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Emergency pain management

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https://www.readbyqxmd.com/read/28934765/qualitative-study-the-experience-and-impact-of-living-with-behcet-s-syndrome
#1
Vicky Tai, Karen Lindsay, Joanne L Sims, Fiona M McQueen
AIM: Behcet's syndrome is a rare chronic multisystemic vasculitis of unknown aetiology, is unpredictable and can cause life-threatening complications. This qualitative study aims to explore the experiences of patients living with Behcet's syndrome in New Zealand. METHODS: Eight English-speaking patients participated in in-depth semi-structured interviews about their experiences of living with Behcet's syndrome. Interviews were recorded and transcribed. Data were analysed using a general inductive thematic approach...
September 22, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28932734/spontaneous-ruptured-pheochromocytoma-an-unusual-case-report-and-literature-review
#2
Ye Seob Jee
Ruptured pheochromocytoma is a rare disease. Its mortality rate is up to 31%-50%. Proper management of ruptured pheochromocytoma remains unclear. A 44-year-old male patient visited our Emergency Department and presented with abrupt onset of left flank pain. His blood pressure was 190/140 mmHg with purse rate of 130 beats/min. CT scan showed 8.1 × 5.6-cm-sized heterogeneously mass with rupture on the left retroperitoneal space and active bleeding. His symptom of abdominal pain was aggravated. Follow-up laboratory analysis revealed elevated WBC count and decreased hemoglobin 2 hours after admission...
September 2017: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/28931801/elizabethkingia-meningoseptica-in-a-case-of-biliary-tract-infection-following-liver-transplantation
#3
Hebah M Musalem, Yazan N Honjol, Lin M Tuleimat, Saleh I Al Abbad, Fahad I Alsohaibani
BACKGROUND Elizabethkingia meningoseptica (E. meningoseptica) is an aerobic Gram-negative bacillus known to thrive in moist environments, and is now recognized as a hospital-acquired infection, being found to contaminate hospital equipment, respiratory apparatus, hospital solutions, water, and drainage systems. Nosocomial infection with E. meningoseptica occurs in immunocompromised patients, requires specialized identification methods, and is resistant to conventional antibiotics. We report a case of E. meningoseptica infection arising from a percutaneous transhepatic biliary drainage (PTBD) tube...
September 21, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28929914/the-conundrum-of-opioid-tapering-in-long-term-opioid-therapy-for-chronic-pain-a-commentary
#4
Ajay Manhapra, Albert A Arias, Jane C Ballantyne
BACKGROUND: In response to the opioid epidemic and new guidelines, many patients on high-dose long term opioid therapy (LTOT) for chronic pain are getting tapered off opioids. As a result, a unique clinical challenge is emerging: while many on LTOT have poor pain control, functional decline, psychiatric instability, aberrancies and misuse, these issues may often worsen with opioid tapering. Currently, a clear explanation and practical guidance on how to manage this perplexing clinical scenario is lacking...
September 20, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28929260/preferences-for-injectable-prep-among-young-u-s-cisgender-men-and-transgender-women-and-men-who-have-sex-with-men
#5
Katie B Biello, Sybil Hosek, Morgan T Drucker, Marvin Belzer, Matthew J Mimiaga, Elliot Marrow, Julia Coffey-Esquivel, Jennifer Brothers, Kenneth H Mayer
Young men who have sex with men account for approximately 20% of incident HIV infections in the U.S. Antiretroviral pre-exposure prophylaxis (PrEP) administered as a daily pill has been shown to decrease HIV acquisition in at-risk individuals. New modalities for PrEP are being developed and tested, including injectable PrEP; however, acceptability of these emerging modalities has not yet been examined in youth. We conducted six focus groups with 36 young men and transgender men and women who have sex with men in Boston, Chicago, and Los Angeles in 2016 to assess interest in and preference for different PrEP modalities...
September 19, 2017: Archives of Sexual Behavior
https://www.readbyqxmd.com/read/28929043/supraventricular-tachycardia-and-tricuspid-regurgitation-in-the-setting-of-misplaced-implantable-port-catheter-tip
#6
Ahmad Awan, Bisma Ahsan, Hasan Iftikhar, Akbar Khan, Fasil Tiruneh, Yididia Bekele, Ankit Mahajan, Ahmed A Awan
We present the case of a 31-year-old female with a past medical history of B-cell leukemia, on maintenance chemotherapy administered via centrally placed implantable catheter port, who presented to the emergency room with fever, chills, and generalized body pain of one day's duration. After initial workup, the patient was admitted to the intensive care unit and managed for severe sepsis. The patient was found to have a new-onset 3/6 holosystolic murmur at the left lower sternal border. Furthermore, she developed an episode of supraventricular tachycardia that responded to adenosine...
July 11, 2017: Curēus
https://www.readbyqxmd.com/read/28929031/procalcitonin-a-powerful-rescuer-on-surgical-floors
#7
EDITORIAL
Ahsan Zil-E-Ali, Syeda Naqvi, Mariam Tariq
Necrotizing fasciitis (NF) is a rare but life-threatening medical and surgical emergency. It is characterized by necrosis of the soft tissue leaving the overlying tissue unaffected, which delays the diagnosis and treatment. Delay in recognition of the severity of necrotizing fasciitis might lead to serious morbidity and mortality. Diagnosis of NF relies on strong clinical judgment, predictable by severe pain, erythema, and a presence of air under the skin, but all of them are not always present. Management of NF is prompt surgical intervention and antimicrobial therapy...
July 8, 2017: Curēus
https://www.readbyqxmd.com/read/28928589/laparoscopic-cholecystectomy-under-segmental-thoracic-spinal-anesthesia-a-feasible-economical-alternative
#8
Aditya Kumar Kejriwal, Shaheen Begum, Gopal Krishan, Richa Agrawal
Laparoscopic surgery is normally performed under general anesthesia, but regional techniques like thoracic epidural and lumbar spinal have been emerging and found beneficial. We performed a clinical case study of segmental thoracic spinal anaesthesia in a healthy patient. We selected an ASA grade I patient undergoing elective laparoscopic cholecystectomy and gave spinal anesthetic in T10-11 interspace using 1 ml of bupivacaine 5 mg ml(-1) mixed with 0.5 ml of fentanyl 50 μg ml(-1). Other drugs were only given (systemically) to manage patient anxiety, pain, nausea, hypotension, or pruritus during or after surgery...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28927228/management-of-chronic-pain-through-pain-management-programmes
#9
I R Wilson
Introduction: Chronic pain carries significant impact and is difficult to treat with limited success. Pain management programmes (PMPs) use cognitive behavioural therapy (CBT)-based multidisciplinary rehabilitative approaches to drive functional improvement. Sources of data: A search was conducted using Medline and the Cochrane Library to identify published literature about PMPs or CBT to treat chronic pain. Areas of agreement: PMPs have significant benefit on functioning for some patients but relatively little impact on the pain...
September 13, 2017: British Medical Bulletin
https://www.readbyqxmd.com/read/28926506/family-perspectives-on-visiting-the-pediatric-emergency-department-for-migraine-a-qualitative-study
#10
Serena Laura Orr, Liam OʼSullivan, Roger Zemek, Natalie M Ward, Hugh J McMillan
OBJECTIVE: The aim of this study was to explore the perspectives of families regarding their expectations and experience of visiting the emergency department (ED) for migraine. METHODS: This was a qualitative study involving the families of 25 patients aged 10 to 18 years receiving ED care for acute migraine. Following their visit, independent semistructured telephone interviews were conducted with both the patient and parent or guardian. Questions were designed to explore factors pertaining to the family's perspective regarding their visit to the ED and expectations for the ED visit...
September 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28925655/pleuritic-chest-pain-sorting-through-the-differential-diagnosis
#11
Brian V Reamy, Pamela M Williams, Michael Ryan Odom
Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Pulmonary embolism is the most common serious cause, found in 5% to 21% of patients who present to an emergency department with pleuritic chest pain. A validated clinical decision rule for pulmonary embolism should be employed to guide the use of additional tests such as d-dimer assays, ventilation-perfusion scans, or computed tomography angiography. Myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax are other serious causes that should be ruled out using history and physical examination, electrocardiography, troponin assays, and chest radiography before another diagnosis is made...
September 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28924614/porcelain-gallbladder-often-an-overlooked-entity
#12
Sohail Iqbal, Sarfraz Ahmad, Usman Saeed, Mohammed Al-Dabbagh
Background  Porcelain gallbladder (GB) is a rare but potentially premalignant condition with minimal symptoms. Accident and Emergency (A&E) departments often tend to investigate abdominal pain through plain radiographs, which are occasionally reported by radiologists, thereby leaving behind few uncommon conditions, such as porcelain gallbladder unreported. Objectives  We present three cases of porcelain GB in which initial diagnosis was not considered due to the presence of various other calcifications in the upper abdomen...
October 2017: Surg J (N Y)
https://www.readbyqxmd.com/read/28923845/high-sensitivity-cardiac-troponin-i-as-a-gatekeeper-for-coronary-computed-tomography-angiography-and-stress-testing-in-patients-with-acute-chest-pain
#13
Maros Ferencik, Thomas Mayrhofer, Michael T Lu, Pamela K Woodard, Quynh A Truong, W Frank Peacock, Fabian Bamberg, Benjamin C Sun, Jerome L Fleg, John T Nagurney, James E Udelson, Wolfgang Koenig, James L Januzzi, Udo Hoffmann
BACKGROUND: Most patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) undergo noninvasive cardiac testing with a low diagnostic yield. We determined whether a combination of high-sensitivity cardiac troponin I (hs-cTnI) and cardiovascular risk factors might improve selection of patients for cardiac testing. METHODS: We included patients from the Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) I and II trials who presented to the ED with acute chest pain and were referred for cardiac testing...
September 18, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28923678/a-case-report-on-gastric-volvulus-of-a-17-years-old-boy-from-bangladesh
#14
M Tasdik Hasan, S M Tajdit Rahman, Hasan M Shihab, Hassan Rushekh Mahmood, Tanni Chowdhury, Quamrul Akhtar Sanju
INTRODUCTION: Gastric volvulus is a rare and true surgical emergency which is life threatening if not recognized and treated quickly. There have been approximately 300 reported cases globally till now. This condition most often occurs during 5th decade of life but there are over 100 reported pediatric cases also. This following rare incidence was such a case of a young patient in Bangladesh. It was the first case of gastric volvulus managed by the surgery department of the concerned hospital...
September 7, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28922959/compliance-to-the-primary-health-care-treatment-guidelines-and-the-essential-medicines-list-in-the-management-of-sexually-transmitted-infections-in-correctional-centres-in-south-africa-findings-and-implications
#15
Tammy B Matsitse, Elvera Helberg, Johanna C Meyer, Brian Godman, Amos Massele, Natalie Schellack
BACKGROUND: The emergence of antimicrobial resistance (AMR) is a global concern and a growing health crisis. Additionally, evidence has shown that non-compliance to treatment guidelines, especially in the management of communicable diseases such as sexually transmitted infections (STIs), has the potential of further enhancing AMR rates. Data on the extent of these challenges in Primary Health Care (PHC) facilities in correctional centres in South Africa (SA) is limited. Hence this study was conducted to determine the level of compliance with the 2008 PHC Standard Treatment Guidelines and Essential Medicines List (PHC STGs/EML) in the management of STIs, and to identify potential factors contributing to the compliance and non-compliance to guide future strategies...
September 19, 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28922625/living-and-dying-with-advanced-dementia-a-prospective-cohort-study-of-symptoms-service-use-and-care-at-the-end-of-life
#16
Elizabeth L Sampson, Bridget Candy, Sarah Davis, Anna Buylova Gola, Jane Harrington, Michael King, Nuriye Kupeli, Gerry Leavey, Kirsten Moore, Irwin Nazareth, Rumana Z Omar, Victoria Vickerstaff, Louise Jones
BACKGROUND: Increasing number of people are dying with advanced dementia. Comfort and quality of life are key goals of care. AIMS: To describe (1) physical and psychological symptoms, (2) health and social care service utilisation and (3) care at end of life in people with advanced dementia. DESIGN: 9-month prospective cohort study. SETTING AND PARTICIPANTS: Greater London, England, people with advanced dementia (Functional Assessment Staging Scale 6e and above) from 14 nursing homes or their own homes...
August 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28921009/radiation-overexposure-from-repeated-ct-scans-in-young-adults-with-acute-abdominal-pain
#17
Massimo Tonolini, Elena Valconi, Angelo Vanzulli, Roberto Bianco
PURPOSE: The purpose of this study is to assess the dose of ionizing radiation caused by repeated CT scans performed to investigate non-traumatic acute abdominal conditions in young adults. METHODS: Over 26 months, we collected a cohort of patients aged 18 to 45 years who were subject to at least one urgent contrast-enhanced abdomen/pelvis CT. Patients affected with urolithiasis, HIV infection, tumors, and vascular and chronic inflammatory bowel diseases were excluded...
September 18, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28919630/deep-vein-thrombosis-in-a-post-coronary-artery-bypass-grafting-patient-successful-conservative-management
#18
S H Sarker, A K Miraj, M A Hossain, M Aftabuddin
Deep vein thrombosis is an alarming medical emergency. Deep vein thrombosis or deep venous thrombosis (DVT) is the formation of a blood clot (thrombus) within a deep vein predominantly in the legs. Post-Coronary Artery Bypass Grafting deep vein thrombosis is a very rare medical condition relatively in Asian. Approximately 80% of deep vein thrombosis (DVTs) is clinically asymptomatic, 20% of those that actually demonstrate signs and symptoms can be easily confused with symptoms of other commonly presenting musculoskeletal disorders...
July 2017: Mymensingh Medical Journal: MMJ
https://www.readbyqxmd.com/read/28917436/comparison-of-the-loop-technique-with-incision-and-drainage-for-soft-tissue-abscesses-a-systematic-review-and-meta-analysis
#19
REVIEW
Michael Gottlieb, Gary D Peksa
INTRODUCTION: Skin and soft tissue infections are a common presentation to the emergency department. Traditional management of abscesses involves a linear incision through the center of the abscess with packing placed. The loop drainage technique (LDT) is an alternate approach that may reduce pain and scarring, as well as decrease the number of follow up visits needed. This systematic review and meta-analysis aimed to compare the efficacy of the LDT with conventional incision and drainage (CID) in the treatment of soft tissue abscesses...
September 10, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28915703/treatments-of-traumatic-neuropathic-pain-a-systematic-review
#20
REVIEW
Chenglun Yao, Xijie Zhou, Bin Zhao, Chao Sun, Keshav Poonit, Hede Yan
Traumatic neuropathic pain caused by traumatic neuroma has long been bothering both doctors and patients, the mechanisms of traumatic neuropathic pain are widely discussed by researchers and the treatment is challenging. Clinical treatment of painful neuroma is unclear. Numerous treatment modalities have been introduced by experts in this field. However, there is still no single standard recognized treatment. Different forms of treatments have been tested in animals and humans, but pharmacotherapies (antidepressants, antiepileptics) remain the basis of traumatic neuropathic pain management...
August 22, 2017: Oncotarget
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