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Emergency pain management

Yoshihiro Ohara, Hitoshi Ohto, Tetsunori Tasaki, Hideki Sano, Kazuhiro Mochizuki, Mitsuko Akaihata, Shogo Kobayashi, Tomoko Waragai, Masaki Ito, Mitsuaki Hosoya, Kenneth E Nollet, Kazuhiko Ikeda, Chitose Ogawa, Takahiro Kanno, Yayoi Shikama, Atsushi Kikuta
BACKGROUND: Pediatric apheresis for peripheral blood stem cell transplantation should be carried out with due concern for low corporeal blood volume and vulnerability to hypocalcemia-related complications, hypovolemic shock, and hypervolemic cardiac overload. STUDY DESIGN AND METHODS: We retrospectively investigated a total of 267 apheresis procedures from 1990 to 2013 on 93 children between 0 and 10 years old, including 89 patients and 4 healthy donors, with body weights of 6...
September 30, 2016: Transfusion and Apheresis Science
Trond Erik Grønnestad, Hildegunn Sagvaag
OBJECTIVE: The objective of this article is to gain insight into how individuals who frequent open illicit drug scenes experience opioid maintenance treatment (OMT) and investigate how this appears to affect their recovery processes. METHOD: By means of the ethnographic method, one of the researchers spent time in an open illicit drug scene over a 1-year span, and gathered data on individuals who frequent the scene on a regular basis, and their experiences with OMT...
2016: International Journal of Qualitative Studies on Health and Well-being
Lukasz Krokowicz, Adam Bobkiewicz, Maciej Borejsza-Wysocki, Barbara Kuczynska, Aleksandra Lisowska, Urszula Skowronska-Piekarska, Jacek Paszkowski, Jaroslaw Walkowiak, Michal Drews, Tomasz Banasiewicz
The term constipation with regard to patients with a stoma is defined as impaired bowel movements associated with increased stool consistency or long periods without bowel movements that lead to discomfort, flatulence, and abdominal pain. Information about constipation in patients with a stoma is limited. A prospective, descriptive study was conducted among patients attending ostomy and proctology outpatient clinics in Poznan, Poland between January 2011 and December 2014 to assess the role of dietary and pharmacological strategies in the management of constipation in patients with a stoma...
December 2015: Ostomy/wound Management
John W Pickering, Jaimi H Greenslade, Louise Cullen, Dylan Flaws, William Parsonage, Sally Aldous, Peter George, Andrew Worster, Peter A Kavsak, Martin P Than
BACKGROUND: -The European Society of Cardiology (ESC) new guidelines to rule-in and rule-out acute myocardial infarction (AMI) in the emergency department (ED) include a rapid assessment algorithm based on high-sensitivity cardiac troponin and sampling at zero and one hour. ED physicians require very high sensitivity to confidently rule-out AMI, while cardiologists aim to minimise false positive results. METHODS: -High-sensitivity troponin I (hs-cTnI) and T (hs-cTnT) assays were used to measure troponin concentrations in patients presenting with chest-pain symptoms and being investigated for possible acute coronary syndrome at hospitals in New Zealand, Australia and Canada...
October 17, 2016: Circulation
William R Fox, Deborah B Diercks
Troponins are proteins commonly found in cardiac tissue that are released during myocardial ischemia or necrosis. These troponins can be detected by assays that can then be used to guide clinical decision-making and disposition, especially if the suspected insult is related to acute coronary syndrome. Timing of troponin measurement can be important as elevations may not be detectible immediately after an insult. New assays have been designed to detect troponin con-centrations previously too low to be detected by conventional assays...
March 2016: Clin Exp Emerg Med
Katherine Moore, Rachel Haroz
BACKGROUND: Intractable bone pain is a notorious adverse effect of granulocyte-colony stimulating factors (G-CSFs), such as pegfilgrastim and filgrastim, which are given to help prevent neutropenia in patients who are undergoing chemotherapy. G-CSF-induced bone pain is surprisingly common and often refractory to treatment with conventional analgesics. CASE REPORT: This article describes an emergency department case of opiate and nonsteroidal anti-inflammatory drug-resistant pegfilgrastim-induced bone pain that was successfully alleviated with 10 mg of oral loratadine, allowing for discharge home...
October 14, 2016: Journal of Emergency Medicine
Samantha Rothberg, Benjamin W Friedman
BACKGROUND: A total of 2.7 million patients present to US emergency departments annually for management of low back pain (LBP). Despite optimal medical therapy, more than 50% remain functionally impaired 3 months later. We performed a systematic review to address the following question: Among patients with nonchronic LBP, does spinal manipulation, massage, exercise, or yoga, when combined with standard medical therapy, improve pain and functional outcomes more than standard medical therapy alone? METHODS: We used published searches to identify relevant studies, supplemented with our own updated search...
October 5, 2016: American Journal of Emergency Medicine
Arindam Pande, Soumya Patra, Manabhanjan Jena, Rabin Chakraborty
Thirty-nine year male had a history of road traffic accident with polytrauma. At emergency room he started having chest pain with ventricular tachycardia. He was subsequentially diagnosed with right coronary artery dissection secondary to blunt trauma which is an extremely rare cause of inferior wall myocardial infarction. After some dilemmas, he was ultimately treated with intravascular ultrasound guided coronary angioplasty with stenting and had an uneventful recovery.
September 2016: Indian Heart Journal
Merritt D Kinon, Rani Nasser, Jonathan Nakhla, Rupen Desai, Jessica R Moreno, Reza Yassari, Carlos A Bagley
Pediatric emergency physicians must have a high clinical suspicion for atlantoaxial rotatory subluxation (AARS), particularly when a child presents with neck pain and an abnormal head posture without the ability to return to a neutral position. As shown in the neurosurgical literature, timely diagnosis and swift initiation of treatment have a greater chance of treatment success for the patient. However, timely treatment is complicated because torticollis can result from a variety of maladies, including: congenital abnormalities involving the C1-C2 joint or the surrounding supporting muscles and ligaments, central nervous system abnormalities, obstetric palsies from brachial plexus injuries, clavicle fractures, head and neck surgery, and infection...
October 2016: Pediatric Emergency Care
Jennifer Singleton, Jonathan A Edlow
Acute back pain is a common presenting complaint in the emergency department that leads to a great deal of resource utilization. The differential diagnosis is long and most cases are caused by benign pathology that will resolve on its own. Imaging is over-used and rarely helps. This article presents an algorithmic approach using red flags in the history and physical examination that will help physicians better identify the small of patients with serious conditions that, if untreated, will result in significant neurological damage...
November 2016: Emergency Medicine Clinics of North America
Rachael Elizabeth Docking
This article provides a brief overview of the challenges and opportunities of new technologies in the area of geriatric pain management. It also reviews emerging evidence to demonstrate the role technology may play in improving and advancing assessment and management of pain in older adults.
November 2016: Clinics in Geriatric Medicine
Hannah A Blair, James E Frampton
Methoxyflurane (Penthrox(®)) is a halogenated ether first used clinically as a volatile inhalational anaesthetic. It has been used as an analgesic in Australia and New Zealand for the past 30 years. In the UK and Europe, methoxyflurane has been approved for the emergency relief of moderate to severe trauma pain in conscious adult patients. Methoxyflurane is self-administered using a hand-held inhaler. This article reviews the pharmacological properties of methoxyflurane and its clinical efficacy and tolerability in these patients...
October 13, 2016: Clinical Drug Investigation
Donald R Hopkins, Ernesto Ruiz-Tiben, Mark L Eberhard, Sharon L Roy, Adam J Weiss
Dracunculiasis (Guinea worm disease) is caused by Dracunculus medinensis, a parasitic worm. Approximately 1 year after a person acquires infection from drinking contaminated water, the worm emerges through the skin, usually on the leg. Pain and secondary bacterial infection can cause temporary or permanent disability that disrupts work and schooling. The campaign to eradicate dracunculiasis worldwide began in 1980 at CDC. In 1986, the World Health Assembly called for dracunculiasis elimination (1), and the global Guinea Worm Eradication Program, led by the Carter Center and supported by the World Health Organization (WHO), United Nations Children's Fund (UNICEF), CDC, and other partners, began assisting ministries of health in countries where dracunculiasis was endemic...
October 14, 2016: MMWR. Morbidity and Mortality Weekly Report
Fares Moustafa, Nicolas Macian, Fatiha Giron, Jeannot Schmidt, Bruno Pereira, Gisèle Pickering
OBJECTIVES: Evaluation of acute pain is often difficult in older patients admitted to the Emergency Department (ED), and self-evaluation of pain is not always possible. This observational study evaluates how the systematic use of Algoplus(®) , a validated behavioral scale, could improve pain management of older persons admitted to the ED. METHOD: The intervention study (NCT 02258503) took place in 4 steps in the ED, University Hospital Clermont-Ferrand, France...
October 13, 2016: Pain Practice: the Official Journal of World Institute of Pain
Hooman Djaladat, Behrod Katebian, Soroush T Bazargani, Gus Miranda, Jie Cai, Anne K Schuckman, Siamak Daneshmand
PURPOSE: To report 90-day complication rates following radical cystectomy (RC) with enhanced recovery after surgery (ERAS) protocol. METHODS: All consecutive patients who underwent open RC with ERAS protocol from 2012 to 2014 were included. The protocol includes no bowel preparation or NGT, early feeding, predominantly non-narcotic pain management and μ-opioid antagonists. Non-consenting and lost to follow-up patients were excluded. All patients were closely followed up, and 90-day complication (Clavien-Dindo grading), readmission and emergency room (ER) visits were prospectively recorded...
October 12, 2016: World Journal of Urology
Fernanda Pacella, Enzo Agostinelli, Sandra Cinzia Carlesimo, Marcella Nebbioso, Roberto Secondi, Michele Forastiere, Elena Pacella
BACKGROUND: Ozurdex is a 700 mcg dexamethasone intravitreal implant, approved for the management of macular edema secondary to retinal vein occlusion, and other related pathoglogiesAnterior chamber dislocation of Ozurdex represents an uncommon complication of the intravitreal injection, which can be managed by repositioning the implant into the vitreous cavity. We describe the case of a successful repositioning of an Ozurdex implant by mobilization and subsequent balanced saline solution injection in the anterior chamber...
October 13, 2016: Journal of Medical Case Reports
Anne-Marie Malfait, Richard J Miller
Worldwide, osteoarthritis (OA) is one of the leading causes of chronic pain, for which adequate relief is not available. Ongoing peripheral input from the affected joint is a major factor in OA-associated pain. Therefore, this review focuses predominantly on peripheral targets emerging in the preclinical and clinical arena. Nerve growth factor is the most advanced of these targets, and its blockade has shown tremendous promise in clinical trials in knee OA. A number of different types of ion channels, including voltage-gated sodium channels and calcium channels, transient receptor potential channels, and acid-sensing ion channels, are important for neuronal excitability and play a role in pain genesis...
October 12, 2016: Current Osteoporosis Reports
Géraldine Layani, Richard Fleet, Renée Dallaire, Fatoumata K Tounkara, Julien Poitras, Patrick Archambault, Jean-Marc Chauny, Mathieu Ouimet, Josée Gauthier, Gilles Dupuis, Alain Tanguay, Jean-Frédéric Lévesque, Geneviève Simard-Racine, Jeannie Haggerty, France Légaré
BACKGROUND: Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec. METHODS: We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada...
July 2016: CMAJ Open
Giovanni Teruzzi, Giuseppe Calligaris, Paolo Ravagnani, Daniela Trabattoni, Luca Grancini, Giovanni Monizzi, Alessandro Lualdi, Antonio L Bartorelli
Spontaneous coronary artery dissection (SCAD) accounts approximately for 0.2% of cases of acute coronary syndrome. It is defined "spontaneous" in absence of any coronary wall damage. This disease affects primarily young women in good health, with no risk factors for coronary artery disease, especially during the postpartum period. Since the clinical presentation varies widely from no symptoms to typical angina and sudden cardiac death, SCAD incidence is underestimated.A 40-year-old woman, in the 8th week after delivery, was admitted to our emergency department because of acute chest pain, and a diagnosis of inferior and posterior non-ST-elevation myocardial infarction was made...
October 2016: Giornale Italiano di Cardiologia
Wayne Varndell, Elizabeth Ryan, Alison Jeffers, Nadya Marquez-Hunt
AIM: The purpose of this prospective observational study was to characterise patients occupying the ambulance bay and to determine the ensuing nursing workload. BACKGROUND: The number of patients presenting to ED by ambulance is increasing. During periods of peak demand and access block in the ED, patients with ongoing care needs, requiring continual assessment and symptom management by emergency nurses can remain in the ambulance bay for extended periods of time...
October 7, 2016: Australasian Emergency Nursing Journal: AENJ
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