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Emergency pain management

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https://www.readbyqxmd.com/read/29776871/patients-experiences-of-pain-have-an-impact-on-their-pain-management-attitudes-and-strategies
#1
Eva Angelini, Helle Wijk, Helena Brisby, Adad Baranto
Postoperative pain remains undermanaged in orthopedic surgery. To identify areas of improvement for future structural changes in pain management, patients' experiences of pain and pain management when undergoing elective lumbar spine surgery were explored, using a qualitative method with focus group interviews. The study setting was an orthopedic spine surgery department at a University Hospital in Sweden. This study consisted of two focus group interviews with patients (n = 6/group, a total of 12 patients) who had undergone lumbar spine surgery 4 days to 5 weeks prior to the focus group interviews...
May 15, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/29774760/safety-of-nonsteroidal-anti-inflammatory-drugs-in-copperhead-snakebite-patients
#2
Hoang X Pham, Michael E Mullins
INTRODUCTION: Current management guidelines for pit viper envenomations recommend against the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control due to concern for platelet dysfunction and resulting coagulopathy. However, prior research suggests that copperhead snakes generally do not cause coagulopathy and they are responsible for most of the venomous snakebites in the USA. Thus, we compared the occurrences of clinically apparent bleeding and most abnormal laboratory values of coagulation between copperhead envenomation patients who received NSAIDs and those who did not...
May 18, 2018: Clinical Toxicology
https://www.readbyqxmd.com/read/29773453/a-structured-bowel-management-program-for-patients-with-severe-functional-constipation-can-help-decrease-emergency-department-visits-hospital-admissions-and-healthcare-costs
#3
Carlos A Reck-Burneo, Alejandra Vilanova-Sanchez, Alessandra C Gasior, Alexander J M Dingemans, Victoria A Lane, Robert Dyckes, Onnalisa Nash, Laura Weaver, Tassiana Maloof, Richard J Wood, Sarah Zobell, Michael D Rollins, Marc A Levitt
BACKGROUND: Published health-care costs related to constipation in children in the USA are estimated at $3.9 billion/year. We sought to assess the effect of a bowel management program (BMP) on health-care utilization and costs. METHODS: At two collaborating centers, BMP involves an outpatient week during which a treatment plan is implemented and objective assessment of stool burden is performed with daily radiography. We reviewed all patients with severe functional constipation who participated in the program from March 2011 to June 2015 in center 1 and from April 2014 to April 2016 in center 2...
March 24, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29771483/managing-shoulder-injuries-in-the-emergency-department-fracture-dislocation-and-overuse
#4
Richard Pescatore, Andrew Nyce
The complex structures of the shoulder can be injured by fracture, dislocation, and overuse, and correctly identifying and classifying injury is essential to avoiding pain, disability, and life- and limb-threatening complications. This issue presents a systematic approach to classifying shoulder injuries based on the mechanism of injury and clinical presentation, choosing appropriate imaging, and determining the best strategies for treatment, including reduction, surgical consultation, or outpatient referral...
June 2018: Emergency Medicine Practice
https://www.readbyqxmd.com/read/29771164/retrospective-evaluation-of-clinical-experience-with-intravenous-ascorbic-acid-in-patients-with-cancer
#5
Anthony J Bazzan, George Zabrecky, Nancy Wintering, Andrew B Newberg, Daniel A Monti
BACKGROUND: Intravenous ascorbic acid (IV AA) has been used extensively in cancer patients throughout the United States. Currently, there are limited data on the safety and clinical effects of IV AA. The purpose of this study was to expand the current literature using a retrospective analysis of adverse events and symptomatic changes of IV AA in a large sample of cancer patients. METHODS: We conducted a retrospective chart review of all patients receiving IV AA for cancer at the Thomas Jefferson University Hospital over a 7-year period...
May 1, 2018: Integrative Cancer Therapies
https://www.readbyqxmd.com/read/29770221/risperidone-induced-type-2-diabetes-presenting-with-diabetic-ketoacidosis
#6
Clarissa Ern Hui Fang, Mohammed Faraz Rafey, Aine Cunningham, Sean F Dinneen, Francis M Finucane
A 28-year-old male presented with 2 days of vomiting and abdominal pain, preceded by 2 weeks of thirst, polyuria and polydipsia. He had recently started risperidone for obsessive-compulsive disorder. He reported a high dietary sugar intake and had a strong family history of type 2 diabetes mellitus (T2DM). On admission, he was tachycardic, tachypnoeic and drowsy with a Glasgow Coma Scale (GCS) of 10/15. We noted axillary acanthosis nigricans and obesity (BMI 33.2 kg/m2 ). Dipstick urinalysis showed ketonuria and glycosuria...
2018: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29769452/acute-glaucoma-attack-following-microvascular-decompression-surgery-for-trigeminal-neuralgia
#7
Kenichi Amagasaki, Masami Nagayama, Saiko Watanabe, Naoyuki Shono, Hiroshi Nakaguchi
Microvascular decompression (MVD) is widely accepted as an effective surgical method to treat trigeminal neuralgia (TN), but the risks of morbidity and mortality must be considered. We experienced a case of acute angle-closure glaucoma attack following MVD for TN in an elderly patient, considered to be caused by lateral positioning during and after the surgery. A 79-year-old female underwent MVD for right TN in the left lateral decubitus position, and TN disappeared after the surgery. Postoperatively, the patient tended to maintain the left lateral decubitus position to prevent wound contact with the pillow, even after ambulation...
May 17, 2018: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/29764832/large-bowel-obstruction-in-a-27-year-old-woman-caused-by-a-sigmoid-faecal-bolus
#8
Radford Arran James Smith, Muhammad Abdalkoddus, Robert Bethune
A 27-year-old woman presented to the emergency department with a 24-hour history of severe left iliac fossa pain associated with vomiting. She reported a history of ovarian cysts and was provisionally diagnosed with a ruptured ovarian cyst and admitted under the obstetrics and gynaecology team for further investigation. 24 hours later, she became haemodynamically unstable with increasing abdominal distention and developed a metabolic acidosis. A CT scan revealed large bowel obstruction (LBO) secondary to a faecal bolus in the sigmoid colon with appearances suggestive of adult-onset Hirschsprung's disease...
May 14, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29764827/not-so-mass-effect-finding-of-a-remarkable-incidentaloma-in-a-teenager-with-neurofibromatosis
#9
Daniel John Keen, Hannah Norman-Bruce, Salah Mansy
A 13-year-old boy with neurofibromatosis type 1 presented to the emergency department twice in a fortnight with moderate intermittent abdominal pain, radiating to the back and associated with nausea and vomiting. He examined as a well child with a soft abdomen and minimal tenderness. A history of constipation was identified but he failed to respond to a trial of laxatives. Subsequent ultrasound abdomen demonstrated a large mass surrounding the porta hepatis. MRI further characterised a focal, non-aggressive lesion extending from his liver, encapsulating his pancreas, portal vessels and laterally displacing his spleen and left kidney...
May 14, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29764234/the-role-of-diet-in-the-management-of-irritable-bowel-syndrome-a-focus-on-fodmaps
#10
Russell Dolan, William D Chey, Shanti Eswaran
Irritable bowel syndrome is a common condition that negatively impacts quality of life and results in significant health care expenditures. The vast majority of IBS patients associate their symptoms with eating. Numerous randomized, controlled trials suggest that restriction of dietary FODMAPs improves overall symptoms, abdominal pain, bloating and quality of life in more than half of IBS sufferers. There is emerging data which suggests that other diets (gluten free, guided elimination diets) might also be of benefit to IBS patients...
May 15, 2018: Expert Review of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29762757/how-are-real-time-opioid-prescribing-cognitions-by-emergency-providers-influenced-by-reviewing-the-state-prescription-drug-monitoring-program
#11
Aaron Landau, Michael Lynch, Clifton Callaway, Brian Suffoletto
Objective: To understand how real-time opioid prescribing cognitions by emergency medicine (EM) providers are influenced by review of the state prescription drug monitoring program (PDMP). Methods: We collected prospective data from a convenience sample of 103 patient encounters for pain from 23 unique EM providers. After seeing the patient, before and immediately after reviewing the PDMP, EM providers answered how much they thought "the patient need[ed] an opioid to help manage their pain?", how concerned they were "about drug abuse and/or diversion?", and whether they planned to prescribe an opioid (yes/no)...
May 11, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29761672/emergency-department-administration-of-oxycodone-by-nurses-treating-musculoskeletal-pain-an-observational-prospective
#12
Mansour Khoury, Sigalit Caspi, Ruth Stalnikowics, Elad Peless, Ela Raiizman, Shaden Salameh
BACKGROUND: Acute musculoskeletal pain is one of the most commonly reported symptoms among patients visiting the emergency department (ED). Treatment with over-the-counter pain medications, given by nurses, results in improved pain management and reduces the waiting time to drug administration without significant side effects. Opioid analgesics are extensively used for acute pain in the ED. Compared to morphine, oxycodone has a much more specific pharmacological activity, higher analgesic potential, and more tolerable side effects...
May 2018: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/29760856/continuous-intravenous-sub-dissociative-dose-ketamine-infusion-for-managing-pain-in-the-emergency-department
#13
Sergey Motov, Jefferson Drapkin, Antonios Likourezos, Tyler Beals, Ralph Monfort, Christian Fromm, John Marshall
Introduction: Our objective was to describe dosing, duration, and pre- and post-infusion analgesic administration of continuous intravenous sub-dissociative dose ketamine (SDK) infusion for managing a variety of painful conditions in the emergency department (ED). Methods: We conducted a retrospective chart review of patients aged 18 and older presenting to the ED with acute and chronic painful conditions who received continuous SDK infusion in the ED for a period over six years (2010-2016)...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29758581/-managment-of-acute-low-back-pain-without-trauma-an-algorithm
#14
Carolin Melcher, Bernd Wegener, Volkmar Jansson, Wolf Mutschler, Karl-Georg Kanz, Christof Birkenmaier
BACKGROUND: Low back pain is a common problem for primary care providers, outpatient clinics and A&E departments. The predominant symptoms are those of so-called "unspecific back pain", but serious pathologies can be concealed by the clinical signs. Especially less experienced colleagues have problems in treating these patients, as - despite the multitude of recommendations and guidelines - there is no generally accepted algorithm. METHODS: After a literature search (Medline/Cochrane), 158 articles were selected from 15,000 papers and classified according to their level of evidence...
May 14, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/29757718/us-of-right-upper-quadrant-pain-in-the-emergency-department-diagnosing-beyond-gallbladder-and-biliary-disease
#15
Gayatri Joshi, Kevin A Crawford, Tarek N Hanna, Keith D Herr, Nirvikar Dahiya, Christine O Menias
Acute cholecystitis is the most common diagnosable cause for right upper quadrant abdominal (RUQ) pain in patients who present to the emergency department (ED). However, over one-third of patients initially thought to have acute cholecystitis actually have RUQ pain attributable to other causes. Ultrasonography (US) is the primary imaging modality of choice for initial imaging assessment and serves as a fast, cost-effective, and dynamic modality to provide a definitive diagnosis or a considerably narrowed list of differential possibilities...
May 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/29756105/non-operative-management-of-abdominal-gunshot-injuries-is-it-safe-in-all-cases
#16
Nidal İflazoğlu, Orhan Üreyen, Osman Zekai Öner, Ulvi Mehmet Meral, Murat Yülüklü
Objective: In line with advances in diagnostic methods and expectation of a decrease in the number of negative laparotomies, selective non-operative management of abdominal gunshot wounds has been increasingly used over the last three decades. We aim to detect the possibility of treatment without surgery and present our experience in selected cases referred from Syria to a hospital at the Turkish-Syrian border. Material and Methods: Between February 2012 and June 2014, patients admitted with abdominal gunshot wounds were analyzed...
2018: Turkish Journal of Surgery
https://www.readbyqxmd.com/read/29755898/an-unusual-presentation-of-kikuchi-fujimoto-disease-with-recurrent-subdural-effusion
#17
Sara Shahid, Syed H Alam, Indira Hadley
A 24-year-old man complained of a right temporal headache for four weeks. The patient denied any trauma or previous anticoagulation use. He also reported tender right facial swelling. His physical exam was unrevealing except for right cranial nerve (CN) VI palsy, right parotid enlargement, and cervical adenopathy. Laboratory findings were significant for mild leukopenia at 3300 cells/uL. The computed tomography (CT) scan obtained showed a chronic left subdural effusion with a 4 mm midline shift and confirmed right parotid enlargement and cervical lymphadenopathy...
March 10, 2018: Curēus
https://www.readbyqxmd.com/read/29755709/perioperative-management-of-sickle-cell-disease
#18
REVIEW
Kwame Ofori Adjepong, Folashade Otegbeye, Yaw Amoateng Adjepong
Over 30 million people worldwide have sickle cell disease (SCD). Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlusive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury. Pre-operative assessment must include a careful review of the patient's known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and opioid use...
2018: Mediterranean Journal of Hematology and Infectious Diseases
https://www.readbyqxmd.com/read/29755078/-re-expansion-pulmonary-edema-after-surgery-for-spontaneous-tension-hemopneumothorax-report-of-a-case
#19
Masanobu Hayakawa, Kazuyuki Oda
A 23-year-old man was admitted to our hospital because of chest pain and dyspnea. X-ray and computed tomography showed left tension hemopneumothorax. After the emergent surgery, re-expansion pulmonary edema (RPE) occurred. Non-invasive positive pressure ventilation (NPPV) was applied to control RPE and RPE was successfully recovered. NPPV may be useful in managing RPE.
March 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29755017/endoscopic-papillectomy-of-benign-ampullary-lesions-outcomes-from-a-multicenter-study
#20
Tan Attila, Erkan Parlak, Emrah Alper, Selçuk Dişibeyaz, Bahattin Çiçek, Bülent Ödemiş
BACKGROUND/AIMS: Endoscopic papillectomy (EP) has emerged as an alternative to surgery in the management of ampullary lesions. The aim of this study is to evaluate feasibility, efficacy, safety, outcome, and impact of EP in the management of benign ampullary lesions. MATERIALS AND METHODS: This is a multicenter, retrospective study of 44 patients who had EP of benign ampullary lesions. RESULTS: Over the 11-year period, 44 (55.7%) of 79 patients underwent EP for benign ampullary lesions...
May 2018: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
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