The utility of transvaginal ultrasound in the ED evaluation of complications of first trimester pregnancy Nova L. Panebianco, Frances Shofer, J. Matthew Fields, Kenton Anderson, Alessandro Mangili, Asako C. Matsuura, Anthony J. Dean
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.023
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: February 20 2015
x For patients with early intrauterine pregnancy (IUP), the sonographic signs of the gestation may be below the resolution of transabdominal ultrasound (TAU); however, it may be identified by transvaginal ultrasound (TVU). We sought to determine how often TVU performed in the emergency department (ED) reveals a viable IUP after a nondiagnostic ED TAU and the impact of ED TVU on patient length of stay (LOS).
High-frequency linear transducer improves detection of an intrauterine pregnancy in first-trimester ultrasonography Matthew Tabbut, Devin Harper, Diane Gramer, Robert Jones
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.001
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 3 2015
x The objective was to determine if the need for transvaginal ultrasonographic examination can be decreased by the addition of the transabdominal high-frequency, 12-4–MHz linear transducer after a failed examination with the 6-2–mHz curvilinear transducer when evaluating for an intrauterine pregnancy (IUP).
Correlation of β -human chorionic gonadotropin with ultrasound diagnosis of ectopic pregnancy in the ED Amy J. Bloch, Scott A. Bloch, Matthew Lyon
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.009
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 13 2013
x Women with ectopic pregnancies tend to have lower β -human chorionic gonadotropin (β -hCG) levels than women with intrauterine pregnancies (IUP) [1]. Transvaginal ultrasound (TVUS) is capable of detecting IUPs when β -hCG levels are greater than 1500 mIU/mL, the so-called discriminatory zone [2–4]. When serum β -hCG levels are less than 1500 mIU/mL and no IUP is detected, possibility of ectopic pregnancy or early IUP exists. Because of the discriminatory zone, emergency physicians often opt not to perform ultrasound on patients whose β -hCG level is less than 1500 mIU/mL.
Pitfalls in cervical ectopic pregnancy diagnosis by emergency physicians using bedside ultrasonography Dewi Chrestiana, Alfred B. Cheng, Nova L. Panebianco, Anthony J. Dean
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.055
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: November 11 2013
x Pelvic pain and vaginal bleeding are common complaints in pregnant women presenting to emergency department. Cervical ectopic pregnancy (EP) is a rare type of EP, with a higher likelihood of complications if missed. Its sonographic findings can be difficult to distinguish from normal pregnancy or an abortion in progress. In this report, we present a rare case of a cervical EP, diagnosed using bedside ultrasonography, and characterize the pitfalls associated with its diagnosis.
Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis Aaron M. Burnett, Christopher P. Anderson, Michael D. Zwank
DOI: http://dx.doi.org/10.1016/j.ajem.2011.07.014
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: October 26 2011
x The aim of this study was to determine the rates of laboratory confirmed gonorrhea (GC) and chlamydia (CT) in emergency department (ED) patients with pelvic inflammatory disease (PID) and cervicitis who were diagnosed clinically and treated empirically. A secondary goal examines which clinical criteria were present in patients with PID testing positive for GC/CT.
Fetal loss in symptomatic first-trimester pregnancy with documented yolk sac intrauterine pregnancy Mary Josephine Hessert, Michael Juliano
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.021
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: February 7 2011
x The possibility of spontaneous miscarriage is a common concern among pregnant women in the emergency department (ED).
Analysis of lawsuits filed against emergency physicians for point-of-care emergency ultrasound examination performance and interpretation over a 20-year period Michael Blaivas, Richard Pawl
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.016
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: January 31 2011
x The study aims to define extent of lawsuits filed against emergency physicians (EPs) over point-of-care emergency ultrasound (US) during the last 20 years.
Initial accuracy of bedside ultrasound performed by emergency physicians for multiple indications after a short training period Juan Torres-Macho, Juan M. Antón-Santos, Isabel García-Gutierrez, María de Castro-García, Sergio Gámez-Díez, Pilar García de la Torre, Gonzalo Latorre-Barcenilla, Yolanda Majo-Carbajo, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.015
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: July 16 2012
x Emergency physician–performed ultrasonography holds promise as a rapid and accurate method to diagnose multiple diseases in the emergency department (ED). Our objective was to assess the initial diagnostic accuracy (first 55 explorations) of emergency physician–performed ultrasonography for multiple categories of ultrasound use after a short training period.
Overtreatment of gonorrhea and chlamydial infections in 2 inner-city emergency departments Colleen E. Holley, Thuy Van Pham, Heather M. Mezzadra, George C. Willis, Michael D. Witting
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.009
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: June 13 2015
x Infections with Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) are the most commonly reported sexually transmitted diseases in the United States.
What is the significance of a previous molar pregnancy? Nancy Lutwak, Curt Dill
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.020
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: December 14 2011
x Emergency department (ED) physicians frequently evaluate women with first trimester vaginal bleeding. Etiologies include spontaneous abortion, ectopic pregnancy, and, rarely, gestational trophoblastic disease. The clinical assessment may be difficult, but the use of transvaginal sonograms and serum quantitative β human chorionic gonadotropin levels is helpful. Pregnant women previously treated for gestational trophoblastic disease may present to EDs with vaginal bleeding. We describe gestational trophoblastic disease and its treatment and discuss the evaluation of a patient with previous history of molar pregnancy presenting to the ED with abdominal pain and vaginal bleeding during a subsequent pregnancy.
Heterotopic pregnancy resulting from in vitro fertilization Douglas D. Brunette, Chad Roline
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.028
The American Journal of Emergency Medicine , Vol. 29 , Issue 8 ,
Published online: October 25 2010
x A previously healthy 32-year-old woman presented to the emergency department complaining of sudden onset of abdominal pain, nausea with vomiting, and syncope. The patient underwent in vitro fertilization 6 weeks prior. The initial differential diagnosis was intrauterine pregnancy with ovarian hyperstimulation syndrome vs heterotopic pregnancy. A deteriorating clinical condition and ultrasound findings prompted emergent exploratory laparotomy. A ruptured ectopic pregnancy was resected, and the patient was discharged with a viable intrauterine pregnancy.
The implications of abdominal palpation with Ou MC manipulation for women with acute abdomen Ming-Cheh Ou, Chung-Chu Pang, Dennis Ou, Chin-Hsu Su
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.008
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: February 28 2011
x Abdominal palpation with Ou MC manipulation (APOM) has showed to be more sensitive than bimanual pelvic examination for the diagnosis of pelvic inflammatory disease in women with acute abdomen (JEM . 2010;). This study compared APOM with traditional abdominal palpation (AP) for diagnostic reliability and enquired into the mechanism of APOM.
The accuracy of ultrasound evaluation in foot and ankle trauma Salih Ekinci, Onur Polat, Müge Günalp, Arda Demirkan, Ayça Koca
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.008
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: August 30 2013
x Foot and ankle injuries that result in sprains or fractures are commonly encountered at the emergency department. The purpose of the present study is to find out the accuracy of ultrasound (US) scanning in injuries in the aforementioned areas.
Novel use of a urine pregnancy test using whole blood Joseph P. Habboushe, Graham Walker
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.020
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: August 16 2010
x We present the case of a 35-year-old woman with hypotension and abdominal tenderness after acute vomiting and syncope. The patient had been breast-feeding since the birth of a child 8 months earlier, was not yet menstruating, and felt that she was having a reaction to sushi. She was unable to provide a urine sample during initial evaluation, and a drop of whole blood was therefore applied to a qualitative urine human chorionic gonadotropin point-of-care test. This test result was positive for pregnancy, ultrasound revealed free fluid in the abdominal cavity, and emergency laparotomy by our gynecologists confirmed ruptured ectopic pregnancy.
Enrollment with a primary care provider does not preclude ED visits for patients with woman’s health–related problems Jessica Burns, Alfred Sacchetti
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.030
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 23 2015
x The Affordable Care Act places primary care at the cornerstone of health maintenance. It is believed that increasing access to primary health care providers will limit emergency department (ED) use. This study examines woman’s health–related ED visits by patients enrolled in an obstetric/gynecologic (OB/GYN) clinic.
Endometriosis presenting with hemorrhagic ascites, severe anemia, and shock Trent L. Morgan, Eric B. Tomich, Jason D. Heiner
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.008
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: July 18 2012
x Hemorrhagic ascites due to endometriosis is an exceedingly uncommon diagnosis rarely reported in the medical literature. We present a case of a 27-year-old woman who presented to the emergency department for flank and neck pain and was found to be hypotensive with massive hemorrhagic ascites and severe anemia. After emergency department resuscitation and hospitalization, her condition was found to be due to complications of endometriosis. A paracentesis of more than 4000 mL of bloody ascitic fluid revealed no evidence of cancer, and she was discharged on hospital day 3 with hormone therapy and no recurrence of symptoms upon outpatient follow-up.
A healthy young woman with massive hemorrhagic ascites Fumiaki Kishino, Ryota Inokuchi, Yohei Komaru, Nobuhiro Takaya, Miyuki Yamamoto, Susumu Nakajima, Naoki Yahagi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.039
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: April 24 2015
x Retrograde menstruation is the backward movement of menstrual fluids. The underlying mechanisms remain unknown. The converse current itself is benign, but the result can be abdominal pain caused by peritoneal irritation and, eventually, endometriosis. The case was of a 25-year-old woman with lower abdominal pain accompanied by significant hemoperitoneum. Physical examination and inspection using abdominal ultrasonography and computed tomography failed to reveal a differential diagnosis. Detailed history taking revealed sexual activities during her menstrual period, which allowed for a diagnosis of retrograde menstruation.
Underrecognition of cervical Neisseria gonorrhoeae and Chlamydia trachomatis infections in pregnant patients in the ED Roman Krivochenitser, Jeffrey S. Jones, David Whalen, Cynthia Gardiner
DOI: http://dx.doi.org/10.1016/j.ajem.2012.11.017
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 6 2013
x The purposes of this study were to (1) quantify the frequency of underrecognized Neisseria gonorrhoeae (GC ) and Chlamydia trachomatis (CT ) infections in pregnant women tested in the emergency department (ED), (2) describe the characteristics of those not treated during the initial visit, and (3) determine how many pregnant women with acute cervicitis were lost to follow-up.
Empiric treatment of sexually transmitted infections in a pediatric Emergency Department: are we making the right decisions? Amy E. Pattishall, Shahnaz Y. Rahman, Shabnam Jain, Harold K. Simon
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.028
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: December 14 2011
x Limited recommendations address empiric versus delayed treatment of pediatric patients for sexually transmitted infections (STIs). This study investigates how frequently empiric STI treatment correlated with subsequent positive test results in an urban, high-risk pediatric emergency department (PED).
Age- and sex-specific normal values for shock index in National Health and Nutrition Examination Survey 1999-2008 for ages 8 years and older Lara D. Rappaport, Sara Deakyne,, Joseph A. Carcillo, Kim McFann, Marion R. Sills
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.014
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 13 2013
x Shock index (SI), the ratio of heart rate to systolic blood pressure, has found to outperform conventional vital signs as a predictor of shock. Although age-specific vital sign norms are recommended in screening for shock, there are no reported age- or sex-specific norms for SI. Our primary goal was to report age- and sex-specific SI normal values for a nationally representative population 10 years and older by 5-year age groups. A secondary goal was to report SI normal values for children ages 8 to 19 years by 1-year age groups.
