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Acute pain management in the emergency department

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https://www.readbyqxmd.com/read/29655571/a-rapid-access-chest-pain-clinic-racpc-initial-australian-experience
#1
C Yu, M J Sheriff, A C C Ng, S Brazete, J Gullick, D B Brieger, L Kritharides, H C Lowe
Chest pain is the second most common presenting symptom to emergency departments (ED) in Australia, although up to 85% of these patients do not have an acute coronary syndrome (ACS). Cardiologist-led rapid access chest pain clinics (RACPC) have been proposed overseas to assist in the management of such patients, with prompt outpatient assessment if patients are deemed low risk and discharged from the ED. The use of RACPCs in Australia has been only recently proposed; we therefore sought to examine one such RACPC in an Australian context...
December 11, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29622975/ischemia-modified-albumin-ima-in-acute-coronary-syndrome-acs-and-left-bundle-branch-block-lbbb-does-it-make-the-difference
#2
Mohamed Abdel Kader Abdel Wahab
Background: Management of patients with a suspected ACS and LBBB is a challenge to the clinician. Aim: To detect the ability of IMA to exclude myocardial ischemia in suspected patients with ACS and LBBB. Material and methods: A total of 68 patients with suspected ACS and LBBB (group I) and another twenty patients age and sex matched known to have LBBB with normal coronary angiography (group II) were included in this study and subjected to: routine laboratory tests, 12 lead ECG, echocardiography, and measurement of serum troponin I (TnI) and IMA (measured by ELISA)...
September 2017: The Egyptian heart journal: (EHJ): official bulletin of the Egyptian Society of Cardiology
https://www.readbyqxmd.com/read/29622325/pediatric-pain-management
#3
REVIEW
Aarti Gaglani, Toni Gross
Nearly 20 years ago, standards were established for hospitals to assess and treat pain in all patients. Research continues to demonstrate evolving trends in the measurement and effective treatment of pain in children. Behavioral research demonstrating long-lasting effects of inadequate pain control during childhood supports the concepts of early and adequate pain control for children suffering from painful conditions in the acute care setting. The authors discuss pain concepts, highlighting factors specific to the emergency department, and include a review of evidence for pharmacologic and nonpharmacologic treatments...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29620434/transient-receptor-potential-polymorphism-and-haplotype-associate-with-crisis-pain-in-sickle-cell-disease
#4
Ellie H Jhun, Xiaoyu Hu, Nilanjana Sadhu, Yingwei Yao, Ying He, Diana J Wilkie, Robert E Molokie, Zaijie J Wang
AIM: Episodes of acute pain crisis contribute to considerable morbidity and mortality in sickle cell disease (SCD). Incomprehensive understanding of the underlying pain heterogeneity results in inadequate pain management. The transient receptor potential (TRP) family of voltage-gated ion channels acts as sensory transducers of diverse noxious stimuli. We performed an association study of polymorphisms in candidate genes TRPV1 and TRPA1 with pain in SCD patients. METHODS: Utilization rate, in other words, number of emergency department/acute care center admissions over 12 months as a result of pain crisis, served as a marker for acute pain...
April 5, 2018: Pharmacogenomics
https://www.readbyqxmd.com/read/29618194/quality-improvement-activity-for-improving-pain-management-in-acute-extremity-injuries-in-the-emergency-department
#5
Hyung Lan Chang, Jin Hee Jung, Young Ho Kwak, Do Kyun Kim, Jin Hee Lee, Jae Yun Jung, Hyuksool Kwon, So Hyun Paek, Joong Wan Park, Jonghwan Shin
OBJECTIVE: The aim of this study was to investigate the effectiveness of a quality improvement activity for pain management in patients with extremity injury in the emergency department (ED). METHODS: This was a retrospective interventional study. The patient group consisted of those at least 19 years of age who visited the ED and were diagnosed with International Classification of Diseases codes S40-S99 (extremity injuries). The quality improvement activity consisted of three measures: a survey regarding activities, education, and the triage nurse's pain assessment, including change of pain documentation on electronic medical records...
March 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29579540/pancreatitis-from-intra-gastric-balloon-insertion-case-report-and-literature-review
#6
Neel Gore, Praveen Ravindran, Daniel Leonard Chan, Kamalakanta Das, Peter H Cosman
INTRODUCTION: Intra-Gastric Balloon (IGB) is increasingly used as a non-operative management strategy in bariatric patients. However, as IGB use has become more prevalent, new potentially life-threatening adverse effects have emerged. We report a case of IGB-related acute pancreatitis from a tertiary referral hospital. A literature review of electronic databases was conducted to identify other cases PRESENTATION OF CASE: A 20-year-old female presented to the emergency department with acute onset of epigastric pain on day-1 post-insertion of an IGB (Orbera® )...
March 16, 2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29579484/patient-controlled-oral-analgesia-for-acute-abdominal-pain-a-before-and-after-intervention-study-on-pain-intensity-and-use-of-analgesics
#7
Sandra Bruun Madsen, Niels Qvist, Sören Möller, Helen Schultz
AIM: To compare the use of patient-controlled oral analgesia with nurse-controlled analgesia for patients admitted to hospital with acute abdominal pain. The primary outcome measure was pain intensity. The secondary outcome measures were the use of analgesics and antiemetics. BACKGROUND: Inadequate pain management of patients with acute abdominal pain can occur during hospital admission. Unrelieved acute pain can result in chronic pain, stroke, bleeding and myocardial ischemia...
April 2018: Applied Nursing Research: ANR
https://www.readbyqxmd.com/read/29564197/conservative-management-of-acalculous-cholecystitis-in-a-seven-year-old-child
#8
Jessica Y Ng, Jennie Gu
Acute acalculous cholecystitis is an uncommon disease in children and is usually associated with trauma, burns, and infections. Whereas acute acalculous cholecystitis is only seen in 10% of cholecystitis in adults, it is uncommon in the paediatric population. A seven-year-old male presented to the emergency department of a regional hospital with a 36-hour history of right-upper-quadrant abdominal pain. He had associated symptoms of anorexia, nausea, and vomiting. He was septic with raised white cell count and inflammatory markers...
January 20, 2018: Curēus
https://www.readbyqxmd.com/read/29540151/anxiety-about-anxiety-a-survey-of-emergency-department-provider-beliefs-and-practices-regarding-anxiety-associated-low-risk-chest-pain
#9
Paul I Musey, John A Lee, Cassandra A Hall, Jeffrey A Kline
BACKGROUND: Approximately 80% of patients presenting to emergency departments (ED) with chest pain do not have any true cardiopulmonary emergency such as acute coronary syndrome (ACS). However, psychological contributors such as anxiety are thought to be present in up to 58%, but often remain undiagnosed leading to chronic chest pain and ED recidivism. METHODS: To evaluate ED provider beliefs and their usual practices regarding the approach and disposition of patients with low risk chest pain associated with anxiety, we constructed a 22-item survey using a modified Delphi technique...
March 14, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/29534916/metoclopramide-induced-pheochromocytoma-crisis
#10
James B Leonard, Kashif M Munir, Hong K Kim
Metoclopramide (MCP) is a commonly used anti-emetic in the emergency department (ED). Its use is generally well tolerated; although infrequent adverse reactions such as extrapyramidal reactions or tardive dyskinesia are reported. However, many ED providers are not familiar with the potentially life-threatening hypertensive emergency that can be precipitated by MCP administration in patients with pheochromocytoma. A previously healthy 36-year-old woman presented to the ED with headache and nausea. She developed acute hypertensive emergency (acute agitation, worsening headache, chest pain and wide complex tachycardia) when her blood pressure (BP) increased to 223/102mmHg (initial BP, 134/86mmHg) after receiving intravenous MCP...
March 5, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29516370/novel-mutation-of-ppox-gene-in-a-patient-with-abdominal-pain-and-syndrome-of-inappropriate-antidiuresis
#11
Isabella Tabaro, Giuseppe Reimondo, Giangiacomo Osella, Caterina Aurizi, Pasquale Caraci, Luca Barbieri, Daniela Francesca Giachino, Fabio Sirchia, Massimo Terzolo
PURPOSE: Acute porphyrias are metabolic disorders of heme biosynthesis characterized by acute life-threatening attacks. The diagnosis is often missed since clinical presentation is aspecific mimicking other medical and surgical conditions. Variegate porphyria (VP) is an autosomal dominant inherited disease with incomplete penetrance due to decreased activity of the Protoporphyrinogen Oxydase (PPOX) gene; most VP mutations are family specific. We report the case of a 40 year-old woman who presented many times to the emergency department complaining of unexplained abdominal pain and laboratory investigations showed repeatedly hyponatremia...
March 7, 2018: Endocrine
https://www.readbyqxmd.com/read/29495237/-development-and-prospective-validation-of-an-ischemic-risk-score-for-acute-chest-pain-patients-with-normal-high-sensitivity-troponin-i-levels-and-without-obvious-st-segment-deviation
#12
C P Ma, X L Liu, Q S Wang, S P Nie
Objective: To develop and prospectively validate a risk score for acute chest pain patients with normal high-sensitivity troponin I (hs-TnI) levels and without obvious ST-segment deviation in China. Methods: Chest pain patients admitted to the emergency department of Beijing Anzhen Hospital from September 2014 to July 2015 were enrolled. Baseline characteristics of patients met inclusion criteria including normal hs-TnI levels and without obvious ST-segment deviation were included. The endpoint (major adverse cardiovascular events) was a composite of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, and all-cause death within 3 months after initial presentation...
February 24, 2018: Zhonghua Xin Xue Guan Bing za Zhi
https://www.readbyqxmd.com/read/29479200/constipation-and-paediatric-emergency-department-utilization
#13
Alison Nutter, Garth Meckler, Mimi Truong, Quynh Doan
Background: Constipation is a common condition in children. Little is known about the acute health care utilization of constipated children, including how many present to the paediatric emergency department (ED), the spectrum of presenting complaints, investigations and treatments used. Methods: We conducted a cross-sectional chart review of all 42,875 visits to British Columbia Children's Hospital ED between August 31, 2012 and September 1, 2013. All visits were assessed for a potential diagnosis of constipation and a total of 913 patients were included...
June 2017: Paediatrics & Child Health
https://www.readbyqxmd.com/read/29467360/atypical-presentation-of-acute-coronary-syndrome-and-importance-of-wellens-syndrome
#14
Kyaw Kyaw, Htun Latt, Sammy San Myint Aung, Nay Min Tun, Wut-Yi Phoo, Htwe Htwe Yin
BACKGROUND Acute coronary syndrome (ACS) is a common and potentially life-threatening condition encountered in emergency departments. Despite its dreaded nature, nearly one-third of ACS present without chest pain and may mislead clinicians. Additionally, Wellens' syndrome is a pre-infarction stage of significant proximal left anterior descending (LAD) artery stenosis, which can lead to extensive anterior wall myocardial infarction without timely intervention.  CASE REPORT We report the case of a 74-year-old woman presenting with isolated throat pain and Wellens' pattern in the initial EKG, which prompted the proper workup and management...
February 22, 2018: American Journal of Case Reports
https://www.readbyqxmd.com/read/29464223/determinants-of-inappropriate-acute-pain-management-in-old-people-unable-to-communicate-verbally-in-the-emergency-department
#15
REVIEW
Attilio Allione, Emanuele Pivetta, Elisa Pizzolato, Bartolomeo Lorenzati, Fulvio Pomero, Letizia Barutta, Giuseppe Lauria, Bruno Tartaglino
Objectives: Poor pain management is relevant among individuals unable to communicate verbally (UCV). Analgesia may be due to three determinants: patients' status, physician's characteristics and pain etiology. Our aim is to investigate the association between prescription of ED pain treatment and these determinants. Materials and Methods: An observational prospective study including UCV patients was conducted. Severity of pain was evaluated by ALGOPLUS Scale and a score P ≥ 2 out of 5 on the pain scale was retained as the threshold for the presence of acute pain in elderly UCV patients...
December 2017: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29464216/demographic-and-clinical-characteristics-among-turkish-homeless-patients-presenting-to-the-emergency-department
#16
Selman Yeniocak, Asım Kalkan, Ozgur Sogut, Gökce Akgül Karadana, Mehmet Toptas
Objective: Since the homeless are at greater risk of encountering health problems than the general population, the reasons for and incidence of their presentations to emergency departments also vary. The purpose of this study was to determine the sociodemographic and clinical characteristics of Turkish homeless patients who brought to the emergency department by ambulance. Materials and methods: The records of homeless adult patients brought to the ED by 112 emergency service ambulance teams over a 1-year period from January to December, 2014, were examined retrospectively...
December 2017: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29461426/emergent-management-of-primary-headache-a-review-of-current-literature
#17
Farnia Naeem, Chris Schramm, Benjamin W Friedman
PURPOSE OF REVIEW: The current article reviews recent data on treatment of acute headache patients in the acute care setting. RECENT FINDINGS: Intravenous fluid hydration, a common component of emergency department (ED) migraine therapy, does not improve pain outcomes and leads to longer ED lengths of stay. Therefore, intravenous fluids should be administered only to migraine patients with clinical evidence of dehydration. Similarly, intravenous ketamine has garnered interest as a treatment for acute pain but does not provide substantial relief to migraine patients...
February 15, 2018: Current Opinion in Neurology
https://www.readbyqxmd.com/read/29455120/amyand-s-hernia-with-acute-gangrenous-appendicitis-and-cecal-perforation-a-case-report-and-review-of-the-literature
#18
William Kromka, Aline S Rau, Charles J Fox
INTRODUCTION: An Amyand's hernia is a heterogeneous clinical condition defined by the presence of the vermiform appendix within an inguinal hernia sac, which may or may not contain other abdominal contents or pathologic inflammatory changes. Herein we present an exceptionally rare case of an Amyand's hernia containing acute appendicitis and a perforated cecum. PRESENTATION OF CASE: A 46-year-old male with a right inguinal hernia of 2-3 year duration presented to our Emergency Department complaining of acute onset abdominal and groin pain...
2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29443696/intravenous-lidocaine-for-intractable-renal-colic-unresponsive-to-standard-therapy
#19
Billy Sin, John Cao, David Yang, Karen Ambert, Sheena Punnapuzha
CLINICAL FEATURES: Renal colic is defined as a flank pain radiating to the groin caused by kidney stones in the ureter (urolithiasis). Renal colic is a frequent cause of Emergency Department visits. Most renal colic cases present as acute distress and severe back and/or abdominal pain that require prompt treatment with analgesics. THERAPEUTIC CHALLENGE: Nonsteroidal anti-inflammatory drugs and opioids are traditionally used for renal colic in the Emergency Department...
January 23, 2018: American Journal of Therapeutics
https://www.readbyqxmd.com/read/29407013/contemporary-emergency-department-management-of-patients-with-chest-pain-a-concise-review-and-guide-for-the-high-sensitivity-troponin-era
#20
REVIEW
James E Andruchow, Peter A Kavsak, Andrew D McRae
This article synthesizes current best evidence for the evaluation of patients with suspected acute coronary syndrome (ACS) using high-sensitivity troponin assays, enabling physicians to effectively incorporate them into practice. Unlike conventional assays, high-sensitivity assays can precisely measure blood cardiac troponin concentrations in the vast majority of healthy individuals, facilitating the creation of rapid diagnostic algorithms. Very low troponin concentrations on presentation accurately rule out acute myocardial infarction (AMI) and enable the discharge of approximately 20% of patients after a single test, whereas an additional 30%-40% of patients can be safely discharged after short-interval serial sampling in as little as 1 or 2 hours...
February 2018: Canadian Journal of Cardiology
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