may negatively influence the use of the system.

What is the difference in size of spontaneous pneumothorax between inspiratory and expiratory x-rays?

Objective: The aims of this study were to compare the estimated size of primary spontaneous pneumothorax (PSP) calculated on inspiratory and expiratory radiographs using the volumetrically derived Collins method and to determine whether radiograph type influences size classification for treatment according to published guidelines. Method: This retrospective cohort study included patients treated for PSP in the emergency departments of two metropolitan teaching hospitals. Data collected included patient demographics and interpleural distances required to calculate pneumothorax size by the Collins method and to classify PSP according to guidelines. The outcomes of interest were the difference in size estimate between radiograph types and agreement in size classification for treatment according to guidelines. Analysis is by bias-plot analysis, kappa analysis and descriptive statistics. Results: A total of 49 pneumothoraces (44 patients) were studied. Median age was 22 years; 66% were men. Median PSP size on inspiratory radiographs was 24% (IQR 14% to 31%, range 5% to 100%). The average size difference between expiratory and inspiratory films was 9%, with size on expiratory radiographs being larger. The 95% limits of agreement were wide (–5% to 23%). For each guideline, size estimation on expiratory rather than inspiratory radiographs would have suggested a change in treatment for an additional seven patients (14%, 95% CI 7% to 27%). Conclusions: On average, PSP size calculated on expiratory radiographs is 9% higher than that calculated on matched inspiratory radiographs. Applying current management guidelines, the size difference between inspiratory and expiratory x-rays may alter initial treatment recommendation for some patients.

Spontaneous iliopsoas muscle haematoma

Protocol-driven trauma resuscitation: survey of UK practice

Objective: To evaluate the use of protocol-driven trauma resuscitation strategies in UK emergency departments. Methods: Postal/internet questionnaire survey of emergency departments to evaluate the existence of guidelines or protocols to direct resuscitation, blood component treatment, second line imaging of patients who had major trauma and the existence of a trauma team/trauma call system. Results: 243 departments were identified and contacted, 183 responded. Five replies were excluded. Of the remaining 178 departments, 139 (78.1%) had a trauma team or trauma call system, but only 49 (27.5%) had a guideline or protocol for resuscitation. 92 (51.7%) had guidelines or protocols for blood component treatment in trauma, and 88 (49.4%) had guidelines or protocols for the use of second line imaging in trauma. The use of protocols and guidelines did not correlate with emergency department size, as measured by volume of activity. Conclusions: The utilisation of trauma resuscitation protocols and guidelines in British emergency departments is limited. Given the clear benefits of these strategies, consideration should be given to greater integration of such algorithms into practice.

Clinical diagnosis of acute coronary syndrome in patients with chest pain and a normal or non-diagnostic electrocardiogram

Background: Clinical features may be used to determine which patients with suspected acute coronary syndrome (ACS), but a normal or non-diagnostic ECG, should be selected for further investigation or inpatient care. We aimed to measure the diagnostic value of clinical features for ACS. Methods: Standardised data relating to presenting characteristics, associated features and risk factors were collected at seven chest pain units established for the ESCAPE trial. All patients received troponin measurement at least 6 h after last significant symptoms, creatine kinase MB(mass) gradient over 2 h and, if appropriate, treadmill exercise testing. The reference standard of ACS was defined as troponin >0.03 ng/ml, creatine kinase MB(mass) gradient >3.0 ng/ml or early positive treadmill exercise test. Results: 1576 patients were analysed, including 132 (8.4%) with ACS. Patients with ACS were older, had longer symptom duration, were more likely to be a man, hypertensive and an ex-smoker or have pain radiating to their right arm. On multivariate analysis, only age, duration, sex and radiation of pain to the right arm were independently associated with ACS. Likelihood ratios (95% CI) were radiation of pain to the right arm, 2.9 (95% CI 1.4 to 6.3), male sex 1.2 (95% CI 1.0 to 1.3) and female sex 0.79 (95% CI 0.62 to 1.0). The area under the receiver operator characteristic curve for age was 0.629 (95% CI 0.573 to 0.686) and for duration was 0.546 (95% CI 0.481 to 0.610). Conclusion: Clinical features have very limited value for diagnosing ACS in patients with a normal or non-diagnostic ECG. Radiation of pain to the right arm increases the likelihood of ACS.

A retrospective review of patients with head injury with coexistent anticoagulant and antiplatelet use admitted from a UK emergency department

Background and aim: Conflicting evidence exists surrounding the increased risk of adverse outcome conferred by preinjury anticoagulant and antiplatelet treatment in patients with head injury. The aim of this study was to determine the epidemiology of patients with head injury on anticoagulant and antiplatelet treatment admitted to a hospital from an emergency department (ED). Methods: This was a retrospective analysis of all patients with head injury admitted to a hospital from a major UK ED between 1 January 2005 and 31 December 2007. Results: 399 patients met the inclusion criteria. 110 patients underwent CT, with 24 having traumatic haemorrhage. Of 271 patients on aspirin, 75 (28%) underwent CT, with 19 of these (25%) having traumatic haemorrhage. Of 89 patients on warfarin, 27 (30%) underwent CT, with 4 of these (15%) having traumatic haemorrhage. Seven of the 24 (29%) patients with traumatic haemorrhage on CT did not undergo urgent ED scanning. All these patients were on aspirin. Conclusions: This study confirms the need for caution in the early discharge of patients with head injury taking anticoagulant medication. This study also raises concerns that patients taking antiplatelet medication prior to injury may also be at high risk of developing covert serious intracranial haemorrhage and suggests the need for a well-designed cohort study looking at antiplatelet risk in head injury.

Ventricular pseudo-bigeminy pattern associated with Wolff-Parkinson-White syndrome

Improvement in time to treatment following establishment of a dedicated medical admissions unit

The importance of medical admissions units (MAU) has been emphasised by the royal colleges and the Society for Acute Medicine. This study looked at the time to treatment of four common medical conditions before and after the establishment of a dedicated MAU. Before the development of the MAU, treatment given in the emergency department (ED; median 111 minutes) was significantly quicker than on the admitting general medical ward (median 262 minutes, p<0.001). Following the establishment of the MAU, treatment given in the ED (median 70 minutes) remained significantly quicker than on the MAU (median 180 minutes, p<0.05). Treatment was given significantly quicker on the MAU compared with the antecedent admitting medical wards (p<0.05). In addition, more patients were treated within protocol-driven time guidelines. In summary, the establishment of a MAU significantly improved time to treatment, compared with admitting directly to general medical wards. This has implications for patients who are boarded directly to medical wards when the MAU is at full capacity.

Traumatic choroidal rupture

Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary

BET 1: Which is the best clinical test for diagnosing a full thickness rotator cuff tear?

BET 2: ARE CALCIUM CHANNEL BLOCKERS SUPERIOR TO DIGOXIN FOR CONTROLLING THE VENTRICULAR RATE IN PATIENTS WITH ACUTE ATRIAL FIBRILLATION?

BET 3: IS CERVICAL SPINE PROTECTION ALWAYS NECESSARY FOLLOWING PENETRATING NECK INJURY?

BET 4: USE OF LITMUS PAPER IN CHEMICAL EYE INJURY

Prehospital advanced airway management by ambulance technicians and paramedics: is clinical practice sufficient to maintain skills?

Introduction: Ambulance paramedics are now trained routinely in advanced airway skills, including tracheal intubation. Initial training in this skill requires the insertion of 25 tracheal tubes, and further ongoing training is attained through clinical practice and manikin-based practice. In contrast, training standards for hospital-based practitioners are considerably greater, requiring approximately 200 tracheal intubations before practice is unsupervised. With debate growing regarding the efficacy of paramedic intubation, there is a need to assess current paramedic airway practice in order to review whether initial training and maintenance of skills provide an acceptable level of competence with which to practice advanced airway skills. Methods: All ambulance patient report forms (anonymised) for the period 1 January 2007 to 31 December 2007 were reviewed, and data relating to airway management were collected. Paramedic and technician identification codes were used to determine the number of airway procedures undertaken on an individual basis. Results: Of the 269 paramedics, 128 (47.6%) had undertaken no intubation and 204 (75.8%) had undertaken one or less intubation in the 12-month study period. The median number of intubations per paramedic during the 12-month period was 1.0 (range 0–11). A total of 76 laryngeal mask insertion attempts were recorded by 41 technicians and 30 paramedics. The median number of laryngeal mask insertions per paramedic/technician during the 12-month period was 0 (range 0–2). A survey of ongoing continuing professional development across all ambulance trusts demonstrated no provision for adequate training to compensate for the lack of clinical exposure to advanced airway skills. Conclusion: Paramedics use advanced airway skills infrequently. Continuing professional development programmes within ambulance trusts do not provide the necessary additional practice to maintain tracheal intubation skills at an acceptable level. Advanced airway management delivered by ambulance crews is likely to be inadequate with such infrequent exposure to the skill.

Personal protective equipment provision in prehospital care: a national survey

Background: Safety in prehospital practice is a paramount principle. Personal protective equipment (PPE) use is intrinsic to safe practice. There is varied guidance as to what constitutes effective PPE. No evidence is available of what current provision encompasses. Methods: A questionnaire-based study directed to all ambulance trusts, British Association for Immediate Care (BASICS) schemes and air ambulance operations in England, Scotland and Wales. Results: Total response rate was in excess of 66%. A specific protocol for PPE use was issued by 81%, 89% and 38% of ambulance trusts, air ambulance and BASICS schemes, respectively. There was a wide variation in provision of PPE both within and between different groups of providers. Fewer than 55% of providers had an evaluation system in place for reviewing PPE use. Conclusions: Many reasons account for the differences in provision. There is a clear need for a standard to be set nationally in conjunction with locally implemented evaluation and re-accreditation processes.

Does the horizontal position increase risk of rescue death following suspension trauma?

Background: It is widely believed that placing a patient who has been subjected to suspension trauma in a horizontal position after rescue may cause rescue death. The discussion whether position is important has been dominated by non-medical personnel. Subsequently, this has led to a general advice on emergency treatment of these patients, which may cause incorrect or even fatal treatment. Methods: To determine whether there is any medical evidence supporting that horizontal positioning after suspension trauma may cause rescue death, the authors located publications, reports, expert opinions and other sources of information addressing the acute treatment of suspension trauma. These sources were then evaluated. Results: Several thousand hits regarding suspension trauma were located on the internet and five articles on the PubMed. Although most of them warned of the dangers of rescue death brought about by assuming the horizontal position after prolonged suspension, the authors found no clinical studies, and none of the sources offered any conclusive evidence as to whether the horizontal position increases the risk of rescue death. Neither the authors, nor the suspension trauma experts who were contacted, had ever experienced or heard of case reports supporting the causal relation between the horizontal position and rescue death. Conclusions: After evaluating the current literature, the authors found no support for the view that the horizontal position may be potentially fatal for patients exposed to suspension trauma. In the absence of any evidence to the contrary, the authors suggest that the initial management of patients who have had suspension trauma should follow normal guidelines for the acute care of traumatised patients, without special modifications.

Can teaching methods based on pattern recognition skill development optimise triage in mass-casualty incidents?

Background: Patient’s triage is a key element of mass-casualty incidents (MCIs) response, although performance of healthcare professionals in triage proved to be poor. It was assessed if specific teaching methods based on pattern recognition skill development can help healthcare students to improve their performance in triage. Methods: 128 medical and nursing students have been assessed while performing triage during disaster medicine exercises. Half of them (group 1) had previously been involved in a standard curriculum. The remaining half (group 2) benefited from specific teaching methods based on pattern recognition skill development. Results: Performance of group 2 was significantly higher compared with group 1 (p<0.01). Group 2 had a lower overtriage rate. Conclusions: Disaster medicine courses based on pattern recognition skill development improve triage performance of healthcare students during simulated MCI. This study may have a high impact on healthcare students and professionals’ education in the perspective of MCIs preparedness and response.

From the prehospital literature

Atrial tachycardia with 1:1 atrioventricular conduction precipitated by propafenone

A 58-year-old man presented to the emergency department with sudden onset rapid palpitations and significant presyncope while walking on the flat. The previous day he had undergone DC cardioversion for atrial fibrillation (AF) which had been initially successful. However, 6 h after cardioversion he was aware of intermittently raised but regular heart rates. On arrival at the emergency department (ED) he was well with no haemodynamic compromise. The ECG showed an atrial tachycardia instead of AF. Medications consisted of propafenone 300 mg twice daily, bisoprolol 5 mg at night and warfain. Bisoprolol was increased to 5 mg twice daily and he was discharged with a plan for outpatient ablation. He collapsed in the hospital car park with rapid palpations, chest tightness and vagal symptoms. On return to the ED he was hypotensive with a heart rate of 200 bpm. The ECG showed 1:1 atrioventricular conduction (AV) of the atrial tachycardia which promptly improved after administering intravenous atenolol. Class 1c antiarrhythmic agents such as propafenone can precipitate 1:1 AV conduction of atrial tachycardias resulting in dangerous exacerbations of ventricular rate or even malignant tachyarrhythmias. It is therefore essential that concomitant AV blocking agents are used both prophylactically or acutely in suspected cases.

Hazards of ultra-marathon running in the Scottish highlands: exercise-associated hyponatraemia

The case histories are presented of four athletes taking part in a 95-mile ultra-endurance foot race in Scotland who were hospitalised after developing exercise-associated hyponatraemia and rhabdomyolysis. Exercise-associated hyponatraemia is relatively uncommon in temperate climates. Risk factors disposing to this disorder are discussed. Exercise-associated hyponatraemia is thought to be due to overconsumption of hypotonic fluid with other associated pathophysiology including an inability to suppress fully antidiuretic hormone during exercise or to mobilise adequate sodium from osmotically inactive internal stores. Non-specific symptoms make this disorder difficult to diagnose on site without the assistance of serum sodium measurement, but any delay in treatment of patients with encephalopathy can prove fatal. Mainstays of treatment include fluid restriction, hypertonic saline, loop diuretics and mannitol.

Aortic dissection in a case of Turner's syndrome

A case report is presented of an aortic dissection in a patient with Turner’s syndrome that went undignosed. A thorough discussion of this fatal condition in this group of patients is included.

An unusual cause of lower abdominal pain in pubertal girls

A rare cause of acute lower abdominal pain in pubertal girls is described. The diagnosis is often missed at initial presentation and this may result in multiple presentations to the emergency department or general practitioner. The clinical features, diagnosis, management and possible complications of this condition are discussed. The case illustrates the importance of keeping this diagnosis in mind when seeing teenage girls with lower abdominal pain.

Treatment of supraventricular tachycardia with adenosine in children: size does matter

Adenosine is frequently used as first-line therapy for supraventricular tachycardia in both adults and children. A large bore cannula is recommended to ensure a rapid rate of delivery, as adenosine has a relatively short half-life. This may not always be considered in paediatric patients. This case concerns a 15-year-old male patient who presented to the emergency department with a fast heart rate, who had previously required repeated high doses of adenosine. The case reinforces the need for a large bore cannula when giving intravenous adenosine.

Acute angle closure glaucoma following head and orbital trauma

The case is reported of a 52-year-old woman who suffered a minor head injury and orbital trauma and returned 2 days later with a unilateral headache, vomiting and photophobia. This was initially thought to be secondary to her head injury but, once severe visual impairment and a dilated unreactive pupil developed, the true diagnosis became obvious. A diagnosis of acute angle closure glaucoma was made and she was treated with no complications. This case highlights acute angle closure glaucoma as an important diagnosis to consider in patients who present with unilateral headache and dilated pupil after head injury.

Calcified pleural plaque mimicking a traumatic pneumothorax

Pneumothorax is a common presentation to the emergency department, arising from traumatic and non-traumatic aetiologies. Diagnosis of non-tension pneumothorax is by a visible lung edge on chest radiography together with the absence of lung markings more peripherally. The Advanced Trauma Life Support (ATLS) system recommends tube thoracostomy as the definitive treatment for traumatic pneumothorax. The case is described of a patient who presented following thoracic trauma with an unusual finding on chest radiography that led to diagnostic confusion by mimicking a pneumothorax.

Spontaneous splenic rupture in a patient who received haemodialysis: case report and a review of the literature

Spontaneous splenic rupture is an extremely rare complication in patients who received haemodialysis. We describe a 51-year-old woman who underwent regular haemodialysis and was admitted because of sudden onset of abdominal pain, hypovolemic shock and dizziness. Haemoperitoneum caused by spontaneous rupture of spleen was found on abdominal CT scan. Emergency splenectomy was performed, and the patient was discharged 9 days after the admission. This report demonstrates that spontaneous splenic rupture requires a high index of suspicion for diagnosis in a patient who received haemodialysis with abdominal pain and should be considered in the differential diagnosis when a patient who received haemodialysis without any trauma history has abdominal pain with unexplained hypovolemic shock.

Reduced frequent attendance: Could it be seasonal?

Hypopituitarism after brain injury

Manual of emergency airway management

Emergency sedation and pain management

Expedition and wilderness medicine

Sophia

Who are my readers? Unscientific poll results

Earlier I asked who my readers were, and had a poll. It’s time I posted the results a couple of weeks in (people have stopped voting, so it’s time): A completely unscientific, Scouts' Honor survey Thanks to all of you who participated, and to you lurkers, too. Related posts:Who are my readers, really? I’ve been asked this [...] Related posts:Who are my readers, really? I’ve been asked this quite a lot recently, and have...Day by Day: Don’t Mess with Texas Mr. Muir at Day by Day… ...Washington adventure day 1 evening and day 2 Got to Washington, met up with two other classmates and... Related posts brought to you by Yet Another Related Posts Plugin.

DIY Botox Seller Busted by Texas Attorney General | Wired Science | Wired.com

Well, good: DIY Botox Seller Busted by Texas Attorney General | Wired Science | Wired.com There seems to be no limit to either the desire for body modification or the willingness to serve that desire. Related posts:Better Health » What Does The Surgeon General Do? Better Health » What Does The Surgeon General Do? Dr....CNN Political Ticker: Senate [...] Related posts:Better Health » What Does The Surgeon General Do? Better Health » What Does The Surgeon General Do? Dr....CNN Political Ticker: Senate confirms Benjamin as surgeon general CNN Political Ticker: All politics, all the time Blog Archive...And guess who has the night shift in the ER… Bewerewolves: Fullest Moon in 15 Years Tonight | Wired Science... Related posts brought to you by Yet Another Related Posts Plugin.

Funny YouTube Post: ED Drug Seeker

This is wayyy too close to reality: Heh. Dunno why they’re in a convenience store, but that might me a commentary on the ED environment. Thanks to a reader with a very recognizable name, who shall therefore remain nameless… Related posts:Why does this bathroom always smell funny? Oh. ...Better Health » The Friday Funny: The Homeopath’s [...] Related posts:Why does this bathroom always smell funny? Oh. ...Better Health » The Friday Funny: The Homeopath’s ER Better Health » The Friday Funny: The Homeopath’s ER Go...Those drug-interaction warnings sure are irritating | Booster Shots | Los Angeles Times Those drug-interaction warnings sure are irritating | Booster Shots |... Related posts brought to you by Yet Another Related Posts Plugin.

Fun with Amazon

Tipped by Ace, here’s some hilarity brought to you by Amazon: Laptop Steering Wheel Desk. It’s not the product that’s funny, it’s the comments. For instance: This has been a total lifesaver. It allows me to prop my sheet music against the wheel, allowing me to play the guitar with both hands while driving. Except they just get [...] Related posts:Another tech bleg My son is home from law school, which is terrific....Weirdest prescription? From an old HS buddy (also a Navy Man) now... Related posts brought to you by Yet Another Related Posts Plugin.

Money for Nothing, Healthcare for Free : PANDA BEAR, MD

Panda has roused himself to post again. Money for Nothing, Healthcare for Free : PANDA BEAR, MD Dead on, as usual. Related posts:Skin in the Game and Other Things : PANDA BEAR, MD Skin in the Game and Other Things : PANDA BEAR,...Movin’ Meat: Modern Healthcare vs ER Docs Movin’ Meat: Modern Healthcare vs ER Docs May you [...] Related posts:Skin in the Game and Other Things : PANDA BEAR, MD Skin in the Game and Other Things : PANDA BEAR,...Movin’ Meat: Modern Healthcare vs ER Docs Movin’ Meat: Modern Healthcare vs ER Docs May you be...Free Zippy! Zippy the Lobster was here in the Great State of... Related posts brought to you by Yet Another Related Posts Plugin.

Dr. Wes: What To Opt Out of Medicare?

Interesting. Dr. Wes links a major Medicare opt-out in Arizona: Dr. Wes: What To Opt Out of Medicare? Note, this is before the current health bill, which includes Medicare cuts. We live in interesting times… via Dr. Wes Related posts:A Happy Hospitalist: You Are Living In The Medicare Tomato A Happy Hospitalist: You Are Living In The Medicare Tomato...Medicare [...] Related posts:A Happy Hospitalist: You Are Living In The Medicare Tomato A Happy Hospitalist: You Are Living In The Medicare Tomato...Medicare is going to bankrupt us, which is why we need universal health care – Megan McArdle Medicare is going to bankrupt us, which is why we...KeithHennessey.com » Understanding the Kennedy health care bill The author was a Policy person in the Bush 43... Related posts brought to you by Yet Another Related Posts Plugin.

iMedicalApps.com

iMedicalApps.com is the new home for the former iphonemdeicalappreview.com I linked to a while back. (Kudos on the name change, the original isn’t easy or intuitive to type). From their email today: Just wanted you to know we changed our blogs name from iphonemedicalappreview.com, to iMedicalApps.com. We now have a team of physicians and medical [...] Related posts:iPhone Medical App Review iPhone Medical App Review is a new site that reviews...iPhone display of this blog I have installed a plugin for WordPress that displays the...Valour-IT: Technology for the Wounded: 2009 totals – MARINES WIN! Valour-IT: Technology for the Wounded: 2009 totals – MARINES WIN!... Related posts brought to you by Yet Another Related Posts Plugin.

Health Care Law Blog: A 1930 Medical Record

Very cool glimpse into the past: Health Care Law Blog: A 1930 Medical Record Here are photos of the medical record of a patient from 1934. The medical record format is simple yet complete. Today’s medical record takes up pages on pages, and is a giant time-sink when compared with this notation system. Before 3rd party billing [...] Related posts:Nadeem Esmail Says Nationalized Health Care Will Cost Us Pain and Suffering – WSJ.com Nadeem Esmail Says Nationalized Health Care Will Cost Us Pain...Holman Jenkins: Why Obama Bombed on Health Care – WSJ.com Holman Jenkins: Why Obama Bombed on Health Care – WSJ.com...Dr. Wes: US Health Care Reform Photoshop Contest Dr. Wes: US Health Care Reform Photoshop Contest In the... Related posts brought to you by Yet Another Related Posts Plugin.

Valour-IT: Technology for the Wounded: 2009 totals – MARINES WIN!

Valour-IT: Technology for the Wounded: 2009 totals – MARINES WIN! 2009 totals – MARINES WIN! Thanks to all who participated and or contributed to this campaign. A lot of technology for our wounded heroes will be purchased because of you! Total brought in for all teams, including donations not designated to any team: $113,124.90 By team - Air Force: $15,662.17 Army: [...] Related posts:Bumped: Project Valour-IT Today through November 11th Victory! Team Marine got to the Goal first! (But keep...Going after Las Vegas’ medical mafia – Aug. 19, 2009 Going after Las Vegas’ medical mafia – Aug. 19, 2009...VIDEO: Red Bull Racing gives a virtual tour of 2009 F1 rulebook – Autoblog VIDEO: Red Bull Racing gives a virtual tour of 2009... Related posts brought to you by Yet Another Related Posts Plugin.

BBC News : Alcohol ‘protects men’s hearts’

Lifestyle validation, or confounding variable? BBC News : Alcohol 'protects men's hearts' Wine, beer, vodka – the type of drink did not appear to change the results Drinking alcohol every day cuts the risk of heart disease in men by more than a third, a major study suggests. The Spanish research involving more than 15,500 men and 26,000 women [...] Related posts:BBC NEWS | Health | Steaming hot tea linked to cancer From the ‘life causes cancer’ files: BBC NEWS | Health...Walk it off, it’s only a heart attack – Baltimore News, Weather, Breaking News | WMAR-TV Walk it off, it’s only a heart attack – Baltimore...THC and testicles I’ve been working on a pun for this, but... Related posts brought to you by Yet Another Related Posts Plugin.