An unusual case of bilateral anterior shoulder dislocations.

A 23-year-old man was transported to a trauma center after injuring himself while snowboarding. He presented with bilateral shoulder pain and associated deformity to both shoulders. His exam was otherwise unremarkable, and his x-rays confirmed bilateral shoulder dislocations. Cunningham and external rotation without sedation and analgesia techniques were unsuccessful even with local anesthesia to the joint. Subsequent bilateral reduction was successful with moderate sedation using the Milch technique. Simultaneous anterior bilateral shoulder dislocations are rare and providers may need to adjust their techniques to accommodate this unusual presentation

An unusual case of bilateral anterior shoulder dislocations

A 23-year-old man was transported to a trauma center after injuring himself while snowboarding. He presented with bilateral shoulder pain and associated deformity to both shoulders. His exam was otherwise unremarkable, and his x-rays confirmed bilateral shoulder dislocations. Cunningham and external rotation without sedation and analgesia techniques were unsuccessful even with local anesthesia to the joint. Subsequent bilateral reduction was successful with moderate sedation using the Milch technique. Simultaneous anterior bilateral shoulder dislocations are rare and providers may need to adjust their techniques to accommodate this unusual presentation

Prevalence of Homelessness by Gender in an Emergency Department Population in Pennsylvania.

Context: According to the US Department of Housing and Urban Development, nearly 1.5 million people spend at least 1 night in an emergency shelter or transitional housing each year, and more than 500,000 people are homeless on a given night in the United States. To our knowledge, limited data exist regarding the prevalence of homelessness in ED patients by gender (male, female, and transgender). Objective: To assess the prevalence of homelessness by gender in 3 EDs in Pennsylvania. Methods: From May 2015 through February 2016, patients in 3 EDs were approached to take a 5-question homelessness screening survey. To participate, patients had to be aged at least 18 years, speak English, have capacity to complete the survey, be willing to participate, and not be critically ill. Frequency comparisons were made using χ2 analysis. Statistical significance was defined as P≤.05. Results: A total of 4395 patients were included in the analysis. The mean (SD) age of the participants was 50.8 (20.5) years; 2557 (58.2%) were women and 3 (0.07%) were transgender. No difference in the rate of homelessness was observed between men and women, with 135 of 1835 men (7.4%) and 173 of 2557 women (6.8%) screening positive for homelessness (P=.472). Forty of 2557 women (1.6%) and 41 of 1835 men (2.2%) admitted they had slept outside or in an abandoned building, their car, an emergency shelter, or a hotel due to financial hardship in the past 60 days (P=.26). One transgender patient screened positive for homelessness. The mean age of participants who screened positive for homelessness was 40.9 (15.9) years. Conclusion: No significant difference was observed in the rate of homelessness between men and women in this ED population, which defies the perception that this issue primarily affects men. Public health interventions aimed at homeless populations should consider that both men and women may be equally affected by homelessness

Prevalence of Homelessness in the Emergency Department Setting

Background/Objective: To determine the prevalence of homelessness or at-risk for homelessness in the ED setting.Methods: Using a 5 question screening tool derived from teh US department of Housing and Urband Development (HUD), Health and Human Services (HHS) and the Beterans Administration (VA) definition for homelessness, we surveyed all patients meeting inclusion criteria on scheudled shifts in one of three EDs in Northeastern Pennsylvania  Two survey periods were selected to represent seasonal variations.Results: 4395 subjects were included in the analysis.  The mean age of participants was 50.8 (SD 20.5) and 2,557(58.2%) were women.  The mean age of those who screened positive for homelessness or at-risk for homelessness was 43.1 (SD16.6). Overall, 136 (3.1%) participants screened positive for at-risk for homelessness and 309 (7.0%) screened positive for homelessness.  103 (9.8%) subjects screened positive for homelessness or at-risk for homelessness on weekends and 312 (10.3%) on weekedays (p=-.64).  The proportion of those screening positive for homelessness or at-risk for homelessness varied by site: 145 (7.5%) at hte trauma cetner, 151 (9.1%) at the suburban site and 149 (18.7%) at the center city site, p<0.001.  There was no statistical significance to the difference between the trauma center and the suburban site (p=.088), but there was statistical significance between both the suburban and the trauma cneter when compared to the center city site (both p<0.0001).  The proportion of those screening positive for homelessness in the summer months (156,7.5%) was similar to those in the winter months (153, 6.6%), p=-.23, but it did favor summer months if those who were at-risk for homelessness were included (230, 11.1%, summer versus 215, 9.2% winter; p=0.045).Conclusions: In our study, the overall prevalence of homelessness or at-risk for homelessness was 10.1%. This prevalence did not seem to vary between weekdays and weekends.  Additionally summer months had a prevalence that was was concerning as winter months.  The prevalence does, however, seem to vary by institutional characteristics even in the same geographic region.  Understanding the patterns of prevalence of homelessness is a step toward considering possible interventions to assist this vulnerable populatio

Loperamide-Induced Torsades de Pointes: A Case Series

Background: Loperamide (Imodium™) is an antidiarrheal opioid acting at the μ receptor agonist in high concentrations. Due to the US opioid epidemic, loperamide abuse and ensuing life-threatening toxicity have surfaced. Hypothesis: The timing and duration of Torsades de Pointes (TdP) from loperamide toxicity is unpredictable and should be heeded with caution, even in asymptomatic patients and drug discontinuance. Methods: Two patients presenting with life-threatening TdP requiring lengthy hospital admissions for confirmed loperamide toxicity are discussed. Patient data were retrieved from the hospital’s EMR system