Tactical Medicine News Blog

[Click for larger view] Chief complaint: Foreign Body Ingestion History of Present Illness: A 4-year-old male presents to the Pediatric ED for evaluation of swallowed foreign body. The mother reports the patient was at his grandmother’s house playing near a cabinet when they witnessed him put a small unknown object in his mouth and swallow. Family denies vomiting, difficulty breathing, change in behavior, abdominal pain, or any additional symptoms at this time.

[Click for larger view] Chief complaint: Headaches for 1 year History of Present Illness: A 31-year-old woman with no significant past history presents with a dull headache. She notes the headache is generalized, has been almost daily for a year and is worsened by bending over. She denies nausea, vomiting, photophobia, trauma, seizures, focal weakness, numbness, or vision change. Acetaminophen and ibuprofen provide only mild, short-acting relief. She takes oral birth control and her periods have been normal.

Figure 1: Terminal extensor tendon avulsion at distal interphalangeal joint of 5th digit A 17-year-old baseball player presents complaining of finger pain and difficulty straightening his finger after a baseball game. You obtain x-rays and see the following fracture (photo credit). What is your diagnosis and emergency department management?

Background: Migraine is a chronic neurologic disease characterized by attacks of throbbing, often unilateral headache that are exacerbated by physical activity and associated with photophobia, phonophobia, nausea, vomiting, and, in many patients, cutaneous allodynia. Migraine is very common, and the burden of illness is substantial, with annual total costs estimated at $27 billion in the United States and ranking as the second most-disabling neurologic condition globally in terms of years lost to disability. Both preventive and abortive treatments have evolved alongside medicine’s improving understanding of the underlying pathophysiology of migraine and the discovery of new and effective therapies, however current treatments such as triptan therapy and neuroleptics are limited due to adverse effects (up to 52% in some cohorts) and contra-indications. Concerns about these effects were reported in one study to result in delays in treatment or avoidance of treatment in two thirds of patients. (Gallagher 2003).

Tamponade physiology, in which a pericardial effusion impedes cardiac output, is a medical emergency and requires prompt diagnosis and intervention before cardiovascular collapse ensues. However, not every fluid collection in the pericardial sac results in tamponade physiology. A clinical diagnosis of tamponade (Beck’s triad) has poor sensitivity and will occur only in the late stages of tamponade.​1​ In order to know whether or not an intervention is necessary for the setting of pericardial effusion, ultrasound diagnosis of tamponade is paramount.