Sunday, December 4, 2016

Why is My Arm Swollen?

Image Credit: Flickr
Author: Pollianne Ward, MD
Temple University Hospital
Originally Published: Modern Resident February/March '13

A 16-year-old female presented to a children's hospital emergency department with two weeks of intermittent left shoulder pain. Over the last few days, her left arm had become diffusely swollen and painful with mottling of the skin, coolness of her left hand and paresthesias on the lateral forearm. Exam revealed strong radial and brachial pulses with her arm dependent, and decreased pulses when she raised her arm. She was a competitive swimmer and practiced up to four hours per day and symptoms were worse after exercise.

Thoracic outlet syndrome (TOS) is an uncommon condition with varying presentations and a constellation of signs and symptoms that make diagnosis very tricky. It is characterized by compression of the neurovascular bundle exiting the thoracic outlet, involving the subclavian artery, vein and Brachial plexus. Historically, it was categorized by the anatomic abnormality causing the compression, such as cervical or first rib, scalene muscle hypertrophy, costoclavicular and hyperabduction syndrome.

Thursday, December 1, 2016

Decreasing Door to Doc Time: The Online Waiting Room

Image Credit: Flickr
This post was peer reviewed.
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Author:
Christine Au
Medical Student- OMS-II
Western University of Health Sciences, College of Osteopathic Medicine of the Pacific
AAEM/RSA Social Media Committee

While the demand for emergency medical service has dramatically increased throughout the last five years, patients are finding that they are spending a great deal of time waiting to be seen.[1] In fact, emergency department (ED) visits have doubled the increase in population rates from 1997-2007.[2] On average, patients wait for two hours and 15 minutes from the time of arrival to the time they are admitted, or to the time of discharge.[2] However, this data point varies depending on the state the patient is being seen in, patient demographic, as well as the complexity of a patient’s case. In some of the more extreme cases, patients may wait an average of four hours or more before being seen by any healthcare professional.[1]