A Great Heist: Subclavian Steal Syndrome Causing Posterior Transient Ischemic Attack and Stroke.

Introduction Subclavian steal syndrome is a phenomenon of arterial flow reversal secondary to occlusive disease in proximal subclavian arteries, occasionally resulting in neurologic sequelae. Case Presentation The authors present the case of a 67-year-old man with stroke risk factors and a history of receiving head and neck radiation therapy who developed subclavian steal physiology leading to a transient ischemic attack and posterior circulation stroke. He was medically optimized without substantial progression or recurrence of disease. Conclusion This case illustrates a case of vertebrobasilar transient ischemic attack and posterior circulation stroke from subclavian steal syndrome in the setting of prior radiation therapy manifesting as extremity weakness and discoordination. Further research on therapeutic radiation dosages and subsequent incidence of arterial disease which could contribute to subclavian steal syndrome is necessary.

Pneumomediastinum Diagnosed on Ultrasound in the Emergency Department: A Case Report.

A previously healthy patient was seen in the Emergency Department for evaluation of a one-month history of cough and one-day history of hemoptysis. This case report, from a pulmonologist's perspective, includes a comprehensive review of the patient's clinical presentation and outcome, as well as a discussion of recurrent respiratory papillomatosis.

Development and validation of a web-based assessment tool for the extended focused assessment with sonography in trauma examination.

OBJECTIVES: Extended focused assessment with sonography in trauma (EFAST) examinations are routinely performed by emergency physicians and general surgeons as an integral part of trauma care. Although guidelines for competency in the EFAST examination exist, tools to assess competency are lacking. Our goal was to develop and validate a Web-based competency assessment tool to evaluate providers who perform the EFAST examination. METHODS: A multiple-choice test regarding the performance and interpretation of the EFAST examination was developed following National Board of Medical Examiner guidelines. Five emergency physician experts with fellowship training in emergency ultrasound established face and content validity. The test was administered to emergency medicine residents and ultrasound fellows. Concurrent validity was evaluated by assessing the correlation of scores on our test with guidelines set by the American College of Emergency Physicians (ACEP) for emergency ultrasound. Scores were analyzed, and statistical analysis was performed. RESULTS: Sixty-three emergency medicine residents and 2 ultrasound fellows from 2 residency programs completed the assessment tool. Examinees who met ACEP guidelines scored significantly higher than those who had not: 70.4% (95% confidence interval, 67.3%-73.4%) versus 48.3% (43.2%-53.5%). Evaluation of scores showed a significant correlation between an increased level of training, participation in an ultrasound rotation, and the number of EFAST and total ultrasound examinations performed with higher test scores. However, overall test scores were lower than initially anticipated. CONCLUSIONS: Use of this assessment tool for interpretation of EFAST images showed face and content validity. Score trends showed a significant correlation with existing ACEP guidelines, ultrasound experience, and the training level. Scores continued to improve with experience beyond ACEP recommended guidelines.