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Acute pain management emergency department

E Castagno, A F Urbino, R L Mancusi, F Benini
Pain is a major cause of admissions to pediatric emergency departments, but is often inappropriately managed (1). The findings of the Pain Practice in Italian Pediatric Emergency Departments on the appropriate use of paracetamol and ibuprofen have previously been reported (1,2). This multicentre, retrospective study evaluated the prescription of opioids given to patients up to the age of 14 with acute non-procedural pain by 18 Italian emergency departments between October 2014 and January 2015. This article is protected by copyright...
December 8, 2018: Acta Paediatrica
Kwame Ofori Affram, Tanya Luke Reddy, Kofi M Osei
BACKGROUND Thyrotoxic periodic paralysis (TPP) is a rare cause of acute paralysis, which if not promptly recognized and treated, can lead to significant morbidity and mortality. TPP can be precipitated by several factors, including a high carbohydrate diet and exercise. This report is of a rare case of TPP after epidural steroid injection in a young man, with a review of the literature of previous cases. CASE REPORT A 36-year-old Asian man presented to the emergency department with sudden onset of paralysis of all his limbs following epidural steroid injection for traumatic low back pain...
December 8, 2018: American Journal of Case Reports
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
Ibrahim S Tuna, Bedirhan Tarhan, Mauricio Escobar, Mehmet S Albayram
Differentiation of bone infarct from osteomyelitis is one of the most challenging issues in the evaluation of acute bone pain in sickle cell patients. The imaging modalities that are currently being used for assessment of bone marrow in this population have several limitations. We present a case of an 18-year-old male with a history of sickle cell disease, who was transferred to our emergency department with progressively severe headache and jaw pain for one-week. Initial evaluation was concerning for osteomyelitis and epidural abscess formation...
November 15, 2018: Clinical Imaging
(no author information available yet)
Although compartment syndrome can occur in any compartment in the body, it rarely occurs in the paraspinal musculature and has therefore only been reported in a few case reports. Despite its rare occurrence, acute paraspinal compartment syndrome has been shown to occur secondary to reperfusion injury and traumatic and atraumatic causes. Diagnosis can be based on clinical examination findings, MRI or CT studies, or through direct measurement of intramuscular pressures. Conservative management should only be used in the setting of chronic presentation...
October 1, 2018: Journal of Neurosurgery. Spine
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
David J Keene, Michael M Schl├╝ssel, 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
Emily Chan, Alaa El-Banna
INTRODUCTION: Epiploic appendagitis is a rare cause of acute abdominal pain. It's presentation often mimics other causes of acute abdominal pain. It is important for clinicians to be aware of an epiploic appendagitis since a delay in diagnosis can lead to unnecessary hospital stay, antibiotic usage and surgical intervention [1-4]). We present a case of epiploic appendagitis mimicking acute cholecystitis in a rural community hospital. CASE REPORT: A 54 Caucasian male self-presents to the emergency department on a Saturday with severe right upper quadrant pain...
November 13, 2018: International Journal of Surgery Case Reports
Titika-Marina Strati, Konstantinos Sapalidis, Georgios D Koimtzis, Efstathios Pavlidis, Stefanos Atmatzidis, Lazaros Liavas, Ioannis Chrysogonidis, Georgios Samoilis, Katerina Zarampouka, Kyriaki Michailidou, Isaac I Kesisoglou, Christoforos Kosmidis
BACKGROUND Although diverticular disease is well described and treated in daily clinical practice, there are cases that attract great interest because of their complexity and difficulty in management. Herein, we describe a rare case of colo-colonic fistula-complicated diverticulitis that necessitated urgent surgical intervention. CASE REPORT A 76-year-old female patient with a known history of diverticular disease of the sigmoid colon presented in the Emergency Department for evaluation of left lower quadrant abdominal pain...
November 22, 2018: American Journal of Case Reports
Elena Boccuzzi, Valentina A Ferro, Bianca Cinicola, Paolo M Schingo, Luisa Strocchio, Umberto Raucci
Leukemia is the most common childhood malignancy, and it is often characterized by pallor, fatigue, cytopenia, and organomegaly; sometimes musculoskeletal symptoms, mainly characterized by diffuse bone pain in the lower extremities, are the onset clinical characteristics of the disease. In these cases, the disease may initially be misdiagnosed as reactive arthritis, osteomyelitis, or juvenile idiopathic arthritis delaying appropriate diagnosis and management. Even if leukopenia, thrombocytopenia, and a history of nighttime pain are reported to be the most important predictive factors for a pediatric leukemia, blood examinations can sometimes be subtle or within normal limits, and this represents a further diagnostic difficulty...
November 19, 2018: Pediatric Emergency Care
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
Roger Dodo, Alban Zohoun, Tatiana Baglo, Josiane Mehou, Ludovic Anani
Introduction: Evolution of sickle cell disease is marked by the occurrence of acute complications, some of which are real emergencies that can give rise to life-threatening or functional cosequences. This study aims to evaluate the frequency and the evolution of emergency treatment of sickle cell disease in the Blood Diseases Department at the Koutoukou Maga National Teaching Hospital, Cotonou. Methods: We conducted a retrospective and descriptive study of all patients hospitalized for emergency treatment of sickle cell disease from January 2014 to December 2015...
2018: Pan African Medical Journal
Jacques Eastment, Matthew Burstow
Introduction Parastomal herniation commonly occurs following formation of an end-colostomy or ileostomy. Those patients presenting with acute complications of parastomal hernias typically undergo surgical repair. Stomach-containing parastomal hernias are rare. Presentation of case A 92-year-old lady presented to the emergency department with vomiting and abdominal pain. She had undergone a total colectomy with end-ileostomy many years earlier. A computed tomography scan of her abdomen diagnosed gastric outlet obstruction secondary to parastomal stomach herniation...
November 11, 2018: International Journal of Surgery Case Reports
Mari A Griffioen, Melissa L Ziegler, Robert V O'Toole, Susan G Dorsey, Cynthia L Renn
BACKGROUND: Effective acute pain management following injury is critical to improve short-and long-term patient outcomes. Analgesics can effectively reduce pain intensity, yet half of injury patients report moderate to severe pain during hospitalization. PURPOSE: The primary aim of this study was to identify the analgesic, different analgesic combinations, or analgesic and adjuvant analgesic combination that generated the largest percent change from pre- to post-analgesic pain score...
November 12, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Brandon R Allen, Grant G Simpson, Ideen Zeinali, Jared T Freitas, Jeffrey J Chapa, Liam J Rawson, Julie A Richter, Thomas F Payton, Joseph Adrian Tyndall
Chest pain can be a challenging complaint to manage in the emergency department. A missed diagnosis can result in significant morbidity or mortality, whereas avoidable testing and hospitalizations can lead to increased health care costs, contribute to hospital crowding, and increase risks to patients. The HEART score is a validated decision aid to identify patients at low risk for acute coronary syndrome who can be safely discharged without admission or objective cardiac testing. In the largest and one of the longest studies to date (N = 31,060; 30 months), we included the HEART score into a larger, newly developed low-risk chest pain decision pathway, using a retrospective observational pre/post study design with the objective of safely lowering admissions...
December 2018: Critical Pathways in Cardiology
Keith M Porter, Anthony D Dayan, Sara Dickerson, Paul M Middleton
Methoxyflurane is an inhaled analgesic administered via a disposable inhaler which has been used in Australia for over 40 years for the management of pain associated with trauma and for medical procedures in children and adults. Now available in 16 countries worldwide, it is licensed in Europe for moderate to severe pain associated with trauma in conscious adults, although additional applications are being made to widen the range of approved indications. Considering these ongoing developments, we reviewed the available evidence on clinical usage and safety of inhaled analgesic methoxyflurane in trauma pain and in medical procedures in both adults and children...
2018: Open Access Emergency Medicine: OAEM
M Rockett, S Creanor, R Squire, A Barton, J Benger, L Cocking, P Ewings, V Eyre, J E Smith
The effect of patient-controlled analgesia during the emergency phase of care on the prevalence of persistent pain is unkown. We studied individuals with traumatic injuries or abdominal pain 6 months after hospital admission via the emergency department using an opportunistic observational study design. This was conducted using postal questionnaires that were sent to participants recruited to the multi-centre pain solutions in the emergency setting study. Patients with prior chronic pain states or opioid use were not studied...
October 27, 2018: Anaesthesia
Kusay Ayoub, Nihad Mahli, M Fateh Dabbagh, Bashar Banjah, Bassel Banjah
Introduction: Although relatively rare, an obturator hernia is a significant cause of intestinal obstruction. It usually occurs in emaciated elderly females. Computed tomography is the imaging modality of choice to diagnose obturator hernias. Case report: In this report we present a case of an elderly female who presented to the emergency department with features suggesting bowel obstruction. The patient was admitted to the hospital and was initially managed conservatively...
December 2018: Annals of Medicine and Surgery
Getaw Worku Hassen, Amaninder Dhaliwal, Catherine Ann Jenninigs, Hossein Kalantari
Background: Acute liver failure can result from acetaminophen overdose, viral infection, toxins, and other disease conditions. Liver transplant is available in limited fashion and the criteria are strict as to who should get an available liver. N- Acetyl Cysteine (NAC) has been used in non-acetaminophen induced liver failure with success. Here we report a case of acute liver failure from cocaethylene that was reversed with NAC along with other medical therapy. Case Presentation: A 50-year-old female patient presented to the Emergency Department (ED) with a two-day history of coffee ground vomiting and hematemesis...
2018: Case Reports in Emergency Medicine
Erdal Tekin, Ali Ahiskalioglu, Muhammed Enes Aydin, Emre Sengun, Atif Bayramoglu, Haci Ahmet Alici
Herpes zoster is a painful, eruptive, viral condition occurring with reactivation in immunosuppressed individuals. The selection of an effective analgesic method in the acute phase of herpes zoster can decrease the incidence of postherpetic neuralgia by reducing neural sensitization. The erector spinae plane block has been reported to provide diffuse and effective analgesia in the cervical, thoracic, and lumbar regions. We report an effective decrease in pain with the application of the high-thoracic erector spinae plane block in the emergency department in a patient with herpes zoster pain in the cervicothoracic and shoulder region...
October 16, 2018: American Journal of Emergency Medicine
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