The American journal of emergency medicine
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Comparative Study
Opioid doses and acute care utilization outcomes for adults with sickle cell disease: Emergency department versus acute care unit.
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. ⋯ Applying guidelines for higher dosing of opioids for acute painful episodes in adults with SCD in ACU was associated with improved pain outcomes and decreased hospitalizations, compared to ED. Adoption of this approach for SCD pain in ED may result in improved outcomes, including a decrease in hospital admissions.
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In this study, we aimed to investigate whether performing the immobilization at 20° instead of 0° changes cerebral oxygenation. ⋯ Our study results revealed that spinal immobilization at 20°, which was a new suggestion for spinal immobilization following a report that this position reduced the decrease in pulmonary function secondary to spinal immobilization, did not alter the cerebral oxygenation, so this suggestion is safe at least from the standpoint of cerebral oxygenation.
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Cyanoacrylate (LOCTITE® 401™) is a fast-acting adhesive available nationwide, with medical and household uses. Most cases of cyanoacrylate exposure are accidental and occur in children less than 5years old. ⋯ In addition, there have been no reports of serious complications following intentional cyanoacrylate ingestion requiring surgical intervention. Herein, we report a case of intentional ingestion of cyanoacrylate in a 70-year-old man who required gastric wedge resection due to delayed gastric perforation.
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Household pets are well known to cause allergic symptoms in susceptible individuals, most commonly conjunctivitis, rhinitis, bronchospasm or urticaria. The increasing prevalence of exotic pets, including rodents, may introduce novel allergens into the household setting. We describe the case of a 16-year-old female who presented to the emergency department (ED) with an immediate systemic reaction consistent with anaphylaxis following a bite injury from a pet Mongolian gerbil. Although rare, gerbil bite injury represents another possible allergen source for precipitating a severe allergic reaction.
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In adult patients with blunt trauma, severe mechanism of injury leads to routine pan-computed tomography (CT). Due to concerns about the risk of radiation, we sought to determine whether clinical suspicion could identify children requiring radiographic imaging. ⋯ In our study, clinical suspicion was able to identify children with CSI. If further studies support our findings, using clinical suspicion rather than mechanism alone to guide radiographic imaging may avoid unnecessary radiation exposure.