Detection of Unknown Pregnancy With Complications Using Point-of-Care Ultrasound.

Eclampsia, a condition diagnosed in pre-eclamptic patients who experience seizures, can lead to maternal and fetal death if not treated early. The present case discusses the clinical management of an 18-year-old female who presented to the emergency department (ED) after a generalized tonic-clonic seizure. A physical examination revealed that she was also hypertensive. Based on these symptoms which required urgency due to the patient\u27s instability, and the suspicion that the patient could be pregnant, point-of-care ultrasound (POCUS) was performed. In this case, a POCUS was a faster more accessible modality than a urine or serum human chorionic gonadotropin test. Although the patient denied that she was pregnant, POCUS identified that she was approximately 22-24 weeks pregnant. The patient was promptly diagnosed with eclampsia and given medication to control her blood pressure and seizures. This case highlights the benefits of using POCUS in the ED to expedite clinical decisions by identifying the etiology of a patient\u27s condition and lends itself to the discussion of its utility in a critically ill pregnant woman. It also serves to reinforce the importance of keeping eclampsia as part of an emergency physician\u27s differential when confronted with a potentially pregnant patient with relevant symptoms

A Case Report of Massive Acetaminophen Poisoning Treated with a Novel “Triple Therapy”: N-Acetylcysteine, 4-Methylpyrazole, and Hemodialysis

Massive acetaminophen (N-acetyl-p-aminophenol; APAP) ingestion is characterized by a rapid onset of mitochondrial dysfunction, including metabolic acidosis, lactemia, and altered mental status without hepatotoxicity which may not respond to the standard doses of N-acetylcysteine (NAC). A 64-year-old woman without medical history presented comatose after an ingestion of 208 tablets of Tylenol PM™ (APAP 500 mg and diphenhydramine 25 mg). The initial APAP concentration measured 1,017 µg/mL (therapeutic range 10-30 µg/mL), and elevated anion gap metabolic acidosis, lactemia, and 5-oxoprolinemia were detected. High-dose intravenous (IV) NAC, 4-methylpyrazole (4-MP), and hemodialysis (HD) were initiated. She was transferred to a liver transplant center and continued both NAC and HD therapies until complete resolution of metabolic acidosis and coma without developing hepatitis. She was discharged without sequelae. This is the fourth highest APAP concentration recorded in a surviving patient. Moreover, this is the first report of a novel “triple therapy” using NAC, 4-MP, and HD in the setting of massive APAP ingestion that presents with coma, elevated anion gap metabolic acidosis, and lactemia. Emergency physicians should recognize these critically ill patients and consider high-dose NAC, 4-MP, and HD to be initiated in the emergency department (ED)

Lack of Gender Differences in Prevalence of Homelessness in the Emergency Department.

Background: Concordant with the NIH policy on the inclusion of women in clinical research, and their support of analyses that address potential sex and gender differences, researchers are focusing more on assessing outcomes by sex. Objective(s): We set out to assess gender differences in the prevalence of homelessness in the Emergency Department (ED). Material/Methods: From 5/2015-2/2016, ED patients were approached to take a five-question homelessness screening survey. To participate, patients had to be: 18 years or older, speak English, have capacity, not be critically ill, and be willing to participate. Results: 4494 subjects met inclusion criteria; 99 surveys were excluded (took the survey before). 4395 subjects were analyzed. The mean age of subjects was 50.8 years (SD 20.5) and 2,557 (58.2%) were women. No difference in the rate of homelessness was observed between male and female participants with 135 men out of 1,835 (7.4%) and 173 out of 2,557 (6.8%) women screening positive, (p = 0.472). The mean age of those screening positive for homelessness was 40.9 years (SD 15.9); the mean age of men screening positive was 42.4 years (SD = 16.2) and women was 43.7 years (SD 16.9). Both men (N = 41) and women (N = 40) admitted they had slept outside, in an abandoned building, in their car, a shelter or a motel due to financial hardship. Conclusions: We did not observe differences in the rate of homelessness between men and women who screened positive for homelessness in the ED. These data combat stereotypes that this social issue is a problem primarily affecting male populations. Public health interventions aimed at homeless populations should be cognizant that both genders are dealing with this burden. A deeper understanding of the demographics of homelessness may allow for better access to medical treatment since women have different health care needs than men