Gus M. Garmel

An Introduction to Clinical Emergency Medicine

An introduction to clinical emergency medicine / , An introduction to clinical emergency medicine / , کتابخانه دیجیتال جندی شاپور اهواز

Gas gangrene from subcutaneous insulin administration

A case of gas gangrene that caused intractable shoulder pain refractory to narcotics in an immunocompromised host is presented. Gas gangrene has been associated with severe trauma involving penetrating wounds, compound fractures, extensive soft-tissue injury, intramuscular injection of epinephrine, and interruption of arterial blood supply. This case describes an elderly insulin-dependent diabetic woman who developed gas gangrene in her arm and leg at the site of her subcutaneous insulin injections. The responsible organism was Clostridium septicum. Emergency medicine physicians must consider gas gangrene Clostridium infection in immunocompromised individuals without evidence of trauma who present with localized and intractable pain.

Radial artery pseudoaneurysm formation after cat bite to the wrist.

Pseudoaneurysms may occur in the groin after catheterization of the femoral artery but may also occur in arteriovenous shunting for dialysis after placement of indwelling catheters or after direct trauma to an artery. We report a unique cause of radial artery pseudoaneurysm at the wrist related to a cat bite sustained by an elderly woman. The patient underwent successful operative repair of the aneurysm, with ligation of the radial artery.

Hysterical stridor: A diagnosis of exclusion

Two stridorous patients who presented to the emergency department with respiratory distress are discussed. Thorough history, physical examination, and direct visualization of the larynx failed to detect any anatomical upper airway abnormalities; therefore, the etiology of airway obstruction in both patients was determined to be psychogenic. Stridor caused by psychogenic causes is uncommon and, probably, underrecognized. Stridor caused by structural and pathological causes must be considered and excluded before it can be attributed to psychogenic causes, thereby making this a diagnosis of exclusion.

Didelphic uterus and unilaterally imperforate double vagina as an unusual presentation of right lower-quadrant abdominal pain

Imperforate hymen should be considered in girls of menarcheal age with a history of amenorrhea and vague abdominal discomfort, particularly if associated with symptoms of urinary obstruction or constipation. Patients may present with severe dysmenorrhea and localized pain mimicking appendicitis if hematocolpometra is due to unilaterally imperforate hymen with duplicate vagina and didelphic uterus. Although this condition is exceedingly rare, the case presented stresses the importance of a careful history and physical examination of an adolescent girl presenting with symptoms of abdominal pain associated with menstruation.

Acute urinary retention due to ectopic pregnancy

Two cases of ectopic pregnancy are presented in which acute urinary retention was a salient clinical feature. The emergency physician must consider ectopic pregnancy in the differential diagnosis in any woman of child-bearing age with abdominal, pelvic, or urinary complaints.

Does the Multiple Mini-Interview Address Stakeholder Needs? An Applicant's Perspective

INTRODUCTION The multiple mini-interview is an interview format originally created for medical school admissions to provide an objective, validated, and predictive measure for selecting applicants. It is essentially an objective structured clinical evaluation that measures noncognitive characteristics imprecisely defined in the literature to date. Applicants participate in 3 to 12 stations of one-on-one interviews, each lasting 7 to 10 minutes. Each station has 1 unique question that the applicant answers. For example, at one station a candidate may be asked to consider the ethical problems that exist in circumcision, and at another describe possible implications of health care reform. It is important to recognize the multiple mini-interview as an interview format (much like a standardized, written test is a type of test format), rather than a specific tool (such as the Medical College Admissions Test). The success of this new format depends on the complex needs and interactions of the interview process stakeholders, defined in the literature as the applicants, interviewers, and admissions teams.

Environment-dependent sports emergencies

As more individuals participate in sports and outdoor activities, the frequency of environmentally related illnesses will increase. Participants in sporting events of long duration and those requiring particularly inclement weather and adverse conditions are especially prone to developing injury. Hypothermia, heat-related illnesses, and high-altitude illnesses are multisystem emergencies that require immediate, specific therapeutic maneuvers. Physicians must be able to recognize the signs and symptoms of these medical emergencies and institute definitive care. Rapid core rewarming, airway control, and prolonged cardiopulmonary resuscitation are the key factors in managing the hypothermic patient. Adequate cooling and volume resuscitation provide the basis for treating the hyperthermic patient. The patient with high altitude-related illness should be returned to a lower elevation and given supplemental oxygen. Specific intervention depends on the patients presentation. Environmental illnesses cause severe morbidity and mortality and are frequently within the control of the sport participant. Thus physicians must educate their patients on basic preventive measures if they are going to participate in outdoor sporting activities.

An unusual case of mesenteric ischemia in a patient with new-onset diabetes mellitus

The early detection of acute mesenteric ischemia is crucial for the preservation of bowel viability. The emergency physician must have a high index of suspicion to identify mesenteric ischemia when there is a paucity of physical examination findings. We discuss the case of a patient who presented to the emergency department with confusion, hyperglycemia, abdominal tenderness, and metabolic acidosis who also developed mesenteric ischemia.

Development of Ventricular Fibrillation After Intravenous Calcium Chloride Administration in a Patient With Supraventricular Tachycardia

The i.v. administration of calcium before or shortly after treatment of supraventricular tachycardia with verapamil has been suggested to counteract a hypotensive response to verapamil. We discuss the case of a patient who presented to the emergency department with an accelerated wide-complex tachycardia and minimal symptoms. Immediately after i.v. administration, of 1 g calcium chloride as pretreatment for verapamil administration, ventricular fibrillation developed. Emergency physicians should be aware of potential dangers after the administration of i.v. calcium preparations when trying to prevent known hypotensive side effects of i.v. verapamil administration.