Case Report: Uterine Torsion – A Rare Cause of Right Lower Quadrant Pain

Uterine torsions are very rare. In an article by Matsumoto et al published in 2021, only 25 cases have been documented on PubMed in non-gravid females in the past 20 years. Uterine torsion is defined as rotation of the uterus greater than 45 degrees in the long axis. Rotation can occur anywhere between 45 degrees to 180 degrees. The torsion can be due to a congenital anomaly or an obstetrics emergency such as with an ovarian torsion. Uterine torsions presenting as an obstetrics emergency carries the potential for irreversible ischemic damage to the uterus, and just as in ovarian torsion, is predisposed by a mass such as ovarian cyst, tumors, or fibroids. Uterine torsions are mostly found in gravid patients since the fetus is an impetus for rotation. Findings in non-gravid women are very rare and only a few cases have been documented. One of the reasons why uterine torsions are so rare is that they present with very non-specific symptoms or hardly any symptoms at all. Additionally, some cases are not diagnosed until laparoscopic surgery or incidentally during pelvic surgery4 As a result, clinicians usually do not even consider uterine torsion in their differential for lower pelvic pain

Economic analysis of potato, corn and wheat response to nitrogen and phosphorus application in the highlands of Ecuador

Cover title.Includes bibliographical references (page 39)

A Case of Cocaine Toxicity from Body Stuffing

Body stuffing refers to the ingestion of an illegal substance in an effort to conceal it and avoid prosecution. This is distinct from, and more common than, the practice of body packing in which large amounts of an illegal substance are carefully packaged and ingested to be transported discreetly by smugglers [1]. While body packers tend to ingest much larger quantities of a drug, they are less prone to developing symptoms of drug toxicity due to the meticulous packaging methods used when compared with those who ingest packets of drugs in haste to avoid prosecution [2]. Many substances have been reported to be contained in these ingested packets, but cocaine continues to be the most common [1]. While many patients who present to the emergency department with suspected cocaine body stuffing will be asymptomatic, about 30% will develops symptoms of drug intoxication, and 4% will develop severe symptoms including seizures [3]. Here we report a case of body stuffing leading to severe cocaine toxicity

Literature Review: Incidentalomas in Emergency Medicine - How Often Are They Reported and Are Patients Informed?

The purpose of this proposed study is to look at the rate of incidental findings on CT scan in a community hospital setting, as well as to look at the rate of documentation of communication of the findings to the patient and referral for follow-up to primary care or to a specialty follow-up

Giving Feedback [to Residents and Students]

Advice for giving effective, constructive feedback to residents and students. Part of a Faculty Development Series

Brief Review: IV Fluid Choice in the Emergency Department

Normal saline and balanced crystalloids, such as lactated Ringer\u27s (LR) and Plasma-Lyte A, are commonly used in the emergency setting for fluid resuscitation. However, there has been growing interest in recent years in whether balanced crystalloids may be superior to normal saline, particularly in critically ill patients. Normal saline has been the traditional fluid of choice for decades due to its widespread availability, low cost, and presumed safety. However, normal saline has a high chloride concentration (154 mmol/L), which can lead to hyperchloremic metabolic acidosis and other adverse effects, such as renal vasoconstriction and reduced renal blood flow. In contrast, balanced crystalloids have a more physiologic electrolyte composition, with lower chloride and higher bicarbonate levels, and may therefore be associated with better acid-base balance, renal function, and other outcomes. Several large randomized controlled trials (RCTs) have compared the use of balanced crystalloids to normal saline in various patient populations, including sepsis, major surgery, and critically ill patients in the emergency department. According to severe ill patients, we will answer the following questions in this literature review. How does Normal saline vs Balanced cystalloids (LR or plasma-lyte) affect mortality? Which fluid selection does better in the setting of AKI? Which fluids is better in the setting of lactic acidosis