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ED pain management

Francesco Saverio Biagiarelli, Simone Piga, Antonino Reale, Pasquale Parisi, Marta Luisa Ciofi Degli Atti, Angelo Gabriele Aulisa, Paolo Schingo, Chiara Ossella, Maria Pia Villa, Umberto Raucci
OBJECTIVE: We aimed to describe characteristics, etiology and health care use in children with low back pain (LBP) presenting to pediatric emergency department (ED) and to develop an algorithm to design a diagnostic approach. METHODS: We conducted a 7-year cohort study of children admitted to ED with a primary complaint of LBP. They were classified into diagnostic groups: visceral LBP; traumatic LBP; non-visceral/non-traumatic LBP. To identify high-risk factors (red flags) associated with severe prognosis conditions (SPCs), we analyzed the non-visceral/non-traumatic group comparing the SPC children with those children without SPCs...
July 21, 2018: American Journal of Emergency Medicine
Ziad Abbassi, Francesco Strano, Evangelos Koliakos, Théodoros Thomopoulos, Michel Christodoulou
BACKGROUND The incidence of metastasis to the thyroid gland is extremely rare, with hemorrhage being a particularly uncommon manifestation of metastatic thyroid disease. CASE REPORT A 68-year-old man who underwent a right nephrectomy for RCC 8 years ago was referred to the Emergency Department (ED) complaining of upper-chest pain radiating to the left shoulder, tachycardia, and increased dysphonia. An enhanced computed tomography (CT) scan suggested a thyroid mass originating from both thyroid lobes, with right deviation of the trachea due to active bleeding...
August 6, 2018: American Journal of Case Reports
Jonathan S Schiffman
BACKGROUND: Rare causes of abdominal pain include abnormalities of the urachus, including patent urachus and urachal cyst with or without infection. However, reviews discussing etiology of abdominal pain, even in children, may completely omit mention of urachal remnants. OBJECTIVES: Determine the incidence of symptomatic urachal remnants in patients presenting to the emergency department (ED), including common presenting findings and method of diagnosis. METHODS: A retrospective chart review was performed of all patients presenting to the ED with abdominal pain who were diagnosed with urachal remnants, including patent urachus or urachal cyst or abscess over a period of 11 years and 7 months in one hospital...
July 30, 2018: Journal of Emergency Medicine
Karolina Paziana, Edmund Timpano, Andrew Stolbach
Objectives: Our primary objective was to use the Delphi method (DM) to choose learning objectives for an Internet-based pain management teaching module for emergency care providers. The DM is a structured communication technique that uses systematic, interactive data gathering to reach a consensus among a panel of experts. Methods: We extracted preliminary educational objectives from nationwide pain fellowship training programs. After redundant objectives and those relating to procedures outside the scope of emergency medicine (EM) were removed, 23 preliminary objectives remained...
April 2018: AEM education and training
Josie Acuna, Elaine Situ-LaCasse, Robert P Jamplis, Richard Amini, Srikar Adhikari
It can be difficult to diagnose a tibial avulsion fracture based on physical examination alone as findings are often non-specific. Emergency physicians will usually opt for radiography as their initial imaging modality, which has several disadvantages in evaluating tibial avulsion fractures. The objective of this case series is to describe the utility of point-of-care ultrasound (POCUS) in the evaluation of tibial avulsion injuries. A 15-year-old male presented to the emergency department (ED) after sustaining a left knee injury while playing soccer...
May 23, 2018: Curēus
Lauren J Gleason, Emily D Escue, Teresita M Hogan
Older adults frequently present to the emergency department (ED) with pain, which is often underrecognized and undertreated. There is high variability of pain management and prescribing practices by ED providers. This article focuses on treatment of older adults in the ED who present with pain and addresses special considerations for this population. Social supports and follow-up must be considered in discharge treatment recommendations.
August 2018: Clinics in Geriatric Medicine
Sergey Motov, Jefferson Drapkin, Mahlaqa Butt, Ralph Monfort, Antonios Likourezos, John Marshall
OBJECTIVE: To describe our experience with intravenous lidocaine (IVL) to manage pain of renal colic origin in the emergency department (ED). METHODS: A retrospective analysis of all patients presenting with pain of renal colic origin from the periods of 2014 to 2017 by using the ED electronic medical record database (Allscripts™). RESULTS: Forty-four patients received IVL for renal colic over a three-year period. The average dose of IVL as a primary analgesic was 117...
July 9, 2018: American Journal of Emergency Medicine
Derek L Isenberg, Katrina M Kissman, Ellie P Salinski, Mark A Saks, Loreen B Evans
Introduction: In 2013 the Society for Critical Care Medicine (SCCM) published guidelines for the management of pain and agitation in the intensive care unit (ICU). These guidelines recommend using an analgesia-first strategy in mechanically ventilated patients as well as reducing the use of benzodiazepines. Benzodiazepines increase delirium in ICU patients thereby increasing ICU length of stay. We sought to determine whether a simple educational intervention for emergency department (ED) staff, as well as two simple changes in workflow, would improve adherence to the SCCM guidelines...
July 2018: Western Journal of Emergency Medicine
Jawad M Husain, Marc LaRochelle, Julia Keosaian, Ziming Xuan, Karen E Lasser, Jane M Liebschutz
Objective: To identify reasons for opioid discontinuation and post-discontinuation outcomes among patients in the Transforming Opioid Prescribing in Primary Care (TOPCARE) study. Design: In TOPCARE, an intervention to improve adherence to opioid prescribing guidelines, randomized intervention primary care providers (PCPs) received nurse care manager support, an electronic registry, academic detailing, and electronic tools, and control PCPs received electronic tools only...
June 27, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Celia Ia Choo Tan, Jennifer Suet Ching Liaw, Bo Jiang, Sohil Equbal Pothiawala, Huihua Li, Mark Kwok Fai Leong
Low back pain (LBP) is a common complaint among patients presenting to emergency department (ED) in Singapore. The STarT Back Screening Tool (SBT) was recently developed and validated for triage of LBP patients in primary care settings. This study aimed to investigate whether the SBT could provide prognostic information for long-term outcomes of acute LBP patients visiting the ED, who might benefit from appropriate and timely management at an earlier stage.Data were collected in a prospective observational cohort study from 177 patients who consulted emergency physicians for acute LBP and completed 6-month follow-up...
June 2018: Medicine (Baltimore)
Jerome R Lyn-Sue, Justin A Doble, Ryan M Juza, Vamsi V Alli
Background and Objectives: The prevalence of patients with a history of bariatric surgery is climbing. Medical and surgical questions arising in this patient population may prompt them to present to the nearest emergency department (ED), irrespective of that facility's experience with bariatric surgery. The emergency physician is the first to evaluate patients with a history of bariatric surgery who present with abdominal symptoms. As a quality improvement project aimed at reducing resource utilization, we sought to determine which patients presenting to the ED could be treated in an outpatient setting in lieu of hospital admission...
April 2018: JSLS: Journal of the Society of Laparoendoscopic Surgeons
Jay Baruch, Stacey Springs
The opioid crisis poses challenges to patients who come to the emergency department (ED) in pain and the clinicians who have a duty to offer relief. In search of help, patients often find suspicion. But clinicians have reasons to be concerned about feeding addiction and its lethal consequences. This article discusses the narrative challenges facing many clinicians in the ED tasked with caring for complex patients in pain. It will discuss the many ways our brains are influenced by story, and how this susceptibility is often beyond our grasp...
June 26, 2018: Medical Humanities
Nicholas M McManus, Ryan P Offman, Tammy L Provatas, Erik E Sievertsen
BACKGROUND: A carotid cavernous fistula is a rare type of arteriovenous (AV) fistula due to an abnormal communication between the cavernous sinus and the carotid arterial system. Normal venous return to the cavernous sinus is impeded as high-pressure arterial blood enters the cavernous sinus. The classical triad of symptoms is characterized by pulsating exophthalmos, ocular bruit, and conjunctival chemosis. However, it is important to note that some patients do not exhibit this triad of symptoms...
June 22, 2018: Journal of Emergency Medicine
William Brady, Katya de Souza
Chest pain is one of the most common, potentially serious presenting complaints for adult emergency department (ED) visits. The challenge of acute coronary syndrome (ACS) identification with appropriate disposition is quite significant. Many of these patients are low risk and can be managed non-urgently in the outpatient environment; other patients, however, are intermediate to high risk for ACS and should be managed more aggressively, likely with inpatient admission and cardiology consultation. The HEART score, a recently derived clinical decision rule aimed at the identification of risk in the undifferentiated chest pain patient, is potentially quite useful as an adjunct to physician medical decision-making...
June 2018: Turkish Journal of Emergency Medicine
Thomas M Attard, Mikaela Miller, Brian Lee, Thomas W Champion, Mike Thomson
BACKGROUND AND AIM: Increased access to endoscopic procedures have entrenched these investigative tools in routine pediatric gastroenterology practice. Patient outcomes following endoscopy therefore are topical in the decision toward endoscopy. We studied the likelihood and patient characteristics of children admitted following ambulatory endoscopy. METHODS: Hospitalization data were obtained from the Pediatric Hospital Information System including 49 tertiary children's hospitals in the USA...
June 13, 2018: Journal of Gastroenterology and Hepatology
Wayne Varndell, Margaret Fry, Doug Elliott
AIM: This paper reports a systematic literature review evaluating the impact and quality of pain management associated with nurse initiated analgesia in patients presenting to the emergency department (ED). BACKGROUND: Pain is a major presenting complaint for individuals attending the ED. Timely access to effective analgesia continues to be a global concern in the ED setting; emergency nurses are optimally positioned to improve detection and management of pain. DESIGN: Systematic review...
June 6, 2018: International Emergency Nursing
Amna Jawaid, Nida Amjad, Khubaib Arif
Baker's cysts or popliteal cysts are common cystic lesions surrounding the knee joint. These are prevalent among the adult population but rare in children. These are asymptomatic in majority of cases, and are identified incidentally by the parent or physician. We report a case of 15-year boy who presented to the emergency room with symptoms of calf pain and swelling for two weeks. He was in good health previously, and had no underlying knee pathology. Prior to presenting in emergency department (ED), he was suspected as deep vein thrombosis (DVT), and referred for evaluation and management...
June 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Julia M Rosenbloom, Sara M Burns, Eugene Kim, David A August, Vilma E Ortiz, Timothy T Houle
BACKGROUND: Although racial/ethnic and sex disparities have been examined in health care generally and pain management more specifically, the combined influence of these sociodemographic factors together has not been well documented. The aim of this study was to examine the association between administration of opioid analgesics in the emergency department (ED) and interaction of race/ethnicity and sex. METHODS: We conducted a retrospective cohort study using 2010-2014 Center for Disease Control-National Hospital Ambulatory Medical Care Survey data for patients 12-55 years of age presenting to EDs with a primary diagnosis of appendicitis or gallbladder disease as defined by International Classification of Diseases, Ninth Revision codes...
May 31, 2018: Anesthesia and Analgesia
Annemieke E Boendermaker, Constant W Coolsma, Marloes Emous, Ewoud Ter Avest
INTRODUCTION: Many patients presenting with abdominal pain to emergency departments (EDs) are discharged without a definitive diagnosis. For these patients, often designated as having non-specific abdominal pain, re-evaluation is often advocated. We aimed to investigate how often re-evaluation changes the diagnosis and clinical management and discern factors that could help identify patients likely to benefit from re-evaluation. METHODS: This was a retrospective study conducted in the Netherlands between 1 January 2014 and 31 December 2015 of patients asked to return to the ED after an initial presentation with acute non-traumatic abdominal pain...
August 2018: Emergency Medicine Journal: EMJ
Ben Ho, Michael De Paoli
BACKGROUND: Although use of the superficial cervical plexus block (SCPB) by anesthesia for perioperative indications is well described, there is a paucity of research on use of SCPB in the emergency department (ED). OBJECTIVE: This prospective observational study aims to prospectively characterize the feasibility, potential for efficacy, and safety of ultrasound-guided SCPB in a convenience sample of ED patients presenting with painful conditions of the "cape" distribution of the neck and shoulder...
July 2018: Journal of Emergency Medicine
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