Journal of the American College of Emergency Physicians open最新文献

{"title":"Efficacy and safety of two Antivenoms in the treatment of eastern copperhead (Agkistrodon contortrix) envenomations in Southeast Texas","authors":"Spencer Greene MD, MS,&nbsp;Alexander Teshon MD","doi":"10.1002/emp2.13310","DOIUrl":"10.1002/emp2.13310","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There are two Food and Drug Administration–approved antivenoms for the treatment of North American pitviper envenomations: Crotalidae polyvalent immune fab (ovine) (CroFab, henceforth FabAV) and Crotalidae immune F(ab’)₂ (equine) (Anavip, henceforth Fab2AV). This study compared the effectiveness and safety of the two products in eastern copperhead envenomations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed eastern copperhead bites on which our toxicology service consulted between January 1, 2021 and November 1, 2023. Collected data included patient demographics, bite location, clinical features, antivenom use, response to treatment, and adverse reactions to antivenom.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 134 patients with confirmed copperhead envenomations. We administered antivenom to 89 patients, of which 36 (40%) were female. The median age was 42 years old (range: 2–89 years). Fifty-nine patients received Fab2AV and 30 were treated with FabAV. Initial control was achieved in 30 (100%) patients treated with FabAV. In the Fab2AV group, 53 (89.8%) achieved control; six patients with acute adverse reactions declined further treatment despite persistent symptoms. The median FabAV dose required for initial control was six vials (range: 4–6). A median dose of 10 vials (range: 10–30) was used in the Fab2AV group. Repeat doses of Fab2AV were required in 15 (25.4%) cases. There were no acute adverse reactions to FabAV. Acute adverse reactions were seen in seven (11.9%) of patients treated with Fab2AV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Fewer patients treated with FabAV required repeat antivenom dosing to attain initial control following eastern copperhead envenomation. A higher percentage of patients treated with Fab2AV developed acute adverse reactions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous bruising finger","authors":"Cassandra Bradby MD","doi":"10.1002/emp2.13317","DOIUrl":"https://doi.org/10.1002/emp2.13317","url":null,"abstract":"<p>A 41-year-old female presented with an acute color change of her right 4th finger. The patient reported typing on a keyboard 10 minutes prior, when she noticed a sudden pop at the base of her right 4th finger. Afterward, she noticed a cool sensation and numbness to the entire finger. Minutes later, her finger turned purple, so she came to the emergency department for evaluation. She denied pain, issues with movement, trauma, or other complaints. She had a similar issue once in the past, which self-resolved a few months prior. On examination of the right hand, there was diffuse ecchymosis with swelling across the palmar surface of the 4th finger and decreased sensation to light touch without tenderness. The ecchymosis did not extend into the palmar surface of the hand (Figures 1 and 2). There was full range of motion at both the distal and proximal interphalangeal joints. The remainder of the examination was normal.</p><p>The author declares that there is no conflict of interest to disclose.</p><p>The paper has been previously presented at Clinical Images Exhibit, Society of Academic Emergency Medicine Annual Meeting 2023, Austin, Texas, May 15–18, 2023.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13317","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Man with left flank pain and diphoresis","authors":"Yu-Xuan Jiang MD,&nbsp;Chun-Gu Cheng MD,&nbsp;Yen-Yue Lin MD","doi":"10.1002/emp2.13319","DOIUrl":"10.1002/emp2.13319","url":null,"abstract":"<p>A 63-year-old man with hypertension presented to the emergency department with sudden onset of pain in the left flank with diaphoresis after heavy lifting. His temperature, pulse rate, and blood pressure were 37°C, 80 beats/min, and 183/88 mmHg, respectively. Physical examination revealed left flank knocking tenderness. Blood laboratory tests revealed a leucocyte count of 13,920/µL, hematocrit level of 30.6%, hemoglobin level of 10 g/dL, and creatinine level of 1.77 mg/dL. Urine examination revealed gross hematuria. The emergency physician performed ultrasonography, which demonstrated left renal parenchyma collapse with compression by a huge hypoechoic hematoma (Figure 1), and the diagnosis was confirmed by computed tomography (CT) (Figure 2).</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11439884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orbital damage due to falling screw","authors":"Cassandra Bradby MD,&nbsp;Juan March MD,&nbsp;Roberto Portela MD","doi":"10.1002/emp2.13318","DOIUrl":"10.1002/emp2.13318","url":null,"abstract":"<p>A 33-year-old male presented to a community hospital for vision loss in his left eye after a screw fell from a height of approximately 12 inches onto his eye. The patient complained of mild to moderate pain and was able to see only bright lights and shadows. Physical examination noted fluorescein uptake over the central cornea without a definite Seidel sign present. Pupils were equal, round, and reactive to light. Extraocular movements were painful on examination. Surrounding structures, such as the eyelids, were uninjured. The patient was transferred to a tertiary care center for ophthalmology evaluation for concerns of a ruptured globe. A computed tomography (CT) scan of the orbits was performed prior to transfer and showed a small left periorbital laceration (Figure 1). Ophthalmology evaluation showed a full thickness corneal laceration and traumatic cataract, which were repaired in the operating room. Moxifloxacin, timoptic, prednisolone topical, and cyclogel were started and the patient was discharged with outpatient follow-up (Figures 2 and 3).</p><p>The authors declare they have no conflicts of interest.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11439885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric cannabis exposures in New Jersey","authors":"Ivan Ivanov DO,&nbsp;Bruce Ruck PharmD,&nbsp;Howard A. Greller MD,&nbsp;Diane P. Calello MD,&nbsp;Danielle R. Bartsche MPH, BS","doi":"10.1002/emp2.13297","DOIUrl":"10.1002/emp2.13297","url":null,"abstract":"&lt;p&gt;To the Editor,&lt;/p&gt;&lt;p&gt;We read the recent retrospective cohort analysis by Kane et al&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; titled “Trends in cannabis use in New Jersey: Effects of COVID-19 and cannabis legalization.” We commend the authors for their analysis of cannabis-related visits to a single tertiary emergency department in relation to cannabis legalization in NJ and COVID-19. However, at the New Jersey Poison Information and Education system (NJPIES), our statewide surveillance of pediatric cannabis exposures has demonstrated the opposite result. As has been demonstrated in other states after legalization,&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; we saw an overall increase in pediatric cannabis exposure reports to the NJPIES when comparing the pre-legalization era to the post-legalization era, and a consistent yearly increase from 2016 to 2022. On February 22, 2021, recreational marijuana was made legal in the state of New Jersey, allowing, with limits, flower, concentrates, oil, and edibles. We searched the NJPIES database from 2016 (5 years prior to legalization) to 2022 (2 years post legislation, including legislation year) and searched for general terms including marijuana, plant, pharmaceutical, edible, capsules/pills, extract, topical, and e-cigarettes. We considered pediatric exposures as under the age of 5, which differed vastly from the original study's definition as 21 years and under. Following the recreational legalization of marijuana, we observed an 89.13% increase in total pediatric cannabis exposures, with pre-legalization exposures totaling 138 cases and post-legalization totaling 408 cases. This rise indicates a significant increase in exposure rate from 0.0015% to 0.0084% of total pediatric calls (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). We depict the number of pediatric cannabis exposures as compared to total call volume in Figure 1.&lt;/p&gt;&lt;p&gt;We previously reported on pediatric cannabis exposures in relation to the COVID-19 pandemic surge. In contrast to Kane's findings, we found dramatic increases in cannabis exposures in young children in 2020 compared to 2018 and 2019. It is difficult to ascertain the relative contribution of COVID-19 versus increased cannabis access however, as the trend continued past 2020.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The authors concluded that it was “not the legalization period, but rather the COVID-19 pandemic period” that caused more of an increase in cannabis exposures. This illustrates the importance of statewide and regional toxicosurveillance conducted through poison centers. Patterns may not be detected in single institutions but may be observed and tell a vastly different story when viewed aggregate over a wider area. The increase in pediatric cannabis exposures at the state level has been substantial and is consistent with national data in other States after legalization.&lt;span&gt;&lt;sup&gt;2, 3, 5, 6&lt;/sup&gt;&lt;/span&gt; While the authors provide the perspective of a single tertiary center, it is essential to view larger epidemiologic trends to d","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Man with dizziness, fatigue, and sweating","authors":"Liang Li BS,&nbsp;Hainan Yang PhD,&nbsp;Kailing Yu BS,&nbsp;Zhibing Xu PhD,&nbsp;Ming Lu BS,&nbsp;Tao Zhang BS","doi":"10.1002/emp2.13274","DOIUrl":"https://doi.org/10.1002/emp2.13274","url":null,"abstract":"<p>A 39-year-old male arrived at the hospital reporting dizziness, fatigue, and sweating that had persisted for half a day. He was transferred to the emergency department because his initial peripheral capillary oxygen saturation (SpO₂) was critically low at 70%. Upon examination, the physician observed cyanosis in the patient's lips and fingertips (Figure 1).</p><p>Upon admission, the concentration of methemoglobin (MHb) in the blood was 41.9%. Given the suspected toxic ingestion, hypotension low SpO2 readings, as well as the extra high MHb concentration, the patient was diagnosised with nitrite poisoning (Figure 2). Treatment regimen: one liter of 0.9% normal saline was administered along with oxygen therapy, glucose, electrolyte solutions, ascorbic acid (vitamin C), and H₂ receptor blockers. Additionally, a 60 mg dose of methylene blue in 40 mL of 25% glucose solution was rapidly administered intravenously for 10 min. Note that 1.5 h following treatment, the methemoglobin concentration was measured at 6.7%. The patient's cyanosis gradually improved and blood oxygen saturation increased.</p><p>NaNO₂ affects vital organs, particularly highly perfused organs such as the brain and heart. Clinical manifestations may include cyanosis, hypoxia, altered consciousness, dysrhythmias, and death.<span>^1-3</span> The severity of symptoms is dependent on the level of MHb. In a normal physiological state, the concentration of MHb does not exceed 1%–2%. However, levels of 10%–20% typically result in cyanosis. As MHb levels increase to 30%–40%, symptoms such as headache, fatigue, tachycardia, weakness, and dizziness may occur.<span>^4-7</span></p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13274","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anemia and giant breast mass","authors":"Yuki Muroyama MD, PhD,&nbsp;Mika Yanagaki MD,&nbsp;Akiko Ebata MD, PhD,&nbsp;Yuto Yamazaki MD, PhD,&nbsp;Takanori Ishida MD, PhD,&nbsp;Takashi Suzuki MD, PhD","doi":"10.1002/emp2.13298","DOIUrl":"https://doi.org/10.1002/emp2.13298","url":null,"abstract":"<p>A 65-year-old female was transported to the emergency department with anemia and bleeding from her left giant protruding breast mass with skin ulcers (Figure 1A,B). She first recognized the mass 3–4 years ago, which was gradually growing and started forming skin ulcers and bleeding about a month ago. Contrast computed tomography (CT) scan showed a giant left breast tumor with poor contrast enhancement and slightly enlarged axillary lymph nodes (Figure 1C). Total mastectomy with axillary lymph node dissection was performed. The resected tumor weighed 5.6 kg. Cut surface of the tumor showed circumscribed, lobular structures (Figure 1D). Microscopic examination revealed leaf-like biphasic epithelial patterns and subepithelial accentuation of stromal cellularity without stromal overgrowth, cellular atypia, and mitosis, with stromal hyalinization (Figure 1E). The tumor was not exposed to skin surface. Surgical margins and lymph nodes were negative. The patient was discharged without major postoperative complications.</p><p>Phyllodes tumor of the breast is a fibroepithelial neoplasm, accounting for 0.3%–1% of breast tumors,<span>^{1, 2}</span> and typically presents as a firm unilateral breast mass in middle-aged women.<span>^1-3</span> Phyllodes tumors are histologically classified as benign, borderline, and malignant.<span>¹</span> Skin ulcers can be formed even without direct skin invasion of a tumor, as rapid tumor growth could outpace skin extension and cause cutaneous ischemia.<span>⁴</span> Both skin ulcer bleeding and intertumoral hemorrhage can contribute to anemia. Complete wide excision is the primary curative therapeutic option, but still warrants monitoring for local recurrence, occurring in 21% of phyllodes tumors overall.<span>^{3, 4}</span></p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13298","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Woman with swollen eyelids","authors":"Alaina Brinley Rajagopal MD, PhD","doi":"10.1002/emp2.13277","DOIUrl":"https://doi.org/10.1002/emp2.13277","url":null,"abstract":"<p>A 29-year-old female with a past medical history of well-controlled eczema, latent herpes simplex infection, and 4 months postpartum presented to the emergency department with swelling and erythema of bilateral eyelids. Physical examination demonstrated clustered, vesicular rash to the left eyelid and right eyelid margin with mild conjunctival injection on the right (Figure 1). Slit lamp examination did not show any dendritic lesions. The patient had reactive titers to varicella zoster (previous vaccination) and negative human immunodeficiency virus (HIV) screening. The patient and partner had no history of genital herpes, but the patient did have a history of oral herpes simplex (cold sores).</p><p>The patient was diagnosed with herpes simplex infection of the bilateral eyelids. The patient was started on oral acyclovir and topical erythromycin ointment.<span>¹</span> The patient had complete resolution of symptoms by the end of the acyclovir course. This presentation is rare given the bilateral presentation in an individual who is young and does not have a known immunocompromising condition.<span>^2-4</span></p><p>Dr. Rajagopal has ownership interest in Esperto Medical and Chromacode, Inc. She is a Board Director and Co-founder of Esperto Medical.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13277","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National needs assessment of emergency medicine faculty regarding scholarly activity practices and support","authors":"Nidhi Garg MD,&nbsp;Jennifer Johnson BA,&nbsp;Sumedha Garg PhD,&nbsp;Bernard Chang MD, PhD,&nbsp;Christopher Zabbo DO,&nbsp;Pridha Kumar BS,&nbsp;Lance Becker MD,&nbsp;Phillip Levy MD, MPH,&nbsp;Gabor D. Kelen MD,&nbsp;Joshua J. Davis MD,&nbsp;Manish Shah MD","doi":"10.1002/emp2.13292","DOIUrl":"https://doi.org/10.1002/emp2.13292","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to assess the attitudes and perceptions of scholarly activity (SA) practices among emergency medicine (EM) physicians who are engaged in training residents. This study examined the belief and need for modern-day SA, potential barriers, and department resources provided.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a descriptive cross-sectional survey study of EM physicians across the United States identified from the American College of Emergency Physicians and American College of Osteopathic Physicians directories. The survey consisted of 18 items regarding demographics, attitude toward SA, department support, and questions regarding residency programs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 660 survey recipients completed the survey out of a possible pool of 4296 individuals (15% response rate), of which 530 (80%) indicated they were core faculty. Of core faculty, 428 (80.8%) were part of an allopathic program, whereas 102 (19.2%) were part of an osteopathic program. Department support was provided for protected time (385; 58.3%), research staff (346; 52.4%), Institutional Review Board preparation (240; 36.4%), and biostatistics (314; 47.6%). Of all the institutional roles, the largest percentage (82/125, 65.6%) of chair/vice chair/associate chairs strongly agreed or agreed (score of 5 or 4 of 5) with the statement, “Overall, I am satisfied with the scholarly support provided by my department.” There was no difference in agreement with this statement between respondents in an allopathic versus osteopathic program (210/428, 49.1% allopathic; 45/102, 44.1% osteopathic).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is a need for increased departmental support for SA. To optimally implement the Accreditation Council for Graduate Medical Education (ACGME) SA requirements into strategy and action, the ACGME should consider providing EM residency programs with an outline of best SA practices to foster a uniform consensus across academic institutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13292","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A transit passenger with unilateral leg pain","authors":"Ghazala Faheem MBBS,&nbsp;Muhammad Abd Ur Rehman MBBS,&nbsp;Muhammad Junaid Iqbal MBBS,&nbsp;Tahir Shahzad MD","doi":"10.1002/emp2.13221","DOIUrl":"10.1002/emp2.13221","url":null,"abstract":"<p>A 57-year-old male transit passenger from an 8-hour flight presented to the emergency department with severe left posterior thigh pain. He had experienced a traumatic event a few weeks prior, resulting in fractures of the left hip and left lower ribs. Upon examination, he exhibited severe tenderness, warmth, and fluctuation in the left posterior thigh with minimal swelling. He had a low-grade fever (37.8°C), was markedly tachycardic (heart rate: 125 beats/min), and appeared clinically dehydrated. Blood investigations revealed raised inflammatory markers, elevated creatinine, and high lactate levels (Table 1). Given his clinical presentation and recent surgery combined with the long flight, initial differential diagnoses included deep venous thrombosis (DVT) and sepsis. Point-of-care ultrasound (POCUS) ruled out DVT but revealed subcutaneous edema with fluid collection in the hamstring muscles (Figure 1, Video 1).</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}