Metformin-Associated Lactic Acidosis Presenting Like Acute Mesenteric Ischemia.

BACKGROUND: Metformin-associated lactic acidosis is a rare but serious complication of taking metformin. Making the diagnosis in the emergency department requires vigilance because the presentation can mimic other diseases. CASE REPORT: We present a case of a patient with diabetes who presented moribund with symptoms and signs consistent with mesenteric ischemia. This diagnosis was seemingly confirmed through computed tomography, and as a result the patient was brought to surgery for emergent exploratory laparotomy. Our patient made a remarkable recovery upon initiation of hemodialysis, demonstrating the need to initiate this life-saving procedure early. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Metformin levels are rarely available in the setting of the emergency department. Clinicians must remain alert, recognize that imaging studies may be misleading, and consider hemodialysis early in addition to surgical interventions.

The prevalence of lesbian, gay, bisexual, and transgender health education and training in emergency medicine residency programs: what do we know?

BACKGROUND: The Institute of Medicine, The Joint Commission, and the U.S. Department of Health and Human Services all have recently highlighted the need for cultural competency and provider education on lesbian, gay, bisexual, and transgender (LGBT) health. Forty percent of LGBT patients cite lack of provider education as a barrier to care. Only a few hours of medical school curriculum are devoted to LGBT education, and little is known about LGBT graduate medical education. OBJECTIVES: The objective of this study was to perform a needs assessment to determine to what degree LGBT health is taught in emergency medicine (EM) residency programs and to determine whether program demographics affect inclusion of LGBT health topics. METHODS: An anonymous survey link was sent to EM residency program directors (PDs) via the Council of Emergency Medicine Residency Directors listserv. The 12-item descriptive survey asked the number of actual and desired hours of instruction on LGBT health in the past year. Perceived barriers to LGBT health education and program demographics were also sought. RESULTS: There were 124 responses to the survey out of a potential response from 160 programs (response rate of 78%). Twenty-six percent of the respondents reported that they have ever presented a specific LGBT lecture, and 33% have incorporated topics affecting LGBT health in the didactic curriculum. EM programs presented anywhere from 0 to 8 hours on LGBT health, averaging 45 minutes of instruction in the past year (median = 0 minutes, interquartile range [IQR] = 0 to 60 minutes), and PDs support inclusion of anywhere from 0 to 10 hours of dedicated time to LGBT health, with an average of 2.2 hours (median = 2 hours, IQR = 1 to 3.5 hours) recommended. The majority of respondents have LGBT faculty (64.2%) and residents (56.2%) in their programs. The presence of LGBT faculty and previous LGBT education were associated with a greater number of desired hours on LGBT health. CONCLUSIONS: The majority of EM residency programs have not presented curricula specific to LGBT health, although PDs desire inclusion of these topics. Further curriculum development is needed to better serve LGBT patients.

Evidence-Based Management Of Acute Hand Injuries In The Emergency Department.

Although injuries of the hand are infrequently life-threatening, they are common in the emergency department and are associated with significant patient morbidity and medicolegal risk for physicians. Care of patients with acute hand injury begins with a focused history and physical examination. In most clinical scenarios, a diagnosis is achieved clinically or with plain radiographs. While most patients require straightforward treatment, the emergency clinician must rapidly identify limb-threatening injuries, obtain critical clinical information, navigate diagnostic uncertainty, and facilitate specialist consultation, when required. This review discusses the clinical evaluation and management of high-morbidity hand injuries in the context of the current evidence.

Healthcare-associated pneumonia in the emergency department.

Emergency medicine clinicians frequently diagnose and treat patients with pneumonia. The recent recognition of healthcare-associated pneumonia (HCAP) mandates that emergency medicine clinicians remain current and able to distinguish this from community-acquired pneumonia. This article reviews the diagnosis and management of HCAP from the perspective of the emergency medicine clinician.

The AIDS patient with abdominal pain: a new challenge for the emergency physician.

As the prevalence of HIV infection continues to increase, EPs will be called upon to evaluate increasing numbers of AIDS patients who have abdominal pain, some of whom will require emergent surgical intervention. In addition to the myriad causes of abdominal pain in the nonimmunocompromised patient, the differential diagnosis in the AIDS patient includes a wide variety of opportunistic infections and neoplasms (Table 5). Evaluation frequently requires extensive laboratory studies and cultures and advanced imaging (CT, ultrasound, and so forth). A low threshold for surgical and other subspecialty consultation should be in place because of the often subtle presentation of surgical emergencies in AIDS patients.