The American journal of emergency medicine
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Compartment syndrome is a potentially limb-threatening disease process, leading to decreased tissue perfusion and cellular death [1]. The following presentation is believed to be the first reported case of thenar compartment syndrome, which occurred without an identifiable cause. A 67-year-old male presented with 12 h of left-hand pain, located at the base of the thumb and worsened with movement. ⋯ The diagnosis was confirmed and successfully managed in the operating room. While relatively uncommon, clinicians should consider the diagnosis of compartment syndrome of the hand when patients present with acute hand pain. A missed or delayed diagnosis can lead to severe morbidity, which can profoundly affect patients' functional outcomes and quality of life.
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The shock index is a rapid and simple tool used to predict mortality in patients with acute illnesses including sepsis, multiple trauma, and postpartum hemorrhage. However, its ability to predict mortality in geriatric patients with influenza in the emergency department (ED) remains unclear. This study was conducted to clarify this issue. ⋯ A shock index ≥1 has a high specificity, negative predictive value, and good reliability to predict 30-day mortality in geriatric ED patients with influenza.
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Synovial lactate is a promising biomarker to distinguish septic from aseptic arthritis. If available as a point-of care test, synovial lactate would be rapidly available to aid the emergency provider in clinical decision making. This study assesses the test characteristics of synovial lactate obtained using an EPOC© point-of-care (POC) analyzer to rapidly distinguish septic from aseptic arthritis in the emergency department. ⋯ It is feasible to obtain a synovial lactate level using the EPOC© POC device. In our study, POC SLL performs similarly to other markers used to diagnose septic arthritis. Further study with larger sample sizes is warranted.
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In 2015, approximately 13,436 snowboarding or skiing injuries occurred in children younger than 15. We describe injury patterns of pediatric snow sport participants based on age, activity at the time of injury, and use of protective equipment. ⋯ Level III (Retrospective Comparative Study).
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We studied the impact four new urgent care centers (UCCs) had on a hospital emergency department (ED) in terms of overall census and proportion of low acuity diagnoses from 2009 to 2016. We hypothesized that low acuity medical problems frequently seen in UCCs would decrease in the ED population. Since Medicaid was not accepted at these UCCs, we also studied the Medicaid vs non-Medicaid discharged populations to see if there were some differences related to access to urgent care. ⋯ With the introduction of four new urgent care centers (UCCs) within 5 miles of the hospital, the ED diagnoses of pharyngitis and bronchitis, two of the most common diagnoses seen in UCCs, decreased significantly. Significantly more Medicaid discharged patients presented to the ED with pharyngitis than in the non-Medicaid discharged group, likely because Medicaid patients had no access to UCCs.