John Munyak

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Stress fractures are a frequent injury in ballet companies and the most common location is at the base of the second metatarsal. While previous reports have focused on risk factors for this injury (overtraining, delayed menarche, poor nutrition), there is no published series describing the natural history and outcome following this fracture. We reviewed the(More)
We retrospectively reviewed the office records of the senior author--which include two national ballet companies--and identified 35 dancers who sustained distal shaft fractures of the fifth metatarsal. The usual fracture pattern is a spiral, oblique fracture starting distal-lateral and running proximal-medial. Treatment consisted of open reduction and(More)
It is usually thought by emergency physicians that the diagnosis of a pneumothorax is straightforward and easy to make and to treat, but the diagnosis may sometimes pose a challenge. The present report describes a case of a giant pulmonary bulla in a 40-year-old man that progressed to occupy almost the entire left hemithorax and also subsequently ruptured(More)
This report describes the case of a young woman who presented to an emergency department with severe abdominal pain and shock. The patient was found to have pericardial tamponade due to a massive pericardial effusion. On further evaluation, the etiology of this effusion was considered to be secondary to hypothyroidism with concominant acute viral(More)
CONTEXT Sidelines coverage presents unique challenges in the evaluation of injured athletes. Health care providers may be confronted with the question of when to obtain radiographs following an injury. Given that most sidelines coverage occurs outside the elite level, radiographs are not readily available at the time of injury, and the decision of when to(More)
Although it is imperative that fractures be diagnosed to avoid complications associated with treatment delays, overtriaging patients with low suspicion for a fracture is also undesirable and uses unnecessary resources. Radiographs are generally easily obtained in the clinical setting, but many games and practices occur after hours when offices are closed,(More)
A three-page conscious sedation (CS) monitoring datasheet and sedation-analgesia policy were implemented at the Lincoln Hospital Emergency Department (LHED) to maintain compliance with JCAHO and New York State standards on CS monitoring. The datasheet included areas for physical examination, medications, and vital signs. To determine effects of the new(More)
BACKGROUND Complaints related to the hands, wrists, and fingers comprise approximately 3.7 million emergency department visits annually. The complexity of this subject can confound timely diagnosis and treatment, particularly if the treating physician has not received specialized training. We set out to determine whether emergency medicine training in the(More)
The purpose of this foot and ankle update is to educate the reader on important foot and ankle topics including current controversies, physical examination, diagnostics, and management. Quick-view lists are used to give easy access to the most significant knowledge points for providing patient care for these entities. These topics were chosen either because(More)
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