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Pain and emergency department

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https://www.readbyqxmd.com/read/28534694/the-heart-score-for-early-rule-out-of-acute-coronary-syndromes-in-the-emergency-department-a-systematic-review-and-meta-analysis
#1
Patricia Van Den Berg, Richard Body
AIMS: The objective of this systematic review was to summarise the current evidence on the diagnostic accuracy of the HEART score for predicting major adverse cardiac events in patients presenting with undifferentiated chest pain to the emergency department. METHODS AND RESULTS: Two investigators independently searched Medline, Embase and Cochrane databases between 2008 and May 2016 identifying eligible studies providing diagnostic accuracy data on the HEART score for predicting major adverse cardiac events as the primary outcome...
May 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28533998/ipilimumab-as-a-cause-of-severe-pan-colitis-and-colonic-perforation
#2
Raj Shah, Danielle Witt, Talal Asif, Fahad F Mir
Ipilimumab is a human monoclonal antibody that functions as a cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitor that is used to treat malignant melanoma. Due to ipilimumab's removal of immune regulation, specifically through the inactivation of CTLA-4, it is commonly associated with inflammatory and autoimmune events. Gastrointestinal (GI) related immune-related adverse events such as diarrhea occur in 29% of patients with 7.6% of patients specifically suffering from colitis. We describe a case of colonic perforation with ipilimumab use...
April 20, 2017: Curēus
https://www.readbyqxmd.com/read/28533997/metoclopramide-for-acute-migraine-treatment-in-the-emergency-department-an-effective-alternative-to-opioids
#3
REVIEW
Mejdi Najjar, Tyler Hall, Blanca Estupinan
In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings...
April 20, 2017: Curēus
https://www.readbyqxmd.com/read/28533990/anomalous-origin-of-right-coronary-artery-originating-from-the-pulmonary-trunk-arcapa-an-incidental-finding-in-a-patient-presenting-with-chest-pain
#4
Pragathi Balakrishna, Michael Illovsky, Youssef M Al-Saghir, Abdul M Minhas
Anomalous origin of the right coronary artery originating from the pulmonary trunk (ARCAPA) is a rare congenital coronary anomaly with an estimated prevalence of 0.002%. Most patients are asymptomatic and the anomaly is detected incidentally during evaluation for other problems. Occasionally, ARCAPA may lead to myocardial ischemia and/or sudden cardiac arrest. We present a case of a 55-year-old female with a history of hypertension who presented to the emergency department with intermittent chest discomfort for three days...
April 17, 2017: Curēus
https://www.readbyqxmd.com/read/28533989/iatrogenic-spinal-subdural-extra-arachnoid-hygroma-following-uncomplicated-lumbar-decompression
#5
Benjamin D Elder, Wataru Ishida, Rory C Goodwin, Ali Bydon
Intradural spinal arachnoid cysts (ISACs) have been reported in the current literature as either an idiopathic disease or exceedingly rare sequelae after lumbar puncture, spinal trauma, or meningitis. Other studies have more appropriately termed the iatrogenic pathology as a spinal subdural extra-arachnoid hygroma (SSEH), as there is not often a clear cyst wall as in a true arachnoid cyst. However, to the best of our knowledge, none of the previous studies described an SSEH following uncomplicated posterior lumbar surgery, as they have previously involved clear durotomies during the initial operation...
April 17, 2017: Curēus
https://www.readbyqxmd.com/read/28533582/angular-ectopic-pregnancy-presenting-as-rupture-of-lateral-wall-of-the-uterus-late-presentation-in-gestation-week-20
#6
Malihe Hasanzadeh, Salme Dadgar, Yalda Arian, Yousef Yousefi
The differential diagnosis of acute abdominal pain in pregnancy is broad and can be complicated by atypical manifestations that are due to the anatomic distortions and physiologic changes of pregnancy. Due to the lack of clinical understanding, angular pregnancy does not appear to be recognized as a clinical entity and many cases are likely to go undiagnosed. This is a case report of a 34-year-old woman who was referred to the obstetrics emergency department with sudden abdominal pain and in a state of hypovolemic shock...
May 2017: Iranian Journal of Medical Sciences
https://www.readbyqxmd.com/read/28530770/diagnostic-value-of-appendicular-doppler-ultrasonography-in-acute-appendicitis
#7
Hüseyin Uzunosmanoğlu, Yunsur Çevik, Şeref Kerem Çorbacıoğlu, Emine Akıncı, Hakan Buluş, Kadir Ağladıoğlu
BACKGROUND: Acute appendicitis is one of the most common causes of acute abdominal pain prompting emergency department (ED) visits. It is critical for the physicians to promptly and accurately diagnose acute appendicitis. The present study aimed to evaluate the diagnostic efficacy of Doppler ultrasonography (USG) in patients with acute appendicitis and compare this new method with other commonly used radio-diagnostic tools. METHODS: All patients who were diagnosed with acute appendicitis at the Kecioren Training and Research Hospital ED and later underwent appendectomy between October 2012 and April 2013 were included in the study...
May 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28530107/leptomeningeal-carcinomatosis-in-a-young-patient-with-obstructive-colorectal-signet-ring-cell-adenocarcinoma
#8
Alejandro Lusilla, Jorge de Tomás
We present the case report of a twenty-five-year-old Moroccan male patient who suffered from leptomeningeal carcinomatosis related to a signet-ring cell carcinoma of the rectum. He presented to the emergency department with abdominal pain, constipation, weight loss and rectal bleeding. The rectal examination showed a rectal tumor and a CT scan revealed a large bowel obstruction due to rectal diffuse thickening. An emergency transverse colostomy was performed, with a rectal biopsy and a cytological sample collection...
May 22, 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28528430/risk-classification-of-highly-sensitive-troponin-i-predict-presence-of-vulnerable-plaque-assessed-by-dual-source-coronary-computed-tomography-angiography
#9
Ting Liu, Guan Wang, Peiling Li, Xu Dai
Patients presenting to the emergency department with acute chest pain, negative conventional troponin and electrocardiogram require serial testing to rule out acute coronary syndrome (ACS). We studied the association of highly sensitive troponin (hsTn) I with vulnerable plaque features as detected by coronary dual source computed tomography angiography (DSCTA) and determined whether hsTn I at the time of presentation combined with early DSCTA could improve classification of patients as high-risk or low risk for ACS...
May 20, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28527640/influences-on-patient-satisfaction-among-patients-who-use-emergency-departments-frequently-for-pain-related-complaints
#10
Patricia Newcomb, Marian Wilson, Ralph Baine, Terence McCarthy, Nicholas Penny, Caroline Nixon, Justin Orren
INTRODUCTION: The primary purpose of this study was to assess relationships between opioid prescribing practices, patient and ED attributes, and patient satisfaction ratings of nursing and physician care among patients with high utilization of the emergency department for pain relief. METHODS: A retrospective cohort study was conducted to examine 305 individual patient satisfaction surveys from users with high ED utilization for pain complaints. Responses were compared with an age-matched control group (n = 305) of nonfrequent ED users...
May 17, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28523473/young-colorectal-cancer-patients-often-present-too-late
#11
Jia-Hao Law, Frederick H Koh, Ker-Kan Tan
PURPOSE: Current screening and health education strategies on colorectal cancer (CRC) remain focused on individuals >50 years old. However, CRC in young adults is not uncommon. This paper aims to explore how CRC presents in young adults and their clinical outcomes. METHODS: All patients aged <50 years diagnosed with CRC from January 2007 to December 2015 were reviewed. Patient demographics, clinical symptoms, and outcomes of treatment were collected. RESULTS: Of 1367 patients diagnosed with CRC, 154 (11...
May 18, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/28523439/magnetic-resonance-imaging-of-painful-swollen-legs-in-the-emergency-department-a-pictorial-essay
#12
REVIEW
Ashish Chawla, Niraj Dubey, Kian Ming Chew, Dinesh Singh, Vishal Gaikwad, Wilfred Cg Peh
Patients presenting with a painful swollen leg are not infrequently encountered at the emergency department and can pose a diagnostic dilemma for attending physicians. The potential causes of leg pain and swelling include trauma, infection, inflammation, and neurogenic, vascular, and iatrogenic conditions; with magnetic resonance imaging (MRI) being an important tool in evaluation. We describe the MRI features of various conditions causing painful swollen legs. We also discuss the differential diagnosis and the useful clinical and laboratory findings that radiologists should be aware of, in order to arrive at an accurate diagnosis...
May 18, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28521343/tarlov-cyst-causing-sacral-insufficiency-fracture
#13
Ross C Puffer, Marcus J Gates, William Copeland, William E Krauss, Jeremy Fogelson
BACKGROUND AND IMPORTANCE: Tarlov cysts, also known as perineural cysts, have been described as meningeal dilations of the spinal nerve root sheath between the peri- and endoneurium at the dorsal root ganglion. Most often they are found in the sacrum involving the nerve roots. Normally asymptomatic, they have been reported to present with radiculopathy, paresthesias, and even urinary or bowel dysfunction. Sacral insufficiency has not been a well-documented presentation. CLINICAL PRESENTATION: The patient is a 38-year-old female who started to develop left low back pain and buttock pain that rapidly progressed into severe pain with some radiation down the posterior aspect of her left leg...
June 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28515805/is-computed-tomography-defined-obstruction-a-predictor-of-urological-intervention-in-emergency-department-patients-presenting-with-renal-colic
#14
Peter Alexander Massaro, Avinash Kanji, Paul Atkinson, Ryan Pawsey, Tom Whelan
INTRODUCTION: Our objective was to determine whether unilateral calculus-induced ureteric obstruction on computed tomography (CT) was independently associated with the need for urological intervention and 30-day return to the emergency department (ED). METHODS: We performed a retrospective cohort study of patients with symptomatic urinary calculi diagnosed by unenhanced helical CT. Stepwise regression analysis was used to determine the predictors of urological intervention and 30-day return to the ED...
March 2017: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
https://www.readbyqxmd.com/read/28515272/racial-disparities-in-neurologic-health-care-access-and-utilization-in-the-united-states
#15
Altaf Saadi, David U Himmelstein, Steffie Woolhandler, Nicte I Mejia
OBJECTIVE: To evaluate racial and ethnic differences in the utilization of neurologic care across a wide range of neurologic conditions in the United States. METHODS: We analyzed nationally representative data from the 2006-2013 Medical Expenditure Panel Survey (MEPS), including information on demographics, patient-reported health conditions, neurology visit rates, and costs. Using diagnostic codes, we identified persons with any self-identified neurologic disorder except back pain, as well as 5 subgroups (Parkinson disease, multiple sclerosis, headache, cerebrovascular disease, and epilepsy)...
May 17, 2017: Neurology
https://www.readbyqxmd.com/read/28515106/direct-comparison-of-2-rule-out-strategies-for-acute-myocardial-infarction-2-h-accelerated-diagnostic-protocol-vs-2-h-algorithm
#16
Karin Wildi, Louise Cullen, Raphael Twerenbold, Jaimi H Greenslade, William Parsonage, Jasper Boeddinghaus, Thomas Nestelberger, Zaid Sabti, Maria Rubini-Giménez, Christian Puelacher, Janosch Cupa, Lukas Schumacher, Patrick Badertscher, Karin Grimm, Nikola Kozhuharov, Claudia Stelzig, Michael Freese, Katharina Rentsch, Jens Lohrmann, Wanda Kloos, Andreas Buser, Tobias Reichlin, John Pickering, Martin Than, Christian Mueller
BACKGROUND: We compared 2 high-sensitivity cardiac troponin (hs-cTn)-based 2-h strategies in patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED): the 2-h accelerated diagnostic protocol (2h-ADP) combining hs-cTn, electrocardiogram, and a risk score, and the 2-h algorithm exclusively based on hs-cTn concentrations and their absolute changes. METHODS: Analyses were performed in 2 independent diagnostic cohorts [European Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) study, Australian-New Zealand 2-h Accelerated Diagnostic Protocol to Assess patients with chest Pain symptoms using contemporary Troponins as the only biomarker (ADAPT) study] employing hs-cTnT (Elecsys) and hs-cTnI (Architect)...
May 17, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28514960/segmental-testicular-infarction-a-case-report
#17
Tine Smets, Gina Reichman, Dirk P J Michielsen
BACKGROUND: Segmental testicular infarction is a very rare condition, which can mimic a testicular torsion or testicular cancer. Correct diagnosis is difficult but it is important to avoid unnecessary radical treatment. CASE PRESENTATION: We report a clinical case of a 36-year-old white man who presented at our emergency department with subacute testicular pain. A urine analysis, Doppler ultrasound, surgical exploration, blood analysis, and magnetic resonance imaging were performed to diagnose his condition, to exclude a testicular torsion, and to raise confidence in its non-malignancy...
May 18, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28511924/evaluation-of-the-effectiveness-of-a-phone-based-care-coordination-pilot-on-hospital-utilisation-and-costs-for-patients-with-chest-pain
#18
Peita Price, Ruth Vincent, Mark Tacey, Jane Gilchrist, Danny Liew, Leeanne Grigg, Lucio Naccarella
BACKGROUND: A small percentage of the population represents a disproportionate number of attendances at emergency departments (ED). "Frequent presenters" to ED with chest pain do not always fit into established pathways for acute myocardial events. With accelerated "rule out" protocols, patients are often discharged from the Emergency Department (ED) after short lengths of stay. This research will evaluate the effectiveness of a phone based care-coordination pilot designed to meet the needs of patients attending ED with cardiac and non-cardiac chest pain...
April 20, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28511550/ct-features-in-surgically-proven-cases-of-ovarian-torsion-a-pictorial-review
#19
Sunita Dhanda, Swee Tian Quek, Ying Ting Mok, Clement Yong Hsiang Rong, Yuik Sing Eric Ting, Pooja Jagmohan, Bernard Wee
Ovarian torsion is a surgical emergency characterized by a partial or complete rotation of the ovarian vascular pedicle, causing obstruction to venous outflow followed by arterial inflow. Clinically, ovarian torsion frequently mimics other causes of acute pelvic pain such as appendicitis, diverticulitis, renal colic etc. Ultrasonography (US) is the first line imaging modality of choice for evaluation of ovarian torsion. MRI is useful as a problem solving tool in patients with equivocal or non diagnostic US studies...
May 16, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/28507966/ipsilateral-hip-and-knee-dislocation-with-open-tibial-fracture-a-case-report-of-a-limb-threatening-injury
#20
Ramesh Perumal, S R Sundararajan, J Vasudeva, S Rajasekaran
INTRODUCTION: Hip or knee dislocations are usually treated as a surgical emergency, but ipsilateral hip and knee dislocation should be considered a dual emergency that must be addressed immediately and reduced at the earliest. We present here the sequence of events and the final functional outcome of one such rare injury manages by us. CASE REPORT: A 22-year-old male was involved in a road traffic accident. He presented to the emergency department in 4 h injury time with painful deformities of the right hip and knee, along with Type I open wound right leg with abnormal mobility suggestive of fracture in the ipsilateral leg...
November 2016: Journal of Orthopaedic Case Reports
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