Lincoln Hospital

About: Lincoln Hospital is a healthcare organization based out in New York, New York, United States. It is known for research contribution in the topics: Population & Emergency department. The organization has 1033 authors who have published 929 publications receiving 14486 citations. The organization is also known as: Lincoln Medical and Mental Health Center & Lincoln Hospital.

A case of an unusual hernia associated with gastrointestinal bleeding.

Abstract: Background Acute upper gastrointestinal (GI) bleed is a well-known presentation to the emergency department (ED) frequently accompanied by hematemesis. We describe the case of a patient with abdominal content herniation into the chest wall with a recent history of coronary artery bypass graft presenting with acute onset of hematemesis. Objectives To present an exceedingly rare herniation of abdominal contents into the chest wall that was accompanied by hematemesis and to present the rare visual findings inherent in this pathology. Case Report A 65-year-old man presented to the ED vomiting large amounts of blood upon presentation, compromising hemodynamic stability and prompting emergent resuscitation. The patient’s presentation was complicated by a large 30 × 40-cm anterior chest wall mass extending 2 cm inferior to the sternal notch expanding with each episode of hematemesis. Computed tomography after stabilization revealed a large ventral hernia extending into the chest wall, containing small and large bowel. We suspected this large, unusual hernia to be the underlying cause of the patient’s GI bleeding. Conclusion The emergency physician must be able to assess hemodynamic stability of an upper GI bleed and resuscitate the unstable patient if warranted. Diagnosis is to be subsequently determined after stabilization.

Incision and Drainage of Abscess

Abstract: Abscess greater than 5 mm in diameter and in accessible areas (e.g., axilla, extremities, trunk)

General Evaluation, Risk Management, and Goals of Care

Abstract: The key drivers of this chapter are the empirical evidence of an ever-growing population of elderly trauma patients and the unmet need for reliable approaches to general evaluation, risk management, and goals of care. We describe herein the general evaluation, risk management, and goals of care of geriatric trauma given the complexities present in this age group. These complexities include age-related changes, chronic diseases, polypharmacy, as well as patient and family adverse perceptions and professional biases towards elderly care. The universal ABCDE trauma language taught by ATLS regarding airway, breathing, circulation, disability, and exposure is reviewed with special consideration for the elderly. We added “F,” for frailty, to emphasize the significance of this functional measure in the general evaluation of elderly trauma. We also provide an interesting insight regarding the role of interdisciplinary approach along with the understanding of “definitive and aggressive care” as lessons learned from the ICU with applications across the continuum of care. As proof of concept, we present G-60 Trauma as a robust elderly care management strategy that improves both the processes and outcomes of elderly patients at level I trauma centers. We conclude that the overall goal of care should aim to reduce the disastrous issue of under-triage in the elderly, aggressively restore health, and optimize functional recovery to preinjury levels. These achievements are optimal and limited only by the unalterable aspects of age-dependent changes in the elderly that occur prior to the traumatic event.

A patient with lower extremity weakness after recent endovascular repair of an abdominal aortic aneurysm

Abstract: Background Thrombosis of an endovascular aortic repair (EVAR) is a devastating complication of a common surgical procedure that can lead to serious morbidity and mortality if not promptly recognized. This is the first case report of an EVAR graft thrombosis in the emergency medicine literature. Case report We present a case of a patient with lower extremity paraplegia secondary to thrombosis of an EVAR graft who presented to the emergency room with acute stroke-like symptoms after a recent EVAR procedure. Endovascular repair of abdominal aortic aneurisms is becoming more frequent, and an increased number of patients with recent abdominal aortic aneurism repair by endovascular grafts will be evaluated by emergency physicians in the future. Emergency physicians should be aware that signs of limb ischemia, which may masquerade as acute ischemic stroke-like symptoms, is one of the more serious complications that can occur with abdominal aortic vascular grafts. Among patients with lower extremity neurological deficits in the recent setting of EVAR presenting to an emergency department, there should be a high degree of suspicion for EVAR graft thrombosis, which can be diagnosed via the gold standard of CT angiography or ultrasonography. Prompt vascular surgery consultation is essential to minimize permanent disability.