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Emergency department pain

Jonathan D Shenkin, John Warren, Charles Spanbauer, Elaye Okunseri, Aniko Szabo, Christopher Okunseri
Objective: This study examined the prevalence of ambulance use for nontraumatic tooth pain (NTP) visit to emergency departments (EDs) and the factors associated with ambulance use for NTP in the USA. Materials and methods: Data from the National Hospital Ambulatory Medical Care survey conducted in the USA from 2003 to 2012 were analyzed. Descriptive statistics were obtained, and multivariable logistic regression was used to determine associations with ambulance use for NTP...
2018: Clinical, Cosmetic and Investigational Dentistry
Atakan Yilmaz, Ramazan Sabirli, Mert Ozen, Ibrahim Turkcuer, Bulent Erdur, Cuneyt Arikan, Ezgi Demirozogul, Ahmet Sarohan, Murat Seyit, Nusret Ok
INTRODUCTION: Musculoskeletal system traumas are among the most common presentations in the emergency departments. In the treatment of traumatic musculoskeletal pain, paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are frequently used. Our aim in this study is to compare the efficacy of intravenous dexketoprofen and paracetamol in the treatment of traumatic musculoskeletal pain. METHODS: This prospective, randomised, double blind, controlled study was conducted in a tertiary care emergency unit...
August 8, 2018: American Journal of Emergency Medicine
David P Evans, Jordan Tozer, Michael Joyce, Michael J Vitto
OBJECTIVES: We sought to determine whether US-guided lumbar puncture reduced the rate of lumbar puncture failures for providers at an academic teaching hospital with variable lumbar puncture and US experience compared to the traditional landmark-based technique. METHODS: We conducted a prospective randomized controlled trial to compare US-guided lumbar puncture to the traditional landmark technique in an academic emergency department. Thirty-five patients were randomized to either have their lumbar puncture performed either via the landmark or US-guided technique...
August 12, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Lexandra Schick, Brian Driver, Johanna C Moore, Erik Fagerstrom, James R Miner
OBJECTIVES: To determine if there is a difference in procedural amnesia and adverse respiratory events (ARE) between the target sedation levels of moderate (MS) and deep (DS) procedural sedation. METHODS: This was a prospective, randomized clinical trial of consenting adult patients planning to undergo deep procedural sedation with propofol between March 5th , 2015 and May 24th , 2017. Patients were randomized to a target sedation level of moderate or deep sedation using the American Society of Anesthesiologist's definitions...
August 11, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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
Laurie Malia, Jesse J Sturm, Sharon R Smith, R Timothy Brown, Brendan Campbell, Henry Chicaiza
Ultrasound (US) and laboratory testing are initial diagnostic tests for acute appendicitis. A diagnostic dilemma develops when the appendix is not visualized on US. OBJECTIVE: To determine if specific US findings and/or laboratory results predict acute appendicitis when the appendix is not visualized. METHODS: A prospective study was conducted on children (birth-18 yrs) presenting to the pediatric emergency department with suspected acute appendicitis who underwent right lower quadrant US...
August 7, 2018: American Journal of Emergency Medicine
Karen Sue Hoyt, Elda Ramirez, Robert Topp, Stephen Nichols, Donna Agan
BACKGROUND AND PURPOSE: This retrospective study compared nurse practitioners and physician assistants (NPs/PAs) with physicians on their assignment of Emergency Severity Index level 3 (ESI level 3) acute abdominal pain (AAP) in the emergency department (ED). METHODS: Data obtained from a large ED group staffing four hospitals yielded 12,440 de-identified, adult patients diagnosed on ED admission with AAP ESI level 3 for descriptive analysis with logistic regression...
August 6, 2018: Journal of the American Association of Nurse Practitioners
Chiara Ossella, Floriana DellʼOmo, Elena Zanetti, Isabella Ferdinanda Pestalozza, Pierluigi Galizia, Salvatore Tripodi
BACKGROUND: Belly dancer syndrome is a rare condition consisting of involuntary, repetitive, often rhythmic contractions of the diaphragm, causing undulating movements of the abdomen that recall those of a belly dancer. It is frequently associated with pain or discomfort in the upper abdomen or lower chest, but clinical symptoms are highly variable often resulting in late diagnosis. Very few pediatric cases have been reported, all of which were secondary to other conditions, and to our knowledge, no idiopathic cases of Belly Dancer Syndrome have been reported in children...
August 8, 2018: Pediatric Emergency Care
Petiot Alice, Vassiliki Pasoglou
A 33-year-old man with a history of a Malone Antegrade Continence Enema Procedure presented to the Emergency Department with right lower abdominal pain. Computed Tomography (CT) of the abdomen revealed an appendicitis of the appendicostomy with an associated appendicolith.
July 5, 2018: Journal of the Belgian Society of Radiology
Erik Carvalho, Janet P Bettger, Lynn Bowlby, Marissa Carvalho, Daniel Dore, Misty W Corcoran, Ashley A Harris, Jennifer Bond, Adam P Goode
INTRODUCTION: Annually, >50% of the US population reports musculoskeletal (MSK) pain to a provider, with direct healthcare costs exceeding $185 billion. The number of MSK complaints and the associated costs are projected to rise, increasing demand for and burden on providers. Establishing new care models to decrease inefficiencies may lower costs and optimise care delivery. The purpose of the Integration of Musculoskeletal Physical Therapy Care in the Patient-Centred Medical Home (IMPaC) study is to compare initial evaluation by a physical therapist (PT) integrated into primary care versus initial evaluation by a primary care provider (PCP) for patients with an MSK complaint...
August 8, 2018: BMJ Open
Russell Stanley, Anjana Nair, Francisco Fiallo
Heterotopic pregnancy is a simultaneous intrauterine and ectopic pregnancy. We report a case of a spontaneous ovarian heterotopic pregnancy. A 36-year-old woman, gravida 7 para 4-1-1-5 at 4 weeks gestation (spontaneous conception), presented to the emergency department with vaginal spotting, lower abdominal cramps with human chorionic gonadotropin(hCG) 10 772 mIU/mL (hCG at T0). Abdominal and pelvic examinations were benign. Transvaginal sonogram (TVS) showed an intrauterine gestational sac and yolk sac, no fetal pole visualised...
August 9, 2018: BMJ Case Reports
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
Manu Kaushik, Sunu Philip, Ramachandra Kolachalam
No abstract text is available yet for this article.
August 8, 2018: JAMA Surgery
Ali Zakaria, Bayan Al Share, Georgy Kaspar, Delano Small
Acute coronary syndrome (ACS) is a term used to describe a spectrum of diseases associated with sudden reduced blood flow to the heart. Coronary artery thromboembolism is recognized as an important nonatherosclerotic cause of acute myocardial infarctions in 2.9% of ACS cases, with a long-term outcome indicating that coronary embolism patients represent a high-risk subpopulation. There are various risk factors for developing a coronary thromboembolism, with atrial fibrillation being the most frequently reported cause...
March 2018: Journal of Family Medicine and Primary Care
Betina Franco, Lurdes Busin, Tânia Couto Machado Chianca, Vítor Monteiro Moraes, Ananda Ughini Bertoldo Pires, Amália de Fátima Lucena
OBJECTIVE: To analyze the association between Manchester Triage System flowchart discriminators and nursing diagnoses in adult patients classified as clinical priority I (emergency) and II (very urgent). METHOD: Cross-sectional study conducted in an emergency department in southern Brazil between April and August 2014. The sample included 219 patients. Data were collected from online patient medical records and data analysis was performed using Fisher's exact test or the chi-square test...
August 2, 2018: Revista Gaúcha de Enfermagem
Francesco Saverio Biagiarelli, Simone Piga, Antonino Reale, Pasquale Parisi, Marta Luisa Ciofi Degli Atti, Angelo Gabriele Aulisa, Paolo Schingo, Chiara Ossella, Maria Pia Villa, Umberto Raucci
OBJECTIVE: We aimed to describe characteristics, etiology and health care use in children with low back pain (LBP) presenting to pediatric emergency department (ED) and to develop an algorithm to design a diagnostic approach. METHODS: We conducted a 7-year cohort study of children admitted to ED with a primary complaint of LBP. They were classified into diagnostic groups: visceral LBP; traumatic LBP; non-visceral/non-traumatic LBP. To identify high-risk factors (red flags) associated with severe prognosis conditions (SPCs), we analyzed the non-visceral/non-traumatic group comparing the SPC children with those children without SPCs...
July 21, 2018: American Journal of Emergency Medicine
Paul I Musey, Roma Patel, Colin Fry, Guadalupe Jimenez, Rachael Koene, Jeffrey A Kline
Anxiety contributes to the chest pain symptom complex in 30% to 40% of patients with low-risk chest pain seen in the emergency department (ED). The validated Hospital Anxiety Depression Scale-Anxiety subscale (HADS-A) has been used as an anxiety screening tool in this population. The objective was to determine the prevalence of abnormal HADS-A scores in a cohort of low-risk chest pain patients and test the association of HADS-A score with subsequent healthcare utilization and symptom recurrence. In a single-center, prospective, observational cohort study of adult ED subjects with low-risk chest pain, the HADS-A was used to stratify participants into 2 groups: low anxiety (score <8) and high anxiety (score ≥8)...
July 5, 2018: American Journal of Cardiology
Karleen F Giannitrapani, R Thomas Day, Azin Azarfar, Sangeeta C Ahluwalia, Steven Dobscha, Karl A Lorenz
Objectives: We aimed to understand providers' experiences and preferences regarding several brief pain screening measures. Methods: We collected two waves of data for this analysis. Wave one: We conducted nine focus groups with multidisciplinary Department of Veterans Affairs (VA) providers. Wave two: To understand an emergent theme in wave one, we conducted 15 telephone interviews with prescribing providers where we used a semistructured guide comparing screening measures currently used in VA practices...
July 30, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Noopur Tripathi, Roopa Kanakatti Shankar, Aline Baghdassarian
Rickets due to vitamin D deficiency, typically presenting as bowed legs in toddlers, is uncommon in the modern era. We describe the case of a nine-year-old girl with autism and developmental delay who was evaluated for chronic intermittent extremity pain for more than one year prior to referral to the emergency department for hypocalcemia and increased alkaline phosphatase, which eventually led to the diagnosis of rickets confirmed by radiographic and laboratory findings. This report highlights the importance of the patient's history of developmental delay and autism in the evaluation and approach to limb pain, and discusses the appropriate diagnostic approach...
August 2018: Clinical practice and cases in emergency medicine
Kyle E Nielsen, Sarah A Medeck, Dan B Brillhart, Kasey J Mayclin
A 49-year-old female six days post-endometrial biopsy presented to the emergency department with constant severe suprapubic abdominal pain, fevers and myalgia. A contrasted computed tomography noted an intrauterine fluid collection and a final diagnosis of pyometra was made in the operating room following total hysterectomy. Pyometra is an exceptionally rare clinical condition with significant mortality.
August 2018: Clinical practice and cases in emergency medicine
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