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ED pain management

Jeffrey M Caterino, David Adler, Danielle D Durham, Sai-Ching Jim Yeung, Matthew F Hudson, Aveh Bastani, Steven L Bernstein, Christopher W Baugh, Christopher J Coyne, Corita R Grudzen, Daniel J Henning, Adam Klotz, Troy E Madsen, Daniel J Pallin, Cielito C Reyes-Gibby, Juan Felipe Rico, Richard J Ryan, Nathan I Shapiro, Robert Swor, Arvind Venkat, Jason Wilson, Charles R Thomas, Jason J Bischof, Gary H Lyman
Importance: Better understanding of the emergency care needs of patients with cancer will inform outpatient and emergency department (ED) management. Objective: To provide a benchmark description of patients who present to the ED with active cancer. Design, Setting, and Participants: This multicenter prospective cohort study included 18 EDs affiliated with the Comprehensive Oncologic Emergencies Research Network (CONCERN). Of 1564 eligible patients, 1075 adults with active cancer were included from February 1, 2016, through January 30, 2017...
March 1, 2019: JAMA Network Open
T Allaeys, V Dhooghe, S Nicolay, G Hubens
BACKGROUND: Roux-en-Y gastric bypass is a frequently carried out bariatric procedure, proven to be effective in the management of obesity and its accompanying health issues. Following its popularity, admission to the emergency department for abdominal pain is often seen with known early and late onset causes. We present a case of a young woman with vague abdominal pain years after her gastric bypass, who eventually underwent a resection of a 'candy cane' like biliopancreatic blind loop...
March 22, 2019: Acta Chirurgica Belgica
Jane Nikles, Subaat Khan, John Leou, Gerben Keijzers, Joanna Ng, Catherine Bond, Gota Nakamura, Rhonda Le, Michele Sterling
OBJECTIVE: To describe clinical presentation and management of neck soft tissue injury in an Australian ED. METHODS: This is a retrospective cohort study conducted in a tertiary hospital ED in Queensland, Australia. This study included all patients aged 18-65 years presenting with neck sprain/strain in 2016. Main outcome measures are patient demographics, comorbidities, presentation, acute management and follow up. RESULTS: Of 339 patients, 176 (52%) had cervical computed tomography (CT) scans and 3% plain radiographs...
March 20, 2019: Emergency Medicine Australasia: EMA
Michiel Siebelt, Klaas A Hartholt, Daniëlle F M van Winden, Femke Boot, Dafni Papathanasiou, Bas C Verdouw, Mark R de Vries, Nina M Mathijssen, Gerald A Kraan
OBJECTIVES: To investigate whether a conventional fracture hematoma block (FHB) or an ultrasound-guided peripheral nerve block has more superior analgesic effect during nonoperative management of distal radius fractures in an emergency department setting. Two peripheral nerve block types were investigated, one at the level of the elbow, or cubital nerve block (CNB), and another an axillary nerve block (ANB). DESIGN: Two prospective randomized controlled studies were performed to compare the difference in pain intensity during closed reduction of a distal radius fracture between FHB-, CNB-, and, ANB-treated patients...
April 2019: Journal of Orthopaedic Trauma
Krishan Yadav, Hans Rosenberg, Debra Eagles, Kathryn N Suh
A 47-year-old homeless male presents to the emergency department (ED) with right lower extremity swelling, erythema and pain. He has diabetes mellitus, and had one prior episode of cellulitis three months ago affecting the same leg. He has a history of medication noncompliance. At triage, his temperature is 38.3°C but the remaining vital signs are unremarkable. On examination of the affected leg, there is an approximately 10 × 10 cm area of erythema, induration and increased warmth. There is mild tenderness to palpation and you wonder if there is a small degree of fluctuance...
March 2019: CJEM
Ran D Goldman
No abstract text is available yet for this article.
March 2019: CJEM
E Umana, M Elsherif, J Binchy
Paget-Schroetter Syndrome (PSS) or effort thrombosis of the axillary-subclavian venous axis is a rare disease affecting healthy young adults which requires a high index of suspicion to diagnose. Management often requires not only anticoagulation but also thrombolysis with first rib resection to prevent recurrence and complications. We present a case of a 31-year-old male who presented to our emergency department with pain and swelling of his left upper limb. He was diagnosed with PSS and underwent; anticoagulation, catheter directed thrombolysis and planned for first rib resection...
February 14, 2019: Irish Medical Journal
Emad Aljohani, Atheer S Alotaibi
A 42-year-old lady presented to emergency department with a 3 days history of right-sided abdominal pain. She was afebrile, haemodynamically unstable and the initial diagnosis was acute abdomen with unknown pathology. The CT abdomen/pelvis done, which showed well-defined fatty texture at right lower quadrant suggestive of an epiploic appendagitis and left adnexal cyst. The patient failed to improve on conservative management, diagnostic laparosocopy showed gangrenous sigmoid epiploic appendigitis adherent to the right lower quadrant...
March 2019: Journal of Surgical Case Reports
L Depoorter, T Billiet, M Verhamme, W Van Moerkercke
A Toothpick is a dreaded offender when ingested, as it is risky to cause impaction, obstruction or perforation of the gut. When ingestion of a toothpick leads to one of these complications, it clinically mimics an acute abdomen. Often the patient doesn't recall the ingestion, leading to misdiagnosis as inflammatory bowel disease, appendicitis/diverticulitis, etc. We describe the case of a 50-year old woman presenting to the emergency department with right lower abdominal pain. CT-scan showed an obstruction without clear underlying cause...
January 2019: Acta Gastro-enterologica Belgica
Nicole Segaline, Jeffrey Wang, Bruce Bethancourt, Ken S Ota
BACKGROUND: Symptomatic pleural effusions create discomfort and are a frequent cause of hospitalization. Ultrasound-guided thoracentesis is a key palliative intervention to assist in the management of this vulnerable population. Our institution has created a multidisciplinary transitional care program to address the needs of those discharged from the hospital with chronic complex conditions, including symptomatic pleural effusions. METHODS: This case series was performed in a transitional care clinic between May 8, 2017, and December 11, 2018...
March 18, 2019: American Journal of Hospice & Palliative Care
Wei Hao Lee, Sharon OʼBrien, Dmitry Skarin, John A Cheek, Jessica Deitch, Ramesh Nataraja, Simon Craig, Meredith L Borland
BACKGROUND: Undifferentiated abdominal pain is a common pediatric presentation to the emergency department (ED). OBJECTIVES: The objective of this study was to describe the prevalence of clinically significant abdominal pathology (CSAP) including appendicitis, patterns of imaging and pathology tests, and management and outcomes of children with abdominal pain in ED. METHODS: A prospective multicenter observational cohort pilot study of children under the age of 16 years presenting to 4 Australian EDs with abdominal pain was performed for a 1-month period at each site...
March 12, 2019: Pediatric Emergency Care
Mukhtar Bizrah, Ammar Yusuf, Sajjad Ahmad
INTRODUCTION: To investigate the demographics, acute management and compliance rates of severe chemical eye burn cases that presented to the largest eye hospital in the United Kingdom (UK). METHODS: All patients presenting to the Moorfields Eye Hospital emergency department are registered on the electronic patient administration system (PAS). A search of the PAS for patients assigned a preset diagnosis of 'chemical injury' was performed for the period from 1 January to 31 March 2016...
March 13, 2019: Ophthalmology and Therapy
Shana Kothari, Michael Kalinowski, Matthew Kobeszko, Tarek Almouradi
BACKGROUND: Literature has suggested that imaging is over-utilized in the diagnosis of pancreatitis. If the diagnosis of acute pancreatitis (AP) is established with abdominal pain and increased serum amylase or lipase activity without systemic signs of severe disease, computed tomography (CT) imaging may not be necessary. We hypothesize that among patients with uncomplicated acute pancreatitis (AUP), there is a significant number of unwarranted CT imaging studies. This imposes increased expenditure and cost in our healthcare system and does not improve hospital stay or management of AUP...
March 7, 2019: World Journal of Gastroenterology: WJG
Wei Ping Daniel Chor, Sarah Yun Ping Wong, Muhammad Fadhli Bin Mohamad Ikbal, Win Sen Kuan, Mui Teng Chua, Rakhee Yash Pal
OBJECTIVE: Terminally ill patients at their end-of-life (EOL) phase attending the emergency department (ED) may have complex and specialized care needs frequently overlooked by ED physicians. To tailor to the needs of this unique group, the ED in a tertiary hospital implemented an EOL pathway since 2014. The objective of our study is to describe the epidemiological characteristics, symptom burden and management of patients using a protocolized management care bundle. METHODS: We conducted an observational study on the database of EOL patients over a 28-month period...
March 12, 2019: American Journal of Hospice & Palliative Care
Megan Moore, Kelsey M Conrick, Ashok Reddy, Ann Allen, Craig Jaffe
The perspective of homeless adults on their health care service utilization is not well studied. This article describes a study that used in-depth, semistructured interviews with 18 individuals to highlight the viewpoints of homeless people who are frequent users of the emergency department (ED) about the influence of life events on service utilization. Participants reported high levels of pain and comorbid psychiatric, substance use, and medical conditions. They also reported an identifiable pattern of health care utilization, often centered on a crisis event, influenced by high perceived medical needs, inability to cope after crisis, predisposing vulnerability from social determinants of health, and health care system factors...
March 11, 2019: Health & Social Work
Helen Schultz, Line Abrahamsen, Lise Ewald Rekvad, Ulla Skræp, Tanja Schultz Larsen, Sören Möller, Ulla Krogstrup Tecedor, Niels Qvist
AIM: To investigate the patient experience of pain management, when patient-controlled oral analgesia was compared with standard care for patients admitted to hospital with acute abdominal pain. The primary outcome measures were pain intensity and patient perception of care. BACKGROUND: Pain management of patients admitted to hospital with acute abdominal pain can be insufficient. Patient involvement in health care has been seen to have benefits for patients. METHODS: A before-and-after intervention study was conducted in an emergency department observation unit and a surgical department...
April 2019: Applied Nursing Research: ANR
Elisabeth Ng, Adel Ekladious, Luke P Wheeler
A 62-year-old man presented to the Emergency Department with dyspnoea and central pleuritic chest pain radiating posteriorly to between the scapulae. His medical history included hypertension, osteoporosis and chronic kidney disease secondary to focal segmental glomerulosclerosis with relapsing nephrotic syndrome. Significant examination findings included a loud palpable P2 and a displaced apex beat. An ECG revealed sinus tachycardia with a right-bundle branch block and p-pulmonale. A CT pulmonary angiogram and aortogram demonstrated extensive bilateral pulmonary emboli and a descending thoracic aortic dissection...
March 8, 2019: BMJ Case Reports
Charles W Hwang, Ginger Gamble, Michael Marchick, Torben K Becker
Current advanced cardiac life support (ACLS) guidelines for the management of ventricular fibrillation (VF) and pulseless ventricular tachycardia is defibrillation. However, refractory VF, which is defined as VF that persists despite three defibrillation attempts, is challenging for all ACLS providers; the best resuscitation strategy for patients that persist in refractory VF remains unclear. We report on a 51-year-old man who presented to the emergency department with chest pain and subsequently went into witnessed VF cardiac arrest...
March 8, 2019: BMJ Case Reports
Anais Delgove, Luke Harper, Sylvie Berciaud, Abdelfetah Lalioui, Audrey Angelliaume, Yan Lefevre
INTRODUCTION: Immediate closed reduction and cast immobilization performed under sedation in the emergency room is the mainstay management for most isolated displaced or angulated upper limb fractures in children. We aimed to determine if this approach is safe, effective and if patients, parents and staff are satisfied with this approach.Our working hypothesis was this management provides a high satisfaction rate. PATIENTS AND METHODS: Between January 2017 and October 2017 we included 118 children presenting with upper arm fractures amenable to closed reduction under our institutional analgesia protocol...
March 5, 2019: Orthopaedics & Traumatology, Surgery & Research: OTSR
Vahid Monsef Kasmaee, Seyed Mahdi Zia Zibari, Marjan Aghajani Nargesi
Introduction: Procedural sedation and analgesia (PSA) is a fundamental skill for every emergency physician. This study aimed to compare the PSA characteristics of remifentanil with propofol/fentanyl combination. Methods: In this double-blind randomized clinical trial, the procedural characteristics and number of failures, as well as adverse events were compared between groups treated with either remifentanil or propofol/fentanyl combination consisting of 15-60 year old patients referring to emergency department following acute anterior shoulder dislocation...
2019: Archives of Academic Emergency Medicine
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