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Introduction: The Masimo Radical-7 Pulse CO-Oximeter is a medical device recently approved by the US Food and Drug Administration that performs noninvasive oximetry and estimated venous or arterial hemoglobin measurements. A portable, noninvasive device that rapidly measures hemoglobin concentration could be useful in both austere and modern hospital settings. The objective of this study is to determine the degree of variation between the device's estimated hemoglobin measurement and the actual venous hemoglobin concentration in undifferentiated emergency department (ED) patients.Methods: We conducted a prospective, observational, cross-sectional study of adult patients presenting to the ED. The subjects consisted of a convenience sample of adult ED patients who required a complete blood count as part of their care in the ED. A simultaneous probe hemoglobin was obtained and recorded.Results: Bias between probe and laboratory hemoglobin measurements was –0.5 (95% confidence interval, – 0.8 to –0.1) but this was not statistically significant from 0 (t0.05,124 = 0.20, P > 0.5). The limits of agreement were –4.7 and 3.8, beyond the clinically relevant standard of equivalency of ± 1 g/dL.Conclusion: These data suggest that noninvasive hemoglobin determination is not sufficiently accurate for emergency department use.

Sodium fluoride is an accessible and frequently used compound that if ingested can cause ventricular dysrhythmias, hemorrhage, and death. We present a case report of a 21-year-old female who presented following an intentional ingestion of a lethal dose of sodium fluoride, developing massive hemorrhage and cardiac arrest.

A 57-year-old man presented to the emergency department with a chief complaint of progressive left lower quadrant abdominal and lower back pain for the past 3 weeks. Review of systems revealed only a history of constipation. There was moderate tenderness to palpation of the left abdomen on examination. Vital signs were normal. A complete blood count, basic metabolic panel, and liver function tests with lipase were normal except for platelets of 479,000/mm 3 and creatinine of 1.2 mg/dL (glomerular filtration rate 74 mL/min). Computed tomography (CT) of the abdomen and pelvis with intravenous contrast ( Figure 1) was performed, followed by bedside ultrasonography (US) of the aorta (Figure 2). The bedside US was performed to gain images of possible abnormal findings seen on aortic US. After identification of a mass surrounding the aorta and discussion with Vascular Surgery, the erythrocyte sedimentation rate and C-reactive protein were obtained, with values of 54 mm/hr and 6.2 mg/dL, respectively. The final diagnosis was based on imaging studies including magnetic resonance imaging (MRI). A biopsy of the tissue was not attempted due to the risk associated with biopsy. The patient was placed on high-dose prednisone (1 mg/kg/day), which resulted in the retroperitoneal fibrosis (RPF) shrinking by one-half after a month of treatment. RPF is a rare condition resulting in chronic inflammation and fibrosis of the tissue surrounding the aorta and adjacent retroperitoneal structures.