Adenovirus Infection and Rhabdomyolysis as a Cause of Acute Liver Failure in a Healthy Collegiate Football Athlete: A Case Report and Proposed Return to Play Protocol for Rhabdomyolysis.

Adenovirus is a common cause of upper respiratory and gastrointestinal tract infections. Though cases of significant organ failure and death have been reported in young children and immunocompromised individuals, adenovirus infections in healthy individuals are typically self-limiting without significant morbidity or mortality. Exertional rhabdomyolysis is a pathologic condition resulting from repetitive, excessive, or prolonged exercise, often in a hot environment, leading to acute muscle injury, renal injury and, rarely, death. We report a case of adenovirus infection leading to acute liver failure complicated by rhabdomyolysis in a collegiate football player presenting with nausea, vomiting, and diarrhea. We propose a protocol to safely guide the return to play progression for patients with complicated exertional rhabdomyolysis.

Detection of concussion using cranial accelerometry.

OBJECTIVE: To determine whether skull motion produced by pulsatile cerebral blood flow, as measured by cranial accelerometry, is altered during concussion. DESIGN: In phase 1, to identify a specific pattern indicative of concussion, cranial accelerometry of subjects who sustained a concussion underwent analysis of waveforms, which was compared with accelerometry from subjects without a concussion (baseline). In phase 2, this concussion pattern was tested against prospectively acquired, blinded data. SETTING: High school tackle football practice and game play. PARTICIPANTS: Eighty-four football players. INTERVENTIONS: Subjects had accelerometry measurements and concurrent 2-lead electrocardiograms. In players with a concussion, multiple sequential measurements were obtained. Sport Concussion Assessment Tool 2 was used to assist clinical determination of concussion. MAIN OUTCOME MEASURES: Whether a characteristic waveform pattern of cranial accelerometry occurs in subjects with concussion. RESULTS: Phase 1 demonstrated a consistent pattern correlated to concussion. Phase 2 found this pattern in 10 of 13 subjects with concussion (76.9% sensitivity). Seventy-nine of 82 baseline plus nine postseason (total = 91) recordings from nonconcussed subjects did not show the concussion pattern (87% specificity). CONCLUSIONS: In subjects with concussion, we observed a unique pattern determined by cranial accelerometry. This may provide a method to noninvasively detect and longitudinally observe concussion. CLINICAL RELEVANCE: There is no objective, real-time, noninvasive, and easily accessible measure for concussion. If accelerometry is validated, it could provide a critical diagnostic tool for sports medicine physicians.

The ethics of health care reform: impact on emergency medicine.

The recent enactment of the Patient Protection and Affordable Care Act (ACA) of 2010, and the ongoing debate over reform of the U.S. health care system, raise numerous important ethical issues. This article reviews basic provisions of the ACA; examines underlying moral and policy issues in the U.S. health care reform debate; and addresses health care reform's likely effects on access to care, emergency department (ED) crowding, and end-of-life care. The article concludes with several suggested actions that emergency physicians (EPs) should take to contribute to the success of health care reform in America.