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Traumatic ruptured globe eye injuries in a large urban center
Burstein ES, Lazzaro DR
Clinical Ophthalmology , 2013, DOI: http://dx.doi.org/10.2147/OPTH.S42050
Abstract: aumatic ruptured globe eye injuries in a large urban center Case Series (596) Total Article Views Authors: Burstein ES, Lazzaro DR Published Date March 2013 Volume 2013:7 Pages 485 - 488 DOI: http://dx.doi.org/10.2147/OPTH.S42050 Received: 24 December 2012 Accepted: 22 January 2013 Published: 06 March 2013 Eitan S Burstein, Douglas R Lazzaro Departments of Ophthalmology, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USA Background: The purpose of this study was to examine patient characteristics and outcomes in a group of consecutive patients with ruptured globe eye injuries at Kings County Hospital Center, a large, urban, level 1 trauma center. Methods: A retrospective chart review was performed to identify all patients with ruptured globe eye injuries seen between January 2009 and October 2011. Thirty-eight patients who sustained ruptured globe eye injuries from all causes were investigated for etiology and final visual outcomes Results: Eight eyes in which vision could be assessed were evaluated as having no light perception at presentation and three of these eyes required primary enucleation. Of the 38 eyes, orbit fractures were found in 15 eyes and an intraocular foreign body was found in six eyes. Discussion: Our cohort revealed a 37.5% rate of primary enucleation in eyes with no light perception, which we believe to be a reflection of the severity of injury. All three cases were secondary to a gunshot wound. Further, our sample, although small in size, revealed a very high percentage of eyes that were ruptured secondary to violent causes compared with other studies.
Bedside Ultrasound in a Case of Blunt Scrotal Trauma  [cached]
Mark Cannis,Thomas Mailhot,Phillips Perera
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2013,
Abstract: This case study describes a patient who suffered blunt force trauma to the scrotum. Use of bedsideemergency ultrasound facilitated early diagnosis of a ruptured testicle and allowed for prompturological consultation and timely surgical repair. The utility of bedside emergency ultrasound inthe evaluation of testicular trauma, as well as the outcome of our case, is discussed here.
Traumatic ruptured globe eye injuries in a large urban center  [cached]
Burstein ES,Lazzaro DR
Clinical Ophthalmology , 2013,
Abstract: Eitan S Burstein, Douglas R LazzaroDepartments of Ophthalmology, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USABackground: The purpose of this study was to examine patient characteristics and outcomes in a group of consecutive patients with ruptured globe eye injuries at Kings County Hospital Center, a large, urban, level 1 trauma center.Methods: A retrospective chart review was performed to identify all patients with ruptured globe eye injuries seen between January 2009 and October 2011. Thirty-eight patients who sustained ruptured globe eye injuries from all causes were investigated for etiology and final visual outcomesResults: Eight eyes in which vision could be assessed were evaluated as having no light perception at presentation and three of these eyes required primary enucleation. Of the 38 eyes, orbit fractures were found in 15 eyes and an intraocular foreign body was found in six eyes.Discussion: Our cohort revealed a 37.5% rate of primary enucleation in eyes with no light perception, which we believe to be a reflection of the severity of injury. All three cases were secondary to a gunshot wound. Further, our sample, although small in size, revealed a very high percentage of eyes that were ruptured secondary to violent causes compared with other studies.Keywords: rupture, trauma, violence, urban, epidemiology, emergency, globe
Ruptured Splenic Artery Aneurysms and the Use of an Adapted Fast Protocol in Reproductive Age Women with Hemodynamic Collapse: Case Series  [PDF]
Hope T. Jackson,Silviu C. Diaconu,Patrick J. Maluso,Bruce Abell,Juliet Lee
Case Reports in Emergency Medicine , 2014, DOI: 10.1155/2014/454923
Abstract: Nontraumatic symptomatic hypotension in all patients requires prompt diagnosis and appropriate treatment for optimum outcome. The female population specifically has an expanded differential diagnosis that should be considered when these patients present with hemodynamic collapse. While the most common causes of hypotension in pregnant patients are dehydration, ruptured ectopic pregnancy, and placental and uterine abnormalities, less common nonobstetrical etiologies such as hepatic rupture and ruptured abdominal and visceral artery aneurysms should also be considered. Splenic artery aneurysms are associated with high rates of mortality and in cases of pregnancy, maternal and fetal mortality. These high rates can be attributed to the asymptomatic nature of the aneurysm, rapid deterioration after rupture, and frequent misdiagnosis. In patients with hemodynamic collapse, the role of traditional imaging is limited mainly due to the critical condition of the patient. Bedside ultrasound has emerged as a diagnostic imaging resource in patients with undifferentiated hypotension and in patients with traumatic injuries. However, its use has not been studied specifically in the female population. We present two patients with ruptured splenic artery aneurysms, discuss the role of bedside ultrasound in their management, and introduce a new ultrasound protocol for use in reproductive age female patients with hemodynamic collapse. 1. Introduction Nontraumatic symptomatic hypotension in any patient requires prompt diagnosis and appropriate treatment for optimum outcome. The female population has specific and unique causes of hypotension that should be evaluated. Severe dehydration and ruptured ectopic pregnancy are common etiologies of hypotension and, in known pregnant patients, placental abruption, placenta previa, uterine rupture, and pulmonary embolus should be considered [1]. Less common nonobstetrical etiologies such as hepatic rupture, ruptured abdominal aneurysm, and visceral artery aneurysms should also remain in the differential diagnosis. Misdiagnosis of these intra-abdominal sources of bleeding is common and brings potentially devastating outcomes. In the diagnostic evaluation of unstable patients, the use of a CT scan, MRI, or angiography has a limited role primarily because of their time consuming nature. Ultrasound can be used to diagnose common obstetrical emergencies such as placental abruption, placenta previa, and uterine rupture [1]. Furthermore, several case reports comment on the use of bedside ultrasound to detect intra-abdominal free fluid to aid
Utility of Measurements of Abdominal Perfusion Pressure as a Measure of Isovolemic Status and Intestinal Perfusion in Patients with Ruptured Aortic Aneurysm
Krzysztof Bieda, Fryderyk Pukacki, Maciej Zieliński, Pawe Sobczyński, Grzegorz Oszkinis, Roma Hartman-Sobczyńska, Wac aw Majewski
Polish Journal of Surgery , 2011, DOI: 10.2478/v10035-011-0069-6
Abstract: Ruptured abdominal aorta aneurysm of ten results in intraabdominal hypertension (IAH). When IAH exceeds 20 mm Hg, intestinal ischemia can result that is a common cause of severe postoperative complications, including death. The aim of the study was to evaluate utility of measurement of abdominal perfusion pressure (APP) to estimate intestinal perfusion and isovolemic status in patients undergoing surgical treatment for ruptured abdominal aorta aneurysm. Material and methods. A group of 40 patients of either sex, aged 47 - 93 years (average age 70 ± 10) was treated at an Intensive Care Unit after surgical reconstruction of abdominal aorta due to ruptured aortic aneurysm. The study was prospective. The following were measured: parameters of intraabdominal pressure (intraabdominal pressure - IAP, abdominal perfusion pressure - APP); parameters of intestinal perfusion - tonometric (intramucosal gastric carbon dioxide partial pressure PgCO2, intramucosal-arterial difference in carbon dioxide partial pressure - Pg-aCO2); hemodynamic parameters (mean arterial pressure - MAP, central venous pressure - CVP). Results. A statistically significant correlation was demonstrated between parameters of visceral perfusion and abdominal perfusion pressure. Pearson correlation coefficient for APP/PgCO2 and APP/Pg-aCO2 was negative and was - 0.4664 and - 0.3498, respectively. Conclusions. Abdominal perfusion pressure is an useful parameter in the evaluation of intestinal perfusion in IAH patients after surgical treatment of ruptured aortic aneurysm. MAP reflects current physiological body reserves at a critical stage of the disease, informing about possibility to provide visceral perfusion and indirectly, about adequacy of fluid replacement therapy. In intraabdominal hypertension, CVP is falsely elevated, making it of low utility in the evaluation of volemic status and intestinal perfusion.
Role of Bedside Ultrasound in CMV Retinitis: A Case Report  [PDF]
Lauren Westafer,L. Connor Nickels,Eike Flach,Giuliano De Portu,Latha Ganti Stead
Case Reports in Emergency Medicine , 2012, DOI: 10.1155/2012/690598
Abstract: We present a case of retinal detachment diagnosed by emergency department bedside ultrasonography in a patient with CMV retinitis. The indications and findings of ocular ultrasonography are discussed. 1. Introduction Retinal detachments, though uncommon, are devastating ocular emergencies that may result in permanent vision loss. While most retinal detachments are associated with age, myopia, inflammatory disorders, and trauma, individuals with human immunodeficiency virus (HIV) are at risk for CMV retinitis and subsequent detachment [1]. Individuals with CMV retinitis have an incidence of retinal detachment of approximately 50% per patient per year, as a result of the virus-mediated necrosis of the retina [2]. Although early detection of retinal detachment may preserve a patient’s vision, CMV retinitis can infect both eyes and often progress to retinal detachment in days to weeks. As a result, practitioners should maintain a high index of suspicion for retinal detachment in HIV positive patients and use bedside ultrasound as a means of expedient evaluation in patients with visual changes. 2. Case A 38-year-old male presented to the Emergency Department (ED) with a complaint of progressive vision loss in his left eye over the past week. The patient denied trauma and any prior ocular history. He denied photophobia, pain, discharge, pruritus, nausea, vomiting, or headache. Physical exam revealed a pleasant, well-developed male who appeared comfortable. His past medical history was significant for HIV with an unknown CD4+ cell count. He was not on antiretroviral therapy but was undergoing treatment for toxoplasmosis. On exam, he had no facial swelling, erythema, or discharge from his eyes. His conjunctivas were injected bilaterally. His extraocular movements were intact. The patient’s pupils were round bilaterally, but his left pupil was nonreactive to light. There was no pain with movement of his extra-ocular muscles. He reported complete loss of vision in his left eye, including inability to perceive light. Visual acuity in the patient’s right eye was 20/200, his reported baseline. A high frequency 7.5–10-MHz linear array transducer was used to perform the ocular examination. A large amount of standard, water-soluble ultrasound gel was applied to the patient’s closed eyelid. The patient was instructed to look straight ahead. The eye was scanned in both the sagittal and transverse planes, using essentially no pressure on the globe. The ultrasound demonstrated a large retinal detachment in the left eye with no macular sparing (Figure 1). No vitreous
Pseudoaneurysm of the Radial Artery Diagnosed by Bedside Ultrasound  [cached]
Pero, Thomas,Herrick, John
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2009,
Abstract: A 42-year-old male presented to the emergency department with pain and swelling of his distal right wrist. Bedside ultrasound placed over the swelling revealed a pseudoaneurysm of the radial artery. The patient received percutaneous thrombin injection of the aneurysm sac followed by direct ultrasound compression therapy of the pseudoaneurysm neck, resulting in thrombosis of the sac. The use of bedside ultrasound by the emergency physician led to appropriate care and proper disposition for definitive management. [WestJEM. 2009;10:89-91.]
Variable Access to Immediate Bedside Ultrasound in the Emergency Department  [cached]
Talley, Brad E,Ginde, Adit A,Raja, Ali S,Sullivan, Ashley F
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2011,
Abstract: Objective: Use of bedside emergency department (ED) ultrasound has become increasingly important for the clinical practice of emergency medicine (EM). We sought to evaluate differences in the availability of immediate bedside ultrasound based on basic ED characteristics and physician staffing.Methods: We surveyed ED directors in all 351 EDs in Colorado, Georgia, Massachusetts, and Oregon between January and April 2009. We assessed access to bedside ED ultrasound by the question: “Is bedside ultrasound available immediately in the ED?” ED characteristics included location, visit volume, admission rate, percent uninsured, total emergency physician full-time equivalents and proportion of EM board-certified (BC) or EM board-eligible (BE) physicians. Data analysis used chi-square tests and multivariable logistical regression to compare differences in access to bedside ED ultrasound by ED characteristics and staffing.Results: We received complete responses from 298 (85%) EDs. Immediate access to bedside ultrasound was available in 175 (59%) EDs. ED characteristics associated with access to bedside ultrasound were: location (39% for rural vs. 71% for urban, P20%] rates, P<0.001); and EM BC/BE physicians (26% for EDs with a low percentage [0-20%] vs.74% for EDs with a high percentage [≥80%], P<0.001).Conclusion: U.S. EDs differ significantly in their access to immediate bedside ultrasound. Smaller, rural EDs and those staffed by fewer EM BC/BE physicians more frequently lacked access to immediate bedside ultrasound in the ED. [West J Emerg Med. 2011;12(1):96-99.]
RUPTURED UTERUS
YASMEEN AKHTAR
The Professional Medical Journal , 2010,
Abstract: Objective: To analyze the risk factors for uterine rupture and to share the 5 years experience of ruptured uterus with othercolleagues of the specialty. Study design: Case series descriptive study. Settings: Gynae /Obstetrics Unit -I Lady Willingdon Hospital Lahore. Study Duration: Five years i.e Ist May 2004 to 30th April 2009. Material and Methods: Obstetric patients who presented with ruptured uteri. Results: Results showed that risk factor for ruptured uteri include cesarean sections (61.11%), grand multiparty (16.6%), Instrumental deliveries (4.44%) and undetected perforation (1.11%). Conclusion: Ruptured uterus is a high risk category of patients. The patients with previous scar, grand multiparas, obstructed prolonged labour must be managed by proper trained personnel and in tertiary care centers in order to avoid the morbidity or mortality due to ruptured uterus.
Free the Globe  [PDF]
Alejandro Gangui
Physics , 2015,
Abstract: The parallel globe is an old, very simple and ingenious device that, when systematically employed in astronomy classes, becomes a teaching tool with great potential. Properly oriented according to the local meridian, this instrument allows us to follow the shadows in any region of the Earth that is illuminated by the Sun, as well as offering a clear view of the terminator, the fast-moving grey line that divides the day from the night on our planet. With knowledge of the shadows, it is possible to estimate the latitude of a site and to infer local solar time anywhere in the planet's sunlit hemisphere. Furthermore, by using the parallel globe we may understand simply the existence of regions in which objects sometimes do not cast shadows, and also other regions which, on the contrary, sometimes become "long-shadow" countries. In this work, we first review the device and the basics of its assembly and operation. In the second part, we describe in detail some activities targeted to facilitate its use in the classroom, which our research group has been developing during teacher training workshops.
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