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ED pain management

Amir Nejati, Mohammad Jalili, Saeed Abbasi, Farhad Talebi Sarwari, Ali Bidari, Mahsa Ghajarzadeh, Atousa Akhgar
BACKGROUND: Low dose ketamine can be used as analgesic in acute pain management in the emergency department (ED). OBJECTIVE: Efficacy of IN ketamine in acute pain management in the ED. METHOD: This is a double blind randomized clinical trial on patients older than 15 years who needed digital nerve block (DNB). Participants randomly received IN Ketamine (1 ml = 50 mg) or placebo (normal saline, 1 ml) 5 min before DNB. In both groups, patients' pain score was recorded by visual analogue score (VAS) at baseline, after DNB and 45 min after completion of DNB...
November 17, 2018: American Journal of Emergency Medicine
Brit Long, Jennifer Robertson, Alex Koyfman
BACKGROUND: Small bowel obstruction (SBO) is a commonly diagnosed disease in the emergency department (ED). Recent literature has evaluated the ED investigation and management of SBO. OBJECTIVE: This review evaluates the ED investigation and management of adult SBO based on the current literature. DISCUSSION: SBO is most commonly due to occlusion of the small intestine, resulting in fluid and gas accumulation. This may progress to mucosal ischemia, necrosis, and perforation...
December 6, 2018: Journal of Emergency Medicine
David A Talan, Darin J Saltzman, Daniel A DeUgarte, Gregory J Moran
BACKGROUND: Meta-analyses and a recent guideline acknowledge that conservative management of uncomplicated appendicitis with antibiotics can be successful for patients who wish to avoid surgery. However, guidance as to specific management does not exist. METHODS: PUBMED and EMBASE search of trials describing methods of conservative treatment was conducted according to PRISMA guidelines. RESULTS: Thirty-four studies involving 2944 antibiotic-treated participants were identified...
December 3, 2018: Journal of Trauma and Acute Care Surgery
Gustav Valentin Blichfeldt Sørensen, Jacob Stegger, Jørgen Møller Munkhof, Erika Frischknecht Christensen
INTRODUCTION: Pain is a frequent symptom in patients attending emergency departments (EDs), but it remains unknown whether all patients with pain want pain-relieving treatment. The primary aim of this study was to investigate the frequency and intensity of pain. The secondary aim was to establish the proportion of patients wanting pain-relieving treatment. METHODS: A cross-sectional study was performed at Aalborg University Hospital, Denmark. We interviewed all patients attending the ED using a structured questionnaire to evaluate patient and pain characteristics as well as pain management in the ED...
December 2018: Danish Medical Journal
Asma Sriha Belguith, Kaouthar Beltaief, Mohamed Amine Msolli, Wahid Bouida, Hela Abroug, Manel Ben Fredj, Imen Zemni, Mohamed Habib Grissa, Hamdi Boubaker, Mohamed Hsairi, Samir Nouira
BACKGROUND: We aimed to describe diagnosed acute coronary syndrome (ACS) and its care management and outcomes in emergency departments (EDs) and to determine related cardiovascular risk factors (CVRFs). METHODS: We conducted a cross sectional multicenter study that included 1173 adults admitted to EDs for acute chest pain (ACP) in 2015 at 14 sites in Tunisia. Data included patients' baseline characteristics, diagnosis, treatment and output. RESULTS: ACS represented 49...
December 3, 2018: BMC Emergency Medicine
Takaaki Mori, Osamu Nomura, Takateru Ihara
Although ultrasound-guided peripheral nerve block (UGPNB) has recently been introduced into pediatric emergency departments (EDs), knowledge of its use is still limited among pediatric emergency physicians. Ultrasound-guided ulnar nerve block (UGUNB) is a form of peripheral nerve block available for controlling the pain caused by phalangeal injuries, but studies of its use in pediatric patients are still scarce. The aim of this case series was to describe the experience of UGUNB use for pediatric phalangeal fractures in a pediatric ED setting...
November 24, 2018: American Journal of Emergency Medicine
Iskandar Berbari, Rawan Safa, Gilbert Abou Dagher
Acute mesenteric venous thrombosis (MVT) is an uncommon cause of intestinal ischemia and is associated with high morbidity and mortality. Patients with acute MVT often present with gastrointestinal (GI) bleeding and other unspecific findings making the diagnosis challenging. This condition requires emergent treatment. The high rates of misdiagnosis of these patients and subsequently the delay in proper and quick management put patients at increased risk of having a negative outcome. Physicians should suspect acute MVT in patients with GI bleed while also considering other factors such as, a past medical history of pro-thrombotic conditions, past surgical history of splenectomy, symptoms of nausea, vomiting, abdominal pain, physical exam findings of abdominal tenderness and abdominal distention and a laboratory workup indicating leukocytosis and an increased plasma lactic acid level...
November 7, 2018: American Journal of Emergency Medicine
Belinda De Simone, Luca Ansaloni, Massimo Sartelli, Federico Coccolini, Josephine A Napoli, Fausto Catena
BACKGROUND: Our aim is to present the Video-Consulting Emergency (VCE) protocol to improve the decision-making process between an on-site emergency physician and a remote acute care surgeon using a smart phone and the FaceTime application and the Acute Abdominal Decision Making (AADM) model proposed by World Society of Emergency Surgeons members. METHODS: VCE protocol involves emergency physician and the on-call emergency surgeon. Both must be provided a smart phone for 24-hours video-consulting with FaceTime application...
November 27, 2018: Minerva Chirurgica
Michael K Dalton, Michael J Minarich, Kimberly J Twaddell, Joshua P Hazelton, Nicole M Fox
INTRODUCTION: Rib fractures are a cause of significant morbidity and mortality in trauma patients. It is well documented that optimizing pain control, mobilization, and respiratory care decreases complications. However, the impact of these interventions on hospital costs and length of stay is not well defined. We hypothesized patients with multiple rib fractures can be discharged within three hospital days resulting in decreased hospital costs. METHODS: A retrospective review of adult patients (≥18yrs) admitted to our Level 1 trauma center (2011-2013) with ≥2 rib fractures was performed...
October 13, 2018: Injury
David J Keene, Michael M Schlüssel, Jacqueline Thompson, Daryl A Hagan, Mark A Williams, Christopher Byrne, Steve Goodacre, Matthew Cooke, Stephen Gwilym, Philip Hormbrey, Jennifer Bostock, Kirstie Haywood, David Wilson, Gary S Collins, Sarah E Lamb
BACKGROUND: Ankle sprains are very common injuries. Although recovery can occur within weeks, around one-third of patients have longer-term problems. OBJECTIVES: To develop and externally validate a prognostic model for identifying people at increased risk of poor outcome after an acute ankle sprain. DESIGN: Development of a prognostic model in a clinical trial cohort data set and external validation in a prospective cohort study. SETTING: Emergency departments (EDs) in the UK...
November 2018: Health Technology Assessment: HTA
Paul Fulbrook, Sandra Miles, Fiona Coyer
INTRODUCTION: Pressure injuries are harmful, painful, and potentially preventable. Although hospital-acquired pressure injury prevalence is decreasing, it is unclear if some pressure injuries develop before hospital admission. The objective of this study was to investigate the prevalence of pressure injury in adults on arrival by ambulance to the emergency department (ED). METHODS: An observational, cross-sectional descriptive study design was used. Participants (n = 212) were recruited from the EDs of two Australian tertiary hospitals...
November 20, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Nurettin Özgür Doğan, Sevinç Taş Çaylak, Serkan Yılmaz
Mefenamic acid is a fenamate nonsteroidal anti-inflammatory (NSAI) drug, which is used for several years for pain management. However, it has been rarely reported that, mefenamic acid can induce central nervous system toxicity both in toxic doses and therapeutic usage. We report a case of a 27-year-old female who presented to the emergency department (ED) with altered mental status and vomiting. On admission to the ED, she was lethargic and disoriented. Her vital signs were normal and her physical examination was completely normal except dysarthric speech...
November 17, 2018: American Journal of Emergency Medicine
Basmah Safdar, Peter Ong, Paolo G Camici
Chest pain stands as one of the most frequent patient presentations in the emergency department (ED). Despite established diagnostic algorithms for identifying several important causes of chest pain, such as acute myocardial infarction (AMI), aortic dissection, and pulmonary embolism, guidance on managing patients with recurrent chest pain, one of the top 3 reasons for repeated hospitalization in the United States, is less defined. The assessment of symptoms, serial ECG, and necrosis biomarkers plays a major role in patient management...
November 2018: Clinical Therapeutics
Maíra M Pimenta Branco, Carla F Borrasca-Fernandes, Camila Carbone Prado, Taís Freire Galvão, Marcus Tolentino Silva, Eduardo Mello De Capitani, Stephen Hyslop, Fábio Bucaretchi
CONTEXT: Erucism, envenomation caused by dermal contact with larval forms of moths, may result in intense local pain, mainly after contact with puss caterpillars (family Megalopygidae). OBJECTIVE: To evaluate the response to different treatments for controlling severe pain in a case series of erucism in Campinas, southeastern Brazil. PATIENTS AND METHODS: Prospective cohort study. A Numeric Pain Rating Scale (NPRS 0-10) was used to assess pain intensity in the Emergency Department (ED)...
November 17, 2018: Clinical Toxicology
Zachary I Meyer, Paul Krucylak, Michelle Mo, Mark L Miller, Lindley B Wall
BACKGROUND: Opioids are a commonly utilized component of pain management following pediatric extremity fractures, yet an increasing number of adolescents and children are falling victim to their negative effects. The purpose of this study was to examine opioid use in the pediatric fracture population by determining and comparing the average hospital opioid dosage utilized in the operative pediatric elbow and femur fractures and determining and comparing the average dose prescribed following operative treatment of elbow and femur fractures...
November 13, 2018: Journal of Pediatric Orthopedics
Ryan P McKillip, Anand Gopalsami, Magdeline Montoya, Gene Kim, James J Walter, Colleen Juricek, Eric Shappell
Introduction: Left ventricular assist device (LVAD) insertion is an increasingly common intervention for patients with advanced heart failure; however, published literature on the emergency department (ED) presentation of this population is limited. The objective of this study was to characterize ED presentations of patients with LVADs with a focus on device-specific complications to inform provider education and preparation initiatives. Methods: This was a retrospective chart review of all patients with LVADs followed at an urban academic medical center presenting to the ED over a five-year period (July 1, 2009, to June 30, 2014)...
November 2018: Western Journal of Emergency Medicine
Michelle P Lin, Shaw Natsui, Corine Sinnette, Alexis Ball, Joel S Weissman, Jeremiah D Schuur
BACKGROUND: Chest pain of possible cardiac etiology is a leading reason for emergency department (ED) visits and hospitalizations nationwide. Evidence suggests outpatient management is safe and effective for low-risk patients; however, ED admission rates for chest pain vary widely. To identify barriers and facilitators to outpatient management after ED visits, we performed a multicenter qualitative study of key stakeholders. METHODS AND RESULTS: We identified Massachusetts hospitals with below-average admission rates for adult ED chest pain visits from 2010 to 2011...
December 2018: Critical Pathways in Cardiology
Christopher A Griggs, Christian J Schulz
Emergency Medicine providers are grappling with the dual challenges of adequately treating pain while avoiding the risks associated with opioid pain relievers. The aggressive treatment of pain with opioids for the last three decades has resulted in an epidemic of opioid use disorder and opioid related mortality. This editorial discusses the findings in a study of emergency department (ED) opioid prescribing by Yang et al. and explores the changing landscape of opioid prescribing in emergency medicine. We specifically discuss risks associated with opioid prescribing, strategies to reduce risks while improving pain management, the role of advanced practice providers in ED opioid prescribing, and the importance of further education on opioid sparing pain management strategies...
October 21, 2018: American Journal of Emergency Medicine
Ai Xiao-Ming, Lu Jin-Jing, Ho Li-Chen, Han Lu-Lu, Yue Xiong, Zhang Hong-Hai, Yang Nian-Yin
RATIONALE: Intestinal or enteric duplication (ED) does exit as a rare congenital malformation of the gastrointestinal system clinically. It is a separate entity, but can be communicated with the gastrointestinal tract. It is characterized by a well-developed muscular wall and lumen endowed with ectopic mucosa, simulating a portion of normal bowel. A completely isolated duplication cyst (CIDC) refers to an extremely uncommon variant of ED, which is secluded from the alimentary tract and possesses its own exclusive blood supply...
November 2018: Medicine (Baltimore)
Ruth Treadgold, Daranee Boon, Phillipa Squires, Simon Courtman, Ruth Endacott
INTRODUCTION: Pain management in children is often poorly executed in Emergency Departments and Minor Injury Units. The aim of this study was to assess the impact of a care bundle comprising targeted education on pain score documentation and provision of appropriately dosed analgesia for the paediatric population attending Emergency Departments (EDs) and Minor Injury Units (MIUs). METHODS: A total of 29 centres - 5 EDs and 24 MIUs - participated in an intervention study initiated by Emergency Nurse Practitioners to improve paediatric pain management...
October 29, 2018: International Emergency Nursing
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