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Pain and emergency department

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https://www.readbyqxmd.com/read/27923204/case-report-of-the-surgical-management-of-small-bowel-and-colonic-ischaemia-associated-with-anorexia-nervosa-binge-purge-subtype
#1
Ann T Foran, Cillian Clancy, Tom F Gorey
INTRODUCTION: Anorexia Nervosa affects up to 1% of the population and can present with binge/purge episodes. A paucity of literature exists regarding small bowel and colonic ischaemia relating to this common condition. We report our own experience and management of a patient with anorexia nervosa binge/purge subtype with small bowel and colon ischaemia and review existing cases in the literature. PRESENTATION OF CASE: A 32year old female self-presented to the emergency department complaining of abdominal pain, abdominal distension and vomiting on a background history of binge/purge subtype eating disorder, following consumption of a large amount of carbohydrates...
August 25, 2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27920845/the-great-imitator-igg4-periaortitis-masquerading-as-an-acute-aortic-syndrome-on-computed-tomographic-angiography
#2
Drew W Moore, Neil J Hansen, Dominick J DiMaio, William L Harrison
We present the case of a 52-year-old woman who presented to the emergency department with chest and neck pain. Initial cervical spine magnetic resonance imaging shows an abnormal flow void in the left vertebral artery, which prompted a computed tomographic angiogram. This demonstrated a hyperdense thickened ascending aortic wall, which extended into the great vessel origins. Clinically and radiographically interpreted as an acute aortic syndrome and/or intramural hematoma, the patient underwent ascending aortic repair with graft...
December 2016: Radiology case reports
https://www.readbyqxmd.com/read/27919865/shared-decision-making-in-patients-with-low-risk-chest-pain-prospective-randomized-pragmatic-trial
#3
Erik P Hess, Judd E Hollander, Jason T Schaffer, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Nilay D Shah, Jonathan Inselman, Jeph Herrin, Ana Castaneda-Guarderas, Victor M Montori
OBJECTIVE:  To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. DESIGN:  Multicenter pragmatic parallel randomized controlled trial. SETTING:  Six emergency departments in the United States. PARTICIPANTS:  898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain...
December 5, 2016: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/27918377/utility-of-emergency-department-observation-units-for-neurologically-intact-children-with-head-ct-abnormalities-secondary-to-acute-closed-head-injury
#4
Roxanna Lefort, Jill V Hunter, Andrea T Cruz, A Chantal Caviness, Thomas G Luerssen, Aderonke Adekunle-Ojo
OBJECTIVE: The aim of the study was to evaluate the utility of the emergency department observation unit (EDOU) for neurologically intact children with closed head injuries (CHIs) and computed tomography (CT) abnormalities. METHODS: A retrospective cohort study of children aged 0 to 18 years with acute CHI, abnormal head CT, and a Glasgow Coma Scales score of 14 or higher admitted to the EDOU of a tertiary care children's hospital from 2007 to 2010. Children with multisystem trauma, nonaccidental trauma, and previous neurosurgical or coagulopathic conditions were excluded...
December 1, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27913565/a-24-year-old-male-with-a-painful-and-cold-lower-extremity
#5
Eric A Robinson, Zain I Khalpey, Rajesh Janardhanan
CLINICAL INTRODUCTION: A 24-year-old male presented to the emergency department with intense pain in his right lower extremity. He has a medical history significant for systemic lupus erythematosus and antiphospholipid syndrome. He also had four prior episodes of deep venous thromboses on rivaroxaban. The patient stated that early in the morning, he started to feel intense pain that started from his knee and progressed to his calf, with associated numbness and paraesthesia. On physical examination, the limb felt cold with absent right popliteal and dorsalis pedis pulses...
December 2, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27911458/spondylodiscitis-a-rare-complication-following-percutaneous-nephrostomy
#6
Francesco Chiancone, Maurizio Fedelini, Clemente Meccariello, Luigi Pucci, Marco Fabiano, Paolo Fedelini
Spondylodiscitis is an inflammation of the intervertebral disc and the adjacent vertebral bodies. The spondylodiscitis can not only be a complication of medical interventions such as an operation near spinal column but also urogenital and vascular interventions and intravenous catheter use. A 71-year-old man was admitted to our emergency department with fever and severe abdominal pain. Antibiotic therapy had been performed with intravenous administration of 2 g of ceftriaxone and the patient underwent the placement of a percutaneous nephrostomy according to Seldinger technique...
November 28, 2016: Urologia
https://www.readbyqxmd.com/read/27908810/emergent-treatment-of-a-ruptured-thoraco-abdominal-aortic-aneurysm-by-off-label-rescue-implantation-of-the-ovation-%C3%A2-stent-graft-in-nonagenarians-patient
#7
Chiara Pranteda, Pasqualino Sirignano, Federica Fornelli, Wassim Mansour, Nunzio Montelione, Laura Capoccia, Francesco Speziale
We report a case of a compassionate treatment of a ruptured thoraco-abdominal aortic aneurysm in a 92-year-old patient. Patient was admitted to our emergency department for acute onset of pain irradiating to the back. Computed tomographic angiography showed the presence of a thoraco-abdominal aortic aneurysm with a contained rupture at infrarenal level. Given of the presence of a relative healthy visceral aorta, we decided to treat the patient by Ovation(®) (Endologix, Irvine, CA - USA) implantation in an off-label fashion...
November 28, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27907878/ultrasound-in-cardiac-trauma
#8
Theodosios Saranteas, Andreas F Mavrogenis, Christina Mandila, John Poularas, Fotios Panou
In the perioperative period, the emergency department or the intensive care unit accurate assessment of variable chest pain requires meticulous knowledge, diagnostic skills, and suitable usage of various diagnostic modalities. In addition, in polytrauma patients, cardiac injury including aortic dissection, pulmonary embolism, acute myocardial infarction, and pericardial effusion should be immediately revealed and treated. In these patients, arrhythmias, mainly tachycardia, cardiac murmurs, or hypotension must alert physicians to suspect cardiovascular trauma, which would potentially be life threatening...
November 5, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27905910/is-standardized-care-feasible-in-the-emergency-setting-a-case-matched-analysis-of-patients-undergoing-laparoscopic-cholecystectomy
#9
Fabian Grass, Matthieu Cachemaille, Catherine Blanc, Nicolas Fournier, Nermin Halkic, Nicolas Demartines, Martin Hübner
BACKGROUND: Immediate laparoscopic cholecystectomy is the accepted standard for the treatment of acute cholecystitis. The aim of the present study was to evaluate the feasibility of a standardized approach with tailored care maps for pre- and postoperative care by comparing pain, nausea and patient satisfaction after elective and emergent laparoscopic cholecystectomy. METHODS: From January 2014 until April 2015, data on pain and nausea management were prospectively recorded for all elective and emergency procedures in the department of visceral surgery...
December 1, 2016: BMC Surgery
https://www.readbyqxmd.com/read/27904260/sonographic-identification-of-peripheral-nerves-in-the-forearm
#10
Saundra A Jackson, Charlotte Derr, Anthony De Lucia, Marvin Harris, Zuheily Closser, Branko Miladinovic, Rahul Mhaskar, Theresa Jorgensen, Lori Green
BACKGROUND: With the growing utilization of ultrasonography in emergency medicine combined with the concern over adequate pain management in the emergency department (ED), ultrasound guidance for peripheral nerve blockade in ED is an area of increasing interest. The medical literature has multiple reports supporting the use of ultrasound guidance in peripheral nerve blocks. However, to perform a peripheral nerve block, one must first be able to reliably identify the specific nerve before the procedure...
October 2016: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/27903774/-they-shouldn-t-be-coming-to-the-ed-should-they-a-descriptive-service-evaluation-of-why-patients-with-palliative-care-needs-present-to-the-emergency-department
#11
Emilie Green, Sarah Ward, Will Brierley, Ben Riley, Henna Sattar, Tim Harris
BACKGROUND: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. METHODS: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period...
November 30, 2016: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27902953/rectal-free-perforation-after-stapled-hemorrhoidopexy-a-case-report-of-laparoscopic-peritoneal-lavage-and-repair-without-stoma
#12
Seokyong Ryu, Byung-Noe Bae
INTRODUCTION: Stapled hemorrhoidopexy is widely performed for treatment of prolapsed hemorrhoids because of advantages, including shorter hospital stay and less discomfort, compared with conventional hemorrhoidectomy. However, it can have severe adverse effects, such as rectal bleeding, perforation, and sepsis. PRESENTATION OF CASE: We report the case of a healthy 28-year-old man who presented to the emergency department with sudden-onset diffuse abdominal pain and hematochezia...
November 21, 2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27902675/infected-congenital-epicardial-cyst-presenting-as-acute-abdomen
#13
Timothy Dribin, Matthew D Files, Erin R Rudzinski, Ron Kaplan, Kimberly P Stone
A previously healthy 3-year-old boy presented to the emergency department with abdominal pain, fever, and emesis. Laboratory and radiologic evaluation for causes of acute abdomen were negative; however, review of the abdominal x-ray demonstrated cardiomegaly with the subsequent diagnosis of pericardial cyst by echocardiogram and computed tomography. The patient underwent surgical decompression and attempted removal of the cystic structure revealing that the cyst originated from the epicardium. His abdominal pain and fever resolved postoperatively and he completed a 3-week course of ceftriaxone for treatment of Propionibacterium acnes infected congenital epicardial cyst...
December 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27902672/essential-content-for-discharge-instructions-in-pediatric-emergency-care-a-delphi-study
#14
Janet A Curran, Andrea Murphy, Emma Burns, Amy Plint, Monica Taljaard, Shannon MacPhee, Eleanor Fitzpatrick, Andrea Bishop, Jill Chorney, Megan Bourque
OBJECTIVE: The aim of this study was to identify the 5 most essential discharge instruction content elements that should be communicated to all caregivers of children who present to the emergency department (ED) with asthma, vomiting/diarrhea, abdominal pain, fever, minor head injury, or bronchiolitis. METHODS: A discharge information content list was developed for each illness presentation following a review of the literature. Using a modified Delphi technique, 6 lists were distributed to a panel of experts from EDs across Canada using a secure online survey tool with the goal of achieving the 5 most essential discharge instruction elements...
November 29, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27902667/managing-skin-and-soft-tissue-infections-in-the-emergency-department-observation-unit
#15
Shabana Yusuf, Joseph L Hagan, Aderonke O Adenkule-Ojo
BACKGROUND: Skin and soft tissue infections (SSTIs) are a common reason for presentation to the emergency department (ED) and account for 3% of ED visits. Patients with a diagnosis of cellulitis requiring intravenous (IV) antibiotics have traditionally been admitted to the hospital. In our institution, these patients are placed in the ED Observation Unit (EDOU) for IV antibiotics. OBJECTIVES: The purpose of this study is to determine if 3 doses of IV antibiotics are adequate to document clinical improvement in children with uncomplicated SSTI...
November 29, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27900277/incidentally-diagnosed-multiple-vascular-lesions-of-the-spleen-littoral-cell-angioma-or-hemangioma
#16
Emrah Aydin
Vascular lesions of the solid abdominal viscera may pose diagnostic and management issues. A 16-year old girl admitted to emergency department due to recurrent abdominal pain and diagnosed to have multiple vascular malformations of the spleen on imaging investigations. Littoral cell angioma was preoperative suspicion owing to no response of the vascular lesion to the propranolol. It turned out to be cavernous hemangioma on histopathology.
November 2016: APSP Journal of Case Reports
https://www.readbyqxmd.com/read/27899166/pain-management-of-acute-appendicitis-in-canadian-pediatric-emergency-departments
#17
Andrea L Robb, Samina Ali, Naveen Poonai, Graham C Thompson
OBJECTIVES: Children with suspected appendicitis are at risk for suboptimal pain management. We sought to describe pain management patterns for suspected appendicitis across Canadian pediatric emergency departments (PEDs). METHODS: A retrospective medical record review was undertaken at 12 Canadian PEDs. Children ages 3 to 17 years who were admitted to the hospital in February or October 2010 with suspected appendicitis were included. Patients were excluded if partially assessed or treated at another hospital...
November 30, 2016: CJEM
https://www.readbyqxmd.com/read/27898354/vasitis-mimicking-an-amyand-s-hernia-a-case-report
#18
Juan Manuel Romero Marcos, Santiago Baena Bradaschia, José María Muñoz Pérez, José Andrés Cifuentes Ródenas
INTRODUCTION: Amyand's hernia is an inguinal hernia containing the caecal appendix. It is usually an intraoperative finding, although it can be diagnosed preoperatively with radiologic examinations, which would show a tubular structure inside the inguinal canal. PRESENTATION OF CASE: A male patient presented to the emergency department complaining of abdominal pain in the right lower quadrant. He had been orchidectomized during his childhood due to cryptorchidism, and had been under antibiotic treatment a week before due to a suspected gonorrhoea...
November 22, 2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27896841/dental-pain-in-the-medical-emergency-department-a-cross-sectional-study
#19
C C Currie, S J Stone, J Connolly, J Durham
OBJECTIVE: To examine the number of patients attending a medical emergency department (MED) with dental problems over a three year period. DESIGN: A cross sectional study was carried out as part of a service evaluation. Data were collected via a database search of patient attendances at the MED using free text and the 10(th) revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) for oral and dental diagnoses. Data were analysed using descriptive statistics, T-Test, and chi-squared tests...
November 28, 2016: Journal of Oral Rehabilitation
https://www.readbyqxmd.com/read/27896323/intra-articular-lidocaine-versus-intravenous-sedative-and-analgesic-for-reduction-of-anterior-shoulder-dislocation
#20
Parvin Kashani, Fatemeh Asayesh Zarchi, Hamid Reza Hatamabadi, Abbas Afshar, Marzieh Amiri
OBJECTIVE: This prospective clinical trial was performed to compare the safety and efficiency of intra-articular lidocaine (IAL) versus intravenous sedative and analgesic (IVSA) in reduction of anterior shoulder dislocation. MATERIALS AND METHODS: Patients with anterior shoulder dislocation were randomly divided into 2 groups to receive IAL and IVSA. One group patients received an intravenous dose of 0.05 mg/kg midazolam and 1 μg/kg fentanyl, while the other group received 20 mL intra-articular lidocaine (1%)...
June 2016: Turkish Journal of Emergency Medicine
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