Comparison of Intubation Using Personal Protective Equipment and Standard Uniform in Simulated Cadaveric Models.

Introduction: The use of personal protection equipment (PPE) for patient care can have an impact on the delivery of effective patient care. The purpose of this study is to examine the effects of basic PPE on intubation times and corresponding success rates in cadaver models. Methods: A prospective crossover design using a single cohort of emergency medicine residents was used for this study. The primary objective is to compare time with intubation in standard uniform (e.g., scrubs without PPE) and using PPE. The secondary objectives are measuring success rates of intubation and the perceived difficulty of intubation when using PPE. Results: The mean time to intubation in the standard uniform group was 18.85 s, whereas the mean time to intubation in the PPE group was 19.29. The overall success rate in the standard uniform group was 83% compared with the PPE group, which was 72%. The perceived difficulty was higher in the PPE group (3.38) when compared with the standard uniform. Conclusion: Although the mean intubation times between the groups were not significantly different, the overall success rate was significantly higher in the standard uniform group when compared with PPE group. The perceived difficulty rating was also noted to be significantly higher in the PPE group when compared with the standard uniform group.

A Case of Delayed Traumatic Vertebral Artery Dissection.

Vertebral artery dissection is of special clinical importance because of its often-delayed presentation and the risk of potentially permanent neurological deficit, or even death, as a result of injury. Once a rarely discovered injury, the better availability and use of computed tomography and magnetic resonance imaging have contributed to an increased incidence. Early diagnosis and treatment can almost eliminate the threat of acute cerebral vascular injury and save lives. In this report, we review a case of delayed traumatic vertebral artery dissection and discuss the key clinical findings and management strategies.

Emergency Department Presentation of Iliopsoas Hematoma in a Severe Hemophiliac.

Severe hemophilia A is defined by factor VIII level of <1%. Limited research and case series show that these patients are at the highest risk for bleeding complications, the most common being hemarthrosis and muscle hematoma, respectively.1 While rare, iliopsoas hematoma carries significant morbidity, mortality, and requires prompt intervention in hemophiliac patients. As such, it is essential the emergency providers evaluate for this condition in this unique patient population. We present the case of 21-year-old male with severe hemophilia A who presented with one day of right groin pain after going without his prophylactic factor VIII infusions for one week, with subsequent diagnosis and initial treatment of iliopsoas hematoma made in the ED.

Immunocompetent, Immunized Male With Mumps, Complicated by Orchitis and Meningitis.

Mumps is a rare pathology often not encountered in the emergency department setting. It is an especially unusual finding in a fully immunized individual. We present a case of a 26-year-old Army active duty male who was evaluated in the emergency department for mumps over the course of two visits. The military population is presumed fully immunized and immunocompetent, travels widely and often lives in close quarters. This case highlights the importance for providers to consider such a disease that carries a risk of significant morbidity, and rarely, mortality. A literature review was performed evaluating mumps in the vaccinated population.

The use of model-based iterative reconstruction to decrease ED radiation exposure.

INTRODUCTION: The radiation risk posed by diagnostic computed tomography (CT) is a growing concern. The use of model-based iterative reconstruction (MBIR) technology reduces radiation exposure but requires additional processing time. The goal of this study was to compare MBIR and a standard CT reconstructive protocols in terms of emergency department (ED) visit duration and reduction in radiation exposure. METHODS: A retrospective, matched, case-control design was used to compare patients who received MBIR and standard protocol abdomen and pelvis CTs. ED length of stay (LOS) and radiation exposure were the 2 primary outcome variables. RESULTS: During the study period, 121 patients met inclusion criteria and were matched to controls for a total of 242 subjects. Although the low-dose group LOS was slightly longer, there was no significant difference in LOS. Mean differences were 18 minutes overall (520 vs 502 minutes; P = .497), 11 minutes for admitted patients (587 vs 576 minutes; P = .839), and 22 minutes for discharged patients (490 vs 468 minutes; P = .482). The mean volume CT dose index for the standard-dose CT was 11.6 ± 8.3 and 7.7 ± 4.6 mGy for the reduced-dose CT, a 34% decrease (P < .001). CONCLUSION: Use of MBIR in the ED may provide decreased radiation exposure while minimally impacting ED LOS.

Rupture of an unscarred uterus in a quadruplet pregnancy.

BACKGROUND: Uterine rupture of an unscarred uterus is a rare complication in a quadruplet pregnancy. CASE: A 30-year-old woman, gravida 4 para 0030, with a quadruplet pregnancy and no previous uterine surgeries presented with moderate vaginal bleeding at 32 4/7 weeks of gestation. Fetal testing was reassuring, and the cervix showed no signs of preterm labor. A decision was made to proceed with cesarean delivery because of the amount of vaginal bleeding, with surgical findings of uterine rupture superior to the lower uterine segment. CONCLUSION: High-order gestations may be an independent risk factor for uterine rupture.