Evaluation and Management of Airway Foreign Bodies in the Emergency Department Setting.

BACKGROUND: Airway foreign body can be a life-threatening issue in pediatric and adult patients, and the majority of these patients will first present to the emergency department. OBJECTIVE: This article provides a narrative review of the diagnosis and management of airway foreign bodies for the emergency clinician. DISCUSSION: Foreign bodies in the upper and lower airways are potentially life threatening. This affects all age groups but is more common in pediatric patients. A history of a witnessed ingestion or aspiration event should raise the clinical suspicion for an aspirated foreign body. Patients with upper-airway foreign bodies are more likely to present in respiratory distress when compared with lower-airway foreign bodies, which often present with more subtle signs. Stridor, drooling, and wheezing suggest respiratory distress, but the presenting clinical picture is often unclear and may only include a cough. Immediate intervention is required in the patient with hemodynamic instability or respiratory distress. Airway management including laryngoscopy, fiberoptic bronchoscopy, and cricothyrotomy may be needed in these patients, with the emphasis on removing the obstructing foreign body and securing the airway. Specialist consultation can assist in retrieving the foreign body and managing the airway. If the patient is stable, imaging and specialist consultation for potential operating room intervention should be considered. CONCLUSIONS: An understanding of the presentation, evaluation, and management of the patient with an airway foreign body is essential for emergency clinicians.

Sudden-Onset Paraplegia: A Unique Presentation of Acute Aortic Dissection (AD).

Aortic dissection (AD) is a rare but deadly diagnosis that emergency medicine physicians must consider in a wide variety of patient presentations. This case report describes a 42-year-old male bull rider who developed acute-onset bilateral lower extremity paralysis and loss of sensation. He was later found to have a type A Stanford AD during his emergency department evaluation.

Use of FemoStop device in the setting of inguinal trauma.

Junctional hemorrhage remains a difficult source of bleeding to control with the groin being the most common location. FemoStop devices are a well established tool for achieving hemostasis in post cardiac catheterization femoral access site hemorrhage. Massive hemorrhage is a traumatic presentation well known to emergency physicians and trauma surgeons alike. We describe a case of traumatic proximal femoral artery injury with expanding hematoma and hemorrhage control with a FemoStop device applied in the emergency department.

First and last authorship by gender in emergency medicine publications- a comparison of 2008 vs. 2018.

BACKGROUND AND OBJECTIVES: Recently, investigators reported that there remain substantial disparities in the proportion of women within emergency medicine (EM) who have achieved promotion to higher academic rankings, received grant funding, and attained departmental leadership positions. In 2007, women were first authors on 24% of EM-based peer-reviewed articles. Currently, 28% of the academic EM physician workforce is comprised of women. The goal of this study was to identify whether the proportion of female first authors of original research published in three U.S.-based EM journals increased in 2018 as compared to 2008. METHODS: This was a retrospective review of published original research articles during 2008 and 2018 in the journals Academic Emergency Medicine (AEM), American Journal of Emergency Medicine (AJEM), and Annals of Emergency Medicine (Annals). Review articles, opinion pieces, consensus statements, practice recommendations based on current guidelines, and case reports were excluded from analysis. Investigators conducted a review of each article to identify the gender of the study's first and last authors. A study author blinded to the previous author's data abstraction reviewed a sample of 25 articles to assess for inter-rater reliability (kappa). Categorical data are presented as frequency of occurrence and analyzed by chi-square. RESULTS: Overall for the study journals, there were 368 original research articles published in 2008 vs. 580 in 2018. There were no significant differences noted for the proportion of female first author publications during 2008 vs 2018 overall (28% vs 30%; p = 0.38), within AJEM (29% vs 28%; p = 0.85), and observed at Annals (25% vs 24%; p = 0.82) respectively. However, there was a significant increase in the number of first author publications by females between the two periods within AEM (28% vs 45%; p < 0.01). There were no significant differences noted for the proportion of female last author publications during 2008 vs. 2018 overall (21% vs 22%; p = 0.70) and within each respective journal: AEM 22%% vs 26% (p = 0.51), AJEM 22% vs 19% (p = 0.55), and Annals 19% vs 22% (p = 0.20). Inter-rater reliability for author gender within the sample articles was excellent (0.83). CONCLUSION: While female physicians make up a disproportionate 28% of the academic workforce, we found that they were proportionally represented as first authors within several of the most prominent U.S.-based EM journals. Female resident physicians remain underrepresented as first authors and women remain underrepresented as last authors in the same journals.

Use of Femostop device in the setting of life threatening inguinal bleeding.

Massive hemorrhage from the inguinal space is an indication for the use of the Femostop device in the emergency department. This case report describes a middle-aged male with metastatic and recurrent penile cancer status post inguinal lymph node dissection and chemoradiation with a nonhealing left groin wound with extension to the femoral vessels. The patient experienced massive bleeding from erosion of an open wound in left groin into femoral vein requiring massive transfusion. Direct pressure and pressure dressings were unable to control the bleeding present in the patient's left groin. The Femostop device was applied and hemostasis was immediately achieved.