Gender disparity in stoke: Women have higher ICH scores than men at initial ED presentation for intracerebral hemorrhage.

OBJECTIVE: To determine what if any differences in presentation exist between men and women who present with acute intracerebral hemorrhage (ICH) to the emergency department (ED). METHODS: This was an IRB approved prospective cohort study of ED patients presenting with acute intracerebral hemorrhage. Statistical analyses were performed in JMP 14.1. Non parametric methods were used for skewed variables. The study was conducted in a comprehensive stroke center. The independent variable was the ICH score, and the dependent variable of interest was ultimate disposition (death or hospice vs. home or skilled nursing facility). RESULTS: The cohort consisted of 129 patients (54 women and 75 men). The median age was 71 years (IQR 58-81). The baseline co-morbidities were similar between both men and women and whether or not they were independent in their activities of daily living prior to experiencing their ICH. The overall median ICH score for women was 2, IQR 1-4, and 1 for men, IQR 1-2 (P = 0.0369) . A higher ICH score was significantly associated with in-hospital death and or hospice status (P = .0095, 95% CI 0.6340 - 0.4825). Conversely, a lower ICH score was significantly associated with being discharged home (P< 0.001, 95% CI -0.1694 to -0.0759). CONCLUSION: Women have higher ICH scores than men at initial ED presentation for intracerebral hemorrhage. A higher ICH score is significantly associated with the worse outcomes of death and/or hospice.

Physician-Perceived Barriers to Treating Opioid Use Disorder in the Emergency Department.

Objective We aimed to assess physicians' perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities. Methods This was a cross-sectional survey study of American emergency medicine (EM) physicians with a self-administered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs' listservs. Attendings and residents of all post-graduate years participated. Questions assessed perceptions of barriers to starting OUD patients on MAT, knowledge of the X-waiver, and knowledge of MAT details. Statistics were performed with JMP software (SAS Institute Inc., Cary, NC) using the two-tailed Z-test for proportions. Results There were 98 responses, with 33% female, 55% resident physicians, and an overall 17% response rate. Residents were more eager to start OUD patients on MAT (71% vs 52%, p=0.04) than attendings but were less familiar with the X-waiver (38% vs 73%, p=0.001) or where community outpatient MAT facilities were (21% vs 43%, p=0.02). Conclusion Barriers in the ED were identified as a shortage of qualified prescribers, the lengthy X-waiver process, and the poor availability of outpatient MAT resources. EM residents showed more willingness to prescribe MAT but lacked a core understanding of the process. This shows an area of improvement for residency training as well as advocacy among attendings.

Respiratory Distress with Minimal Exertion: A Case of 2019 Novel Coronavirus (COVID-19) Pneumonia.

Description COVID-19 is a new coronavirus that can cause severe respiratory distress. Interestingly, patients can present with COVID-19 and appear relatively well but with significant hypoxia, even with minimal movement. The authors present the case of a well-appearing gentleman who became acutely short of breath while undergoing chest imaging, stating he could not breathe. He tested positive for COVID-19 and recovered. His presentation, clinical course and imaging findings are discussed.

Pericardial effusion with tamponade: bedside ultrasonography saves another life.

In these video clinical images, the authors present the cause for an elderly gentleman's shortness of breath. It was presumed to be an exacerbation of chronic obstructive pulmonary disease, a condition for which he was in the process of being evaluated. However, bedside ultrasonography revealed a large pericardial effusion with tamponade. This timely diagnosis resulted in the patient being taken expeditiously to the operating room and saving his life.

Ingested Fish Bone Lodged in the Vallecula.

Although foreign body ingestions are less common in adults than children, when they do occur, it is often due to a fish or chicken bone. The authors present a case of a fish bone ingestion, and highlight its appearance on imaging.

A Local Epidemic of Laced Heroin Causing Skin Necrosis.

The authors present a case of severe skin necrosis resulting from injecting heroin laced with a substance known as "Rizzy" powder. This powder is a toxic substance used to color the petals of plants. This report reviews how to manage the complications of such adulterated heroin.

A Case of Hyponatremia-induced Seizures in an Infant Secondary to Water Intoxication from the Use of Almond Milk.

Pediatric seizures are a common presentation to the emergency department. It is important to separate non-febrile seizures from febrile seizures, as non-febrile seizures have a much broader differential diagnosis. For infants less than six months of age with a normal exam, hyponatremia is the leading cause of new onset non-febrile seizure. Most commonly, this is secondary to water intoxication from inappropriate feeding practices. This case report will review the initial workup of new onset non-febrile seizures in an infant and treatment recommendations for seizures secondary to hyponatremia.

Orbital Compartment Syndrome: How a Young Man's Vision was Saved by the Timely Actions of an Emergency Medicine Physician.

In the following case presentation, a young man who incurred orbital compartment syndrome (OCS) from physical trauma significantly improved from timely lateral canthotomy. Lateral canthotomy is recommended to be performed as soon as possible to avoid permanent vision loss, which is the most feared complication associated with orbital compartment syndrome. This procedure completely restored vision in the patient and permitted prompt discharge.

Preseptal and Postseptal Orbital Cellulitis of Odontogenic Origin.

The authors present a case of combined preseptal and postseptal cellulitis of odontogenic origin. The infection started as a dental abscess associated with a first maxillary molar. The infection spread into the paranasal sinus, developed into a pansinusitis, and then spread into the preseptal and postseptal tissues. In addition to extraction of the infected tooth, the patient underwent bilateral nasal endoscopy, maxillary antrostomy, total ethmoidectomy, sphenoidotomy, and frontal sinusotomy with balloon dilation. Sinus cultures were positive for 2+ microaerophilic streptococci.