Ultrasound-Guided Three-In-One Nerve Block for Femur Fractures

Femur fractures typically affect elderly patients with multiple co-morbidities. Pain control can be difficult, requiring intensive nursing and physician care as elderly patients may manifest cardiovascular and respiratory complications from opiate administration. Ultrasound (US)-guided three-in-one (3-in-1) femoral nerve block (FNB) is an option for pain management in patients with femur fractures, as it provides regional anesthesia to the femoral, obturator and lateral cutaneous nerves. Our goal is to provide medical education regarding the use of US-guided 3-in-1FNB as a rapid and easy procedure that may provide optimal patient care in patients with femur fractures

An Evaluation of Non-Uniform Grade Distribution with the Emergency Medicine Off-Service Standardized Letters of Evaluation

Introduction: Standardized Letters of Evaluation (SLOEs) are designed to objectively compare medical students to their peers for completed emergency medicine (EM) rotations to be used in the EM residency match. In an attempt to adapt quickly to the lack of availability of in-person EM rotations due to COVID restrictions, “off-service” SLOEs (OSLOEs) were allowed in place of traditional SLOEs. The purpose of this study was to assess the utility of OSLOEs for candidate selection during the 2020-21 application cycle at a single EM residency.Methods: A retrospective cohort review of all OSLOEs submitted during the 2020-21 academic year to an EM residency program was performed. A total of 270 OSLOES were eligible for review. Summary statistics were calculated for the study variables recorded, including global rank, grade, categorical details, and rank.Results: Of the 270 OSLOEs reviewed, 61.9% ranked candidates in the top 10% of their class, with 95% being ranked in the top two categories. Over 90% of students were graded as honors or high pass and over 75% of students were ranked in the top 1/3 for each specific OSLOE category.Conclusion: Our findings reveal questionable utility of the objective measures in the OSLOE as there are signs it may suffer from non-uniform grade distribution, leading to low utility for candidate selection. Our data shows marked over-ranking within the highest 2 categories. EM program directors and faculty should use caution as the OSLOE may not carry the same weight as a traditional SLOE when objectively evaluating prospectivestudents for a match into EM

Reduction in interval cancer rates following the introduction of two-view mammography in the UK breast screening programme

The Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis receives funding for a research programme from the Department of Health Policy Research Programme. It is a collaboration between researchers from seven institutions (Queen Mary University of London, UCL, King’s College London, London School of Hygiene and Tropical Medicine, Hull York Medical School, Durham University and Peninsula Medical School)

Incarcerated Diaphragmatic Hernia with Bowel Perforation Presenting as a Tension Pneumothorax

We present an interesting case of a patient with a previously known diaphragmatic hernia in which the colon became incarcerated, ischemic and finally perforated. She had no prior history of abdominal pain or vomiting, yet she present with cardiovascular collapse. To our knowledge, this is the only case report of a tension pneumothorax associated with perforated bowel that was not in the setting of trauma or colonoscopy. [West J Emerg Med. 2014;15(2):142-144.

Incarcerated Diaphragmatic Hernia with Bowel Perforation Presenting as a Tension Pneumothorax

We present an interesting case of a patient with a previously known diaphragmatic hernia in which the colon became incarcerated, ischemic and finally perforated. She had no prior history of abdominal pain or vomiting, yet she present with cardiovascular collapse. To our knowledge, this is the only case report of a tension pneumothorax associated with perforated bowel that was not in the setting of trauma or colonoscopy. [West J Emerg Med. 2014;15(2):142-144.

Exertional Near-Syncope: Pericardial Cyst as a Cause of Left Ventricular Outflow Obstruction

Case Presentation: A 41-year-old otherwise healthy male presented to the emergency department with recurrent exertional near-syncope. He was eventually found to have a large pericardial cyst causing an outflow obstruction. After resection of the cyst by cardiothoracic surgery, he had an uneventful hospital course and was discharged seven days later with no recurrent syncopal episodes.Discussion: We describe an otherwise healthy patient who exhibited symptomatic left ventricular outflow obstruction from a pericardial cyst. These cysts are usually benign and asymptomatic, although they can progress to cause significant morbidity or mortality. Surveillance is recommended if no hemodynamic compromise is present. Patients who are symptomatic or have hemodynamic compromise may undergo needle aspiration or thoracoscopy with resection

Symptomatic Vaginal Infection by Neisseria meningitidis Resulting in Meningitis with Septic Shock

The most common infectious etiologies of vaginitis include Gardnerella bacterial vaginosis, candidiasis, and trichomoniasis. A few case reports describe symptomatic infection with Neisseria (N) meningitidis, an organism with potential for causing systemic disease with a high rate of morbidity and mortality. We describe a patient who presented with fulminant meningitis secondary to symptomatic vaginitis in which N. meningitidis was cultured. Due to the potential for significant morbidity and mortality as demonstrated by this case report, knowledge of this entity may prompt physicians to aggressively treat patients with vaginal cultures that are positive for N. meningitidis

Symptomatic Vaginal Infection by Neisseria meningitidis Resulting in Meningitis with Septic Shock

The most common infectious etiologies of vaginitis include Gardnerella bacterial vaginosis, candidiasis, and trichomoniasis. A few case reports describe symptomatic infection with Neisseria (N) meningitidis, an organism with potential for causing systemic disease with a high rate of morbidity and mortality. We describe a patient who presented with fulminant meningitis secondary to symptomatic vaginitis in which N. meningitidis was cultured. Due to the potential for significant morbidity and mortality as demonstrated by this case report, knowledge of this entity may prompt physicians to aggressively treat patients with vaginal cultures that are positive for N. meningitidis

Adult Presentation of Anomalous Pulmonary Artery from the Descending Aorta: A Rare Cause of Exertional Chest Pain

Case Presentation: A 20-year-old female presented to the emergency department for evaluation of exertional, right-sided chest pain. The patient underwent a computed tomography angiogram of her chest as part of her workup, demonstrating the right lower-lobe pulmonary artery arising from the abdominal aorta.Discussion: Anomalous pulmonary arterial supply is exceedingly rare. In adult patients, it is likely to be found incidentally during workup for more common medical conditions. Symptoms may include chest pain, exertional dyspnea, or hemoptysis. The high pressure of systemic blood in a low-pressure pulmonary system can result in right heart strain, pulmonary hypertension, and high-output cardiac failure