Search

Introduction: The perforation of a cecal diverticulum is a rare and challenging condition for the emergency physician.Case Report: A 47-year-old man with a past surgical history of bilateral inguinal hernia repair presented to the emergency department (ED) with acute abdominal pain of three days’ duration. Pain was localized to the right lower quadrant (RLQ), with anorexia as the only associated symptom. Upon arrival to the ED, his exam demonstrated focal RLQ tenderness to palpation, rebound tenderness, and guarding. Labs did not show any elevation in inflammatory markers, liver enzymes, or lipase. Computed tomography showed no evidence of acute appendicitis, colitis, or hernia recurrence. After morphine and reassessment, the patient still had a focal peritoneal exam in the RLQ. Surgical consultation was obtained and recommended additional non-opioid analgesia as well as serial abdominal exams. After several repeat abdominal exams, there was no change in the focality of the patient’s pain. Surgery was reconsulted and opted to take the patient to the operating room for exploratory laparoscopy with “appendicitis” as the presumptive diagnosis. Pathology report revealed a perforated cecal diverticulum that was adherent to the abdominal wall. The patient did well and was discharged on his third postoperative day.Conclusion: This case further underlines that even in the era of sensitive imaging tools, the diagnostic value of a targeted physical exam with clinical re-evaluation can never be overestimated.

Dabigatran etexilate mesylate is a direct thrombin inhibitor used for reducing the risk of stroke andsystemic embolism in patients with non-valvular atrial fibrillation. Dabigatran belongs to a new generationof oral agents for anticoagulation – the direct oral anticoagulants (DOACs). The DOACs also includethe factor Xa inhibitors rivaroxaban, apixaban, and edoxaban. In the case of major or life-threateningbleeding and/or the need for emergent invasive procedures, a reversal agent is needed if a patient istaking one of these medications. Research has shown the efficacy of idarucizumab as an antidote inhealthy volunteers, but data in the case of life-threatening bleeds remains limited. We report a caseof a patient who suffered a traumatic subarachnoid hemorrhage and received effective treatment withidarucizumab. Along with other reports, our case demonstrates that dabigatran-related major and/orlife-threatening bleeds may be effectively counteracted by idarucizumab. This provides an option toemergency department providers in managing clinically significant bleeds in patients taking dabigatran.

Background: There is a growing movement to increase palliative care consults from the emergency department (ED) to reduce healthcare costs and improve quality of life. The surprise question is a screening tool that emergency medicine physicians may be able to use towards achieving this goal.Objective: The objectives of this study were to increase awareness of hospice and palliative care medicine (HPM) among emergency medicine (EM) providers and to evaluate whether this heightened awareness increased palliative care consults among participating emergency medicine providers.Methods: We conducted an anonymous convenience sample survey and two educational interventions about HPM including the surprise question among emergency medicine resident and attending physicians at a large urban public academic quaternary care center from July to November 2018. A report of palliative care consults ordered between August 1, 2017 and January 1, 2019 was generated from the electronic health records used by the hospital. The number of palliative care consults made before and after the educational intervention was compared.Results: After the first educational intervention centered on the surprise question, palliative care consults from the ED increased from an average of 2.25 per month (range 0 to 8, SD: 2.38) to 12.67 per month (range 9 to 19, SD: 4.01, p < .001).Conclusion: Educating EM physicians about the surprise question can increase the number of palliative care consults from the ED, thereby potentially improving patient care and decreasing costs by avoiding unwanted healthcare interventions. [ABSTRACT FROM AUTHOR]

Describes how the urothelial cell differentiation marker, uroplakin IIIb dimerizes with uroplakin Ib as an early step of urothelial plaque assembly. Extracellular juxtamembrane stretch of amino acids; DNA mismatch repair enzyme-related protein; Transmembrane topology.

En: Although infection rates and the impact of infection on hospital emergency departments (EDs) are known or can be reliably estimated, the incidence and prevalence of sepsis vary in relation to which definitions or registers used. Sepsis is also well known to be under-diagnosed by physicians in general and by ED physicians in particular. Over half of sepsis cases are community-acquired, and 50% to 60% of patients in intensive care units (ICUs) with sepsis or septic shock are admitted directly from the ED. Pneumonia and urinary tract infections are the most common points of focus in sepsis, septic shock, bacteremia, and ED admissions to the ICU for infectious processes. For this article a multinational group of experts representing Latin American emergency medicine associations reviewed and analyzed similarities and differences in the epidemiology of sepsis in different geographic locations. We consider key aspects and geographic similarities and differences in the early identification of patients with severe sepsis; criteria that define the diagnosis; appropriate early antibiotic and fluid therapy; the roles of triage systems and multidisciplinary sepsis code units; and the use of biological markers in this time-dependent disease. We also discuss key points and strategies for improving the diagnosis, prognosis, and care of sepsis patients in the ED.