Annals Update 8/7/2012

 

Follow this link from a KP computer or logged in with the RAS to go to the full text articles from MDConsult. Will send this link out with the TOC from now on.

 

http://www.mdconsult.com/das/journallist/issue/352414047-2/32244?issn=0196-0644

Matt


Subject : Fw: What’s new for ‘ANNALS OF EMERGENCY MEDICINE[JOUR]’ in PubMed
PubMed Results

Items 1 – 42 of 42

1.
Ann Emerg Med. 2012 Aug 7. [Epub ahead of print]
Are We Asking the Right Triage Questions?
Pacella CB, Yealy DM.
Source
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA.
PMID: 22883682 [PubMed – as supplied by publisher]
Related citations
2.
Department of Medicine, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA.

Abstract

Safety experts and national guidelines recommend disclosing harmful medical errors to patients. Communicating with patients and families about errors respects their autonomy, supports informed decisionmaking, may decrease malpractice costs, and can enhance patient safety. Yet existing disclosure guidelines may not account for the difficulty in discussing out-of-hospital errors with patients. Emergency medical services (EMS) providers operate in unpredictable environments that require rapid interventions for patients with whom they have only brief relationships. EMS providers also have limited access to patient medical data and risk management resources, which can make conducting disclosure conversations even more difficult. In addition, out-of-hospital errors may be discovered only after the transition of care to the inpatient setting, further complicating the question of who should disclose the error. EMS organizations should support the disclosure of out-of-hospital errors by fostering a nonpunitive culture of error reporting and disclosure, as well as developing guidelines for use by EMS systems.
Copyright © 2012. Published by Mosby, Inc.
PMID: 22883681 [PubMed – as supplied by publisher]
Related citations
3.
Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Abstract
STUDY OBJECTIVE:

We aim to evaluate the accuracy of the broad-range 16S polymerase chain reaction test in the diagnosis of bacterial meningitis through a systematic review and meta-analysis.

METHODS:

We searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Registry, using the Medical Subject Headings terms “polymerase chain reaction,” “RNA, ribosomal, 16S,” and “bacterial meningitis.” For our primary analysis, we examined the 16S polymerase chain reaction in culture-proven bacterial meningitis. In ancillary observations, we included studies of culture-negative presumed bacterial meningitis, in which there was high clinical suspicion for bacterial meningitis despite negative cerebrospinal fluid culture results. We extracted information necessary to calculate sensitivity and specificity and used bivariate hierarchic modeling meta-analysis methods to obtain pooled statistics. We also estimated potential sources of error and bias such as between-study heterogeneity and publication bias.

RESULTS:

Fourteen of 299 studies met inclusion criteria for culture-proven bacterial meningitis; 448 (16.1%) of 2,780 subjects had positive cerebrospinal fluid culture results. Pooled analysis demonstrated a sensitivity of 92% (95% confidence interval [CI] 75% to 98%), specificity of 94% (95% CI 90% to 97%), positive likelihood ratio of 16.26 (95% CI 9.07 to 29.14), and negative likelihood ratio of 0.09 (95% CI 0.03 to 0.28) for culture-proven bacterial meningitis. The polymerase chain reaction test result was also positive in 30% of cases of culture-negative presumed bacterial meningitis. There was significant heterogeneity between studies.

CONCLUSION:

This meta-analysis supports the role of 16S ribosomal ribonucleic acid polymerase chain reaction as a diagnostic tool in bacterial meningitis. With further refinements in technology, the polymerase chain reaction test has the potential to become a useful adjunct in the diagnosis of bacterial meningitis in the emergency department.
Copyright © 2012. Published by Mosby, Inc.
PMID: 22883680 [PubMed – as supplied by publisher]
Related citations
4.
Ann Emerg Med. 2012 Jul 27. [Epub ahead of print]
Is Water Effective for Wound Cleansing?
Cooper DD, Seupaul RA.
Source
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.
PMID: 22841710 [PubMed – as supplied by publisher]
Related citations
5.
Perelman School of Medicine at the University of Pennsylvania, Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
PMID: 22841709 [PubMed – as supplied by publisher]
Related citations
6.
Arizona Emergency Medicine Research Center, Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ.
PMID: 22841182 [PubMed – as supplied by publisher]
Related citations
7.
Pardee RAND Graduate School, RAND Corporation, Santa Monica, CA.
PMID: 22841181 [PubMed – as supplied by publisher]
Related citations
8.
Ann Emerg Med. 2012 Jul 26. [Epub ahead of print]
Clinical Decisions for Pediatric Fever-Still a Hot Mess?
Moran GJ.
Source
Department of Emergency Medicine and Division of Infectious Diseases, Olive View-UCLA Medical Center, Sylmar, CA.
PMID: 22841180 [PubMed – as supplied by publisher]
Related citations
9.
Children’s Mercy Hospitals and Clinics and the Department of Pediatrics, University of Missouri, Kansas City School of Medicine, Kansas City, MO; Children’s Mercy Hospitals and Clinics and the Department of Emergency Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, MO.
PMID: 22841179 [PubMed – as supplied by publisher]
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10.
Ann Emerg Med. 2012 Jul 26. [Epub ahead of print]
How Accurate Is Ultrasonography for Excluding Pneumothorax?
Raja AS, Jacobus CH.
Source
Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.
PMID: 22841178 [PubMed – as supplied by publisher]
Related citations
11.
Ann Emerg Med. 2012 Jul 26. [Epub ahead of print]
How Accurate Are Rapid Influenza Diagnostic Tests?
Jacobus CH, Raja AS.
Source
Department of Emergency Medicine, Central Michigan University College of Medicine, Saginaw, MI.
PMID: 22841177 [PubMed – as supplied by publisher]
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12.
Division of Emergency Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, MA.

Abstract
STUDY OBJECTIVE:

Advanced imaging with computed tomography (CT) or ultrasonography is frequently used to evaluate for appendicitis. The duration of the abdominal pain may be related to the stage of disease and therefore the interpretability of radiologic studies. Here, we investigate the influence of the duration of pain on the diagnostic accuracy of advanced imaging in children being evaluated for acute appendicitis.

METHODS:

A secondary analysis of a prospective multicenter observational cohort of children aged 3 to 18 years with suspected appendicitis who underwent CT or ultrasonography was studied. Outcome was based on histopathology or telephone follow-up. Treating physicians recorded the duration of pain. Imaging was coded as positive, negative, or equivocal according to an attending radiologist’s interpretation.

RESULTS:

A total of 1,810 children were analyzed (49% boys, mean age 10.9 years [SD 3.8 years]); 1,216 (68%) were assessed by CT and 832 (46%) by ultrasonography (238 [13%] had both). The sensitivity of ultrasonography increased linearly with increasing pain duration (test for trend: odds ratio=1.39; 95% confidence interval 1.14 to 1.71). There was no association between the sensitivity of CT or specificity of either modality with pain duration. The proportion of equivocal CT readings significantly decreased with increasing pain duration (test for trend: odds ratio=0.76; 95% confidence interval 0.65 to 0.90).

CONCLUSION:

The sensitivity of ultrasonography for appendicitis improves with a longer duration of abdominal pain, whereas CT demonstrated high sensitivity regardless of pain duration. Additionally, CT results (but not ultrasonographic results) were less likely to be equivocal with longer duration of abdominal pain.
Copyright © 2012. Published by Mosby, Inc.
PMID: 22841176 [PubMed – as supplied by publisher]
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13.
Ann Emerg Med. 2012 Jul 26. [Epub ahead of print]
Don’t Hyperventilate Over Triage Respiratory Rates.
Cooper RJ, Green SM.
Source
UCLA Emergency Medicine Center, Los Angeles, CA.
PMID: 22841175 [PubMed – as supplied by publisher]
Related citations
14.
Cincinnati Children’s Hospital Medical Center, Division of Emergency Medicine, Cincinnati, OH.

Abstract
STUDY OBJECTIVE:

We seek to provide current, comprehensive, and physician-level data for critical procedures performed in a high-volume pediatric emergency department (ED).

METHODS:

We conducted a retrospective study of all critical procedures performed in the ED of a tertiary care pediatric institution. Data were collected from written records of resuscitative care provided. The primary outcome measure was the cumulative frequency of each critical procedure during 12 consecutive months. Additional outcome measures included the number of critical procedures performed by pediatric emergency medicine faculty and fellows and a description of the other physician types performing each procedure.

RESULTS:

Two hundred sixty-one critical procedures were performed during 194 patient resuscitations, which represented 0.22% of all ED patient evaluations. Sixty-one percent of pediatric emergency medicine faculty did not perform a single critical procedure. Orotracheal intubation occurred 147 times and represented 56% of all critical procedures, yet 63% of pediatric emergency medicine faculty did not perform a single successful orotracheal intubation. Pediatric emergency medicine fellows performed a median of 3 critical procedures.

CONCLUSION:

Critical procedures were rarely performed in a large, academic pediatric ED. Pediatric emergency medicine faculty are at significant risk for skill deterioration, and pediatric emergency medicine fellows are unlikely to achieve competence in the performance of critical procedures if clinical exposure is the sole basis for the attainment and maintenance of skill.
Copyright © 2012. Published by Mosby, Inc.
PMID: 22841174 [PubMed – as supplied by publisher]
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15.
Department of Pediatrics, CHU Sainte-Justine.

Abstract
STUDY OBJECTIVE:

We evaluate the association between triage levels assigned using the Canadian Triage and Acuity Scale and surrogate markers of validity for real-life children triaged in multiple emergency departments (EDs).

METHODS:

This was a retrospective cohort study evaluating the triage assessment and outcomes of all children presenting to 12 pediatric EDs, all of which are members of the Pediatric Emergency Research Canada group, during a 1-year period (2010 to 2011). Anonymous data were retrieved from the ED computerized databases. The primary outcome measure was the proportion of children hospitalized for each triage level. Other outcomes were ICU admission, proportion of patients who left without being seen by a physician, and length of stay in the ED. Evaluation of all children visiting these EDs during 1 year was expected to provide more than 1,000 patients in each triage category.

RESULTS:

A total of 550,940 children were included. Pooled data demonstrated hospitalization proportions of 61%, 30%, 10%, 2%, and 0.9% for patients in Canadian Triage and Acuity Scale levels 1, 2, 3, 4, and 5, respectively. There was a strong association between triage level and admission to the ICU, probability of leaving without being seen by a physician, and length of stay.

CONCLUSION:

The strong association between triage level and multiple markers of severity in 12 Canadian pediatric EDs suggests validity of the Canadian Triage and Acuity Scale for children.
Copyright © 2012. Published by Mosby, Inc.
PMID: 22841173 [PubMed – as supplied by publisher]
Related citations
16.
Seattle Children’s Hospital and Seattle Children’s Research Institute, Seattle, WA; University of Washington, Seattle, WA.

Abstract
STUDY OBJECTIVE:

This study aimed to compare test characteristics of standard (lateral and posteroanterior or anteroposterior) chest radiographs with and without special views (expiratory or bilateral decubitus) in the emergency department evaluation of children with suspected airway foreign bodies.

METHODS:

From 1997 to 2008, 328 patients with a suspected airway foreign body had standard and special view chest radiographs: 192 with left and right decubitus views, 133 with expiratory views, and 3 with both. Patients were excluded for cardiorespiratory disease, chest wall deformity, visible airway foreign bodies on standard views, or spontaneously expelled airway foreign bodies. After blinded radiologist review, standard plus special view test characteristics were compared to standard views.

RESULTS:

Nine upper airway and 70 tracheobronchial airway foreign bodies were identified by direct visualization or bronchoscopy, and the remainder were ruled out by bronchoscopy (50 patients) or clinically (199 patients). The sensitivity and specificity of the radiographs were, respectively, decubitus cohort, standard views, 56% and 79% and standard+decubitus views, 56% and 64%; expiratory radiograph cohort, standard views, 33% and 70% and standard+expiratory views, 62% and 72%. For standard plus decubitus views versus standard views alone, the relative sensitivity was 1.0 (0.56/0.56; 95% confidence interval [CI] 0.81 to 1.23) and the relative 1-specificity was 1.76 (0.36/0.21; 95% CI 1.3 to 2.37). For standard plus expiratory views versus standard views alone, the relative sensitivity was 1.87 (0.62/0.33; 95% CI 1.23 to 2.83) and the relative 1-specificity was 0.93 (0.28/0.3; 95% CI 0.6 to 1.44).

CONCLUSION:

The addition of decubitus to standard views increases false positives without increasing true positives and lacks clinical benefit. The addition of expiratory to standard views increases true positives without increasing false positives, but test accuracy remains low and the clinical benefit is uncertain.
Copyright © 2012. Published by Mosby, Inc.
PMID: 22841172 [PubMed – as supplied by publisher]
Related citations
17.
Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Turin, Italy.
PMID: 22818385 [PubMed – in process]
Related citations

 

18. Ann Emerg Med. 2012 Aug;60(2):249-50.
Trauma care systems development, evaluation, and funding.
[No authors listed]
PMID: 22818384 [PubMed – in process]
Related citations

 

19. Ann Emerg Med. 2012 Aug;60(2):249.
Subspecialty certification in critical care medicine.
[No authors listed]
PMID: 22818383 [PubMed – in process]
Related citations

 

20. Ann Emerg Med. 2012 Aug;60(2):249.
Nondiscrimination and harassment.
[No authors listed]
PMID: 22818382 [PubMed – in process]
Related citations
21.
Ann Emerg Med. 2012 Aug;60(2):246.
Stroke mimics and intravenous thrombolysis.
Durston W.
Source
Emergency Department, Kaiser Foundation Hospital, Sacramento, CA.
PMID: 22818381 [PubMed – in process]
Related citations
22.
Ann Emerg Med. 2012 Aug;60(2):246-7.
In reply.
Artto V, Putaala J, Strbian D, Meretoja A, Häppölä O, Kaste M, Tatlisumak T.
Source
Helsinki University Central Hospital, Helsinki, Finland.
PMID: 22818380 [PubMed – in process]
Related citations
23.
Ann Emerg Med. 2012 Aug;60(2):245-6.
In reply.
Gupta M, Schriger DL, Hoffman JR, Baraff LJ, Hiatt JR, Cryer HG, Tillou A.
Source
UCLA Emergency Medicine Center, School of Medicine, University of California, Los Angeles, CA.
PMID: 22818379 [PubMed – in process]
Related citations
24.
Department of Emergency Medicine, University of Virginia, Charlottesville, VA.
PMID: 22818378 [PubMed – in process]
Related citations
25.
Department of Radiology, 167 Military Hospital, Pathankot, Punjab, India.
PMID: 22818377 [PubMed – in process]
Related citations
26.
Ann Emerg Med. 2012 Aug;60(2):243-4.
In reply.
Fields JM, Hennessey A, Setyono DA, Lau WB.
Source
Thomas Jefferson University Hospital, Department of Emergency Medicine, Philadelphia, PA.
PMID: 22818376 [PubMed – in process]
Related citations
27.
Ann Emerg Med. 2012 Aug;60(2):242-3.
Don’T forget the 99%.
Andruchow JE, Schuur JD, Raja AS, Kabrhel C.
Source
Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, MA.
PMID: 22818375 [PubMed – in process]
Related citations
28.
Ann Emerg Med. 2012 Aug;60(2):241-50.
Man with nausea and vomiting.
Chen YG, Dai MS.
Source
Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
PMID: 22818374 [PubMed – in process]
Related citations
29.
Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, NY.
PMID: 22818373 [PubMed – in process]
Related citations
30.
Ann Emerg Med. 2012 Aug;60(2):235.
My mistake.
Veysman BD.
Source
Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ.
PMID: 22818372 [PubMed – in process]
Related citations
31.
Ann Emerg Med. 2012 Aug;60(2):232-4.
Commentary: preventable injury and a trauma system near you.
Kahn C.
Source
Department of Emergency Medicine, University of California, San Diego, CA.
PMID: 22818371 [PubMed – in process]
Related citations
32.
Department of Emergency Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Manhasset, NY.
PMID: 22818370 [PubMed – in process]
Related citations
33.
Division of Emergency Medicine, Division of Critical Care, Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO.
PMID: 22818369 [PubMed – in process]
Related citations
34.
Ann Emerg Med. 2012 Aug;60(2):212-4.
There is oligo-evidence for oligoanalgesia.
Green SM.
Source
Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, CA.
PMID: 22818368 [PubMed – in process]
Related citations
35.
Division of Emergency Medicine, University of Utah, Salt Lake City, UT.

Abstract
STUDY OBJECTIVE:

The aim of this study is to compare the pain management practices in geriatric patients in the emergency department (ED) with that in other adult ED patients to determine whether these patients face increased risk of oligoanalgesia.

METHODS:

This study was a prospective analysis of a convenience sample of patients presenting to an urban academic tertiary care hospital ED from 2000 through 2010. We compared patients aged 65 years and older (geriatric) with adults younger than 65 years and evaluated analgesic administration rates, opioid administration and dosing, and pain and satisfaction scores (0 to 10 scale).

RESULTS:

A total of 15,387 patients presented to the ED during the 10-year study period and agreed to participate in the study; 1,169 patients were geriatric (7.6%). Geriatric patients had a mean age of 75.0 years (SD 7.2 years), whereas mean age of the 14,218 nongeriatric patients was 35.5 years (SD 12.2 years). Geriatric patients reported less pain at presentation (6.2 versus 6.9). After adjusting for presentation pain scores, geriatric patients were not less likely to receive an analgesic during the ED visit (odds ratio 0.90; 95% confidence interval 0.78 to 1.05) or less likely to receive an opioid (odds ratio 1.01; 95% confidence interval 0.87 to 1.18). Geriatric patients, on average, received lower doses of morphine (3.3 versus 4.2 mg) and had longer waiting times for their initial dose of an analgesic medication (65 versus 75 minutes).

CONCLUSION:

Despite longer wait times for analgesia, geriatric and nongeriatric patients were similar in rates of analgesia and opioid administration for pain-related complaints. These findings contrast with previous studies reporting lower rates of analgesia administration among geriatric patients.
Copyright © 2012. Published by Mosby, Inc.
PMID: 22818367 [PubMed – in process]
Related citations
36.
Department of Emergency Medicine, Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO.
PMID: 22818366 [PubMed – in process]
Related citations

 

37. Ann Emerg Med. 2012 Jun;59(6):494-5.
Driver electronic device use in 2010.
National Highway Traffic Safety Administration.
Comment in

PMID: 22799000 [PubMed – indexed for MEDLINE]
Related citations
38.
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.

Abstract

This article introduces a novel framework that classifies emergency department (ED) visits according to broad categories of severity, identifying those categories of visits that present the most potential for reducing costs associated with the ED. Although cost savings directly attributable to the ED are apt to be an important emphasis of organizations operating under reformed payment systems, our framework suggests that a focus on diverting low-acuity visits away from the ED would result in far less savings compared with strategies aimed at reducing admissions and to a lesser extent improving the efficiency of ED care for intermediate or complex conditions. We conclude that targeting these categories, rather than minor injuries/illnesses, should be the primary focus of cost-reduction strategies from the ED. Given this understanding, we then discuss the implications of these findings on the financing of an emergency care system that needs to account for the required fixed costs of “stand-by capacity” of the ED and explore ways in which the ED can be better integrated into a patient-centered health care system.
Copyright © 2012. Published by Mosby, Inc.
PMID: 22795188 [PubMed – as supplied by publisher]
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39. Ann Emerg Med. 2012 Jul 6. [Epub ahead of print]
Hospital Administrators’ Views on Barriers and Opportunities to Delivering Palliative Care in the Emergency Department.
Grudzen CR, Richardson LD, Major-Monfried H, Kandarian B, Ortiz JM, Morrison RS.
Source
Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY; Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY.Abstract
STUDY OBJECTIVE:

We identify hospital-level factors from the administrative perspective that affect the availability and delivery of palliative care services in the emergency department (ED).

METHODS:

Semistructured interviews were conducted with 14 key informants, including hospital executives, ED directors, and palliative care directors at a tertiary care center, a public hospital, and a community hospital. The discussions were digitally recorded and transcribed to conduct a thematic analysis using grounded theory. A coding scheme was iteratively developed to subsequently identify themes and subthemes that emerged from the interviews.

RESULTS:

Barriers to integrating palliative care and emergency medicine from the administrative perspective include the ED culture of aggressive care, limited knowledge, palliative care staffing, and medicolegal concerns. Incentives to the delivery of palliative care in the ED from these key informants’ perspective include improved patient and family satisfaction, opportunities to provide meaningful care to patients, decreased costs of care for admitted patients, and avoidance of unnecessary admissions to more intensive hospital settings, such as the ICU, for patients who have little likelihood of benefit.

CONCLUSION:

Though hospital administration at 3 urban hospitals on the East coast has great interest in integrating palliative care and emergency medicine to improve quality of care, patient and family satisfaction, and decrease length of stay for admitted patients, palliative care staffing, medicolegal concerns, and logistic issues need to be addressed.

Copyright © 2012. Published by Mosby, Inc.
PMID: 22771203 [PubMed – as supplied by publisher]
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40. Ann Emerg Med. 2012 Jul 2. [Epub ahead of print]
The Use of Therapeutic Hypothermia After Cardiac Arrest in a Pregnant Patient.
Chauhan A, Musunuru H, Donnino M, McCurdy MT, Chauhan V, Walsh M.
Source
Indiana University School of Medicine, South Bend, IN; Department of Emergency Medicine, Memorial Hospital, South Bend, IN; Cardiology Associates, Inc, South Bend, IN.Abstract

Therapeutic hypothermia is an effective intervention for the postresuscitative care of patients who have sustained a cardiac arrest. There has been only 1 documented case of successful resuscitation of a pregnant patient and fetus with therapeutic hypothermia, with an abbreviated developmental follow-up of the child. A 33-year-old woman in her 20th week of pregnancy presented to our emergency department after experiencing a cardiac arrest. After successful resuscitation and a discussion with a multidisciplinary team about expected outcomes, the mother and fetus were successfully treated with therapeutic hypothermia, and a healthy baby was delivered 19 weeks later. The mother’s cardiac and neurologic function was normal 36 months after the arrest, and the child has reached all growth and neurodevelopmental milestones. We present a case demonstrating excellent immediate and long-term maternal-fetal neurologic, cardiac, and developmental outcomes after the use of therapeutic hypothermia after cardiac arrest in a pregnant patient.

Copyright © 2012. Published by Mosby, Inc.
PMID: 22762909 [PubMed – as supplied by publisher]
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41. Ann Emerg Med. 2012 Jul 2. [Epub ahead of print]
Emergency Bedside Sonographic Diagnosis of Subclavian Artery Pseudoaneurysm With Brachial Plexopathy After Clavicle Fracture.
Gullo J, Singletary EM, Larese S.
Source

Department of Emergency Medicine, University of Virginia, Charlottesville, VA.

Abstract

Clavicle fractures are common; however, complications are unusual. Two such complications, subclavian artery pseudoaneurysm and brachial plexopathy, are rare events that can cause significant morbidity and mortality. We report the case of a 53-year-old man who presented with shoulder swelling and right arm weakness for 1 week. Three weeks before, he had fallen and fractured his right clavicle. On presentation to our emergency department, his examination revealed a brachial plexopathy and a large supraclavicular mass. An emergency bedside triplex sonogram was performed to characterize the mass and revealed a swirling pattern within a fluid collection anterior to the subclavian artery, suggestive of a pseudoaneurysm. After computed tomography-angiography, the patient was taken to the operating room, where he underwent hematoma washout and subclavian artery stent-graft placement. This case illustrates how bedside point-of-care sonography can rapidly assist in the initial assessment of subclavian artery injury.

Copyright © 2012. Published by Mosby, Inc.
PMID: 22762908 [PubMed – as supplied by publisher]
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42. Ann Emerg Med. 2012 Jul 2. [Epub ahead of print]
Thought-Provoking Assumptions.
Schenkel SM.
Source
Department of Emergency Medicine, University of Maryland School of Medicine, and the Department of Emergency Medicine, Mercy Medical Center, Baltimore, MD.
PMID: 22762907 [PubMed – as supplied by publisher]
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