ABSTRACT
We present the case of a 69 year-old gentleman with non-healing ulcers of the bilateral medial malleoli as a result of graft-versus-host disease (GvHD). The patient discussed was diagnosed with stage IV mantle cell lymphoma. Over the course of 4 years the patient was treated with autologous stem cell transplant, later reduced-intensity allogeneic stem cell transplant, and finally donor lymphocyte infusion due to recurrence. Following these therapies, the patient developed extensive GvHD that resulted in bilateral non-healing ulcers of the medial malleoli. The patient was seen in the wound care center, and his ulcers were treated with standard care that included off-loading, minor outpatient debridement, macrovascular assessment, and local moist wound healing. Despite this care, the ulcers failed to heal over a 6 month period. The patient underwent adjunctive hyperbaric oxygen therapy (HBO). He healed both ulcers within a month of completing HBO. It is our goal to discuss the pathophysiologic mechanism of non-healing wounds in the setting of GvHD and discuss the potential role of HBO in their treatment.
ABSTRACT
BACKGROUND: As emergency physicians perform bedside ultrasound with greater frequency, greater numbers of incidental and potentially unfamiliar sonographic findings will be encountered. OBJECTIVES: Illustrate, discuss, and briefly review literature regarding one such finding and diagnosis in right upper quadrant sonography. CASE REPORT: A middle-aged woman was evaluated in the Emergency Department for abdominal pain. Limited bedside sonography of the gallbladder revealed mural thickening and comet-tailing. A diagnosis of adenomyomatosis was made. CONCLUSION: Gallbladder adenomyomatosis can produce ultrasound findings similar to those of more serious and emergent gallbladder diseases. Cognizance of the sonographic details and typical clinical characteristics will allow the emergency physician to appropriately assess and disposition patients with this condition.
Subject(s)
Adenomyoma/diagnostic imaging , Gallbladder Neoplasms/diagnostic imaging , Diagnosis, Differential , Emphysematous Cholecystitis/diagnostic imaging , Female , Humans , Middle Aged , UltrasonographyABSTRACT
The U.S. Department of Health and Human Services Office of the Inspector General has issued a report concerning "high use" and "questionable use" ultrasound. Findings include those geographic areas where occurrences are most frequent, as well as the most common elements that characterize questionable use. While not its primary focus, emergency physician performed bedside ultrasound is within the scope of the report. Implications for emergency ultrasound are discussed and practice recommendations made for minimizing regulatory exposure for emergency physicians and departments.
ABSTRACT
The evolving relationship between emergency and palliative medicine is expected to benefit patients of each. Two collaborative care encounters involving home hospice patients are discussed. Portable bedside ultrasound was performed in the home to diagnose ascites and to guide palliative paracentesis. Specific interventions and outcomes are reported. The interface of emergency and palliative care and the use of paracentesis in cancer palliation are briefly reviewed. It is concluded that home-performed ultrasound and ultrasound-guided procedures are promising palliative modalities for care at the end of life.
Subject(s)
Emergency Medicine/methods , Home Care Services , Hospice Care , Palliative Care/methods , Ultrasonography, Interventional/methods , Adult , Aged, 80 and over , Ascites/diagnostic imaging , Ascites/etiology , Ascites/therapy , Clinical Protocols , Colonic Neoplasms/complications , Female , Humans , Pancreatic Neoplasms/complications , Paracentesis/methods , Patient Care Team/organization & administration , Patient Selection , Point-of-Care SystemsSubject(s)
Pneumothorax/diagnostic imaging , Thoracic Injuries/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Emergency Service, Hospital , Female , Humans , Infant , Internship and Residency , Male , Middle Aged , Prospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed , Ultrasonography , Young AdultSubject(s)
Embolism, Air , Iatrogenic Disease , Medicaid/legislation & jurisprudence , Embolism, Air/diagnosis , Embolism, Air/prevention & control , Humans , Iatrogenic Disease/prevention & control , International Classification of Diseases , Reimbursement Mechanisms/legislation & jurisprudence , United StatesABSTRACT
A pilot study was done to assess the feasibility of using a LAN-based voice communication system to convey physician-patient assignment in the emergency department (ED). Via their communicators, physicians were expected to notify registration staff in real-time upon care assumption of each new patient. Over a two month trial, compliance went from poor to dismal, and this method of notification was abandoned.
Subject(s)
Emergency Service, Hospital/organization & administration , Hospital Communication Systems/organization & administration , Medical Records Systems, Computerized/organization & administration , Personnel Staffing and Scheduling/organization & administration , Telecommunications , Feasibility Studies , New YorkSubject(s)
Adrenergic beta-Antagonists/therapeutic use , Cocaine-Related Disorders/complications , Myocardial Infarction/chemically induced , Adrenergic beta-Antagonists/pharmacology , Adult , Blood Pressure/drug effects , Contraindications , Female , Hospital Mortality , Humans , Male , Middle Aged , Myocardial Infarction/epidemiology , Myocardial Infarction/prevention & control , Selection Bias , Troponin I/bloodABSTRACT
[American College of Emergency Physicians: Clinical policy for procedural sedation and analgesia in the emergency department. Ann Emerg Med May 1998;31:663-677.].
