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Acute pain management emergency department

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
Sujen Jayakody, Danette Bianca Wright, Corrina Chiong, Mona Liu, Clare Bouffler, Toufic El-Khoury
BACKGROUND: Paclitaxel is a chemotherapy drug commonly used in the management of ovarian cancer. Colonic perforation is an extremely rare complication of paclitaxel administration with few case reports in the medical literature. We report a case of a patient with advanced ovarian cancer who had a rectal perforation following administration of paclitaxel. There has only been one other case report of rectal perforation in the medical literature following paclitaxel therapy. CASE PRESENTATION: A 55-year-old Caucasian woman with advanced ovarian cancer awaiting elective debulking surgery for her tumor presented to our emergency department with abdominal pain, vomiting, and diarrhea...
August 16, 2018: Journal of Medical Case Reports
Syunsuke Yamanaka, Erik D Skarsgard, Ran D Goldman
Question A 10-year-old girl who was seen in my office last week with acute-onset abdominal pain and fever was referred to an emergency department, was diagnosed with appendicitis, and was treated conservatively with antibiotics, without surgery. Has the paradigm for treating appendicitis changed, and which is the preferred treatment of appendicitis in children: antibiotics or appendectomy? Answer For more than 100 years, surgical management was the principal treatment of acute appendicitis. Potential adverse events associated with appendectomy include bleeding, surgical site infection, and ileus, as well as stress for children and their parents...
August 2018: Canadian Family Physician Médecin de Famille Canadien
Xufeng Peng, Wenqiang Luo, Xinru Zhang, Weidong Zhu
Background: Acute abdominal pain is a common complaint of patients presenting at the emergency department (ED). It can be caused by a broad spectrum of diseases. Providing care for patients with acute abdominal pain requires familiarity with the epidemiology, prevalence, and presentation of abdominal pathology, as well as a working knowledge of the differential diagnoses. Case report: In this article, we discuss a case of spontaneous rupture of adrenal hemangioma with large retroperitoneal hemorrhage in a 31-year-old female...
2018: Journal of Pain Research
Renée Dagenais, Peter J Zed
Intranasal lidocaine has been studied and recommended as an alternative in the management of acute headache. The objective of this systematic review was to evaluate the efficacy and safety of intranasal lidocaine in the acute management of primary headaches. The MEDLINE (1946 to May 2018), EMBASE (1974 to May 2018), Cochrane Central Register of Controlled Trials (2008 to May 2018), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to May 2018), and ClincialTrials. gov online databases were searched...
August 11, 2018: Pharmacotherapy
Leo Kyi, Rangi Kandane-Rathnayake, Eric Morand, Lynden J Roberts
BACKGROUND: Hospital admissions for patients with back pain are increasing. Despite their significant contribution to the health-care burden they remain largely unstudied. AIM: To investigate the management and clinical outcomes of patients with acute back pain admitted to hospital under general medicine units when compared to a rheumatology unit. METHODS: A 36-month retrospective, observational study on patients presenting to the Emergency Department with back pain who were subsequently admitted to 1 of 3 General Medicine Units (GM) or a Rheumatology Unit (RU)...
August 8, 2018: Internal Medicine Journal
Alex C Essenmacher, Emma Nash, Sarah K Walker, Graeme J Pitcher, Christopher T Buresh, T Shawn Sato
Abdominal pain is a frequent problem encountered in the emergency department, and acute appendicitis is a well-recognized diagnosis. Laparoscopic appendectomy has become one of the most common surgical procedures in the United States. Patients with a history of appendectomy may experience recurrent right lower quadrant abdominal pain from an infrequently encountered complication that may occur when the residual appendix becomes obstructed and inflamed. We describe two cases of stump appendicitis in pediatric patients with a review of clinical and imaging findings and surgical management...
August 2018: Clinical practice and cases in emergency medicine
Chi-Wei Chen, Yen-Hung Wu, Shun-Ching Chien, Jhong-Ching Lin
RATIONALE: Paraquat, an agent highly toxic to humans and animals, is a widely used herbicide and also commonly used for suicide attempts in Taiwan. The most common route of intoxication is oral ingestion, and parenteral poisoning is respectively rare. PATIENT CONCERNS: A 39-year-old illicit abuser of heroin and amphetamine injected 0.5 mL of 24% paraquat directly into his right cephalic vein due to hallucination. The patient was brought to our emergency department for management 4 hours after injection...
July 2018: Medicine (Baltimore)
Bobby Daly, Kevin Nicholas, Dmitriy Gorenshteyn, Stefania Sokolowski, Lior Gazit, Lynn Adams, Jennie Matays, Lauren L Katzen, Yeneat O Chiu, Han Xiao, Rori Salvaggio, Abigail Baldwin-Medsker, Kimberly Chow, Judith Nelson, Mikel Ross, Kenneth K Ng, Alice Zervoudakis, Wendy Perchick, Diane L Reidy, Brett A Simon, Isaac Wagner
PURPOSE: The Centers for Medicare & Medicaid Services (CMS) identifies suboptimal management of treatment toxicities as a care gap and proposes the measurement of hospital performance on the basis of emergency department visits for 10 common symptoms. Current management strategies do not address symptom co-occurrence. METHODS: We evaluated symptom co-occurrence in three patient cohorts that presented to a cancer hospital urgent care center in 2016. We examined both the CMS-identified symptoms and an expanded clinician-identified set defined as symptoms that could be safely managed in the outpatient setting if identified early and managed proactively...
July 17, 2018: Journal of Oncology Practice
Nneka S Udechukwu, Ryan S D'Souza, Abdullateef Abdulkareem, Oluwaseun Shogbesan
Omental infarction is a rare cause of acute abdominal pain. Without the support of radiological evidence, diagnosis is difficult to attain owing to its infrequent incidence, low awareness among clinicians, and its nonspecific presentation that mimics other causes of acute abdomen, namely, acute appendicitis and cholecystitis. Incorrect diagnosis may lead to unnecessary invasive surgery in patients with omental infarction, a disorder that is typically managed conservatively without exposing the patient to intraoperative risks and postoperative morbidity...
June 2018: Radiology Case Reports
María Cecilia Yubini, Caterina Contreras, Gonzalo Díaz, María Alejandra Cerda, Dannette Guíñez, Nicole Rogers, Francisco Silva, Rodrigo Cornejo
Few cases of bacteremic pneumonia by Neisseria meningitidis (NM) have been described worldwide; mostly in elderly patients or those with comorbidities. They appear clinically indistinguishable from other acute infectious pneumoniae, that do not develope the syndrome of meningococcemia. We report a 17-years-old male, without prior medical history, consulting in the emergency department with a 7-day history of productive cough, right pleural pain, fever and dyspnea. He was admitted to the ICU due to septic shock and respiratory distress...
February 2018: Revista Médica de Chile
Guglielmo Niccolò Piozzi, Elisa Reitano, Valerio Panizzo, Barbara Rubino, Davide Bona, Domenico Tringali, Giancarlo Micheletto
BACKGROUND Bleeding is a major intraoperative complication during surgical procedures. When conventional methods such as ligature and diathermocoagulation are ineffective for bleeding management, hemostatic agents should be used. Oxidized cellulose is one of the major hemostatic agents used worldwide. Oxidized cellulose is often left in situ after hemostasis because of its high level of reabsorption that lasts up to 8 weeks. However, 38 cases of retaining-associated complications are reported in the literature...
July 11, 2018: American Journal of Case Reports
Marissa Nichole Lassere, Kent Robert Johnson, Jeanette Thom, Grant Pickard, Peter Smerdely
INTRODUCTION: Acute sciatica (symptom duration less than 4 weeks), a major cause of pain and disability, is a common presentation to medical practices and hospital emergency departments. Selective CT fluoroscopy transforaminal epidural steroid injection is often used with the hope of reducing pain and improving function. Recently, there has been interest in using systemic corticosteroids in acute sciatica. However, there is limited evidence to inform management of selective CT fluoroscopy transforaminal epidural steroid in subacute and chronic sciatica and there is no evidence in acute sciatica, even though the practice is widespread...
July 5, 2018: BMJ Open
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)
Eoghan P Burke, Patricia Harkins, Ilona Arih, Gerry O'Donoghue
We report a case of a 30-year-old lady who presented to the emergency department with a 1 day history of severe epigastric pain which radiated to the back. Focused history, physical exam findings, haematological and radiological investigations, including ultrasound scanning of the abdomen, supported the diagnosis of acute gallstone pancreatitis. She was managed conservatively and underwent elective laparoscopic cholecystectomy at a later date. Intraoperatively, there was noted to be a small nodule loosely adherent to the gallbladder serosa...
June 2018: Journal of Surgical Case Reports
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
Dimitri Poddighe, Ilaria Brambilla, Amelia Licari, Gian Luigi Marseglia
BACKGROUND: Acute pain is one of the major complaints reported in pediatric emergency departments and general wards. Recently, both the US Food and Drug Administration and European Medicine Agency emitted some warnings regarding the use of opioids, including codeine, in children. OBJECTIVE: The aims of this study were summarizing the main pharmacological aspects of ibuprofen, discussing the current evidence about the use of ibuprofen in different and specific clinical settings, and providing a comparison with acetaminophen and/or codeine, according to available studies...
June 14, 2018: Pediatric Emergency Care
Maaret Castrèn, Veronica Lindström, Jenny Hagman Branzell, Leila Niemi-Murola
Objectives Pain is one of the most common reasons for patients to seek acute medical care. The management of pain is often inadequate both in the prehospital setting and in the emergency department. Our aim was to evaluate the attitudes towards pain management among prehospital personnel in two Scandinavian metropolitan areas. Methods A questionnaire with 36 items was distributed to prehospital personnel working in Helsinki, Finland (n=70) and to prehospital personnel working in Stockholm, Sweden (n=634). Each item was weighted on a five-level Likert scale...
July 1, 2015: Scandinavian Journal of Pain
Marc Gutenstein, John W Pickering, Martin Than
Clinical pathways are used to support the management of patients in emergency departments. An existing document-based clinical pathway was used as the foundation on which to design and build a digital clinical pathway for acute chest pain, with the aim of improving clinical calculations, clinician decision-making, documentation, and data collection. Established principles of decision support system design were used to build an application within the existing electronic health record, before testing with a multidisciplinary team of doctors using a think-aloud protocol...
June 1, 2018: Health Informatics Journal
Jesus Morales-Maza, Jorge Humberto Rodríguez-Quintero, Sonia Cortés-Vázquez, Luis Cruz-Benítez
Biliary cystic disease is a rare entity. Twenty-five per cent of cases are diagnosed during adulthood and only a few reports have described this condition during pregnancy, where it represents a therapeutic challenge for both obstetricians and surgeons with regard to the risks it entails for the patient and the fetus.Definitive management is surgical resection, as cysts may progress to malignancy if untreated. During pregnancy, resection is generally deferred to after delivery, especially in the context of suspected cholangitis...
June 13, 2018: BMJ Case Reports
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