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BackgroundVenous thromboembolism (VTE) is extremely rare but under recognized in the pediatric population. Although the literature on the use of ultrasound to detect VTEs in adults is plentiful, little has been documented on its use in the pediatric population.Case reportWe present a case of a healthy 16-year-old female who presented to our emergency department with 3 months of dyspnea on exertion and one episode of near-syncope. Point-of-care cardiac ultrasound identified an inferior vena cava thrombosis. Subsequent computed tomography angiography diagnosed concurrent bilateral pulmonary emboli (PE). The patient's identical twin sister presented with similar symptoms shortly thereafter and was also diagnosed with VTE and bilateral PE. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case demonstrates an instance of VTE and pulmonary embolism in twin adolescent girls. Physical examination findings, electrocardiogram, chest x-ray study, and several previous evaluations did not reveal the diagnosis. Point of care ultrasound was used to correctly diagnosis VTE and for heightened concern for a pulmonary embolism.

Phenazopyridine is considered one of the classic causes of drug-induced methemoglobinemia. It is often taught as such and seen in board review courses. Nevertheless, the epidemiology is unknown, presentation quite rare, and less than five cases have been reported in PubMed in over 35 years.1-4 We present a case with a different set of patient characteristics than seen in the few recent case reports, and an approach to treatment that validates further uniqueness, justifying reporting the case in the literature. In particular, the patient was a young otherwise-healthy adult, with the initial diagnosis and decision to treat based on clinical grounds versus laboratory values.

The triage system currently recommended by the Association of Emergency Physicians (ACEP) and Emergency Nurses Association (ENA) is a five levels triage, Emergency Severity Index (ESI) due to more structured, concise, and clear. Cibabat Hospital used a relatively new triage of four modified levels of the Australian Triage Scale (ATS) which accuracy and time triage have not been evaluated. The purpose of this study was to compare the four level triage of modification of ATS and five levels of ESI triage based on accuracy and time triage. The researcher used a quantitative quasi-experimental design with samples of triage activities totaling 38 in the control group and 38 intervention groups, using accidental sampling techniques. Univariate analysis consisted of frequency distribution for nurse characteristics, time triage and accuracy, bivariate analysis used the Mann-Whitney test. The results showed there were no differences, triage modification of ATS with ESI triage in accuracy (p-0.488), and length of triage (p-0.488) ESI triage accuracy was in the expected triage category (76.3%), under triage (13.2%), and over triage (10.5%). Triage modified ATS, expected triage (73.7%), under triage (18.4%), and over triage (7.9%). ESI triage has more expected and less under triage than ATS modification triage. Under triage caused prolong waiting times, unexpected risks, increases morbidity and mortality. Based on the length of time, ESI triage averaged 167 seconds, triage modification of ATS an average of 183 seconds. ESI flowchrat is easier to understand because is simple, has slight indicators in each category. Conclusion of this study is there is no significant difference in the level of accuracy and duration of triage. However, based on data distribution, ESI triage gives more expected triage decisions, less under triage and 16 seconds faster. Suggestions given to the Cibabat Hospital, can use ESI triage as an alternative triage assessment option because easy to use, structured, simple, and clear.

The use of wireless networks has become a trend at this time. However, this can cause several problems in the use of this technology. One of the problems arising from this technology is the limited signal coverage in a certain place. To solve these problems, WDS technology is an alternative solution that can be done. WDS technology will be applied to each room. In this study, QOS analysis will be used to evaluate throughput performance and response time. The test scenario is performed with 1000 users (simulated) for seven days, four sampling times considering working hours and outside working hours. The analysis results show that with WDS technology, the resulting performance tends to be more stable with a throughput value of 500 KBps and a max response time of 5.5 ms.

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A comprehensive geostatistical analysis was conducted on a dataset comprising 24,321 seismic events in the Red Sea region, spanning from 1997 to 2020. This analysis involved the creation of a new seismic activity database, incorporating data from both Egyptian and Saudi Seismic Networks. This enriched database provided a robust foundation for a detailed examination of the seismic patterns and activities in the region. Utilizing geographic information systems and various spatial analytic methods, it identifies seismic patterns and tectonic influences. The findings reveal significant seismic clustering along the Central Red Sea axis, indicative of active rifting between the Nubian and Arabian plates. The study demonstrates spatial autocorrelation in seismic activities, with high-high clusters marking zones of elevated seismicity. Kernel Density Estimator analyses highlight concentrated seismic activity in the Gulfs of Aqaba and Suez. Higher magnitude events are shown to localize in areas of greater tectonic stress, aligning with known geological features. This research provides critical insights into the seismic dynamics of the Red Sea, showcasing the effectiveness of geostatistical techniques in analyzing seismic data in tectonically active regions. [ABSTRACT FROM AUTHOR]