Successful Dissolution of a Large Gastric Phytobezoar Through Nonsurgical and Nonendoscopic Fragmentation.

A phytobezoar is the result of poorly digestible vegetable matter that accumulates in the gastrointestinal tract often forming a hard mass in the stomach. We present a case of a phytobezoar in a patient without predisposing risk factors, resulting in significant stomach distension initially believed to require high-risk surgical intervention but which ultimately resolved after 3 days of conservative treatment with prokinetic agents. The patient was discharged uneventfully and was recommended a low-fiber diet indefinitely while undergoing further workup for motility disorders.

Tricuspid Annular Plane of Systolic Excursion (TAPSE) for the Evaluation of Patients with Severe Sepsis and Septic Shock.

INTRODUCTION: Sepsis is a systemic infection that can rapidly progress into multi organ failure and shock if left untreated. Previous studies have demonstrated the utility of point of care ultrasound (POCUS) in the evaluation of patients with sepsis. However, limited data exists on the evaluation of the tricuspid annular plane of systolic excursion (TAPSE) in patients with sepsis. METHODS: We prospectively enrolled patients who presented to the emergency department (ED) with concern for severe sepsis or septic shock in a pilot study. In patients that screened positive, the treating physician then performed POCUS to measure the TAPSE value. We compared the intensive care unit (ICU) admission rate, hospital length of stay, and morbidity with their respective TAPSE values. RESULTS: We enrolled 24 patients in the study. Eight patients had TAPSE values less than 16 millimeters (mm), two patients had TAPSE values between 16mm-20mm, and fourteen patients had TAPSE values greater than 20mm. There was no statistically significant association between TAPSE levels and ICU admission (p=0.16), or death (p=0.14). The difference of length of stay (LOS) was not statistically significant in case of hospital LOS (p= 0.72) or ICU LOS. CONCLUSION: Our pilot data did not demonstrate a correlation between severe sepsis or septic shock and TAPSE values. This may be due to several factors including patient comorbidities, strict definitions of sepsis and septic shock, as well as the absence of septic cardiomyopathy (SCM) in patients with sepsis and septic shock. Future large-scale studies are needed to determine if TAPSE can be beneficial in the ED evaluation of patients with concern for SCM.

Role Of Point Of Care Ultrasound In The Diagnosis Of Retinal Detachment In The Emergency Department.

Ocular complaints represent up to 3% of all emergency department (ED) visits. These presentations can result in permanent vision loss if not promptly diagnosed and treated. Recently, point of care ultrasound (POCUS) has been investigated for the evaluation of ocular pathology in the ED. Multiple studies have investigated the role that ultrasound may play in the early diagnosis of these patients. Ocular ultrasound can be used to visualize the structures of the eye and evaluate for pathology such as retinal detachment, vitreous hemorrhage and vitreous detachment. This comprehensive review aims to present current evidence for the efficacy and reliability of ED ocular ultrasound use in the detection of retinal detachment and additional ocular pathologies.