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Acute pain management in the emergency department

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https://www.readbyqxmd.com/read/29222301/optimizing-the-care-model-for-an-uncomplicated-acute-pain-episode-in-sickle-cell-disease
#1
REVIEW
Paul Telfer, Banu Kaya
The pathophysiology, clinical presentation, and natural history of acute pain in sickle cell disease are unique and require a disease-centered approach that also applies general principles of acute and chronic pain management. The majority of acute pain episodes are managed at home without the need to access health care. The long-term consequences of poorly treated acute pain include chronic pain, adverse effects of chronic opioid usage, psychological maladjustment, poor quality of life, and excessive health care utilization...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29222286/improving-emergency-department-based-care-of-sickle-cell-pain
#2
REVIEW
Jeffrey A Glassberg
Pain is the leading cause of emergency department (ED) visits for individuals living with sickle cell disease (SCD). The care that is delivered in the ED is often cited by patients with SCD as the area of health care in greatest need of improvement. In 2014, the National Heart, Lung, and Blood Institute released guidelines for the care of SCD, including recommendations for the management of acute sickle cell pain in the ED. These guidelines provide a framework to understand the elements of ideal emergency sickle cell pain care; however, they do not provide guidance on barriers and facilitators to achieving these ideals in the complex system of the ED...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29201964/intravenous-lidocaine-compared-to-fentanyl-in-renal-colic-pain-management-a-randomized-clinical-trial
#3
Hassan Motamed, Mohammadreza Maleki Verki
Introduction: Using alpha blockers such as intravenous (IV) lidocaine has been deemed effective in controlling acute pain. Therefore, the current study was designed with the aim of evaluating the efficiency of IV lidocaine in comparison to IV fentanyl in pain management of patients with renal colic in emergency department (ED). Methods: In this double blind clinical trial, 18-65 year old patients that presented to ED with colicky flank pain and met the inclusion criteria of the study were allocated to either lidocaine or fentanyl group using block randomization and compared regarding pain severity 5, 10, 15, and 30 minutes after drug administration...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/29196785/improvement-in-physician-pain-perception-with-using-pain-scales
#4
Umut Cakir, Yildiray Cete, Ozlem Yigit, Mehmet Nuri Bozdemir
BACKGROUND AND AIMS: Acute pain is the most common reason for visits to the emergency department (ED). The underuse of analgesics occurs in a large proportion of ED patients. The physician's accurate assessment of patients' pain is a key element to improved pain management. The purpose of this study was to assess if physicians' perception of pain can improve with looking at the pain score of the patient marked on VAS. STUDY DESIGN: This was a single-center, cross-sectional prospective observational study, that took place in an academic ED...
December 1, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29174752/acute-coronary-syndrome-in-octogenarians-expect-the-unexpected
#5
Samuel T Parnell, Austin T Smith
BACKGROUND: Ischemic heart disease is the leading cause of death in the United States and the world. Advanced age is the strongest risk factor for ischemic heart disease and the best independent predictor for poor outcomes after acute coronary syndrome (ACS). Elderly patients are at high risk for ACS, and numerous studies have shown that octogenarians in particular experience increased morbidity and mortality compared to younger patients. CASE REPORT: We describe a case of an 83-year-old woman who presented to the emergency department with a chief complaint of sore throat and was found to have a non-ST elevation myocardial infarction (NSTEMI) and was treated successfully with primary coronary intervention (PCI)...
November 22, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29174580/a-systematic-review-and-meta-analysis-comparing-the-efficacy-of-nonsteroidal-anti-inflammatory-drugs-opioids-and-paracetamol-in-the-treatment-of-acute-renal-colic
#6
REVIEW
Sameer A Pathan, Biswadev Mitra, Peter A Cameron
CONTEXT: Renal colic is a common, acute presentation of urolithiasis that requires immediate pain relief. European Association of Urology guidelines recommend nonsteroidal anti-inflammatory drugs (NSAIDs) as the preferred analgesia. However, the fear of NSAID adverse effects and the uncertainty about superior analgesic effect have maintained the practice of advocating intravenous opioids as the initial analgesia. OBJECTIVE: The objective of this systematic review and meta-analysis was to compare the safety and efficacy of NSAIDs with opioids and paracetamol (acetaminophen) for the management of acute renal colic...
November 21, 2017: European Urology
https://www.readbyqxmd.com/read/29170325/28%C3%A2-are-we-measuring-what-we-think-we-are-measuring-qualitative-research-exploring-the-role-of-the-0-10-pain-score-within-the-adult-emergency-department
#7
Fiona Sampson, Alicia O'cathain, Steve Goodacre
OBJECTIVES AND BACKGROUND: The assessment of pain in the emergency department (ED) is difficult but important for appropriate management of pain. Guidelines for the management of acute pain in the ED worldwide advocate using numeric rating scales such as the 0-10 pain score as tools to ensure consistency of documenting patient's pain, and this is mandated at initial assessment in many EDs. Studies of interventions to improve pain management in the ED indicate that whilst the inclusion of mandatory pain scoring within interventions may improve documentation of pain, there was mixed evidence as to whether this resulted in improvements in provision of analgesia...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29170297/bet-2-sharing-decisions-for-patients-with-suspected-cardiac-chest-pain-in-the-emergency-department
#8
Abigail Ward, Richard Body
A short-cut review was carried out to establish whether shared decision making used alongside a decision aid can lead to greater patient satisfaction, lower healthcare resource use and non-inferior clinical outcomes in patients with suspected acute coronary syndromes. Four studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that the use of shared decision-making tools in the ED for management of patients with low-risk chest pain appears to be beneficial to the patient and the physician...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29168404/impact-of-a-chronic-pain-management-pathway-on-opioid-administration-and-prescribing-in-an-emergency-department
#9
Caroline Pace, Sneha Shah, Amy X Zhang, Amy E Zosel
CONTEXT: Prescription opioid abuse and misuse is a significant public health crisis. In 2012, an opioid prescribing pathway for patients with chronic pain presenting to the Emergency Department (ED) was implemented. The objective of this study is to determine the impact of the pathway for administration of opioids in the ED as well as the prescribing of opioids for home use after discharge. METHODS: Retrospective pre- and post-intervention time series study of consecutive patients presenting to the ED with acute and chronic pain complaints before and after implementation of the pathway...
November 23, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/29162403/cope-s-sign-and-complete-heart-block-in-a-78-year-old-patient-with-biliary-colic
#10
Panteleimon E Papakonstantinou, Natalia I Asimakopoulou, Emmanuel Kanoupakis, Spyridon Maragkoudakis, Simeon Panagiotakis, Achilleas Gikas
INTRODUCTION: Acute cholecystitis and biliary colic may have signs and symptoms similar to those of Acute Coronary Syndrome(ACS) along with ischemic ECG changes. Cholecystitis and/or biliary colic have been both reported as trigger factors for bradyarrhythmia in the literature. CASE REPORT: A 78-year-old male patient was admitted to our Emergency Department (ED) due to acute abdominal pain. The ECG on admission showed sinus bradycardia with a rate of 40 beats per minute (bpm) without signs of acute ischemia and a brief period (7 s) of complete atrioventricular (AV) block...
November 18, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/29156853/the-importance-of-routine-bedside-biliary-ultrasonography-in-the-management-of-patients-admitted-to-the-emergency-department-with-isolated-acute-epigastric-pain
#11
Vermi Değerli, Tanzer Korkmaz, Hülya Mollamehmetoğlu, Cem Ertan
Background/aim: The aim of our study was to emphasize the importance of routine bedside biliary ultrasonography (USG) for the differential diagnosis of biliary tract disorders in patients admitted with acute isolated epigastric pain. Materials and methods: Adult patients who were admitted to the emergency department with acute isolated epigastric pain were included in the study. Emergency residents (ERs) were asked whether they planned to perform biliary USG during the initial evaluation and following diagnosis/treatment (secondary evaluation) of these patients...
August 23, 2017: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/29135620/safety-of-a-1-hour-rule-out-high-sensitive-troponin-t-protocol-in-patients-with-chest-pain-at-the-emergency-department
#12
E Röttger, S de Vries-Spithoven, J B Reitsma, A Limburg, C E E van Ofwegen-Hanekamp, A W Hoes, J M Poldervaart
BACKGROUND: The 1-hour rule-out high-sensitive cardiac troponin T protocol (hs-cTnT), in which a serial troponin measurement is performed 1 hour after the first to assess the possibility of acute coronary syndrome (ACS), has been implemented in the European guidelines in 2015. Our aim was to assess the safety of this protocol in low-risk patients in the Emergency Department (ED) when implemented in daily practice. METHODS: Patients with acute chest pain presenting to the ED of our hospital and younger than 75 years were included (May 2013 to October 2014, The Netherlands)...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29127600/a-review-of-current-and-emerging-approaches-to-pain-management-in-the-emergency-department
#13
REVIEW
Knox H Todd
INTRODUCTION: Pain is the most common symptom prompting an emergency department visit and emergency physicians are responsible for managing both acute pain and acute exacerbations of chronic pain resulting from a broad range of illnesses and injuries. The responsibility to treat must be balanced by the duty to limit harm resulting from analgesics. In recent years, opioid-related adverse effects, including overdose and deaths, have increased dramatically in the USA. In response to the US opioid crisis, emergency physicians have broadened their analgesic armamentarium to include a variety of non-opioid approaches...
December 2017: Pain and Therapy
https://www.readbyqxmd.com/read/29126847/visualization-of-painful-inflammation-in-patients-with-pain-after-traumatic-ankle-sprain-using-11-c-d-deprenyl-pet-ct
#14
Mikko Aarnio, Lieuwe Appel, Mats Fredrikson, Torsten Gordh, Olof Wolf, Jens Sörensen, Måns Thulin, Magnus Peterson, Clas Linnman
BACKGROUND AND AIMS: Positron emission tomography (PET) with the radioligand [(11)C]-D-deprenyl has shown increased signal at location of pain in patients with rheumatoid arthritis and chronic whiplash injury. The binding site of [(11)C]-D-deprenyl in peripheral tissues is suggested to be mitochondrial monoamine oxidase in cells engaged in post-traumatic inflammation and tissue repair processes. The association between [(11)C]-D-deprenyl uptake and the transition from acute to chronic pain remain unknown...
November 7, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/29122372/sufentanil-sublingual-tablet-30mcg-for-moderate-to-severe-acute-pain-in-the-emergency-department
#15
James R Miner, Zubaid Rafique, Harold S Minkowitz, Karen P DiDonato, Pamela P Palmer
BACKGROUND: Pharmacological properties of the sufentanil sublingual tablet 30mcg (SST 30mcg) could offer potential analgesic advantages in settings requiring noninvasive, acute pain management. The feasibility of using SST 30mcg for moderate-to-severe pain management in the emergency department (ED) was evaluated. METHODS: This open-label, multicenter feasibility study included patients aged ≥18years who presented to the ED with moderate-to-severe pain (≥4 on the numeric rating scale of pain intensity (NRS); opioid-tolerant patients were excluded...
October 31, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29117892/emergency-department-referral-patterns-of-australian-general-practitioner-registrars-a-cross-sectional-analysis-of-prevalence-nature-and-associations
#16
Nigel Catzikiris, Amanda Tapley, Simon Morgan, Mieke van Driel, Neil Spike, Elizabeth G Holliday, Jean Ball, Kim Henderson, Lawrie McArthur, Parker Magin
Objective Limited international evidence suggests general practice registrars' emergency department (ED) referral rates exceed those of established general practitioners (GPs). The aim of the present study was to fill an evidence gap by establishing the prevalence, nature and associations of Australian GP registrar ED referrals.Methods A cross-sectional analysis was performed of the Registrar Clinical Encounters in Training (ReCEnT) cohort study of GP registrars' consultation experiences, between 2010 and 2015...
November 9, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/29114813/opioid-vs-nonopioid-acute-pain-management-in-the-emergency-department
#17
EDITORIAL
Demetrios N Kyriacou
No abstract text is available yet for this article.
November 7, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29104834/a-case-of-spontaneous-isolated-celiac-artery-dissection-with-pseudoaneurysm-formation
#18
John Kim, Lamar H Moree, Michael J Muehlberger
Spontaneous isolated celiac artery dissection is a rare disease and patients without evidence of significant complications often resolve with medical therapy alone; however, the extension of the dissection can lead to more serious complications including aneurysmal dilatation, complete occlusion, and rupture of a visceral artery. In these patients, optimal management has not yet been clearly defined and treatment primarily depends on clinical presentation and lesions identified on imaging studies. This case report demonstrates the conservative management of spontaneous celiac artery dissection...
August 27, 2017: Curēus
https://www.readbyqxmd.com/read/29103410/acupuncture-s-role-in-solving-the-opioid-epidemic-evidence-cost-effectiveness-and-care-availability-for-acupuncture-as-a-primary-non-pharmacologic-method-for-pain-relief-and-management-white-paper-2017
#19
Arthur Yin Fan, David W Miller, Bonnie Bolash, Matthew Bauer, John McDonald, Sarah Faggert, Hongjian He, Yong Ming Li, Amy Matecki, Lindy Camardella, Mel Hopper Koppelman, Jennifer A M Stone, Lindsay Meade, John Pang
The United States (U.S.) is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public's opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives...
November 2017: Journal of Integrative Medicine
https://www.readbyqxmd.com/read/29101666/laparoscopic-appendectomy-vs-antibiotic-therapy-for-acute-appendicitis-a-propensity-score-matched-analysis-from-a-multicenter-cohort-study
#20
Gaetano Poillucci, Lorenzo Mortola, Mauro Podda, Salomone Di Saverio, Laura Casula, Chiara Gerardi, Nicola Cillara, Luigi Presenti
Acute appendicitis (AA) is among the most common causes of acute lower abdominal pain leading patients to the emergency department. Significant debate remains on whether AA should be operated or not. A propensity score-matched analysis was performed in seven Italian Hospitals, with the aim to assess safety and feasibility both nonoperative management with antibiotics (AT) and surgical therapy with appendectomy (ST) for patients with AA. Data regarding all patients discharged from the participating centers with a diagnosis of appendicitis from January 1st, 2014 to December 31st, 2014 were collected retrospectively...
December 2017: Updates in Surgery
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