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ED pain management

Kassi Shave, Samina Ali, Shannon D Scott, Lisa Hartling
BACKGROUND: Children experience multiple painful procedures when being cared for in emergency departments (EDs). Unfortunately, evidence-based interventions to manage such pain and distress are under-utilized across EDs. Caregivers are uniquely positioned and invested to advocate for the adaptation of such evidence into practice. Our objective was to gather information from caregivers of children experiencing procedural pain in the ED to inform the development of a novel, caregiver-focused knowledge translation (KT) tool...
October 13, 2018: BMC Pediatrics
Melissa Corso, Scott Howitt
Background: Knee injuries are the second to fourth most common injuries in youth soccer. In this population, sprains/strains, fractures and contusions are most common. Due to variations in the developing skeleton, it can be difficult to rule out fractures. Case Summary: We present a case of a 13-year-old presenting to the emergency department (ED) with patellar pain after pivoting during a soccer game. After radiographic clearance, he was allowed to return to sport...
August 2018: Journal of the Canadian Chiropractic Association
Monique T Barakat, Aditi Mithal, Robert J Huang, Alka Sehgal, Amrita Sehgal, Gurkirpal Singh, Subhas Banerjee
BACKGROUND: The Affordable Care Act (ACA) with Medicaid expansion implemented in 2014, extended health insurance to >20-million previously uninsured individuals. However, it is unclear whether enhanced primary care access with Medicaid expansion decreased emergency department (ED) visits and hospitalizations for gastrointestinal (GI)/pancreatic/liver diseases. METHODS: We evaluated trends in GI/pancreatic/liver diagnosis-specific ED/hospital utilization over a 5-year period leading up to Medicaid expansion and a year following expansion, in California (a state that implemented Medicaid expansion) and compare these with Florida (a state that did not)...
October 3, 2018: Journal of Clinical Gastroenterology
Anna Waller, Brit Long, Alex Koyfman, Michael Gottlieb
BACKGROUND: Acute pancreatitis is a frequent reason for patient presentation to the emergency department (ED) and the most common gastrointestinal disease resulting in admission. Emergency clinicians are often responsible for the diagnosis and initial management of acute pancreatitis. OBJECTIVE: This review article provides emergency clinicians with a focused overview of the diagnosis and management of pancreatitis. DISCUSSION: Pancreatitis is an inflammatory process within the pancreas...
September 26, 2018: Journal of Emergency Medicine
Meghan V Flood, Neil A Manson, Alana J Green, Edward P Abraham, Erin Bigney
Study Design: Retrospective study. Objective: To identify prevalence of, reasons for, and predictors of emergency department (ED) utilization 6 months following elective thoracolumbar spine surgery. Methods: A retrospective review of a patient database was conducted (N = 577). Visits were divided by orthopedic spinal surgeons into (1) avoidable ED visit, (2) appropriate/no visit, and (3) unrelated visit. Measures: Demographics, pain scores, patient characteristics, and surgical factors...
August 2018: Global Spine Journal
Shamyla Farrukh, Adam B Sivitz, Bilgehan Onogul, Kavita Patel, Cena Tejani
STUDY OBJECTIVE: We evaluate the additive value of pelvic examinations in predicting sexually transmitted infection for young female patients with suspected cervicitis or pelvic inflammatory disease in a pediatric emergency department (ED). METHODS: This was a prospective observational study of female patients aged 14 to 20 years who presented to an urban academic pediatric ED with a complaint of vaginal discharge or lower abdominal pain. Enrolled patients provided a urine sample for chlamydia, gonorrhea, and trichomonas testing, which served as the criterion standard for diagnosis...
July 2, 2018: Annals of Emergency Medicine
Anas Saleh, Mhamad Faour, Assem A Sultan, David P Brigati, Robert M Molloy, Michael A Mont
BACKGROUND: Thirty-day hospital readmissions following total hip arthroplasty (THA) have received increasing scrutiny by policy makers and hospitals. Emergency department (ED) visits may not necessarily result in an inpatient readmission but can be a measure of performance and can incur costs to the health system. The purpose of this study is to describe the following: (1) the frequency and subsequent disposition; (2) patient characteristics; (3) reasons; and (4) potential risk factors for ED visits that did not result in a readmission within 30 days of discharge after THA...
August 31, 2018: Journal of Arthroplasty
Caleb P Canders, Pravin K Krishna, Roya S Moheimani, Catherine M Weaver
BACKGROUND: Acute on chronic neuropathic pain is often refractory to analgesics and can be challenging to treat in the emergency department (ED). In addition, systemic medications such as opiates and nonsteroidal inflammatory drugs have risks, including hypotension and kidney injury, respectively. Difficulties in managing pain in patients with neuropathy can lead to prolonged ED stays, undesired admissions, and subsequent increased health care costs. CASE REPORT: We describe the case of a 51-year-old woman who presented to the ED on two separate occasions for left forearm pain secondary to chronic ulnar neuropathy...
September 21, 2018: Journal of Emergency Medicine
Hendry R Sawe, Teri A Reynolds, Juma A Mfinanga, Michael S Runyon, Brittany L Murray, Lee A Wallis, Julie Makani
Background: Sickle cell anaemia (SCA) is prevalent in sub-Saharan Africa, with high risk of complications requiring emergency care. There is limited information about presentation of patients with SCA to hospitals for emergency care. We describe the clinical presentation, resource utilization, and outcomes of SCA patients presenting to the emergency department (ED) at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods: This was a prospective cohort study of consecutive patients with SCA presenting to ED between December 2014 and July 2015...
2018: BMC Hematology
David Watson Sobel, Theodore Cisu, Tessa Barclay, Andrew Pham, Peter Callas, Kevan M Sternberg
PURPOSE: Efforts have begun to implement non-opioid protocols for outpatient urologic surgery. In this study, we report a retrospective review of the feasibility of implementing a non-opioid protocol to manage postoperative pain after ureteroscopy with stent placement. METHODS: Between November 2016 and March 2018, 210 patients underwent ureteroscopy with stent placement by a single surgeon at an academic medical center. A treatment algorithm was used to determine eligibility and appropriately select patients for the non-opioid pathway...
September 22, 2018: Journal of Endourology
Holli A DeVon, Karen Vuckovic, Larisa A Burke, Sahereh Mirzaei, Katherine Breen, Nadia Robinson, Jessica Zegre-Hemsey
The purpose of the study was to determine whether older (≥65 years) and younger (<65 years) women presenting to the emergency department (ED) with symptoms suggestive of acute coronary syndrome (ACS) varied on risk factors, comorbid conditions, functional status, and symptoms that have implications for emergent cardiac care. Women admitted to five EDs were enrolled. The ACS Symptom Checklist was used to measure symptoms. Comorbid conditions and functional status were measured with the Charlson Comorbidity Index and Duke Activity Status Index...
2018: BioResearch Open Access
Oisin Breathnach, Marc O'Reilly, Keith Morrissey, Breda Conlon, Eoin Sheehan
INTRODUCTION: Virtual fracture clinics (VFC) are now prevalent across many orthopaedic services in the UK and Ireland. The management of a variety of musculoskeletal injuries using the VFC model has been demonstrated to be safe, cost-effective and associated with high levels of patient satisfaction. Referrals were made available through the National Integrated Medical Imaging System (NIMIS). NIMIS allows for electronic movement of patient images throughout the Irish health service. METHODS: A retrospective review of 157 orthopaedic fracture referrals from a regional hospital was performed...
September 18, 2018: Irish Journal of Medical Science
Lauren J Hunt, Christine S Ritchie, Janine K Cataldo, Kanan Patel, Caroline E Stephens, Alexander K Smith
CONTEXT: Pain may be a potentially modifiable risk factor for expensive and burdensome Emergency Department (ED) visits near the end-of-life for older adults with dementia. OBJECTIVES: To assess the effect of pain and unmet need for pain management on ED visits in the last month of life in older adults with dementia. METHODS: Mortality follow-back study of older adults with dementia in the National Health and Aging Trends Study (NHATS) who died between 2012-2014, linked to Medicare claims...
September 14, 2018: Journal of Pain and Symptom Management
Giovanni E Ferreira, Adrian C Traeger, Mary O'Keeffe, Chris G Maher
QUESTION: What are staff and patients' perceptions of physiotherapists working in the emergency department (ED)? DESIGN: Systematic review of qualitative studies. PARTICIPANTS: Staff working in EDs and patients presenting to the ED and managed by ED physiotherapists. OUTCOME MEASURES: Perceptions of ED staff and patients were synthesised using a three-stage thematic analysis consisting of extraction, grouping (codes), and abstraction of findings...
October 2018: Journal of Physiotherapy
Sergey Motov, Jefferson Drapkin, Antonios Likourezos, Joshua Doros, Ralph Monfort, John Marshall
BACKGROUND: We describe our experience of utilizing sub-dissociative dose ketamine (SDK) in managing a variety of acute and chronic painful conditions in the emergency department (ED). METHODS: A descriptive study was conducted in our ED over a period of seven years (2010-2016) by retrospectively reviewing charts of patients aged 18 and older presenting to the ED with painful complaints and receiving SDK analgesia. Primary data analyses included type of SDK administration (intravenous push [IVP], short-infusion [SI] or continuous infusion [CI]), dosing, rates of analgesic utilization before and after SDK administration, and adverse effects...
2018: World Journal of Emergency Medicine
Joseph Longino, Ashish Chaddha, Matthew M Kalscheur, Anne M Rikkers, Deepak V Gopal, Michael E Field, Jennifer M Wright
BACKGROUND: Atrial fibrillation (AF) may result in procedure cancellations and emergency department (ED) referrals for patients presenting for outpatient GI endoscopic procedures. Such cancellations and referrals delay patient care and can lead to inefficient use of resources. METHODS: All consecutive patients presenting in AF for a colonoscopy or upper endoscopy to the University of Wisconsin Digestive Health Center between October 2013 and September 2014 were defined as the pre-intervention group (Group 1)...
September 3, 2018: BMC Cardiovascular Disorders
Jessica K Zègre-Hemsey, Larisa A Burke, Holli A DeVon
Early diagnosis is critical in the management of patients with acute coronary syndrome (ACS), particularly ST-elevation myocardial infarction (STEMI), because effective therapies are time-dependent. Aims of this secondary analysis were to determine: (i) the prognostic value of symptoms for an ACS diagnosis in conjunction with electrocardiographic (ECG) and troponin results; and (ii) if any of 13 symptoms were associated with prehospital delay in those presenting to the emergency department (ED) with potential ACS...
August 31, 2018: Research in Nursing & Health
Kirsten Strudwick, Megan McPhee, Anthony Bell, Melinda Martin-Khan, Trevor Russell
Neck pain and whiplash injuries are a common presentation to the ED, and a frequent cause of disability globally. This rapid review investigated best practice for the assessment and management of musculoskeletal neck pain in the ED. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. Primary studies, systematic reviews and guidelines were considered for inclusion. English-language articles published in the past 12 years addressing acute neck pain assessment, management or prognosis in the ED were included...
August 30, 2018: Emergency Medicine Australasia: EMA
Brian Ferguson, Justin Geralds, Jessica Petrey, Martin Huecker
BACKGROUND: Malpractice in emergency medicine is of high concern for medical providers, the fear of which continues to drive decision-making. The body of evidence evaluating risk specific to emergency physicians is disjointed, and thus it remains difficult to derive cohesive themes and strategies for risk minimization. OBJECTIVE: This review evaluates the state of malpractice in emergency medicine and summarizes a concise approach for the emergency physician to minimize risk...
August 27, 2018: Journal of Emergency Medicine
Ali Pourmand, Gregory Jasani, Courtney Shay, Maryann Mazer-Amirshahi
PURPOSE OF REVIEW: The purpose of the study is to evaluate and analyze the role of both opioid and non-opioid analgesics in the emergency department (ED). RECENT FINDINGS: Studies have shown that the implementation of opioid-prescribing policies in the ED has the potential to reduce the opioid addiction burden. Clinical studies point to inconsistencies in providers' approach to pain treatment. In this review, we discuss specific aspects of opioid utilization and explore alternative non-opioid approaches to pain management...
August 27, 2018: Current Pain and Headache Reports
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