Incidental Identification of Right Atrial Mass Using Bedside Ultrasound: Cardiac Angiosarcoma

<p>Background: Emergency ultrasound is now used in both community and academic hospitals for rapid diagnosis and treatment of life-threatening conditions. Bedside emergency echocardiography can rapidly identify significant pathology such as pericardial effusions and tamponade, right ventricle dilatation due to pulmonary embolism, and cardiac hypokinesis, and aid in the diagnosis and management of patients in emergency department (ED).</p> <p>Case Report: A 41-year-old man presented twice to the ED with history of abdominal pain and was diagnosed with primary cardiac angiosarcoma with point-of-care ultrasound.</p> <p>Conclusion: This case is illustrative of how bedside cardiac ultrasound in the ED can dramatically change a patient’s hospital course. [West J Emerg Med. 2011;12(4):478–480.]</p

Application of nanomedicine in emergency medicine: Point-of-care testing and drug delivery in twenty - first century

The application of emerging nanotechnology to the practice of medicine represents a frontier of nanomedicine. Nanomedicine has been defined as a science which emphasizes the use of nanoscale tools in conjunction with background knowledge of the human body for medical diagnosis and treatment. Application of nanomedicine in EM may give EM providers the opportunity to diagnose and treat life-threatening diseases in a shorter period of time. These applications include diagnostic utilities, preventive medicine, targeted pharmacotherapy, and tissue regeneration

Online Health Information Impacts Patients’ Decisions to Seek Emergency Department Care

Objective: To investigate the impact of online health information (OHI) and patients’ decisions to seek emergency department (ED) care.Methods: We conducted a survey of a convenience sample of 489 ambulatory patients at an academic ED between February and September 2006. The primary measure was the prevalence of Internet use, and the secondary outcome was the impact of OHI on patients’ decision to seek ED care.Results: The study group comprised 175 (38%) males. Mean age was 33 years old; 222 (45.4%) patients were white, 189 (38.7%) patients were African American, and 33 (6.7%) were Hispanic. 92.6% had Internet access, and 94.5% used email; 58.7% reported that OHI was easy to locate, while 49.7% felt that it was also easy to understand. Of the subjects who had Internet access, 15.1% (1.6, 95% CI 1.3-2.0) stated that they had changed their decision to seek care in the ED.Conclusion: This study suggests that Internet access in an urban adult ED population may mirror reported Internet use among American adults. Many ED patients report that they are able to access and understand online health information, as well as use it to make decisions about seeking emergency care. [West J Emerg Med. 2011; 12(2):174-177.

Tension pneumothorax, pneumoperitoneum, and cervical emphysema following a diagnostic colonoscopy

Colonoscopy is currently a widespread procedure used in screening for colorectal cancer. Iatrogenic colonic perforation during colonoscopy is a serious and potentially life-threatening complication that can cause significant morbidity and mortality. “Triple pneumo” (a combination of pneumothorax, pneumomediastinum, and pneumoperitoneum) following colonoscopy is a rare but a serious condition requiring immediate diagnosis and emergent intervention. In majority of these cases a colonic perforation is the initial injury that is followed by pneumothorax and pneumomediastinum through the potential anatomical connection with retroperitoneal and mediastinal spaces. In this rare case report we are presenting a case of “triple pneumo” with no evidence of colonic perforation. This patient developed a simultaneous pneumoperitoneum, pneumomediastinum, and a tension pneumothorax requiring immediate tube thoracostomy. This case may raise the awareness on the likelihood of these serious complications after colonoscopy

PHENOMENOLOGY OF ZAR RITUAL CEREMONY WITH AN EMPHASIS ON GEOGRAPHICAL RELATIONS OF ZANGEBAR AND QESHM

Abstract. The initial exposure of human beings to nature was a terrifying encounter due to lack of sufficient cognition and human was compelled to solve lots of his mental and subjective difficulties by means of believing in existence of spirits and numerous powers. In ancient times, mental illnesses were known as the effect of supernatural powers, and sickness was known as the result of being possessed by evil spirits. The individual, who is possessed, could suffer from disease with physical and mental symptoms. In southern seashores of Iran, subduing these ghosts, which are known as "winds", would be viable by performing a ceremony called Zar. Zar have been set in the spiritual beliefs ofthis region. Studying this curative ritual, assists to comprehend the rules and beliefs of fringe inhabitants of Persian Gulf and its ritual aspect is greatly significant. Zar, which is remained from the primary tribes of east Africa, was originated from Shamanism. From psychological point of view, some of the symptoms of being haunted by winds are defined as indications of psychosis and hysterics nature; furthermore, these symptoms probably arise from an individual's mental disorders and reactions to the pressures and disputes with his social conditions. Since psychology deals with humanmind and thoughts and inner emotions, proving behavioral theories and subjective processes that are presented by psychologists and psychoanalysts, is very difficult and even doubtable. In addition, proof of issues which are derived from the humanities, is encountered with difficulties because they cannot undergo experience. In psychology, in which human mind is the main part, this case runs into more complications. Nevertheless, research methods, current tools and techniques for studying psychological subjects have rectified the mentioned defect to a large extent. Zar ritual, as a substitute for conventional medical descriptions, provides a kind of interpretation of the illness that science is notcapable of its healing.Key words: Zar, the people of the air, possession, Qeshm, Zangebar

Asynchronous web-based learning, a practical method to enhance teaching in emergency medicine

Objective: To compare medical knowledge acquisition among emergency medicine (EM) residents who attend weekly core content lectures with those absent but asynchronously viewing the same lectures in a Web-based electronic platform. Subjects and Methods: During the study period all EM residents attending or absent from weekly educational conferences were given a quiz on the covered material. During Phase 1, absentees were not given supplemental educational content for missed lectures. During Phase 2, absentees were sent a link to an online multimedia module containing an audiovisual recording of the actual missed lecture with presentation slides. Scores between attendees and absentees during both phases were compared using a repeated-measures analysis to evaluate the effect of the supplemental online module on knowledge acquisition. Results:Thirty-nine EM residents (equally distributed in postgraduate years 1–4) were studied during a 15-week period. Overall and after adjusting for sex and postgraduate year level, both lecture attendance (b=27; 95% confidence interval, 22–32;p Conclusions: In an EM residency program, asynchronous Web-based learning may result in medical knowledge acquisition similar to or better than attending traditional core content lectures. The percentage of curriculum delivery by asynchronous learning that may be used to achieve overall terminal learning objectives in medical knowledge acquisition requires further study

A survey of poison control centers worldwide

To stem the rising incidence of toxic exposure as well as the associated morbidity and mortality, the past century has seen the establishment and evolution of poison control centers (PCCs) worldwide. Depending on the location, PCCs vary in terms of staffing model, services offered, and funding sources. In this article, we discuss a survey of poison control centers worldwide

High dose insulin therapy, an evidence based approach to beta blocker/calcium channel blocker toxicity

Poison-induced cardiogenic shock (PICS) as a result of beta-blocker (?-blocker) or calcium channel blocker (CCB) overdose is a common and potentially life-threatening condition. Conventional therapies, including fluid resuscitation, atropine, cardiac pacing, calcium, glucagon, and vasopressors often fail to improve hemodynamic status. High-dose insulin (HDI) is an emerging therapeutic modality for PICS. In this article, we discuss the existing literature and highlight the therapeutic success and potential of HDI. Based on the current literature, which is limited primarily to case series and animal models, the authors conclude that HDI can be effective in restoring hemodynamic stability, and recommend considering its use in patients with PICS that is not responsive to traditional therapies. Future studies should be undertaken to determine the optimal dose and duration of therapy for HDI in PICS

Emergency department approach to electrical toothbrush associated hand injury, a unique case of non-oropharyngeal injury.

Puncture wounds are common injuries treated in the emergency department (ED). Prior studies have shown that toothbrushes are common reservoirs for oral flora, especially in regions near the head of the toothbrush near the bristles. ED providers must be aware of the danger associated with bacterial contamination of the associated wound and should be familiar with different pathogens and options for treatment. We present a unique case of a 30-year-old male with non-intraoral injury who presented to the ED after puncturing his left palm with the metal post of an electric toothbrush