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Emergency department pain

Kheng Song Leow, Kian Ming Chew, Ashish Chawla, Tze Chwan Lim
Calf pain or swelling is a common presentation to the emergency department. The differential diagnoses are wide. Deep vein thrombosis (DVT) is often the first diagnosis to be excluded given its potentially fatal complications. Musculoskeletal causes of calf pain or swelling such as Baker's cyst, muscle or tendon tear, soft tissue infection, and inflammation are not uncommon and can often be confidently diagnosed with ultrasonography (US). Familiarity with these conditions and the sonographic findings would be useful in making timely and correct diagnosis...
February 13, 2019: Emergency Radiology
Aron Downie, Mark Hancock, Hazel Jenkins, Rachelle Buchbinder, Ian Harris, Martin Underwood, Stacy Goergen, Chris G Maher
OBJECTIVES: To (1) estimate the proportion of patients seeking care for low back pain (LBP) who are imaged and (2) explore trends in the proportion of patients who received diagnostic imaging over time. We also examined the effect of study-level factors on estimates of imaging proportion. DATA SOURCES: Electronic searches of MEDLINE, Embase and CINAHL databases from January 1995 to December 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational designs and controlled trials that reported imaging for patients presenting to primary care or emergency care for LBP...
February 13, 2019: British Journal of Sports Medicine
Gen Nakamura, Muneaki Abe, Hozumi Kumano
Acute compartment syndrome of the forearm secondary to hematoma without direct trauma has been reported rarely. We report a case of acute compartment syndrome of the forearm following a hematoma after playing golf. A 55-year-old man felt pain in his left forearm while playing golf that gradually worsened. He could not continue to play and visited the emergency department of our hospital. The radial side of his left forearm was markedly swollen on presentation, and he suffered severe pain that worsened with ulnar flexion of the wrist; no paralysis or hypesthesia was observed...
March 2019: Journal of Hand Surgery Asian-Pacific Volume
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
Alessandro Aprato, Alessandro Casiraghi, Giovanni Pesenti, Marco Bechis, Alessandro Samuelly, Claudio Galante, Dario Capitani, Alessandro Massè
BACKGROUND: In the last 10 years, the rate of femur fractures treated within 48 h from trauma has been introduced as a performance index for hospital management in Italy. Literature showed a significant indirect correlation between early treatment and mortality/comorbidity. The aims of early treatment are pain management and reduction of time to ambulation. The purpose of this study is to evaluate whether early treatment has reduced time to ambulation in femur fracture. MATERIALS AND METHODS: All patients admitted to two level I trauma centers with proximal femoral fracture between 1/1/2017 and 31/12/2017 were included in this study...
February 13, 2019: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
A B Niculescu, H Le-Niculescu, D F Levey, K Roseberry, K C Soe, J Rogers, F Khan, T Jones, S Judd, M A McCormick, A R Wessel, A Williams, S M Kurian, F A White
We endeavored to identify objective blood biomarkers for pain, a subjective sensation with a biological basis, using a stepwise discovery, prioritization, validation, and testing in independent cohorts design. We studied psychiatric patients, a high risk group for co-morbid pain disorders and increased perception of pain. For discovery, we used a powerful within-subject longitudinal design. We were successful in identifying blood gene expression biomarkers that were predictive of pain state, and of future emergency department (ED) visits for pain, more so when personalized by gender and diagnosis...
February 12, 2019: Molecular Psychiatry
Horton J Lee, Rasmita Budhathoki
Point-of-care ultrasound can be used to help identify the source of dyspnea in patients presenting to the emergency department. We present a case of an adolescent girl with a history of systemic lupus erythematosus presenting to the emergency department with chest pain and dyspnea and found to have both pleural and pericardial effusions on point-of-care ultrasound.
February 8, 2019: Pediatric Emergency Care
Troy Madsen, Rachelle Perkins, Brennen Holt, Margaret Carlson, Jacob Steenblik, Philip Bossart, Stephen Hartsell
BACKGROUND: Although some emergency department observation units (EDOUs) may exclude patients over 65 years old, our EDOU accepts patients up to 79 years old. We assessed the utilization of our EDOU by older patients (those 65-79 years old). METHODS: We prospectively enrolled emergency department (ED) patients with chest pain. We gathered baseline data at the time of ED presentation and tracked outcomes related to the ED stay, EDOU, and/or inpatient admission. Our primary outcome included EDOU placement among older patients...
March 2019: Critical Pathways in Cardiology
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
Chadwick D Miller, Jason P Stopyra, Simon A Mahler, L Doug Case, Sujethra Vasu, Ronny A Bell, W Gregory Hundley
BACKGROUND: Patients from racial and ethnic minority groups presenting to the Emergency Department (ED) with chest pain experience lower odds of receiving stress testing compared with nonminorities. Studies have demonstrated that care pathways administered within the ED can reduce health disparities, but this has yet to be studied as a strategy to increase stress testing equity. METHODS: A secondary analysis from 3 randomized clinical trials involving ED patients with acute chest pain was performed to determine whether a care pathway, ACES (Accelerated Chest pain Evaluation with Stress imaging), reduces the racial disparity in index visit cardiac testing between African American (AA) and White patients...
March 2019: Critical Pathways in Cardiology
Christopher W Baugh, Benjamin M Scirica, James L Januzzi, David A Morrow, Kent B Lewandrowski, Petr Jarolim, Benjamin A White, Mark S Weinfeld, Udo Hoffmann, John T Nagurney
No abstract text is available yet for this article.
March 2019: Critical Pathways in Cardiology
Nikhil Crain, Talar Tejirian
Although inguinal herniorrhaphy is low risk, patients still return to the urgent care or ED. We performed a retrospective study on 19,296 inguinal hernia operations across 14 Southern California Kaiser Permanente medical centers over five years. Unplanned returns within the first postoperative week were evaluated focusing on four potentially avoidable diagnoses (AD): pain, constipation, urinary retention, and nausea/vomiting. Overall, 1370 (7%) patients returned to the urgent care/emergency department, of which 537 (39%) had an AD...
October 1, 2018: American Surgeon
Lindsay A Weiner, Adam C Richardson, Semhar Z Tewelde
BACKGROUND: Spontaneous spinal and intracranial subdural hematomas are rarely reported, especially occurring simultaneously. Anticoagulation use has been associated with spontaneous hemorrhages. Prompt diagnosis is required to prevent permanent neurological sequelae. In this case report, we describe a spontaneous spinal and intracranial subdural hematoma in a woman taking warfarin and initially presenting with severe vaginal pain. CASE REPORT: A 42-year-old woman who had a history of mechanical valve replacement and was therefore taking warfarin, came to an emergency department for relief of severe vaginal pain...
February 8, 2019: Journal of Emergency Medicine
C Joubert, S Gazzola, A Sellier, A Dagain
Acute spinal cord compression usually results from trauma, infection, or cancer. Spinal subdural hematoma is an uncommon cause of spinal cord compression that occurs after spine trauma or spinal invasive procedure, especially in context of coagulopathy. In the following reported case, an 82-year-old woman with a history of rapidly progressive paraparesis after a sudden middle back pain, with no previous trauma or coagulopathy, due to an acute spontaneous spinal subdural hematoma. In fact, the main difficulty was to determine, in an emergency situation, the right strategy to identify both the lesion and its cause to adapt therapeutics...
February 8, 2019: Neuro-Chirurgie
Ezgi Demirozogul, Atakan Yilmaz, Mert Ozen, Ibrahim Turkcuer, Murat Seyit, Cuneyt Arikan
INTRODUCTION: Although acute musculoskeletal pain has a wide range of causes from tendinitis, muscle spasm, to bone and joint injuries, it is a frequent occurrence in emergency services. Paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are common used in the treatment of musculoskeletal pain. This study sets out to compare the effectiveness of intravenous dexketoprofen and paracetamol in musculoskeletal pain relief. METHODS: This prospective, randomized, double blind, controlled study was carried out in a university emergency room...
February 4, 2019: American Journal of Emergency Medicine
John W Martel, Samuel B Potter
Neck and back pain are common reasons for seeking evaluation and treatment in the emergency department. Within both systems there exist several time-sensitive diagnoses that the emergency provider should be familiar with in order to prevent significant morbidity and mortality. In this article we provide a general overview of these complaints by discussing problems in a systems-based fashion as well as discussing the initial evaluation, work-up, and treatment options for these diagnoses.
February 2019: Seminars in Neurology
Aylin Hande Gökçe
Gastrointestinal stromal tumors (GISTs) are among the rare tumors of gastrointestinal (GI) tract. GISTs occur respectively in the stomach, small intestines, colon and rectum, omentum and mesentery, esophagus, retroperitoneal space, and abdominal cavity. However, they may occur anywhere along the GI tract. Typically, these tumors generally do not cause symptoms; however symptomatic patients may show stomach pain, GI bleeding, and palpable abdominal masses. These patients usually undergo surgery for obstruction symptoms or some other diagnosis...
January 2019: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Alison Wallace, Danny Marcuzzi, Micheal Ko, David Latter
A 47-year-old male who previously underwent emergency surgery for type A aortic dissection presented to the emergency department 4 years later with acute chest pain radiating to his back and a significant drop in hemoglobin. Clinical presentation was concerning for aortic graft failure, but imaging revealed a large (6.0 × 3.2 × 12.8 cm3 ) soft tissue mediastinal mass that was not present 4 years before. Pathologic analysis revealed a rare thymic cyst with a hemorrhagic component. This was a challenging case from diagnostic and operative perspectives, involving the expertise of both cardiac and thoracic surgical teams...
January 2019: Journal of Surgical Case Reports
Sahereh Mirzaei, Alana Steffen, Karen Vuckovic, Catherine Ryan, Ulf Bronas, Jessica Zegre-Hemsey, Holli A DeVon
INTRODUCTION: More than 5.5 million patients present to emergency departments in the United States annually for potential acute coronary syndrome (ACS); however, diagnosing ACS remains a challenge in emergency departments. Our aim was to describe the quality of symptoms (chest discomfort/description of pain, location/radiation, and overall symptom distress) reported by women and men ruled-in and ruled-out for ACS in emergency departments. METHODS: The sample consisted of 1,064 patients presenting to emergency departments with symptoms that triggered cardiac workups...
February 7, 2019: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
George Neelankavil Davis, Maithreyi Swaminathan
OBJECTIVE: To compare the accuracy of Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and modified Alvarado scores with that of non-contrast computed tomography scan and ultrasound of abdomen and pelvis. Methods: The observational correlational study was conducted at Manipal Hospital, Bengaluru, India, from April 1, 2014, to April 30, 2016, and comprised patients aged 18-60 years presenting with right lower quadrant pain to the emergency department. Modified Alvarado, RIPASA scores and ultrasound of abdomen and pelvis with optional non-contrast computed tomography scan reports were collected...
February 2019: JPMA. the Journal of the Pakistan Medical Association
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