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Acute pain management emergency department

Tallat Ejaz, Eltaib Saad, Andik Nabil, James Slattery
A 46-year-old female presented to our emergency department (ED) with a 2-day history of right lower abdominal pain which was associated with nausea and anorexia. Abdominal examination revealed tenderness in the right iliac fossa (RIF) with rebound tenderness and a localized guarding. Urine dipstick was normal, and the pregnancy test was negative. Her laboratory investigations were significant only for a CRP of 16.6. A presumptive clinical diagnosis of acute appendicitis was suggested based on the given history and relevant physical signs...
2019: Case Reports in Surgery
P Marazuela García, A López-Frías López-Jurado, A Vicente Bártulos
Crohn's disease is an autoimmune disease that predominantly affects the gastrointestinal tract. Crohn's disease is diagnosed at a young age and runs a chronic course with acute flare-ups. When patients with Crohn's disease present with flare-ups at the emergency department, they are usually managed in a way similar to patients with acute abdomen; there is no consensus about the most appropriate imaging work-up for patients with flare-ups of Crohn's disease. Thus, we decided to review the literature about the imaging tests indicated (whether related to their diagnostic performance or to lower exposure to ionizing radiation) for acute flare-ups in patients with Crohn's disease...
February 13, 2019: Radiología
Cecilia Carubbi, Elena Masselli, Giulia Pozzi, Maria Mattioli, Silvia Martini, Matteo Goldoni, Rosalia Aloe, Gianfranco Cervellin, Marco Vitale, Giuliana Gobbi
A rapid differential diagnosis of the clinical conditions underlying chest pain is a relevant clinical issue. Specifically, a fast rule-in or -out of acute myocardial infarction (AMI) is mandatory to improve diagnostic outcome and cost-effectiveness of patient management. We demonstrated that Protein Kinase C (PKC) epsilon is selectively expressed by platelets from AMI patients, accounting for increased platelet activation. Thus, we hypothesized that PKCepsilon-expressing platelets may represent a pathophysiological marker of AMI that could be utilized in combination with troponin-I, the conventional marker of cardiac injury, to add diagnostic information in chest pain workup...
February 14, 2019: Scientific Reports
Lars Petter Bjørnsen, Lars Eide Naess-Pleym, Jostein Dale, Bjørnar Grenne, Rune Wiseth
OBJECTIVES: Chest pain is one of the most frequent chief complaints in patients admitted to the emergency department (ED). No study has evaluated this patient population in Norway. The aim of the present study was to describe the diagnoses and logistics of chest pain patients admitted to the ED at a Norwegian university hospital. DESIGN: Data were collected from all patients referred to the ED at St. Olav's Hospital-Trondheim University Hospital in 2015. Patients presenting at the ED with a chief complaint of chest pain based on the Rapid Emergency Triage and Treatment System were included in this study...
February 14, 2019: Scandinavian Cardiovascular Journal: SCJ
Asad Shabbir, Lampson Fan, Gregory Fraser, Mark Philip Cassar, Jon Swinburn
The latest European Society of Cardiology guideline on the management of acute coronary syndromes without persistent ST-elevation stipulates several acceptable pathways through which patients presenting with chest pain can be assessed for unstable coronary disease. This article reviews the data behind the "rule-in and rule-out algorithm," which can exclude acute myocardial infarction within 1 hour of presentation through the use of fifth generation high-sensitivity troponin assays.
March 2019: Critical Pathways in Cardiology
Vivienne Chong, TimothyJ Schultz, Frank Donnelly
RATIONALE, AIMS AND OBJECTIVES: Patients with acute abdominal pain are a common presentation in hospital emergency departments; however, international studies have demonstrated that hospitals often lack clinical protocols to guide care. This study aimed to investigate whether Australian hospital emergency departments have acute abdominal pain clinical protocols, identify hospital-level predictors of the presence of these clinical protocols, and assess the quality of protocols. METHODS: A survey was sent to all Australian hospitals with emergency departments, collecting data on hospital characteristics and the presence of acute abdominal pain clinical protocols...
February 4, 2019: Journal of Evaluation in Clinical Practice
Dale Bowers, Melissa Mason, Molly Clinkscales
Salicylates are among the oldest and most widely used medication to date and are utilized for a variety of purposes including the management of fever, inflammation, pain, and cardiovascular prophylaxis. Reports from U.S. Poison Control Centers indicate that over 40,000 Americans are exposed to salicylate-containing substances annually, and although generally deemed safe, fatal intoxications can occur from a single ingestion. Although some ingestions are intentional, many are not, and are a result of the prevalence of salicylates in a wide array of prescription and over-the-counter substances...
January 2019: Advanced Emergency Nursing Journal
Scott Hartman, Elizabeth Brown, Elizabeth Loomis, Holly Ann Russell
Acute gastroenteritis is defined as a diarrheal disease of rapid onset, with or without nausea, vomiting, fever, or abdominal pain. In the United States, acute gastroenteritis accounts for 1.5 million office visits, 200,000 hospitalizations, and 300 deaths in children each year. Evaluation of a child with acute gastroenteritis should include a recent history of fluid intake and output. Significant dehydration is unlikely if parents report no decrease in oral intake or urine output and no vomiting. The physical examination is the best way to evaluate hydration status...
February 1, 2019: American Family Physician
Òscar Miró, Paul I Dargan, David M Wood, Alison M Dines, Christopher Yates, Fridtjof Heyerdahl, Knut Erik Hovda, Isabelle Giraudon, Miguel Galicia
OBJECTIVE: To analyse the epidemiology, clinical picture and emergency department (ED) management of a large series of patients who presented to European EDs after cocaine consumption, comparing data from powder (C1 group) and crack (C2 group) consumers. METHODS: Between October 2013 and December 2016, the Euro-DEN Plus Registry recorded 17,371 consecutive acute recreational drug toxicity presentations to 22 EDs in 14 European countries. Epidemiological and demographic data, co-ingestion of alcohol and other drugs, clinical features, ED management and outcome (death) were analysed for cocaine cases, and comparison of clinical picture in C1 and C2 patients were performed adjusting for alcohol and other drug co-ingestion...
January 30, 2019: Clinical Toxicology
Sunny Dhadlie, Sujith Ratnayake
INTRODUCTION: Severe acute pancreatitis is associated with high morbidity and mortality. This is a result of the development of pancreatic and extra-pancreatic necrosis with subsequent infection which can lead to multiorgan failure. Complications include localized ileus, abscess formation, mechanical obstruction, rupture and perforation into the gastrointestinal tract and fistula formation (Aldridge et al., 1989; Bassi et al., 2001 [1,2]). CASE PRESENTATION: A 72 year old man attended the emergency department with acute epigastric pain...
January 21, 2019: International Journal of Surgery Case Reports
Dilpreet Singh, Idrees Suliman, Iryna Chyshkevych, Nemer Dabage
BACKGROUND Acute chest pain is a common presentation in emergency departments worldwide. Ruling out acute coronary syndrome is essential in ensuring patient safety. Workup includes electrocardiogram (ECG) and cardiac biomarkers. Wellens syndrome is characterized by a history of chest pain, normal or minimally elevated biomarkers, no STEMI/Q-waves, and specific ECG changes. These changes consist of biphasic T waves in lead V2 and V3 or deep symmetrically inverted T waves in leads V1-V4. CASE REPORT A 55-year-old male presented to the emergency department with acute chest pain in a background of active smoking, hypertension, and hyperlipidemia...
January 28, 2019: American Journal of Case Reports
Brit Long, Alex Koyfman, Michael Gottlieb
BACKGROUND: Acute compartment syndrome (ACS) is a time-sensitive surgical emergency caused by increased pressure within a closed compartment. ACS can lead to significant morbidity and mortality if it is not rapidly identified and treated. OBJECTIVE: This article provides an evidence-based review of the diagnosis and management of ACS, with focused updates for the emergency clinician. DISCUSSION: ACS is the result of decreased perfusion within a compartment and is associated with a number of risk factors, but it occurs most commonly after fractures or trauma to the involved area...
January 23, 2019: Journal of Emergency Medicine
Christian Saliba, Samer H Diab, Gregory Nicolas, Julien S El Sayegh, Dani Osman, Jean Michel Azzo, Ali Dabbous, Hussein Hmadeh, Ali Wehbe, Houssein Haidar Ahmad
BACKGROUND Left-sided acute appendicitis, although well described in the literature, is still an easily missed diagnosis. Midgut malrotation and situs inversus are 2 known leading conditions that contribute to misdiagnosis of appendicitis. CASE REPORT Here is the case of a 27-year-old male without any previous medical history, who presented with left lower quadrant tenderness and was misdiagnosed with gastroenteritis as an outpatient and sent home; the patient presented the next day to the emergency department where he was found to have acute appendicitis with situs inversus...
January 19, 2019: American Journal of Case Reports
Sang Mok Yeo, Hayeon Park, Jin Hyuk Paek, Woo Yeong Park, Seungyeup Han, Sung Bae Park, Kyubok Jin
RATIONALE: Dapagliflozin (a sodium-glucose cotransporter-2 [SGLT2] inhibitor) represents the most recently approved class of oral medications for the treatment of type 2 diabetes. Dapagliflozin lowers plasma glucose concentration by inhibiting the renal reuptake of glucose in the proximal renal tubules. In 2015, the US Food and Drug Administration released a warning concerning a potential increased risk of ketoacidosis in patients taking this medication. PATIENT CONCERNS: We present the case of a 23-year-old woman with type 2 diabetes treated with dapagliflozin (10 mg, once a day) for 2 years who presented to the emergency department with abdominal pain...
January 2019: Medicine (Baltimore)
T J Huei, H T Lip, O Shamsuddin
Priapism is a rare clinical presentation of a patient with chronic myeloid leukaemia (CML). Herein, we present a young Nepalese man that presented to the emergency department with an acute and painful penile erection for two days. Clinically, he was pale and abdominal examination revealed hepatomegaly. Combined oncologic and initial urological intervention with carvernosal aspiration and intracavernosal phenylephrine failed to achieve detumescence. The patient underwent an emergency corporoglandular shunting eventually...
December 2018: Medical Journal of Malaysia
Urbano L França, Michael L McManus
Importance: Hospital care for children is becoming more concentrated, with interhospital transfer occurring more frequently even for common conditions. Condition-specific analysis is required to determine the value, costs, and consequences of this trend. Objectives: To describe the capabilities of transferring and receiving hospitals and to determine how often children transferred after an initial diagnosis of abdominal pain or appendicitis require higher levels of care...
October 5, 2018: JAMA network open
Sabrina J Poon, Lan Vu, Leanne Metcalfe, Olesya Baker, Ateev Mehrotra, Jeremiah D Schuur
BACKGROUND: Freestanding emergency departments (FSEDs), EDs not attached to acute care hospitals, are expanding. One key question is whether FSEDs are more similar to higher-cost hospital-based EDs or to lower-cost urgent care centers (UCCs). OBJECTIVE: Our aim was to determine whether there was a change in patient population, conditions managed, and reimbursement among three facilities that converted from a UCC to an FSED. METHODS: Using insurance claims from Blue Cross Blue Shield of Texas, we compared outcomes of interest for three facilities that converted from a UCC to an FSED for 1 year before and after conversion...
January 8, 2019: Journal of Emergency Medicine
Billy Sin, Iain Jeffrey, Zachary Halpern, Adebanke Adebayo, Tom Wing, Amy S Lee, Josel Ruiz, Kevin Persaud, Lilia Davenport, Sylvie de Souza, Mollie Williams
BACKGROUND: Patients in the United States frequently seek medical attention in the emergency department (ED) to address their pain. The intranasal (i.n.) route provides a safe, effective, and painless alternative method of drug administration. Sufentanil is an inexpensive synthetic opioid with a high therapeutic index and rapid onset of action, making it an attractive agent for management of acute pain in the ED. OBJECTIVE: The objective of our study was to evaluate the safety and efficacy of i...
January 8, 2019: Journal of Emergency Medicine
Beibei Li, Zhixu Ming, Jing Wu, Mingyou Zhang
RATIONALE: Myocardial infarction with nonobstructive coronary artery (MINOCA) is one of the common causes of cardiac related death. While patients with MINOCA usually do not need coronary artery intervention treatments, the prognosis could be worsened if the condition is not appropriately managed. This report describes a case of MINOCA patient suffered with multiple complications. PATIENT CONCERNS: A 63-year-old female was admitted to the emergency department with acute onset of chest pain, electrocardiogram showed ST segment elevation in precordium leads...
January 2019: Medicine (Baltimore)
Huma Saleem, Sara Haider Malik, Syed Raza Mehdi
Postoperative diaphragmatic hernia (PDH) is an increasingly reported complication of esophageal cancer surgery. It occurs more frequently with minimally invasive techniques and very little is known about its pathogenesis. Currently, no consensus exists concerning preventive measures and its management. A 36 years old male underwent minimally invasive esophagectomy and presented with chest pain and dyspnoea in the emergency department 8 months after the procedure. He was started on acute coronary syndrome treatment protocol but was later diagnosed on CT scan to have diaphragmatic hernia through a defect in the oesophageal hiatus...
October 2018: Journal of Ayub Medical College, Abbottabad: JAMC
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