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Acute pain management in the emergency department

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https://www.readbyqxmd.com/read/27905910/is-standardized-care-feasible-in-the-emergency-setting-a-case-matched-analysis-of-patients-undergoing-laparoscopic-cholecystectomy
#1
Fabian Grass, Matthieu Cachemaille, Catherine Blanc, Nicolas Fournier, Nermin Halkic, Nicolas Demartines, Martin Hübner
BACKGROUND: Immediate laparoscopic cholecystectomy is the accepted standard for the treatment of acute cholecystitis. The aim of the present study was to evaluate the feasibility of a standardized approach with tailored care maps for pre- and postoperative care by comparing pain, nausea and patient satisfaction after elective and emergent laparoscopic cholecystectomy. METHODS: From January 2014 until April 2015, data on pain and nausea management were prospectively recorded for all elective and emergency procedures in the department of visceral surgery...
December 1, 2016: BMC Surgery
https://www.readbyqxmd.com/read/27903774/-they-shouldn-t-be-coming-to-the-ed-should-they-a-descriptive-service-evaluation-of-why-patients-with-palliative-care-needs-present-to-the-emergency-department
#2
Emilie Green, Sarah Ward, Will Brierley, Ben Riley, Henna Sattar, Tim Harris
BACKGROUND: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. METHODS: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period...
November 30, 2016: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27899166/pain-management-of-acute-appendicitis-in-canadian-pediatric-emergency-departments
#3
Andrea L Robb, Samina Ali, Naveen Poonai, Graham C Thompson
OBJECTIVES: Children with suspected appendicitis are at risk for suboptimal pain management. We sought to describe pain management patterns for suspected appendicitis across Canadian pediatric emergency departments (PEDs). METHODS: A retrospective medical record review was undertaken at 12 Canadian PEDs. Children ages 3 to 17 years who were admitted to the hospital in February or October 2010 with suspected appendicitis were included. Patients were excluded if partially assessed or treated at another hospital...
November 30, 2016: CJEM
https://www.readbyqxmd.com/read/27896323/intra-articular-lidocaine-versus-intravenous-sedative-and-analgesic-for-reduction-of-anterior-shoulder-dislocation
#4
Parvin Kashani, Fatemeh Asayesh Zarchi, Hamid Reza Hatamabadi, Abbas Afshar, Marzieh Amiri
OBJECTIVE: This prospective clinical trial was performed to compare the safety and efficiency of intra-articular lidocaine (IAL) versus intravenous sedative and analgesic (IVSA) in reduction of anterior shoulder dislocation. MATERIALS AND METHODS: Patients with anterior shoulder dislocation were randomly divided into 2 groups to receive IAL and IVSA. One group patients received an intravenous dose of 0.05 mg/kg midazolam and 1 μg/kg fentanyl, while the other group received 20 mL intra-articular lidocaine (1%)...
June 2016: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27890522/design-and-challenges-of-a-randomized-clinical-trial-of-medical-expulsive-therapy-tamsulosin-for-urolithiasis-in-the-emergency-department
#5
Pamela K Burrows, Judd E Hollander, Allan B Wolfson, Michael C Kurz, Lorna Richards, Sara DiFiore, Phillip Watts, Nivedita Patkar, Jeremy Brown, Stephen Jackman, Ziya Kirkali, John W Kusek, Chloe Michel, Andrew C Meltzer
Urolithiasis or urinary stone disease has been estimated to affect about 1 in 11 Americans. Patients with urinary stone disease commonly present to the emergency department for management of their acute pain. In addition to providing analgesia, administration of drug (medical expulsive therapy) is often prescribed to assist passage of the urinary stone. In this methodology paper, we describe the design of a prospective, multi-center, randomized, double-blind placebo controlled clinical trial of the alpha-adrenergic blocker, tamsulosin, to evaluate its effectiveness as medical expulsive therapy...
November 23, 2016: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/27861834/an-algorithm-for-opioid-and-barbiturate-reduction-in-the-acute-management-of-headache-in-the-emergency-department
#6
Zubair A Ahmed, Dimitrios A Nacopoulos, Seby John, Nancy Papesh, David Levine, Cynthia C Bamford
OBJECTIVE: To develop and implement an algorithm for the management of headaches presenting to the emergency department (ED) in order to decrease the frequency of opioid and barbiturate treatment both acutely as well as on discharge. BACKGROUND: Headache is the fifth leading cause of ED visits in the United States. In the case of primary headache, particularly migraine, treatment in the ED can be highly variable. Patients with migraine continue to be treated with opioids more commonly than nonopioid, migraine specific medications...
November 10, 2016: Headache
https://www.readbyqxmd.com/read/27857995/anaphylaxis-after-intravenous-infusion-of-dexketoprofen-trometamol
#7
Sertac Guler, Ilyas Ertok, Nurdan Yilmaz Sahin, Hayri Ramadan, Yavuz Katirci
Dexketoprofen trometamol (DT), a nonsteroidal anti-inflammatory drug, is a highly water-soluble salt and active enantiomer of rac-ketoprofen. Its parenteral form is commonly used for acute pain management in emergency departments of our country. Side effects such as diarrhea, indigestion, nausea, stomach pain, and vomiting may be seen after the use of DT. Anaphylactic shock (AS) secondary to infusion of DT is very rare and, to our knowledge, it is the first case report describing this side effect. This case report was presented to emphasize that AS may be seen after the use of DT...
September 2016: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27846004/implementation-of-a-risk-stratification-and-management-pathway-for-acute-chest-pain-in-the-emergency-department
#8
Christopher W Baugh, Jeffrey O Greenberg, Simon A Mahler, Joshua M Kosowsky, Jeremiah D Schuur, Siddharth Parmar, George R Ciociolo, Christina W Carr, Roya Ghazinouri, Benjamin M Scirica
OBJECTIVES: Chest pain is a common complaint in the emergency department, and a small but important minority represents an acute coronary syndrome (ACS). Variation in diagnostic workup, risk stratification, and management may result in underuse, misuse, and/or overuse of resources. METHODS: From July to October 2014, we conducted a prospective cohort study in an academic medical center by implementing a Standardized Clinical Assessment and Management Plan (SCAMP) for chest pain based on the HEART score...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27843669/a-case-of-a-chronic-pancreatic-pseudocyst-causing-atraumatic-splenic-rupture-without-evidence-of-acute-pancreatitis
#9
P Moori, E J Nevins, T Wright, C Bromley, Y Rado
Atraumatic splenic rupture is a rare complication of a pancreatic pseudocyst (PP), described in the setting of chronic pancreatitis. There is common understanding, within the literature, that an inflammatory process at the tail of the pancreas may disrupt the spleen and result in such splenic complications. The authors present a case report of a 29-year-old male with a PP, associated with chronic pancreatitis. The patient had a history of excessive alcohol intake and presented to the emergency department with a short history of abdominal pain and vomiting...
2016: Case Reports in Surgery
https://www.readbyqxmd.com/read/27825694/does-gender-bias-in-cardiac-stress-testing-still-exist-a-videographic-analysis-nested-in-a-randomized-controlled-trial
#10
David M Nestler, Waqas I Gilani, Ryan T Anderson, M Fernanda Bellolio, Megan E Branda, Annie LeBlanc, Sean Phelan, Ronna L Campbell, Erik P Hess
OBJECTIVES: Despite a high prevalence of coronary heart disease in both genders, studies show a gender disparity in evaluation whereby women are less likely than men to undergo timely or comprehensive cardiac investigation. Using videographic analysis, we sought to quantify gender differences in provider recommendations and patient evaluations. METHODS: We analyzed video recordings from our Chest Pain Choice trial, a single center patient-level randomized trial in which emergency department patients with chest pain being considered for cardiac stress testing were randomized to shared decision-making or usual care...
September 30, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27800739/assessing-pain-in-children-after-traumatic-injury
#11
(no author information available yet)
Children with acute musculoskeletal pain caused by traumatic injury often present to emergency departments (EDs). However, practitioners tend to underestimate the level and intensity of children's pain, and there is variation in pain assessments and management.
November 1, 2016: Nursing Management (Harrow)
https://www.readbyqxmd.com/read/27800652/opioid-prescription-practices-at-discharge-and-30-day-returns-in-children-with-sickle-cell-disease-and-pain
#12
Leslie M Okorji, Devin S Muntz, Robert I Liem
BACKGROUND: Acute pain episodes in children with sickle cell disease (SCD) represent a leading cause of readmissions. We examined prescription practices at the time of discharge in children with SCD presenting with acute pain to determine their impact on 30-day emergency department (ED) revisits and readmissions. METHODS: In this single-institution, 5-year retrospective study, we reviewed 290 encounters of patients with SCD aged 7-21 years hospitalized or discharged from the ED with acute pain...
November 1, 2016: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/27797440/the-association-of-electrocardiographic-abnormalities-and-major-adverse-cardiac-events-in-emergency-patients-with-chest-pain
#13
Thomas Knowlman, Jaimi H Greenslade, William Parsonage, Tracey Hawkins, Lorcan Ruane, Paul Martin, Sandhir Prasad, Daniel Lancini, Louise Cullen
OBJECTIVES: The electrocardiograph (ECG) is an essential tool in initial management and risk stratification of patients with suspected acute coronary syndrome (ACS). A six-point reporting criterion has been proposed to facilitate standardized clinical assessment of patients presenting to the emergency department (ED) with suspected ACS. We set out to evaluate the efficacy of these criteria in identifying patients with major adverse cardiac events (MACE), Type 1 myocardial infarction (T1MI), Type 2 myocardial infarction (T2MI), and one-year mortality in a cohort of emergency patients with chest pain...
October 31, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27754881/assessment-of-the-european-society-of-cardiology-0-hour-1-hour-algorithm-to-rule-out-and-rule-in-acute-myocardial-infarction
#14
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 new European Society of Cardiology guidelines to rule-in and rule-out acute myocardial infarction (AMI) in the emergency department include a rapid assessment algorithm based on high-sensitivity cardiac troponin and sampling at 0 and 1 hour. Emergency department physicians require high sensitivity to confidently rule-out AMI, whereas cardiologists aim to minimize false-positive results. METHODS: High-sensitivity troponin I and T 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...
November 15, 2016: Circulation
https://www.readbyqxmd.com/read/27752608/troponin-assay-use-in-the-emergency-department-for-management-of-patients-with-potential-acute-coronary-syndrome-current-use-and-future-directions
#15
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: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/27741986/acute-nontraumatic-back-pain-risk-stratification-emergency-department-management-and-review-of-serious-pathologies
#16
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
https://www.readbyqxmd.com/read/27738897/methoxyflurane-a-review-in-trauma-pain
#17
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...
December 2016: Clinical Drug Investigation
https://www.readbyqxmd.com/read/27734573/intervention-study-with-algoplus-%C3%A2-a-pain-behavioral-scale-for-older-patients-in-the-emergency-department
#18
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
https://www.readbyqxmd.com/read/27729666/-peripartum-spontaneous-coronary-artery-dissection-a-case-report
#19
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
https://www.readbyqxmd.com/read/27724100/assessment-and-management-of-pain-in-children-following-traumatic-limb-injury
#20
Shiela Pantrini
Children with acute musculoskeletal pain caused by traumatic injury often present to emergency departments (EDs). However, there is a tendency for practitioners to underestimate the level and intensity of children's pain, and there is variation in pain assessments and management. This article discusses the assessment and management of pain in children who attend EDs following acute traumatic limb injury. It uses a case study to illustrate some of the points raised, and offers evidenced-based guidance on assessment and management of children's pain following acute traumatic limb injury...
October 6, 2016: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
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