Endocarditis is a well-known disease, yet septic embolization resulting in myocardial infarction is much rarer and very infrequently diagnosed in the emergency department (ED). Point-of-Care-Ultrasound (POCUS) can be used to confirm clinical suspicion within minutes of patient presentation, thereby expediting patient care. We report the case of a 26-year-old female with known intravenous drug use who presented with altered mental status. Her clinical presentation prompted urgent evaluation in the ED with POCUS which showed a hyperdynamic functioning left ventricle, greater than 50% inferior vena cava collapse, and a large tricuspid valve vegetation. In light of the electrocardiogram (ECG) ST changes suggesting an acute myocardial infarction, the patient was emergently taken to the cardiac catheterization laboratory where coronary angiography revealed multiple coronary emboli. Primary diagnoses included endocarditis due to Staphylococcus , septic pulmonary embolism, and ST-elevated myocardial infarction (STEMI) due to embolic occlusion of the distal left anterior descending artery. Myocardial infarction caused by septic embolization from endocarditis is a rare condition; however, POCUS is a quick, non-invasive tool that can aid the emergency medicine (EM) physician in identifying this life-threatening pathology thereby expediting appropriate care for the patient.
Situ-LaCasse, Elaine. (2019). Can emergency physicians perform extended compression ultrasound for the diagnosis of lower extremity deep vein thrombosis?. World Journal of Emergency Medicine.
INTRODUCTION AND OBJECTIVES: Marriage has been associated with improved outcomes in a number of health conditions. We wished to determine whether marital status was associated with urinary incontinence and lower urinary tract symptoms.METHODS: We used data from the 2003 to 2012 National Health and Nutrition Examination Survey cycles to examine the association between marital status and self-reported stress incontinence, urge incontinence and nocturia. Marital status was defined as single (never married, divorced, widowed or separated) or married (married or living with a partner). Marital status was examined in a weighted, variance-corrected multivariate logistic regression for association with each outcome of interest. Models examining male subjects were adjusted for age, body mass index, race, diabetes, and self-reported health status. Models examining female subjects were also adjusted for parity.RESULTS: Cohorts of 4949 women and 6616 men were included in the study. Married women were less likely to report urge incontinence (OR 0.86, 95%CI 0.73-0.99) and nocturia (OR 0.78, 95% CI 0.64-0.95) and more likely to report stress incontinence (OR 1.27, 95%CI 1.10-1.47), than their single counterparts. Married men were less likely to report urge incontinence (OR 0.74, 95%CI 0.59-0.92) and nocturia (OR 0.75, 95%CI 0.61-0.92) than their single counterparts. No difference in stress incontinence was observed between married and single men.CONCLUSIONS: This study demonstrates that married women and men are less likely than single individuals to report urge incontinence and nocturia. Marital status is known to have a protective role in a number of health outcomes. To our knowledge, this is the first study to demonstrate an association between marriage and decreased incontinence. Interestingly, marriage was significantly associated with increased stress incontinence in women even after adjustment for parity. This finding suggests that other factors may contribute to stress incontinence in married women.
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