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This paper describes an alternative approach to emergency burr hole evacuation of epidural hematoma using the intraosseous (IO) vascular access system. The IO vascular access system is commonly available in the Emergency Department. We demonstrate that it can be used in rare situations where immediate neurosurgical intervention and the standard cranial drill and brace are not available for burr hole craniostomy.
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The authors of this article report on a case of a patient who presented to the emergency department (ED) in anaphylaxis after receiving the Moderna® COVID-19 vaccine. The patient was hypoxic, with diffuse wheezing bilaterally to auscultation, flush skin, swollen face, and the feeling of her throat closing. Anaphylaxis can have wide range of presentation, the key is recognizing the symptoms and treating early. The incidence of anaphylaxis from COVID-19 vaccine is not well documented to date.
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The authors report a case of a middle-aged female presenting with a chief complaint of shoulder pain. Workup revealed a non-ST-segment elevation myocardial infarction. The typical symptoms of myocardial infarction and the evaluation of a non-ST-segment elevation myocardial infarction are discussed. The authors highlight the sex-based differences in the presentation of myocardial infarction and remind us to keep a broad differential and consider atypical presentations.
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BACKGROUND: Rapid identification of patients with occult injury and illness in the emergency department can be difficult. Transcutaneous carbon dioxide (TCO2) and oxygen (TO2) measurements may be non-invasive surrogate markers for the identification of such patients. OBJECTIVES: To determine if TCO2 or TO2 are useful adjuncts for identifying severe illness and the correlation between TCO2, lactate, and end tidal carbon dioxide (ETCO2). METHODS: Prospective TCO2 and TO2 measurements at a tertiary level 1 trauma center were obtained using a transcutaneous sensor on 300 adult patients. Severe illness was defined as death, intensive care unit (ICU) admission, bilevel positive airway pressure, vasopressor use, or length of stay >2 days. TCO2 and TO2 were compared to illness severity using t tests and correlation coefficients. RESULTS: Mean TO2 did not differ between severe illness (58.9, 95% CI 54.9-62.9) and non-severe illness (58.0, 95% CI 54.7-61.1). Mean TCO2 was similar between severe (34.6, 95% CI 33-36.2) vs non-severe illness (35.9, 95% CI 34.7-37.1). TCO2 was 28.7 (95% CI 24.0-33.4) for ICU vs. 35.9 (95% CI 34.9-36.9) for non-ICU patients. The mean TCO2 in those with lactate > 2.0 was 29.8 (95% CI 25.8-33.8) compared with 35.7 (95% CI 34.9-36.9) for lactate < 2.0. TCO2 was not correlated with ETCO2 (r = 0.32, 95% CI 0.22-0.42). CONCLUSION: TCO2 could be a useful adjunct for identifying significant injury and illness and patient outcomes in an emergency department (ED) population. TO2 did not predict severe illness. TCO2 and ETCO2 are only moderately correlated, indicating that they are not equivalent and may be useful under different circumstances.
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Pityriasis rosea is a common skin condition that mainly affects people in their mid to late 20s. The disease commonly begins with the presentation of a herald patch, followed by the spreading of smaller lesions. The authors of this case look at a school-age male child with pityriasis rosea that originated on his back and spread to his chest, legs, arms, and buttocks. The age of this child falls below the expected range of pityriasis rosea patients. On his back, there are multiple herald patches at which the rash originated, which is significantly less common than a single herald patch.
