[BREAKING NEW GROUND: THE EMERGENCY DEPARTMENT IN THE SAMSON ASSUTA ASHDOD UNIVERSITY HOSPITAL - FROM VISION TO REALITY].

INTRODUCTION: In 2017 the Samson Assuta Ashdod University Hospital opened its doors to the public. The opening of a new public hospital presented a unique opportunity to create a fully integrated emergency department, staffed exclusively by emergency medicine physicians, based on the Anglo-American model; the first of its kind in Israel. In this article we describe the model: its establishment, the challenges it presented, the solutions implemented and the interim outcomes.

Correction to: Atypical presentation of hemorrhagic shock in pregnancy: a case highlighting the developing field of emergency medicine in Israel.

The original article [1] contained a misspelling in first author, Baruch Berzon's name which has since been corrected.

Atypical presentation of hemorrhagic shock in pregnancy: a case highlighting the developing field of emergency medicine in Israel.

BACKGROUND: Occult hemorrhagic shock secondary to uterine rupture represents a true obstetric emergency and can result in significant morbidity and mortality for both the patient and the fetus. Multiparity and prior cesarean sections are known risk factors. Typically, these patients present late in gestation, often secondary to the physiologic stresses on the uterus related to contractions. This pathology is less common earlier in pregnancy and can often be overlooked in the acute setting. CASE PRESENTATION: We present the case of a 31-year-old female with three prior gestations, two parities and two prior cesarean sections, resulting in three live births, who presented to the Emergency Department (ED) 22-weeks pregnant with acute onset dyspnea and an episode of syncope. Due to her altered mental status there was concern for occult shock, despite normal vital signs. Large amounts of free fluid in the abdomen were noted on bedside ultrasonography with a high suspicion for uterine pathology. She was resuscitated with blood and taken immediately to the operating room for surgical management where she was found to have had a uterine rupture. CONCLUSION: This case highlights a rare presentation of a well-known obstetric emergency, due to the patient's development of uterine rupture early in gestation. Consequently, emergency physicians should consider atraumatic hypovolemic shock, secondary to this obstetric catastrophe, even at a stage that far precedes its expected presentation. In addition, we make note of how this case validated our department's integrated emergency medicine model, the first in the State of Israel.