First trimester vaginal bleeding is a common complaint seen in the Emergency Department (ED). Patients are obviously stressed about the possibility of miscarriage while providers are stressed about missing diagnoses such as ectopic pregnancies. There have been multiple studies questioning the interrater reliability of the pelvic examination. But is there added utility to the examination once the presence of an intrauterine pregnancy (IUP) has been established?
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Ascites is the most common complication of liver cirrhosis, and infection of that abdominal fluid, spontaneous bacterial perotinitis (SBP) is both common (reported in 10-30% of hospitalized patient) and deadly, with a mortality rate of 10%. SBP can be diagnosed by analysis of ascitic fluid obtained by a simple bedside diagnostic paracentesis, a procedure well within the scope of all emergency medicine physicians.
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Abusive head trauma is the leading cause of death from child abuse and the leading cause of death from traumatic brain injury. Identification of clinically important traumatic brain injury is essential. The PECARN head trauma rule for children less than 2 years of age includes 6 predictors (PECARN 2009). The predictors of “acting normally as per parents” and “a high-risk mechanism of injury” may be unreliable in infants with abusive head trauma.
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Background: Assessing fluid responsiveness in patients in shock is crucial as fluid balance is important in their management. Identifying patients who are fluid responsive allows us to rapidly increase their cardiac index. However, rapid infusion does not benefit all patients in shock and in some, may be harmful. As a result, it is crucial to identify parameters that can aid in identifying patients who may benefit from volume expansion.
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Background
The clinical diagnosis of pulmonary embolism (PE) can be challenging given its variable presentation, requiring dependence on objective testing. Decision instruments such as PERC and the Wells’ score help stratify patients to low or high probability, enabling focused use of CT pulmonary angiography (CTPA) for diagnosis. However, despite these algorithms, there is evidence of increasing use of CTPA along with diminishing diagnostic rate (less than 10%).
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Point of Care Ultrasound (POCUS) has gained wider use in resuscitation of patients presenting with cardiac arrest. POCUS can play an important role in determining the etiology of arrest as well as being used to determine the presence or absence of mechanical activity. The REASON study demonstrated that patients with PEA or asystole without cardiac activity on POCUS are extremely unlikely to survive to hospital discharge though this study did not investigate the more important question of a survival with a good neurologic outcome.
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Each year approximately 790,000 Americans suffer an acute myocardial infarction (AMI) (Benjamin 2017). Traditional treatment for an acute myocardial infarction has included morphine, oxygen, nitroglycerine and aspirin (MONA) with interventions such as percutaneous coronary intervention providing more definitive management. There has been little data from randomized control studies that supports the use of oxygen in AMI.
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Syncope, the sudden, brief loss of consciousness followed by spontaneous, complete recovery is a common presentation to the Emergency Department (ED). It represents a significant portion of overall admissions to the hospital because while many cases are benign (i.e. vasovagal syncope), some may result from a life-threatening cause (ventricular tachydysrhythmia, myocardial ischemia, gastrointestinal bleeding etc).
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