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Pain and emergency

Brian E Lacy, Michael D Crowell, Carole Mathis, David Bauer, Leslie J Heinberg
BACKGROUND AND AIMS: Gastroparesis (GP) patients suffer from recurrent symptoms of nausea, vomiting, early satiety, and abdominal pain. The impact of GP on quality of life (QoL), health care utilization and daily activities is not well understood. MATERIALS AND METHODS: Part 1: 398 adult patients (≥18 y) with documented GP (symptoms >6 mo) were surveyed to assess QoL and pain using the Short Form 36 and McGill pain questionnaires. Part 2: 491 adult GP patients were surveyed to evaluate employment status, work and daily activities, medication use, physician visits, diagnostic testing, emergency room visits, and hospitalizations related to their GP symptoms...
October 21, 2016: Journal of Clinical Gastroenterology
Jihyun Yoon, Hyeyoung Seo, In Hwan Oh, Seok Jun Yoon
In recognition of Korea's rising burden of non-communicable diseases (NCDs), we investigated the nation's NCD status and extracted detailed information from the 2012 Korean Burden of Disease study. Consistent with that study, we used disability-adjusted life year (DALY) as a metric. Using national data sources and disability weights specific to the Korean population, we analyzed 116 disaggregated NCDs from the study's four-level disease and injury hierarchy for both sexes and nine age groups. Per 100,000 population, 21,019 DALYs were lost to 116 NCDs...
November 2016: Journal of Korean Medical Science
Ranee Solomon, Karen Jurica
: Patients and practitioners rate the insertion of a nasogastric tube as one of the most painful and distressing procedures performed. Research supports using lidocaine and a nasal vasoconstrictor to significantly decrease patient discomfort. The recommended medications were not being used routinely in a large urban emergency department. METHODS: We identified departmental barriers using a nurse survey and physician interviews. We educated the nursing and physician staff about the comfort medications for nasogastric tube insertion recommended in the literature...
October 20, 2016: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Maddibande Ramachar Sreevathsa, Khyati Melanta
INTRODUCTION: The most common cause of gas under diaphragm is hollow viscous perforation. In 10% of cases it can be due to rare causes, both abdominal and extra-abdominal, one of them being intra abdominal infection by gas forming organisms. PRESENTATION OF THE CASE: A 51 year old male patient, a poorly controlled diabetic, presented with a second episode of severe pain abdomen and abdominal distention, with lower abdominal tenderness. Plain Xray of the abdomen in erect posture showed gas under the right dome of diaphragm and ultrasound abdomen confirmed gross pneumoperitoneum...
October 14, 2016: International Journal of Surgery Case Reports
Sergio Susmallian, Benjamin Raskin, Royi Barnea
INTRODUCTION: Retained surgical sponge or other items in patients' bodies happens more frequently than is reported. Healthcare personnel can forget to remove textile material or instruments during complicated, extended, or emergency surgery. In addition, changes in the operating team can influence the occurrence of such errors. PRESENTATION OF CASE: We present a case with a symptomatic gossypiboma nine years after a previous cesarean section. A 34-year-old woman was admitted to the emergency room having experienced abdominal pain and fever for the previous month...
October 14, 2016: International Journal of Surgery Case Reports
Manuel Guerrero-Hernandez, Carlos A Hinojosa, Javier E Anaya-Ayala, Erika Elenes, Aldo Torre
Portal vein (PV) thrombosis (PVT) in the absence of liver disease or thrombophilia is rare. We report a 57-year-old male with a history of stage 3 chronic kidney disease who presented at the emergency department 18 months after abdominal surgery with progressive abdominal pain and distention. Computed tomography revealed PVT with multiple collaterals and moderate ascites. He had undergone partial gastrectomy and gastrojejunal anastomosis at an outside facility for gastrointestinal stromal tumors that caused an iatrogenic stenotic lesion in the PV...
October 20, 2016: Vascular and Endovascular Surgery
Elizabeth A Sternke, Kathleen Abrahamson, Matthew J Bair
Clinician empathy is a well-documented component of effective patient/provider communication. Evidence surrounding the association between patient perspectives on clinician empathy and perception of pain management is currently limited, particularly among patients with chronic pain and depression. The aim of this study was to analyze patients' perspectives on the emergent theme of empathy and describe how patients construct their experiences and expectations surrounding empathic interactions. A secondary analysis of focus group data was designed using grounded theory methodology...
October 18, 2016: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Anne-Maree Kelly, Sharon Klim
BACKGROUND: To determine the rate of all cause and cardiac death, new myocardial infarction (MI) or coronary revascularisation at over three years from index visit in emergency department chest pain patients without known coronary artery disease (CAD) at index presentation who had a negative electrocardiogram (ECG) and biomarker workup for acute coronary syndrome (ACS). METHODS: An unplanned sub-study of a prospective observational study of consecutive adult patients presenting to the ED with atraumatic chest pain (or equivalents)...
September 13, 2016: Heart, Lung & Circulation
Kristy Bultema, Sara Fowler, Melissa Drum, Al Reader, John Nusstein, Mike Beck
INTRODUCTION: In the treatment of patients with symptomatic irreversible pulpitis, endodontic debridement is a predictable method to relieve pain. However, there are clinical situations in which emergency care cannot be provided immediately. An unexplored treatment option in these cases may be the use of a long-acting anesthetic to reduce pain in untreated irreversible pulpitis. Some medical studies have shown potential for infiltrations of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, San Diego, CA) to prolong pain relief and reduce opioid use postoperatively...
October 18, 2016: Journal of Endodontics
Richard J Hamilton, Vadim Keyfes, Sahil S Banka
BACKGROUND: Synthetic cannabinoids (SC) are recreational designer drugs intended to mimic delta-9-tetrahydrocannabinol while surreptitiously circumventing classification by the Drug Enforcement Administration. CASE REPORT: A 50-year-old black male arrived in the Emergency Department transported by Emergency Medical Services (EMS) for altered mental status after complaining of chest pain associated with smoking SCs. EMS found the patient with an empty foil pack labeled "Scooby Snax Limited Edition Blueberry Potpourri...
October 19, 2016: Journal of Emergency Medicine
Michèle M Kislan, Adam T Bernstein, Loretta R Fearrington, Timothy J Ives
BACKGROUND: Clinical Pharmacist Practitioners are advanced practicing pharmacists in North Carolina that provide disease-specific management. The purpose of this retrospective cohort study was to compare the efficacy and charges from referrals to a Clinical Pharmacist Practitioner by the primary care provider, to those managed by a primary care provider alone. METHODS: Patients were separated into cohorts depending if they had at least two appointments with a Clinical Pharmacist Practitioner from November 2008 to November 2011...
October 21, 2016: BMC Health Services Research
Sumeja Zahirovic, Faizah Siddique
A 55 year-old African American man presented to the Emergency Room with acute-onset fevers, chills, and bilateral thumb pain, swelling, and redness. MRI revealed extensive cellulitis involving bilateral hands and wrists, along with fluid collection and carpal bone erosion on the left. Given concerns for septic arthritis and osteomyelitis, patient underwent surgical debridement revealing an abscess in the wrist without osteomyelitis. Blood cultures grew Pasteurella multocida. Subsequently, patient noted two pet dogs at home, but no history of bites...
October 21, 2016: Arthritis Care & Research
U M Stamer, U Gundert-Remy, E Biermann, J Erlenwein, W Meiβner, S Wirz, T Stammschulte
BACKGROUND: Dipyrone (metamizole) is a non-opioid analgesic commonly used in Germany, which can, in very rare cases, cause life-threatening agranulocytosis. The prescribing information calls for regular monitoring of the differential blood count in cases of long-term treatment. However, there is uncertainty about how this testing should be handled in practice. OBJECTIVES: Which recommendations can be derived from the published literature for evaluating blood cell counts during treatment with metamizole and which other options for monitoring exist? METHODS: Data from recent epidemiological studies, reviews, and spontaneously reported cases were evaluated...
October 20, 2016: Der Schmerz
Jinping Shao, Jing Cao, Jiannan Wang, Xiuhua Ren, Songxue Su, Ming Li, Zhihua Li, Qingzan Zhao, Weidong Zang
Voltage-gated sodium channels, which are involved in pain pathways, have emerged as major targets for therapeutic intervention in pain disorders. Nav1.7, the tetrodotoxin-sensitive voltage-gated sodium channel isoform encoded by SCN9A and predominantly expressed in pain-sensing neurons in the dorsal root ganglion, plays a crucial role in nociception. MicroRNAs are highly conserved, small non-coding RNAs. Through binding to the 3' untranslated region of their target mRNAs, microRNAs induce the cleavage and/or inhibition of protein translation...
2016: Molecular Pain
Deven A Karvelas, Sean D Rundell, Janna L Friedly, Alfred C Gellhorn, Laura S Gold, Bryan A Comstock, Patrick J Heagerty, Brian W Bresnahan, David R Nerenz, Jeffrey G Jarvik
BACKGROUND: The association between early physical therapy (PT) and subsequent healthcare utilization following a new visit for low back pain is not clear, particularly in the setting of acute low back pain. PURPOSE: To estimate the association between initiating early physical therapy following a new visit for an episode of low back pain and subsequent back-pain-specific health care utilization in older adults. STUDY DESIGN/SETTING: Prospective cohort study...
October 17, 2016: Spine Journal: Official Journal of the North American Spine Society
Aditya H Gaur, Hilda Kizito, Wasana Prasitsueubsai, Natella Rakhmanina, Mohammed Rassool, Rana Chakraborty, Jagmohan Batra, Pope Kosalaraksa, Wicharn Luesomboon, Danielle Porter, Yongwu Shao, Michael Myers, Lillian Ting, Devi SenGupta, Erin Quirk, Martin S Rhee
BACKGROUND: The prodrug tenofovir alafenamide is associated with improved renal and bone safety compared with tenofovir disoproxil fumarate. We aimed to assess safety, pharmacokinetics, and efficacy of this single-tablet, fixed-dose combination of elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide in HIV-infected, treatment-naive adolescents. METHODS: We did a 48 week, single-arm, open-label trial in treatment-naive adolescents with HIV from ten hospital clinics in South Africa, Thailand, Uganda, and the USA...
October 17, 2016: Lancet HIV
Yoshihiro Ohara, Hitoshi Ohto, Tetsunori Tasaki, Hideki Sano, Kazuhiro Mochizuki, Mitsuko Akaihata, Shogo Kobayashi, Tomoko Waragai, Masaki Ito, Mitsuaki Hosoya, Kenneth E Nollet, Kazuhiko Ikeda, Chitose Ogawa, Takahiro Kanno, Yayoi Shikama, Atsushi Kikuta
BACKGROUND: Pediatric apheresis for peripheral blood stem cell transplantation should be carried out with due concern for low corporeal blood volume and vulnerability to hypocalcemia-related complications, hypovolemic shock, and hypervolemic cardiac overload. STUDY DESIGN AND METHODS: We retrospectively investigated a total of 267 apheresis procedures from 1990 to 2013 on 93 children between 0 and 10 years old, including 89 patients and 4 healthy donors, with body weights of 6...
September 30, 2016: Transfusion and Apheresis Science
Robert F Riley, Chadwick D Miller, Gregory B Russell, Erin N Harper, Brian C Hiestand, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Simon A Mahler
INTRODUCTION: The HEART Pathway is a diagnostic protocol designed to identify low-risk patients presenting to the emergency department with chest pain that are safe for early discharge. This protocol has been shown to significantly decrease health care resource utilization compared with usual care. However, the impact of the HEART Pathway on the cost of care has yet to be reported. METHODS AND RESULTS: We performed a cost analysis of patients enrolled in the HEART Pathway trial, which randomized participants to either usual care or the HEART Pathway protocol...
October 5, 2016: American Journal of Emergency Medicine
Kongkiat Chaikriangkrai, Ghanshyam Palamaner Subash Shantha, Hye Yeon Jhun, Patompong Ungprasert, Gardar Sigurdsson, Faisal Nabi, John J Mahmarian, Su Min Chang
STUDY OBJECTIVE: Coronary artery calcium score (CACS) is a well-established test for risk stratifying asymptomatic patients. Recent studies also indicate that CACS may accurately risk stratify stable patients presenting to the emergency department (ED) with acute chest pain; however, many were underpowered. The purpose of this systematic review and meta-analysis is to evaluate the prognostic value and accuracy of a zero (normal) CACS for identifying patients at acceptable low risk for future cardiovascular events who might be safely discharged home from the ED...
October 10, 2016: Annals of Emergency Medicine
Trond Erik Grønnestad, Hildegunn Sagvaag
OBJECTIVE: The objective of this article is to gain insight into how individuals who frequent open illicit drug scenes experience opioid maintenance treatment (OMT) and investigate how this appears to affect their recovery processes. METHOD: By means of the ethnographic method, one of the researchers spent time in an open illicit drug scene over a 1-year span, and gathered data on individuals who frequent the scene on a regular basis, and their experiences with OMT...
2016: International Journal of Qualitative Studies on Health and Well-being
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