Anterior Shoulder Dislocations in Busy Emergency Departments: The External Rotation Without Sedation and Analgesia (ERWOSA) Method May Be the First Choice for Reduction.

Shoulder joint is the most common joint requiring reduction by emergency physicians. Successful reduction is based on the overcoming of resistance of the shoulder muscles. Pain is the most important factor in resistance increase and sedation; analgesia and, in certain cases, intra-articular anesthesia are preferred for reduction. The external rotation (ER) method can provide successful reduction without causing an increase in muscle resistance if applied slowly and gently. The aim of this study was, therefore, to determine the usefulness of the ERWOSA method in the reduction of acute anterior shoulder dislocations (AASDs).This was a retrospective descriptive study. The records of patients admitted to the emergency department with anterior shoulder dislocation between 2009 and 2011 were reviewed for demographic data, sedation, analgesia, and discharge times. Patients were then divided into ERWOSA (n = 80) and external rotation and sedation-analgesia (ERASA, n = 59) groups, with regard to the application of SA (sedation-analgesia). The study data were analyzed using SPSS version 22.0 software for Windows. Numerical data were presented as mean ± standard deviation and categorical data as rates.A total of 139 patients were included in the study. The patients' average age was 35 ± 14 years, 108 (77.7%) were male. Successful reduction rates for 59 male and 21 female patients in the ERWOSA group were 83% and 66.7% (78.7% total success), respectively. Successful reduction rates for 49 male and 10 female patients in the ERASA group were 87.7% and 90% (88.1% total success), respectively. The length of stay of the ERWOSA and ERASA groups in emergency services were found to be significantly different, with 55 ± 17 and 118 ± 23 minutes for each group, respectively. There were no complications.The ER method can be used in reduction of anterior shoulder dislocations without sedation and analgesia, if applied slowly enough to overcome the resistance of shoulder muscles. The ERWOSA method causes both a significant decrease in the length of stay of patients in the emergency department results in negating the possibility of adverse drug effects. In busy emergency departments, male patients with anterior shoulder dislocation are particularly suitable candidates for ERWOSA.

Bedside heart type fatty acid binding protein (H-FABP): Is an early predictive marker of cardiac syncope.

OBJECTIVE: To determine the value of bedside heart-type fatty acid binding protein in diagnosis of cardiac syncope in patients presenting with syncope or presyncope. METHODS: The prospective study was conducted at Ankara Numune Training and Research Hospital, Ankara, Turkey, between September 1, 2010, and January 1, 2011, and comprised patients aged over 18 years who presented with syncope or presyncope. Patients presenting to emergency department within 4 hours of syncope or presyncope underwent a bedside heart-type fatty acid binding protein test measurement. SPSS 16 was used for statistical analysis. RESULTS: Of the 100 patients evaluated, 22(22%) were diagnosed with cardiac syncope. Of them, 13(59.1%) patients had a positive and 9(40.9%) had a negative heart-type fatty acid binding protein result. Consequently, the test result was 12.64 times more positive in patients with cardiac syncope compared to those without. CONCLUSIONS: Bedside heart-type fatty acid binding protein, particularly at early phase of myocardial injury, reduces diagnostic and therapeutic uncertainity of cardiac origin in syncope patients.

An unusual presentation of ruptured abdominal aorta aneurysm.

PATIENT: Female, 65 FINAL DIAGNOSIS: Ruptured abdominal aorta aneursym Symptoms: - MEDICATION: - Clinical Procedure: After surgery the patient was discharged without sequelae Specialty: Surgery. OBJECTIVE: Unusual clinical course. BACKGROUND: Rupture of an abdominal aortic aneurysm is the most frightening and potentially life threatening complication of an abdominal aorta aneurysm (AAA). PATIENTs present with atypical symptoms such as abdominal or flank pain, gastrointestinal hemorrhage, or shock. CASE REPORT: A 65-year-old woman presented to our emergency department with gradually increasing left flank pain for 4-5 days. Her laboratory, radiologic, and physical examination revealed no significant pathology, so she was discharged, but 3 days later she was readmitted because her symptoms returned. Further research revealed a ruptured AAA and the patient was hospitalized for surgical intervention. CONCLUSIONS: Emergency physicians should keep in mind that AAA and its rupture can present with a wide range of symptoms that appear to be simple.

Gallbladder volvulus.

Gallbladder volvulus or torsion; is an uncommon cause of acute abdomen and occurs by rotation of the gallbladder on its mesentery. The entity commonly misdiagnosed as cholecystitis before laparatomy, although it has some critical findings that alert physician for correct diagnosis. A 47 years old male patient admitted to our emergency department with right upper quadrant pain, and then progressed through abdominal rigidity indicating acute abdomen, was subjected to laparatomy. At surgery; gangrenous and rotated gallbladder was observed and cholecystectomy was performed. Early diagnosis and prompt surgical treatment is mandatory to lower the complications of this entity. Clinical signs and radiographic studies should guide physicians for proper diagnosis of gallbladder torsion.