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Acute pain management emergency department

Baseer Sultan Ahmad, Adeel Ahmad, Sajjad Jamil, Saiyed Abdullah Abubakar Mohsin Ehsanullah, Abeera Munir
Hepatitis E virus is the etiological agent for Hepatitis E infection, which is congruent to Hepatitis A infection. The clinical spectrum of the disease range from asymptomatic self-limiting disease which requires no treatment to life threatening fulminant liver disease in pregnancy, G6PD deficient and post-liver transplant patients, which necessitate urgent treatment. Similarly we are reporting a case of a 28 year old male with no previous known comorbids, who presented in emergency department with low grade fever, yellow discolouration of eyes and upper abdominal pain for last 5-6 days...
September 2018: JPMA. the Journal of the Pakistan Medical Association
Caleb Tsetse, Shazia Rahat Chaudhry, Feraas Jabi, Jennifer Nicole Taylor
Acute diverticulitis is a painful condition of the gastrointestinal tract that results from sudden inflammation of one or more diverticula in the bowel wall. Right-sided acute diverticulitis, such as cecal diverticulitis, is uncommon diagnosis that can be easily misdiagnosed as acute appendicitis as it shares similar clinical presentation. An unusual complication of right-sided acute diverticulitis such as perforated cecal diverticulitis has different management from acute appendicitis. Thus, definitive diagnosis of this clinical condition with imaging is crucial to optimal management...
January 2019: Radiology Case Reports
Veit Phillip, Rickmer Braren, Nikolaus Lukas, Roland M Schmid, Fabian Geisler
The formation of pancreatic pseudocysts and (pseudo-)aneurysms of intestinal vessels are rare but life-threatening complications in acute and chronic pancreatitis. Here we report the rare case of a patient suffering from chronic pancreatitis with an arterial pseudoaneurysm within a pancreatic pseudocyst and present its successful therapeutic management by angioembolization to prevent critical bleeding. A 67-year-old male with a history of chronic pancreatitis presented with severe acute abdominal pain and vomiting to the emergency department...
May 2018: Case Reports in 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
Lu-Lu Gao, Li-Shan Yang, Jun-Jun Zhang, Yi-Ling Wang, Ke Feng, Lei Ma, Yuan-Yuan Yu, Qiang Li, Qing-Huan Wang, Jin-Tao Bao, Ya-Liang Dai, Qiang Liu, Yu-Xiang Li, Qiang-Jian Yu
BACKGROUND: Acute pain is always the most common complaint in Emergency Department admissions and options for analgesia are limited. Nitrous oxide/oxygen possess many properties showing it may be an ideal analgesic method for the Emergency Department; it is quick-acting, well-tolerated, and does not mask signs and symptoms. The aim of this study is to evaluate the safety and analgesic effect of the fixed nitrous oxide/oxygen mixture for trauma patients in a busy emergency environment...
September 29, 2018: Trials
Fareeda Sohrabi, Francesco DiMaggio, Ala Alasadi, Dipankar Mukherjee
Acute massive gastric dilatation (AMGD) is a recognised complication after Nissen fundoplication.1 A 63-year-old man recently presented to our emergency department in acute respiratory distress, acute abdominal pain and distension, having had an elective umbilical port incisional hernia repair a day prior. In the year preceding his presentation, the patient had undergone a laparoscopic paraoesophageal hiatus hernia repair and excision of sac, posterior cruropexy, dual mesh reinforcement of repair and 360° fundoplication, as a day case...
September 27, 2018: BMJ Case Reports
Sophie Lanzkron, Jane Little, Joshua Field, Joseph Ryan Shows, Hang Wang, Rebecca Seufert, Jasmine Brooks, Ravi Varadhan, Carlton Haywood, Mustapha Saheed, Chiung Yu Huang, Brandi Griffin, Steven Frymark, Allie Piehet, Derek Robertson, Marc Proudford, Adrienne Kincaid, Charles Green, Lorri Burgess, Marcus Wallace, Jodi Segal
The ESCAPED (Examining Sickle Cell Acute Pain in the Emergency vs Day Hospital) trial is an ongoing prospective study comparing outcomes of people with sickle cell disease (SCD) seeking care for acute pain management in either an emergency department or specialty infusion clinic. The objective of this paper is to describe the baseline characteristics and health care utilization of patients in the trial. This is a multicenter study across 4 US cities that enrolled all adults with SCD living within 60 miles (96...
September 25, 2018: Blood Advances
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
Shiu-Lin Tsai, Elena Reynoso, Da Wi Shin, James W Tsung
OBJECTIVES: With epidemic opioid deaths and abuse in the United States, government agencies recommend nonpharmacological treatments for pain. However nonopioid treatment options for moderate to severe pain in the pediatric emergency department (PED) are limited. Acupuncture has been shown to be effective for pain. The objective of this study was to evaluate the feasibility of using traditional acupuncture (TA) and battlefield acupuncture (BFA) in the treatment of pain in the PED. METHODS: A pediatric cohort treated with acupuncture for pain in an urban PED was assessed...
September 21, 2018: Pediatric Emergency Care
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
Christopher R Carpenter, Lawrence Lewis, Randall S Jotte, Evan S Schwarz
Opioid misuse is reducing Americans' life expectancy, thereby catalyzing professional societies and legislators to action. Efforts to combat the opioid epidemic must work hand-in-hand with appropriate efforts to reduce the severity and duration of suffering. Pharmacologic analgesia is temporizing. Current opioid prescribing guidelines focus on reducing the frequency and quantity of narcotics prescribed, but lack attention to alleviation of the source of pain. Conditions eliciting acute pain sometimes require additional specialist management following discharge from the emergency department...
May 2018: Missouri Medicine
Alicia Guntiñas, Janette L Kirk, M Teresa Blanco, Javier Pérez-Pedregosa, Miguel A Rodríguez
The incidence of systemic infection attributed to group A streptococci (GAS) is increasing, mainly in postpartum women. Such infections require multidisciplinary management and prompt treatment, but an atypical presentation can delay diagnosis. We report the case of a 24-year-old woman admitted to the emergency department for evaluation. She had acute abdominal pain and fever 18 h after insertion of a levonorgestrel intrauterine device (IUD). She had a normal vaginal delivery 45 days earlier, and no other significant medical background...
October 2018: Case Reports in Women's Health
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
Vivien Min Er Lee, Lai Lai Ang, Derek Tuck Loong Soon, Jonathan Jia Yuan Ong, Victor Weng Keong Loh
Headaches are common in primary care. For safe assessment and management of the patient with headache, a focused history and physical examination are important to identify secondary headache, and find out whether an immediate referral to the emergency department or a non-emergent referral to the neurologist is warranted. The majority of patients with primary headache may be safely managed in the outpatient setting. Key steps include proper categorisation of the primary headache, attention to lifestyle and psychosocial factors, prescription of analgesics for acute pain relief, and the use of preventive medication when indicated...
August 2018: Singapore Medical Journal
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
Maria Francesca Secchi, Carlo Torre, Giovanni Dui, Francesco Virdis, Mauro Podda
Colonoscopic perforation is a serious and potentially life-threatening complication of colonoscopy. Its incidence varies in frequency from 0.016% to 0.21% for diagnostic procedures, but may be seen in up to 5% of therapeutic colonoscopies. In case of extraperitoneal perforation, atypical signs and symptoms may develop. The aim of this report is to raise the awareness on the likelihood of rare clinical features of colonoscopic perforation. A 72-year-old male patient with a past medical history of myocardial infarction presented to the emergency department four hours after a screening colonoscopy with polypectomy, complaining of neck pain, retrosternal oppressive chest pain, dyspnea, and rhinolalia...
2018: Case Reports in Surgery
Beau M Bailey, Kenneth S Ramos, Alice Johnson, Charlene Mitchell
Systemic lupus erythematosus (SLE) is an autoimmune disease known to affect a variety of organ systems. Patients with SLE are more prone to developing common infections that can mimic the complications of SLE. As such, it is essential to differentiate complications of SLE from infection to ensure appropriate management and to improve morbidity and mortality of this patient population. Here we present a 24-year-old, Hispanic male, with SLE complicated by dialysis-dependent end-stage renal disease and dilated cardiomyopathy...
September 2018: Journal of Clinical Medicine Research
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