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Pain and emergency department

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https://www.readbyqxmd.com/read/28228912/anatomical-variation-t1-spina-bifida-occulta-radiological-findings
#1
Guglielmo Manenti, Riccardo Iundusi, Eliseo Picchi, Salvatore Marsico, Adolfo D'Onofrio, Giorgia Rossi, Umberto Tarantino, Roberto Floris
We report a 26-year-old male patient who was admitted to our emergency department after a traffic accident and who suffered from neck pain. We have found accidentally a dorsal spinous process schisis, a very rare vertebral abnormality, that we recognized in the X-rays imaging performed for the study of the lung parenchyma.
March 2017: Radiology case reports
https://www.readbyqxmd.com/read/28228898/disseminated-coccidioidomycosis-with-multifocal-musculoskeletal-disease-involvement
#2
Michael F McConnell, Ann Shi, Todd M Lasco, Luke Yoon
We report a rare case of disseminated coccidioidomycosis with multifocal musculoskeletal involvement. The patient presented to the emergency department with left shoulder pain and swelling. Magnetic resonance imaging of the left shoulder revealed enhancing soft tissue masses, bony lesions, and fluid collections in and around the glenohumeral joint with involvement of the proximal humerus, glenoid, and rotator cuff musculature. Multiple additional areas of involvement were subsequently discovered. Fungal cultures confirmed coccidioidomycosis infection at all surgical sites with superimposed polymicrobial bacterial infection in the left shoulder...
March 2017: Radiology case reports
https://www.readbyqxmd.com/read/28228876/a-hairy-situation-trichobezoar-presenting-with-intussusception-and-intestinal-and-biliary-perforation-in-a-child
#3
Akshay D Baheti, Jeffrey P Otjen, Grace S Phillips
Trichobezoars are an uncommon cause of acute abdominal pain. We present a case of a 12-year-old girl with a history of a trichobezoar who presented to the emergency department with acute abdominal pain. Abdominal sonography was performed which suggested portal venous gas and showed complex peritoneal fluid. Subsequent computed tomography demonstrated both gastric and small bowel bezoars, with a jejunojejunal intussusception, and confirmed portal venous gas and complex ascites. At the time of surgery, there was evidence of intestinal and biliary perforation...
March 2017: Radiology case reports
https://www.readbyqxmd.com/read/28228875/traumatic-nonanastomotic-axilloprofundal-ptfe-bypass-rupture-a-case-report
#4
Borna K Barth, Fabian Hässler, Oliver Graubitz
A 76-year-old male patient was admitted to our emergency department with painful swelling of the right lateral chest after a fall. Imaging revealed a hematoma, secondary to rupture of a synthetic axilloprofundal bypass. In an emergency surgical procedure, the spelled hematoma was evacuated and the graft legs were successfully ligated. The patient was discharged after an uneventful hospital stay. Traumatic bypass rupture because of blunt trauma is an exceedingly rare event; however, it must be taken into consideration in a patient with bypass surgery in his/her history...
March 2017: Radiology case reports
https://www.readbyqxmd.com/read/28228343/ultrasound-guided-femoral-nerve-blockage-in-a-patellar-dislocation-an-effective-technique-for-emergency-physicians
#5
Sami Eksert, Sinan Akay, Murtaza Kaya, Ali Kantemir, Kenan Keklikci
BACKGROUND: Patellar dislocation is an orthopedic emergency and its reduction can be painful. The aim of this case is to show that the ultrasound-guided femoral nerve blockage can be effectively used in the pain management of patellar reduction in the emergency department (ED). CASE REPORT: A 21-year-old man was admitted to our ED after suffering a fall down a flight of stairs. The initial physical examination and plain radiography showed a patellar dislocation in the right knee...
February 19, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28228138/current-management-practices-for-patients-presenting-with-low-back-pain-to-a-large-emergency-department-in-canada
#6
Matthew L Nunn, Jill A Hayden, Kirk Magee
BACKGROUND: Low back pain (LBP) is one of the leading causes of disability. Presentations to the emergency department (ED) are common and consume significant healthcare resources. However, treatment of patients with LBP is variable and highly physician dependent. Our study objective was to describe the demographic and clinical characteristics of patients presenting to the ED with LBP, the diagnostic strategies employed by ED physicians, and the subsequent management. METHODS: We conducted a retrospective study using clinical and electronic health data at the Queen Elizabeth II Health Science Center's Charles V...
February 23, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28226416/the-contribution-of-the-emergency-department-to-opioid-pain-reliever-misuse-and-diversion-a-critical-review
#7
REVIEW
Tatyana Lyapustina, Renan Castillo, Elise Omaki, Wendy Shields, Eileen McDonald, Richard Rothman, Andrea Gielen
Prescription opioid pain reliever (OPR) misuse and diversion is an important and growing public health problem in the United States that is responsible for significant morbidity and mortality. Emergency physicians are among the top prescribers of OPRs, yet the relative contribution of emergency department (ED) OPR prescriptions to the overall opioid abuse epidemic remains unclear. This study critically reviews seven peer-reviewed studies that specifically identified the ED as a source of OPRs. Of the OPRs prescribed in the ED, approximately 10% are associated with indicators of inappropriate prescribing, and approximately 42% may ultimately be misused; of the OPRs that are diverted, approximately 10% originate from an ED prescription...
February 22, 2017: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/28222988/thirty-day-and-90-day-hospital-readmission-after-outpatient-upper-extremity-hemodialysis-access-creation
#8
Jeffrey J Siracuse, Nishant K Shah, Matthew R Peacock, Georges Tahhan, Jeffrey A Kalish, Denis Rybin, Mohammad H Eslami, Alik Farber
OBJECTIVE: Patients with end-stage renal disease have multiple comorbidities and are at increased risk for postoperative complications and resource utilization. Our goal was to determine the rate and causes of 30-day and 90-day hospital readmissions after the creation of outpatient hemodialysis access. METHODS: We retrospectively reviewed all outpatient upper extremity hemodialysis access creations performed at our medical center from 2008 to 2015. Readmission was defined as any inpatient status admission ≤30 and 90 days...
February 17, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28222456/nausea-vomiting-%C3%A2-tachycardia-%C3%A2-unintentional-weight-loss-%C3%A2-dx
#9
Daryl J Selen, Matthew P Gilbert
A 22-year-old woman presented to the emergency department (ED) with a 24-hour history of nausea, vomiting, diarrhea, generalized abdominal pain, and mild headache. She denied shortness of breath, chest pain, or anxiety, and didn't have a history of cardiac problems. The physical examination revealed tachycardia (heart rate, 135 beats/min) and a respiratory rate of 24 breaths per minute.
February 2017: Journal of Family Practice
https://www.readbyqxmd.com/read/28221280/the-elusive-diagnosis-of-adolescent-systemic-lupus-erythematosus
#10
Michelino Mancini
Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple systems, and its various symptoms are often mistaken for other diseases. This case report describes a 15-year-old girl who presented to the emergency department with complaints of diffuse abdominal pain, facial swelling, joint pain, low-grade fever, and rash. An initial autoimmune process was suspected, and, with prompt referral, a diagnosis of SLE was confirmed. This case report and discussion review the difficulty of diagnosing SLE and the importance of maintaining autoimmune diseases, such as SLE, on an emergency physician's differential...
February 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28218883/case-239-cerebrotendinous-xanthomatosis
#11
Amy C Gerrish, Suchi Gaba
History A 63-year-old man with learning difficulties presented to the Accident and Emergency Department with right ankle pain after an inversion injury and underwent plain radiography. The patient had developed normally until his teenage years, at which point he experienced cognitive regression. He experienced swallowing difficulties, tinnitus, and fecal incontinence, and he had undergone cataract surgery at the age of 20 years. He also had a small nodule on the volar surface of his right ring finger. Magnetic resonance (MR) imaging of the brain and the right ankle had been performed 3 years previously...
March 2017: Radiology
https://www.readbyqxmd.com/read/28218634/radiology-case-of-the-month-intussusception-in-adults-is-there-a-lead-point
#12
Lorena Garza, Nhan Nguyen, Jeremy Nguyen, Cynthia Hanemann
A 36-year-old woman presents to the emergency department with a 4-day history of progressive lower abdominal pain accompanied by nausea.
January 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28216937/renal-cell-carcinoma-atypical-metastasis-to-inguinal-lymph-nodes
#13
Qamar Saeed Chaudhry, Tanweer Ahmed Naveed Bhatty, Ziauddin Khan, Elsawi Medani Osman
Renal cell carcinoma (RCC) is a common tumor of the urinary tract. It is known to have variable presentations due to the extremely vascular nature of the organ. RCC are known to metastasize to lungs, bone, and brain commonly but atypical metastasis to various sites are reported in literature but as very rare pathology. We report a case of a 60-year-old female who presented with multiple inguinal and axillary lymph node enlargements which on excision biopsy showed metastatic RCC. RCC can present with synchronous metastatic deposits in the various organs...
January 2017: Urology Annals
https://www.readbyqxmd.com/read/28215710/altered-mental-status-in-the-emergency-department-can-an-electrocardiogram-show-the-right-way-to-go
#14
Andre Dias, Emiliana Franco, Jasmine Martinez, Vincent M Figueredo
A 38-year-old African American male patient with a past medical history of human immunodeficiency virus and schizophrenia who was noncompliant with medications presented to the emergency department (ED) after activation of the local crisis response center for altered mental status. Upon arrival he was lethargic and uncooperative, unable to provide any significant details apart from pleuritic chest pain. His blood pressure was 133/88 mmHg, heart rate 43 beats per minute and initial body temperature 36.1 °C which prompted an electrocardiogram (EKG)...
February 2, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28214369/diagnostic-accuracy-of-history-physical-exam-laboratory-tests-and-point-of-care-ultrasound-for-pediatric-acute-appendicitis-in-the-emergency-department-a-systematic-review-and-meta-analysis
#15
Roshanak Benabbas, Mark Hanna, Jay Shah, Richard Sinert
BACKGROUND: Acute appendicitis (AA) is the most common surgical emergency in children. Accurate and timely diagnosis is crucial but challenging due to atypical presentations and the inherent difficulty of obtaining a reliable history and physical examination in younger children. OBJECTIVES: To determine the utility of history, physical exam, laboratory tests, Pediatric Appendicitis Score (PAS) and Emergency Department-Point-of-Care Ultrasound (ED-POCUS) in the diagnosis of AA in ED pediatric patients...
February 18, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28213342/virtual-visits-for-acute-nonurgent-care-a-claims-analysis-of-episode-level-utilization
#16
Aliza S Gordon, Wallace C Adamson, Andrea R DeVries
BACKGROUND: Expansion of virtual health care-real-time video consultation with a physician via the Internet-will continue as use of mobile devices and patient demand for immediate, convenient access to care grow. OBJECTIVE: The objective of the study is to analyze the care provided and the cost of virtual visits over a 3-week episode compared with in-person visits to retail health clinics (RHC), urgent care centers (UCC), emergency departments (ED), or primary care physicians (PCP) for acute, nonurgent conditions...
February 17, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28211278/endoscopic-removal-of-multiple-sharp-gastro-duodenal-foreign-bodies
#17
Samuel Costa, Raquel Gonçalves, Carla Rolanda
A 45 years old female,with bipolar disorder,was brought to the Emergency Department with abdominal pain. The patient was hemodynamically stable,with no signs of respiratory distress. On abdominal examination she had pain in the upper quadrants,without peritoneal irritation. The successful endoscopic removal decreases if delayed approach, beyond 12 h, and sharp objects. Moreover in case of sharp objects, even if already into the stomach or duodenum, they should be retrieved endoscopically if it can be accomplished safely, because the risk of a complication during its natural exteriorization is as high as 35%...
February 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28210363/using-the-electronic-medical-record-to-reduce-unnecessary-ordering-of-coagulation-studies-for-patients-with-chest-pain
#18
Jeremiah S Hinson, Binoy Mistry, Yu-Hsiang Hsieh, Nicholas Risko, David Scordino, Karolina Paziana, Susan Peterson, Rodney Omron
INTRODUCTION: Our goal was to reduce ordering of coagulation studies in the emergency department (ED) that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR). METHODS: We used a pre and post quasi-experimental study design to evaluate the impact of an EMR-based intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28210350/use-of-physician-in-triage-model-in-the-management-of-abdominal-pain-in-an-emergency-department-observation-unit
#19
John R Marshall, Robert Katzer, Shahram Lotfipour, Bharath Chakravarthy, Siri Shastry, Jessica Andrusaitis, Craig L Anderson, Erik D Barton
INTRODUCTION: Given the nationwide increase in emergency department (ED) visits it is of paramount importance for hospitals to find efficient ways to manage patient flow. The purpose of this study was to determine whether there is a significant difference in success rates, length of stay (LOS), and other demographic factors in two cohorts of patients admitted directly to an ED observation unit (EDOU) under an abdominal pain protocol by a physician in triage (bypassing the main ED) versus those admitted via the traditional pathway (evaluated and treated in the main ED prior to EDOU admission)...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28209195/qualitative-exploration-of-why-people-repeatedly-attend-emergency-departments-for-alcohol-related-reasons
#20
Tom Parkman, Joanne Neale, Ed Day, Colin Drummond
BACKGROUND: Understanding why people repeatedly attend Emergency Departments (EDs) for alcohol-related reasons is an important prerequisite to identifying ways of reducing any unnecessary demands on hospital resources. We use Andersen's Behavioural Model of Health Services Use to explore factors that contributed to repeat ED attendances. METHODS: Qualitative interviews were conducted with 30 people who repeatedly attended EDs for alcohol-related reasons (≥10 attendances in the past 12 months)...
February 16, 2017: BMC Health Services Research
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