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Acute pain management in the emergency department

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https://www.readbyqxmd.com/read/28632578/acute-abdominal-pain-recognition-and-management-of-constipation-in-the-emergency-department
#1
Stefania Norbedo, Giulia Bassanese, Francesca Barbieri, Egidio Barbi
OBJECTIVE: The main aim of the study was to investigate the incidence and the clinically relevant features of functional constipation in patients evaluated for acute abdominal pain in a tertiary care pediatric emergency department. METHODS: This is a retrospective study. We analyzed 4394 medical records and recorded the information (demographics, triage code, symptoms, medical history, physical evaluation, laboratory tests, radiological studies, procedures, and treatments) of all patients admitted for acute abdominal pain to the emergency department of the IRCCS Burlo Garofolo, Trieste, during 2010 to 2013...
June 20, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28628521/experiences-of-acute-pain-in-children-who-present-to-a-healthcare-facility-for-treatment-a-systematic-review-of-qualitative-evidence
#2
Nicole Pope, Mary Tallon, Ruth McConigley, Gavin Leslie, Sally Wilson
BACKGROUND: Pain is a universal and complex phenomenon that is personal, subjective and specific. Despite growing knowledge in pediatric pain, management of children's pain remains sub-optimal and is linked to negative behavioral and physiological consequences later in life. As there is no synthesis of these studies, it was timely to undertake a systematic review. OBJECTIVES: To identify, evaluate and synthesize the existing qualitative evidence on children's experiences of acute pain, including pain management, within a healthcare facility...
June 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/28619303/effect-of-light-pressure-stroking-massage-with-sesame-sesamum-indicum-l-oil-on-alleviating-acute-traumatic-limbs-pain-a-triple-blind-controlled-trial-in-emergency-department
#3
Morteza Nasiri, Zahra Farsi
OBJECTIVES: Due to adverse effects of common medications used for traumatic pain management, it is crucial to use complementary methods to alleviate this pain. Present study aimed to assess the effect of light pressure stroking massage with topical sesame oil on pain severity of patients with limbs trauma. METHODS: This triple-blinded randomized trial was conducted on 40 patients with upper or lower extremities trauma in emergency department of Busheher Amir Al-Momenian Hospital, Busheher, Iran, in 2015-2016...
June 2017: Complementary Therapies in Medicine
https://www.readbyqxmd.com/read/28616621/a-rare-cause-of-acute-abdominal-pain-in-children-isolated-tubal-torsion-a-case-series
#4
Yasemin Dere Gunal, Gokhan Berktug Bahadir, Ozlem Boybeyı, Aylin Pelin Cıl, Mustafa Kemal Aslan
Isolated tubal torsion -a rare cause of acute abdomen in children-is usually difficult to diagnose because of non-specific findings. Surgical salphingectomy is required in delayed diagnosis in most cases. Three sexual inactive adolescents diagnosed in isolated tubal torsion (ITT) were discussed for its diagnostic features and surgical management. Laboratory tests and radiological studies including ultrasonography (US), color doppler ultrasound were performed in all patients after evaluation for acute lower abdominal pain in emergency department and they underwent surgical intervention with laparotomy (n:2) and laparoscopy (n:1)...
June 2017: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28601270/comparative-effectiveness-of-patient-controlled-analgesia-for-treating-acute-pain-in-the-emergency%C3%A2-department
#5
Polly E Bijur, Angela M Mills, Andrew K Chang, Deborah White, Andrew Restivo, Shaun Persaud, Clyde B Schechter, E John Gallagher, Adrienne J Birnbaum
STUDY OBJECTIVE: We assess the effectiveness of patient-controlled analgesia in the emergency department (ED). We hypothesized that decline in pain intensity from 30 to 120 minutes after initial intravenous opioid administration is greater in patients receiving morphine by patient-controlled analgesia compared with usual care and would differ by a clinically significant amount. METHOD: This was a pragmatic randomized controlled trial of patient-controlled analgesia and usual care (opioid and dose at physician's discretion) in 4 EDs...
June 7, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28600631/acute-pain-management-acetaminophen-and-ibuprofen-are-often-under-dosed
#6
Gregorio P Milani, Franca Benini, Laura Dell'Era, Davide Silvagni, Alberto F Podestà, Rossella Letizia Mancusi, Emilio F Fossali
Most children with pain are managed by either acetaminophen or ibuprofen. However, no study has so far investigated if children are prescribed adequate doses of acetaminophen or ibuprofen in emergency department. Aim of this retrospective study was to investigate the prevalence of under-dosage of these drugs in children presenting with pain in emergency department. Children initially prescribed with acetaminophen or ibuprofen for pain management were included. The χ (2) automatic interaction detection method was used considering the percentage variation from the minimum of the appropriate dose as dependent variable while prescribed drug, age, gender, body weight, type of hospital (pediatric or general), and availability of internal guidelines on pediatric pain management in the emergency department as independent variables...
June 10, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28586152/right-upper-quadrant-pain-ultrasound-first
#7
Margarita V Revzin, Leslie M Scoutt, Joseph G Garner, Christopher L Moore
Acute right upper quadrant (RUQ) pain is a common presenting symptom in emergency departments and outpatient medical practices, and is most commonly attributable to biliary and hepatic pathology. Ultrasound should be used as a first-line imaging modality for the diagnosis of gallstones and cholecystitis, as it allows the differentiation of medical and surgical causes of upper abdominal pathology, and in many circumstances is sufficient to guide patient management. Knowledge of strengths and limitations of ultrasound in the evaluation of RUQ is paramount in correct diagnosis...
June 6, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28562240/dental-emergencies-management-strategies-that-improve-outcomes
#8
Ryan Anthony Pedigo
Acute dental emergencies are a common chief complaint presenting to emergency departments, and they are increasing substantially in frequency. The diagnosis and management of dental emergencies is a core competency of the emergency clinician, and proper therapeutic strategies can significantly improve cosmetic and functional outcomes for patients. This issue provides a systematic review of the literature on common acute traumatic and atraumatic dental emergencies with a focus on the historical and physical examination findings that must be understood to identify life-threatening infections, relieve pain, salvage natural teeth, and communicate with specialists in the further management of patients after emergency treatment...
June 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28542661/-benign-acute-childhood-myositis-clinical-series-and-literature-review
#9
Felipe Cavagnaro S M, Alejandra Aird G, Ingrid Harwardt R, Carmen Gloria Marambio Q
Benign acute childhood myositis (BACM) is a rare clinical condition that mainly affects pre-school and school age-children. It is usually preceded by a viral illness, particularly influenza virus infection. OBJECTIVE: To describe a cluster of BACM cases that were seen in a paediatric unit. PATIENTS AND METHODS: A retrospective series of cases that presented with a clinical picture suggestive of BACM between August and November 2012 in the paediatric emergency department of a private clinic...
April 2017: Revista Chilena de Pediatría
https://www.readbyqxmd.com/read/28538139/advanced-musculoskeletal-physiotherapists-are-effective-and-safe-in-managing-patients-with-acute-low-back-pain-presenting-to-emergency-departments
#10
James M Sayer, Rita M Kinsella, Belinda A Cary, Angela T Burge, Lara A Kimmel, Paula Harding
Objective The aim of this study was to compare emergency department (ED) key performance indicators for patients presenting with low back pain and seen by an advanced musculoskeletal physiotherapist (AMP) with those seen by other non-AMP clinicians (ED doctors and nurse practitioners).Methods A retrospective audit (October 2012-September 2013) was performed of data from three metropolitan public hospital EDs to compare patients with low back pain seen by AMP and non-AMP clinicians. Outcome measures included ED length of stay, ED wait time, admission rates and re-presentation to the ED...
May 25, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28533997/metoclopramide-for-acute-migraine-treatment-in-the-emergency-department-an-effective-alternative-to-opioids
#11
REVIEW
Mejdi Najjar, Tyler Hall, Blanca Estupinan
In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings...
April 20, 2017: Curēus
https://www.readbyqxmd.com/read/28533582/angular-ectopic-pregnancy-presenting-as-rupture-of-lateral-wall-of-the-uterus-late-presentation-in-gestation-week-20
#12
Malihe Hasanzadeh, Salme Dadgar, Yalda Arian, Yousef Yousefi
The differential diagnosis of acute abdominal pain in pregnancy is broad and can be complicated by atypical manifestations that are due to the anatomic distortions and physiologic changes of pregnancy. Due to the lack of clinical understanding, angular pregnancy does not appear to be recognized as a clinical entity and many cases are likely to go undiagnosed. This is a case report of a 34-year-old woman who was referred to the obstetrics emergency department with sudden abdominal pain and in a state of hypovolemic shock...
May 2017: Iranian Journal of Medical Sciences
https://www.readbyqxmd.com/read/28511924/evaluation-of-the-effectiveness-of-a-phone-based-care-coordination-pilot-on-hospital-utilisation-and-costs-for-patients-with-chest-pain
#13
Peita Price, Ruth Vincent, Mark Tacey, Jane Gilchrist, Danny Liew, Leeanne Grigg, Lucio Naccarella
BACKGROUND: A small percentage of the population represents a disproportionate number of attendances at emergency departments (ED). "Frequent presenters" to ED with chest pain do not always fit into established pathways for acute myocardial events. With accelerated "rule out" protocols, patients are often discharged from the Emergency Department (ED) after short lengths of stay. This research will evaluate the effectiveness of a phone based care-coordination pilot designed to meet the needs of patients attending ED with cardiac and non-cardiac chest pain...
April 20, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28504322/racial-differences-in-the-pain-management-of-children-recovering-from-anesthesia
#14
Olubukola O Nafiu, Wilson T Chimbira, Margaret Stewart, Kathleen Gibbons, L Kareen Porter, Paul I Reynolds
BACKGROUND: When pain management has been studied in settings such as pediatric emergency departments, racial disparities have been clearly identified. To our knowledge, this has not been studied in the pediatric perioperative setting. We sought to determine whether there are differences based on race in the administration of analgesia to children suffering from pain in the postanesthesia care unit. METHODS: This is a prospective, observational, study of 771 children aged 4-17 years who underwent elective outpatient surgery...
July 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28500193/viral-myositis-in-children
#15
Haley Magee, Ran D Goldman
Question I recently evaluated a child in my clinic after an emergency department visit where she presented having woken up that morning refusing to walk and was crawling around the house. The parents reported she was getting over a cold, and I recall similar cases of myositis during the H1N1 influenza epidemic a few years ago. What are the key features of myositis that I should recognize? Which investigations are needed to confirm the diagnosis and how should affected patients be managed? Answer Benign acute childhood myositis is a mild and self-limited sudden onset of lower extremity pain during or following recovery from a viral illness...
May 2017: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/28500059/toothpick-impaction-in-a-sigmoid-diverticulum
#16
Shanesh Kumar, Ramin Mehdipour, Asiri Arachchi, Antony Cass
A 70-year-old woman presented to our emergency department with recurrent episodes of left lower quadrant pain. She subsequently underwent high anterior resection with working diagnosis of acute diverticulitis, but intraoperatively was found to have perforated sigmoid diverticulum due to toothpick impaction. A high index of suspicion is required for diagnosis of toothpick ingestion. Appropriate preoperative investigations such as endoscopy and CT, despite their fairly low sensitivity, should be performed to increase the ability to accurately diagnose this condition and therefore optimise subsequent management...
May 12, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28483544/clinical-decision-support-decreases-volume-of-imaging-for-low-back-pain-in-an%C3%A2-urban-emergency-department
#17
Adam Min, Vivian W Y Chan, Ruben Aristizabal, Ed R Peramaki, David B Agulnik, Nardia Strydom, Damon Ramsey, Bruce B Forster
PURPOSE: To determine whether point-of-care clinical decision support can effectively reduce inappropriate medical imaging of patients who present to the emergency department (ED) with low-back pain (LBP). MATERIALS AND METHODS: This was a prospective, single-center study of lumbar imaging referrals made by 43 emergency physicians at a major acute care center. Each physician saw at least 10 LBP cases in both pre- and post-intervention periods. A point-of-care checklist of accepted red flags for LBP was designed by a working group of physicians and embedded in the computerized order entry form for lumbar imaging...
May 2, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28463948/emergency-management-of-the-ingested-magnet-an-algorithmic-approach
#18
Brent Bauman, Kendall McEachron, Deborah Goldman, Amanda Louiselle, Eugene Zheng, David Mills, Jeffrey Louie, Bradley Segura
INTRODUCTION: Accidental ingestion of foreign bodies is an increasing problem in the pediatric population. Symptoms are often nonspecific and may lead to a missed diagnosis because the ingestion event often goes unwitnessed. CASE: We present a case of a missed diagnosis of a multiple magnet ingestion event in a pediatric patient leading to operative management. A 2-year-old boy with a 4-week history of nonspecific abdominal pain presented to the emergency department (ED) with vomiting and worsening abdominal pain...
May 1, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28463863/is-subdissociative-ketamine-as-safe-and-effective-as-morphine-for-pain-management-in-the-emergency-department
#19
Patricia Kunz Howard, Christine M Gisness
: Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial." This prospective, randomized controlled inquiry enrolled 90 patients into 2 groups (ketamine vs. morphine) for patients seeking care in an emergency department with acute pain. Data regarding pain scores were collected at baseline, 15, 30, 60, 90, and 120 min...
April 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/28461966/management-of-the-first-episode-of-traumatic-shoulder-dislocation
#20
REVIEW
Michele Boffano, Stefano Mortera, Raimondo Piana
Shoulder joint dislocation is the most common joint dislocation seen in the emergency department.Traumatic dislocation may cause damage to the soft-tissues surrounding the shoulder joint and sometimes to the bone. The treatment, which aims at restoration of a fully functioning, pain-free and stable shoulder, includes either conservative or surgical management preceded by closed reduction of the acute dislocation.Conservative management usually requires a period of rest, generally involving immobilisation of the arm in a sling, even though it is still debated whether to immobilise the shoulder in internal or external rotation...
February 2017: EFORT Open Rev
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