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Pain and emergency department

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https://www.readbyqxmd.com/read/28816891/computed-tomography-use-plateaus-among-children-with-emergency-visits-for-abdominal-pain
#1
Jahan Fahimi, Aaron E Kornblith, Hemal Kanzaria, Andrew Herring, Ralph C Wang
OBJECTIVES: Abdominal pain is a common pediatric complaint to emergency departments (EDs), and clinicians often rely on imaging for diagnosis. Studies have demonstrated an increase in computed tomography (CT) in this population. Following emphasis on radiation reduction by researchers and organizations, this study evaluates recent national trends in CT use among pediatric patients presenting to EDs with abdominal pain. METHODS: This is a cross-sectional analysis of ED patients 18 years or younger with chief complaint of abdominal pain in the National Hospital Ambulatory Medical Care Survey from 2008 to 2011...
August 14, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28816176/-severely-increased-serum-lipid-levels-in-diabetic-ketoacidosis-case-report
#2
Hrafnkell Stefansson, Kristinn Sigvaldason, Hilmar Kjartansson, Helga Águsta Sigurjonsdottir
Severe hypertriglyceridemia is a known, but uncommon complication of diabetic ketoacidosis. We discuss the case of a 23-year-old, previously healthy, woman who initially presented to the emergency department with abdominal pain. Grossly lipemic serum due to extremely high triglyceride (38.6 mmol/L) and cholesterol (23.2 mmol/L) levels were observed with a high blood glucose (23 mmol/L) and a low pH of 7.06 on a venous blood gas. She was treated successfully with fluids and insulin and had no sequale of pancreatitis or cerebral edema...
July 2017: Læknablađiđ
https://www.readbyqxmd.com/read/28814122/flibanserin-toxicity-in-a-toddler-following-ingestion
#3
Nicholas Granzella, Betty C Chen, Geoffrey S Baird, Matthew Valento
INTRODUCTION: Flibanserin is a medication recently approved by the FDA for treatment of generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. Its mechanism of action is not fully understood but is thought to modulate serotonin receptors and increase levels of norepinephrine and dopamine. While much is known about toxicity of other drugs which affect these systems, there is little information about toxicity of flibanserin at this time. CASE: We present a case of a 2-year-old boy who ingested an estimated 600 mg of his mother's flibanserin...
August 17, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28812175/a-prospective-non-randomized-controlled-multicenter-trial-comparing-appendectomy-and-conservative-treatment-for-patients-with-uncomplicated-acute-appendicitis-the-actuaa-study
#4
Mauro Podda, Fernando Serventi, Lorenzo Mortola, Stefano Marini, Danilo Sirigu, Michela Piga, Marcello Pisano, Massimiliano Coppola, Ferdinando Agresta, Francesco Virdis, Salomone Di Saverio, Nicola Cillara
PURPOSE: Acute appendicitis (AA) is among the most common causes of lower abdominal pain and admissions to the emergency department. Over the past 20 years, there has been a renewed interest in the conservative management of uncomplicated AA, and several studies demonstrated that an antibiotic-first strategy is a viable treatment option for uncomplicated AA. The aim of this prospective non-randomized controlled, multicenter trial is to compare antibiotic therapy and emergency appendectomy as treatment for patients with uncomplicated AA confirmed by US and/or CT or MRI scan...
August 15, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/28811982/a-matched-cohort-analysis-comparing-stand-alone-cages-and-anterior-cervical-plates-used-for-anterior-cervical-discectomy-and-fusion
#5
Samuel C Overley, Robert K Merrill, Dante M Leven, Joshua J Meaike, Abhishek Kumar, Sheeraz A Qureshi
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare perioperative characteristics of stand-alone cages and anterior cervical plates used for anterior cervical discectomy and fusion (ACDF). METHODS: We reviewed 40 adult patients who received a stand-alone cage for elective ACDF and matched them with 40 patients who received an anterior cervical plate. We statistically compared operative time, length of stay, proportion of ambulatory cases, overall complications necessitating a trip to the ED, readmission, or reoperation related to index procedure...
August 2017: Global Spine Journal
https://www.readbyqxmd.com/read/28810369/a-closer-look-at-the-relationships-between-panic-attacks-emergency-department-visits-and-non-cardiac-chest-pain
#6
Guillaume Foldes-Busque, Isabelle Denis, Julien Poitras, Richard P Fleet, Patrick Archambault, Clermont E Dionne
This study examined the prevalence of emergency department visits prompted by panic attacks in patients with non-cardiac chest pain. A validated structured telephone interview was used to assess panic attacks and their association with the emergency department consultation in 1327 emergency department patients with non-cardiac chest pain. Patients reported at least one panic attack in the past 6 months in 34.5 per cent (95% confidence interval: 32.0%-37.1%) of cases, and 77.1 per cent (95% confidence interval: 73...
January 1, 2017: Journal of Health Psychology
https://www.readbyqxmd.com/read/28808608/intrathecal-catheter-associated-inflammatory-mass-in-a-neurofibromatosis-type-1-patient-receiving-fentanyl-and-bupivacaine
#7
Derek G Southwell, Joseph A Osorio, Christopher S Liverman, Lauren M Friedman, Ramana K Naidu, Lawrence R Poree, Melanie M Henry, Line Jacques
BACKGROUND: Catheter-associated inflammatory masses (CIMs) are a rare but serious complication of intrathecal drug delivery devices. CIM formation is influenced by local medication concentration, which is determined in part by flow dynamics at the catheter tip. Underlying spinal pathologies, such as neoplasms, may alter flow at the catheter tip, thereby contributing to CIM formation. Moreover, they may also complicate the clinical and radiologic diagnosis of a CIM. CASE DESCRIPTION: A 36-year-old man with neurofibromatosis type 1 presented to our emergency department with complaints of increased back pain and leg weakness...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28804656/pneumomediastinum-and-mediastinal-hematoma-secondary-to-right-brachiocephalic-vein-thrombectomy-mimicking-stemi
#8
Prem Shukla, Prudence Dy, Rishi Raj, Sayee Sundar Alagusundaramoorthy, Noel Nivera
A 50-year-old male with a history of hemodialysis dependent chronic kidney disease presented to our emergency department with acute midsternal crushing chest pain. Patient was diagnosed with acute anterolateral wall Myocardial Infraction due to the presence of corresponding ST segment elevations in EKG and underwent emergent cardiac catheterization which revealed normal patent coronaries without any disease. He continued to have chest pain for which CT of the chest was done which revealed pneumomediastinum with mediastinal hematoma, due to the recent attempted thrombectomy for thrombus in his right brachiocephalic vein...
2017: Case Reports in Cardiology
https://www.readbyqxmd.com/read/28803137/aspiration-pneumonia-in-patients-with-carbon-monoxide-poisoning-who-had-loss-of-consciousness-prevalence-outcomes-and-risk-factors
#9
Chang Hwan Sohn, Jin Won Huh, Dong Woo Seo, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim
BACKGROUND: Aspiration pneumonia is associated with significant morbidity and mortality, however little is known about in patients with carbon monoxide intoxication which is the leading cause of poisoning-related death. This study aimed to evaluate the prevalence, clinical impacts and risk factors for developing aspiration pneumonia in carbon monoxide poisoning patients with loss of consciousness. METHODS: A retrospective analysis of a carbon monoxide poisoning registry was performed at our emergency department from January, 2008 to December, 2015...
August 9, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28802985/clinical-analysis-of-48-h-emergency-department-visit-post-outpatient-extracorporeal-shock-wave-lithotripsy-for-urolithiasis
#10
Chin-Heng Lu, Junne-Yih Kuo, Tzu-Ping Lin, Yi-Hsiu Huang, Hsiao-Jen Chung, William J S Huang, Howard H H Wu, Yen-Hwa Chang, Alex T L Lin, Kuang-Kuo Chen
BACKGROUND: Patients suffering from renal or ureteral stones can undergo significant discomfort, even when timely diagnosed and treated. The aim of this study was to assess the risk factors and safety of outpatient Extracorporeal Shock Wave Lithotripsy (ESWL) in the management of patients with renal or ureteral stones. METHODS: In this study, our cohort consisted of 844 outpatients who underwent outpatient ESWL treated between February 2012 and November 2014 at Taipei Veterans General Hospital...
August 9, 2017: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/28802544/a-role-of-the-endothelial-nitric-oxide-system-in-acute-renal-colic-caused-by-ureteral-stone
#11
Emre Bulbul, Elif Funda Sener, Nahide Ekici Gunay, Bahadir Taslidere, Elif Taslidere, Serhat Koyuncu, Nurullah Gunay
BACKGROUND AND AIMS: Endothelial nitric oxide synthase gene polymorphisms play a role in some pathophysiological processes. In this study, the possible effects of endothelial nitric oxide synthase gene polymorphisms on ureteral stone disease in patients who were admitted to the emergency department with severe pain due to renal colic are examined. MATERIALS AND METHODS: The study groups were designed as controls and patients. The control group was formed from the healthy volunteers who applied to the blood center next to the emergency service...
August 7, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28802541/opioid-doses-and-acute-care-utilization-outcomes-for-adults-with-sickle-cell-disease-emergency-department-versus-acute-care-unit
#12
Robert E Molokie, Chariz Montminy, Corissa Dionisio, Muhammad Ahmen Farooqui, Michel Gowhari, Yingwei Yao, Marie L Suarez, Miriam O Ezenwa, Judith M Schlaeger, Zaijie J Wang, Diana J Wilkie
BACKGROUND: Acute care units (ACUs) with focused sickle cell disease (SCD) care have been shown to effectively address pain and limit hospitalizations compared to emergency departments (ED), the reason for differences in admission rates is understudied. Our aim was compare effects of usual care for adult SCD pain in ACU and ED on opioid doses and discharge pain ratings, hospital admission rates and lengths of stay. METHODS: In a retrospective, comparative cohort, single academic tertiary center study, 148 adults with sickle cell pain received care in the ED, ACU or both...
July 13, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28801039/kohler-s-disease-presenting-as-acute-foot-injury
#13
Mazin Alhamdani, Christopher Kelly
Kohler's disease is rare cause of foot pain and limping in the pediatric population. The exact etiology of Kohler's disease is unknown. It usually presents as sudden and unexplained foot pain and limping. We report a case of a 5-year-old male who presented to the Pediatric Emergency Department with foot pain and inability to bear weight for two days after overactivity and acute foot injury. The patient was eventually diagnosed with Kohler's disease (avascular necrosis of the navicular bone). Although Kohler's disease is not very common, it should be considered in the differential diagnosis of foot pain in the pediatric population, as it may prevent unnecessary tests and treatments...
August 2, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28800938/using-hospital-use-trends-to-improve-transitional-care
#14
Joe Feinglass, Celeste A Mallama, Angela Rogers, Caroline Teter, Courtney Hurt, Christine Schaeffer
BACKGROUND: This study evaluates the Northwestern Medicine Group Transitional Care clinic (NMG-TC), which transitions patients from an urban hospital to primary care at partner community clinics. We evaluate change over the 55 month study period in emergency department, observation or inpatient use within 90 days of an initial NMG-TC visit. METHODS: Electronic health records were used to determine patient demographic, insurance and clinical characteristics, including inflation-adjusted total hospital charges in the 90 days prior and the 90 days after an initial NMG-TC visit...
August 8, 2017: Healthcare
https://www.readbyqxmd.com/read/28800866/five-year-trends-of-critical-care-practice-and-outcomes
#15
Craig M Lilly, Sunil Swami, Xinggang Liu, Richard R Riker, Omar Badawi
BACKGROUND: Longitudinal analyses of large detailed adult critical care datasets provide insights into practice trends and generate useful outcome and process benchmarks. METHODS: Data representing 991,571 consecutive critical care visits to160 United States adult ICUs during 2009 to 2013 from the eICU Research Institute clinical practice database were used to quantitate patient characteristics, APACHE IV based acuity predictions, treatments, and outcomes. Analyses for changes over time were performed for patient characteristics, entry and discharge locations, primary admission diagnosis, treatments, adherence to consensus ICU best practices, length of stay (LOS), and inpatient mortality...
August 8, 2017: Chest
https://www.readbyqxmd.com/read/28796552/diagnostic-accuracy-of-mri-versus-ct-for-the-evaluation-of-acute-appendicitis-in-children-and-young-adults
#16
Sonja Kinner, Perry J Pickhardt, Erica L Riedesel, Kara G Gill, Jessica B Robbins, Douglas R Kitchin, Timothy J Ziemlewicz, John B Harringa, Scott B Reeder, Michael D Repplinger
OBJECTIVE: Appendicitis is frequently diagnosed in the emergency department, most commonly using CT. The purpose of this study was to compare the diagnostic accuracy of contrast-enhanced MRI with that of contrast-enhanced CT for the diagnosis of appendicitis in adolescents when interpreted by abdominal radiologists and pediatric radiologists. SUBJECTS AND METHODS: Our study included a prospectively enrolled cohort of 48 patients (12-20 years old) with nontraumatic abdominal pain who underwent CT and MRI...
August 10, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28793910/the-prevalence-of-non-cardiac-chest-pain-nccp-using-emergency-department-ed-data-a-northern-ireland-based-study
#17
Orla McDevitt-Petrovic, Karen Kirby, Mark Shevlin
BACKGROUND: The aim of this study was to assess the frequency of chest pain presentations and the subsequent non-cardiac chest pain diagnoses in an emergency department (ED) over a 3 year period. METHODS: Administrative data on ED attendances to an urban general hospital in Northern Ireland between March 2013 and March 2016 were used. Data were coded and analysed to estimate frequencies of 'chest pain' presentation and the subsequent diagnoses for each year. RESULTS: Both chest pain presentations and chest pain presentations with a subsequent diagnosis of unknown cause increased each year...
August 9, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28793384/factors-that-influence-care-priority-for-chest-pain-patients-using-the-manchester-triage-system
#18
Carine Lais Nonnenmacher, Ananda Ughini Bertoldo Pires, Vitor Monteiro Moraes, Amália de Fátima Lucena
AIMS AND OBJECTIVES: Analyze crucial factors for determining care priority for patients with acute myocardial infarction based on the Manchester Triage System. BACKGROUND: Triage is the first potentially critical step in the care of myocardial infarction patients. However, there are still very few studies on the factors interfering in the lack of care priority for these patients, impacting their treatment and prognosis. DESIGN: Retrospective cohort study with 217 patients in the emergency department of a Brazilian hospital...
August 9, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28793374/pain-assessment-by-emergency-nurses-at-triage-in-the-emergency-department-a-qualitative-study
#19
Marilène Vuille, Maryline Foerster, Eliane Foucault, Olivier Hugli
AIM: To investigate the assessment of pain intensity in the specific context of triage. BACKGROUND: Acute pain affects most patients admitted in emergency departments (ED) but pain relief in this setting remains insufficient. Evaluation of pain and its treatment at the time of patient triage expedites the administration of analgesia, but may be awkward at this time-pressured moment. The assessment of pain intensity by a validated pain scale is a critical initial step, and a patient's self-reporting is widely considered as the key to effective pain management...
August 9, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28791786/emergency-department-provider-perspectives-on-benzodiazepine-opioid-co-prescribing-a-qualitative-study
#20
Howard S Kim, Danielle M McCarthy, Jason A Hoppe, D Mark Courtney, Bruce L Lambert
OBJECTIVE: Benzodiazepines and opioids are prescribed simultaneously (i.e. "co-prescribed") in many clinical settings, despite guidelines advising against this practice and mounting evidence that concomitant use of both medications increases overdose risk. This study sought to characterize the contexts in which benzodiazepine-opioid co-prescribing occurs and providers' reasons for co-prescribing. METHODS: We conducted focus groups with ED providers (resident and attending physicians, advanced practice providers, and pharmacists) from three hospitals using semi-structured interviews to elicit perspectives on benzodiazepine-opioid co-prescribing...
August 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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