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https://www.readbyqxmd.com/read/29776436/rates-and-causes-of-30-day-readmission-and-emergency-room-utilization-following-head-and-neck-surgery
#1
Vincent Wu, Stephen F Hall
BACKGROUND: Unplanned returns to hospital are common, costly, and potentially avoidable. We aimed to investigate and characterize reasons for all-cause readmissions to hospital as in-patients (IPs) and visits to the Emergency Department (ED) within 30-days following patient discharge post head and neck surgery (HNS). METHODS: Retrospective case series with chart review. All patients within the Department of Otolaryngology - Head and Neck Surgery who underwent HNS for benign and malignant disease from January 1, 2010 to May 31, 2015 were identified...
May 18, 2018: Journal of Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/29773479/emergency-department-diagnosis-of-septic-pulmonary-embolism-due-to-infectious-endocarditis-using-bedside-ultrasound
#2
Jason Arthur, Juvenal Havyarimana, Ashley Booth Norse
BACKGROUND: Septic pulmonary embolism (SPE) is a rare disorder caused by metastasis of infectious thrombi to the lungs. Most commonly, this occurs as a result of infectious endocarditis. This clinical entity may easily be confused for more common and less mortal diagnoses such as pneumonia, bronchitis, or pulmonary embolism. CASE REPORT: A 47-year-old woman presented in respiratory distress with a complaint of cough productive of rusty sputum, shortness of breath, and pleuritic chest pain...
May 14, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29771483/managing-shoulder-injuries-in-the-emergency-department-fracture-dislocation-and-overuse
#3
Richard Pescatore, Andrew Nyce
The complex structures of the shoulder can be injured by fracture, dislocation, and overuse, and correctly identifying and classifying injury is essential to avoiding pain, disability, and life- and limb-threatening complications. This issue presents a systematic approach to classifying shoulder injuries based on the mechanism of injury and clinical presentation, choosing appropriate imaging, and determining the best strategies for treatment, including reduction, surgical consultation, or outpatient referral...
June 2018: Emergency Medicine Practice
https://www.readbyqxmd.com/read/29769153/point-of-care-ultrasound-to-diagnose-appendicitis-in-a-canadian-emergency-department
#4
Sameer Sharif, Steven Skitch, Dean Vlahaki, Andrew Healey
OBJECTIVES: Appendicitis is a common surgical condition that frequently requires diagnostic imaging. Abdominal computed tomography (CT) is the gold standard for diagnosing appendicitis. Ultrasound offers a radiation-free modality; however, its availability outside business hours is limited in many emergency departments (EDs). The purpose of this study is to evaluate the test characteristics of emergency physician-performed point-of-care ultrasound (POCUS) to diagnose appendicitis in a Canadian ED...
May 17, 2018: CJEM
https://www.readbyqxmd.com/read/29768359/case-report-of-gastric-distension-due-to-superior-mesenteric-artery-syndrome-mimicking-hollow-viscus-perforation-considerations-in-critical-care-ultrasound
#5
Yan-Mei Feng, Dong Wan, Rui Guo
RATIONALE: Critical care ultrasound identifies the signs of free intraperitoneal air and echogenic free fluid always indicates hollow viscus perforation (HVP) and needs immediate surgical interventions. However, in rare cases, these classic signs may also mislead proper clinical decisions. We report perforated viscus associated large peritoneal effusion with initial critical care ultrasound findings, whereas computed tomography (CT) examination confirmed a giant stomach due to superior mesenteric artery syndrome (SMAS)...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29766136/can-necrotizing-soft-tissue-infection-be-reliably-diagnosed-in-the-emergency-department
#6
Sharon M Henry, Kimberly A Davis, Jonathan J Morrison, Thomas M Scalea
Necrotizing soft tissue infections (NSTIs) are associated with a high mortality and require prompt recognition and treatment, consisting of aggressive surgical debridement and critical care support. Diagnosis is a key step, which is generally made in the operating room (OR), but the decision to debride requires guidance. This is frequently made on clinical grounds, but NSTI can be occult in presentation and several other infective processes can mimic NSTI. It is unknown whether the various scoring systems described in the literature can enable clinicians to reliably diagnose NSTI in the emergency department, rather than the OR...
2018: Trauma Surg Acute Care Open
https://www.readbyqxmd.com/read/29762935/septic-shock-meningoencephalitis-and-multiple-pulmonary-emboli-case-report-of-an-uncommon-clinical-presentation-of-ventricular-septal-defect-acute-infective-endocarditis
#7
Laura Varela Barca, Jose López-Menéndez, Ana Redondo Palacios, Jorge Rodríguez-Roda Stuart
The case is reported of a 55 year-old woman, with a previously known congenital septal defect, who was admitted to the emergency department with a diagnosis of meningoencephalitis, septic shock, and rapid clinical deterioration. Echocardiography revealed a vegetation occupying the right-side heart. Endocarditis affectation of the septal defect, aortic and tricuspid valves was noted and blood cultures were positive for Staphylococcus aureus. Urgent surgical treatment was performed whereby the ventricular septal defect was closed, a meticulous debridement of the affected area was conducted, and the aortic and tricuspid valves were replaced...
September 2017: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/29762453/microvascular-replantation-following-facial-dog-bites-in-children-systematic-review-and-management-algorithm
#8
Amanda J Williams, Jeremy M Powers, Jennifer L Rhodes, Andrea L Pozez
BACKGROUND: Pediatric dog bite injuries account for 1% of emergency department visits per year and represent an underrecognized and underreported public health problem. Reconstructive surgery is frequently utilized, and in the most extreme injuries, microvascular replantation may be considered. We sought to systematically review the available literature on microvascular replantation after facial dog bite injuries in children, with particular attention to perioperative morbidity and long-term follow-up...
May 14, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29762292/a-dedicated-satellite-trauma-orthopaedic-program-operating-room-safely-increases-capacity
#9
Peter M Waters, Brian W Yang, Doreen White, Ellen Barth, Vincent Chiang, Arielle Mizrahi-Arnaud, William Sparks
BACKGROUND: Providing high-value care for urgent orthopaedic trauma patients requires effective and timely treatment. Herein, we describe the implementation of an innovative program utilizing the operating room (OR) capacity of a satellite campus to decrease stress on a pediatric tertiary care center without jeopardizing patient safety. METHODS: In addition to the daily emergency surgical room on the main campus, a dedicated orthopaedic trauma surgery OR was established in a satellite hospital location for 3 days per week in the summer and for 2 days per week for the rest of the year...
May 16, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29755898/an-unusual-presentation-of-kikuchi-fujimoto-disease-with-recurrent-subdural-effusion
#10
Sara Shahid, Syed H Alam, Indira Hadley
A 24-year-old man complained of a right temporal headache for four weeks. The patient denied any trauma or previous anticoagulation use. He also reported tender right facial swelling. His physical exam was unrevealing except for right cranial nerve (CN) VI palsy, right parotid enlargement, and cervical adenopathy. Laboratory findings were significant for mild leukopenia at 3300 cells/uL. The computed tomography (CT) scan obtained showed a chronic left subdural effusion with a 4 mm midline shift and confirmed right parotid enlargement and cervical lymphadenopathy...
March 10, 2018: Curēus
https://www.readbyqxmd.com/read/29754963/predictors-of-a-drainable-suppurative-adenitis-among-children-presenting-with-cervical-adenopathy
#11
Amir A Kimia, Tiffany F Rudloe, Nadine Aprahamian, Jennifer McNamara, David Roberson, Assaf Landschaft, Jennifer Vaughn, Marvin B Harper
OBJECTIVES: We sought to identify predictors for a drainable suppurative adenitis [DSA] among patients presenting with acute cervical lymphadenitis. METHODS: A retrospective cross sectional study of all patients admitted to an urban pediatric tertiary care emergency department over a 15 year period. Otherwise healthy patients who underwent imaging for an evaluation of cervical lymphadenitis were included. Cases were identified using a text-search module followed by manual review...
May 5, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29753518/application-of-the-canadian-computed-tomography-head-rule-to-patients-with-minimal-head-injury
#12
Kevin Davey, Turandot Saul, Geoffrey Russel, Jonathan Wassermann, Joshua Quaas
STUDY OBJECTIVE: Two clinical decision rules, the Canadian CT Head Rule and the New Orleans Criteria, set the standard to guide clinicians in determining which patients with minor head trauma need computed tomography (CT) imaging. Both rules were derived with patients with minor head injury who had had a loss of consciousness or witnessed disorientation. No evidence exists for evaluating patients and need for CT imaging with minimal head injury; that is, patients who had a head injury but no loss of consciousness or disorientation and therefore would have been excluded from the Canadian CT Head Rule and New Orleans Criteria trials...
May 9, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29751600/inflamed-phylloides-tumour-in-a-girl-a-challenging-diagnosis-in-paediatric-breast-lesions
#13
Ilaria Testa, Cristina Salvatori, Marco Prestipino, Maria Elena Laurenti, Paolo Gerli, Giuseppe Di Cara, Nicola Principi, Susanna Esposito, Mirko Bertozzi
Introduction : Phylloides tumours (PTs) are rare fibroepithelial neoplasms that account for 0.3⁻0.9% of all breast tumours. These tumours typically occur in women aged 30⁻70 years. The occurrence of these tumours in older children and adolescents poses particular diagnostic and therapeutic problems. However, early diagnosis is mandatory because although most of the cases of PTs in children are benign, the borderline and malignant cases with potential negative outcomes cannot be excluded. Case presentation : A 12-year-old girl presented at the Paediatric Emergency Department for hyperaemia and warmth of the left breast that occurred a few days prior without fever...
May 11, 2018: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29749881/reversible-ventriculoperitoneal-shunt-dysfunction-and-chronic-constipation-case-report
#14
Barbara A Morais, Daniel D Cardeal, Fernanda G Andrade, Wellingson S Paiva, Hamilton Matushita, Manoel J Teixeira
Constipation can cause transient malfunction of the ventriculoperitoneal shunt (VPS). Patients with myelomeningocele or cerebral palsy are often diagnosed with hydrocephalus and constipation due to neurogenic bowel. These patients are more prone to VPS dysfunction, often requiring surgical revision. The authors report the case of a 6-year-old girl with a VPS that had been implanted due to hydrocephalus secondary to myelomeningocele. The patient was brought to the emergency department with intermittent headache, vomiting, constipation, and abdominal distension and pain...
May 11, 2018: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/29749778/barriers-to-implementing-the-sepsis-six-guidelines-in-an-acute-hospital-setting
#15
Sarah-Jane Breen, Sharon Rees
AIM: To identify the barriers to implementation of the Sepsis Six pathway. BACKGROUND: Research has suggested that compliance with the Sepsis Six pathway remains low. METHODS: A convenience sample of doctors and nurses from one emergency department, two medical wards and two surgical wards were asked to complete a survey questionnaire. RESULTS: Data from 108 respondents were available for analysis. Doctors and nurses agreed that lack of sepsis recognition during observation rounds and failure to associate sepsis with deranged temperature and blood results acted as barriers to the identification of sepsis...
May 10, 2018: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/29747669/role-of-the-general-practitioner-in-improving-rural-healthcare-access-a-case-from-nepal
#16
Bikash Gauchan, Stephen Mehanni, Pawan Agrawal, Mandeep Pathak, Santosh Dhungana
BACKGROUND: There is a global health workforce shortage, which is considered critical in Nepal, a low-income country with a predominantly rural population. General practitioners (GPs) may play a key role improving access to essential health services in rural Nepal, though they are currently underrepresented at the district hospital level. The objective of this paper is to describe how GPs are adding value in rural Nepal by exploring clinical, leadership, and educational roles currently performed in a rural district-level hospital...
May 10, 2018: Human Resources for Health
https://www.readbyqxmd.com/read/29746364/management-and-outcome-of-pediatric-patients-with-transient-small-bowel-small-bowel-intussusception
#17
Jennifer E Melvin, Noel S Zuckerbraun, Chijindu R Nworgu, Kevin P Mollen, Andre D Furtado, Mioara D Manole
OBJECTIVE: The aim of this study was to assess the management and outcomes of healthy pediatric patients diagnosed radiologically with transient and benign small bowel-small bowel intussusception (SB-SBI). METHODS: Retrospective cohort study of healthy patients 0 to 18 years of age who presented to a children's hospital emergency department from January 1, 2005, to June 30, 2015, and had transient and benign SB-SBI characterized by spontaneous resolution (ie, transient), diameter of less than 2...
May 5, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29742719/cauda-equina-syndrome-following-an-uneventful-spinal-anesthesia-in-a-patient-undergoing-drainage-of-the-bartholin-abscess-a-case-report
#18
Waldo Merino-Urrutia, Milca Villagrán-Schmidt, Priscilla Ulloa-Vásquez, Rubén Carrasco-Moyano, Alberto Uribe, Nicoleta Stoicea, Sergio D Bergese
RATIONALE: Neuraxial anesthesia is a commonly used type of regional anesthesia. Cauda equina syndrome is an unusual and severe complication of neuraxial anesthesia, and is caused by damage to the sacral roots of the neural canal. We present a case of cauda equina syndrome following spinal anesthesia in a patient who underwent Bartholin abscess drainage. PATIENT CONCERNS: A 23-year old female scheduled to undergo surgical drainage of Bartholin abscess. Spinal anesthesia was performed with bupivacaine and fentanyl...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29742468/native-septic-arthritis-is-not-an-immediate-surgical-emergency
#19
Nicolas Lauper, Marie Davat, Ergys Gjika, Camillo Müller, Wilson Belaieff, Didier Pittet, Benjamin A Lipsky, Didier Hannouche, Ilker Uçkay
Acute native joint septic arthritis is generally considered a surgical emergency, requiring drainage within hours, including during night, weekend or holiday shifts. However, there are few data supporting the need for the disruption caused by this degree of urgency. METHODS: We performed a retrospective review of all adult patients seen in our medical center from 1997-2015 with culture-proven septic arthritis and noted the epidemiology of sequelae, and their possible association with a delay in surgical drainage...
May 6, 2018: Journal of Infection
https://www.readbyqxmd.com/read/29740589/cervical-hyperostosis-leading-to-dyspnea-aspiration-and-dysphagia-strategies-to-improve-patient-management
#20
Georgios Psychogios, Monika Jering, Johannes Zenk
Diffuse idiopathic skeletal hyperostosis (DISH) is a rare but well known cause of dysphagia. In very few cases aspiration and dyspnea are described as a clinical manifestation. An 82-year-old man presented himself in our clinic with severe dyspnea, aspiration, and pneumonia. After performing a microlaryngoscopy an emergency tracheotomy became necessary. In laryngoscopy a severe bulging of the posterior oropharyngeal and hypopharyngeal wall was detected. The glottis area was not observable and immobilisation of the right vocal cord could be detected...
2018: Frontiers in Surgery
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