The American journal of emergency medicine
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Cannabidiol (CBD) has become a popular supplement in consumer products in recent years, resulting in part from normalization of the cultivation of low THC cannabis in 2018. However, the actual content of CBD-labeled products is frequently uncertain, as oversight of such products is minimal. To date, there is little pragmatic knowledge regarding exposures to products labeled as containing CBD. ⋯ Cases reported to Poison Control Centers regarding exposures to CBD-labeled products have been increasing, representing an emerging trend of interest to Poison Control Center professionals, clinicians, and public health officials. Further monitoring of this trend is recommended.
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To develop a novel predictive model for emergency department (ED) hourly occupancy using readily available data at time of prediction with a time series analysis methodology. ⋯ Accounting for current ED occupancy, average department-wide ESI, and boarding total, a 24-SARIMAX model was able to provide up to 4 h ahead predictions of ED occupancy with improved performance characteristics compared to other forecasting methods, including the rolling average. The prediction intervals generated by this method used data readily available in most EDs and suggest a promising new technique to forecast ED occupancy in real time.
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Gallstone disease is a burden affecting about 15% percent of the population around the world. The complications of gallstone disease are numerous and many require emergency care. Severe complications are not uncommon and require special attention, as lethal outcome is possible. ⋯ Special care should be taken in patients with risk factors of severe complications in order to improve outcome and prevent the development of life-threatening conditions.
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Patients with white-eyed blowout fracture with muscle entrapment in the pediatric population may be misdiagnosed as increased intracranial pressure (ICP) due to the similarity in presenting symptoms. A delay in the correct diagnosis can lead to permanent sequelae including diplopia, permanent loss of vision, and death. In this case report we discuss the treatment of a male pediatric patient who presented in the ED with nausea, confusion, and restricted eye gaze. ⋯ Symptoms of white-eyed orbital blowout fractures with muscle entrapment easily mimic symptoms of head trauma with increased ICP. Misdiagnosis of trapdoor orbital fractures with entrapment can be avoided by ordering and critically reviewing an orbital CT and requesting an ophthalmologic consultation in the ED to evaluate extraocular movement. This report should help to increase awareness of symptoms of white-eyed orbital blowout fractures with muscle entrapment, prevent confusion with elevated ICP, and assist accurate and timely diagnosis in the ED to arrange appropriate management and surgical intervention to ensure best outcomes.
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We present the case of a 2-month-old adopted female seeking evaluation in the pediatric emergency department due to a one-day history of decreased right arm movement and fussiness. The physical exam was largely unremarkable with the exception of decreased spontaneous movement of the right upper extremity, obvious discomfort with passive movement and subtle edema of the forearm. Because of concern for non-accidental trauma, plain films were obtained which revealed no signs of traumatic injury. ⋯ These abnormalities led to the consideration of congenitally acquired infections, specifically syphilis, and serologies were confirmatory. Ultimately, the infant was diagnosed with Pseudoparalysis of Parrot - a rare musculoskeletal manifestation secondary to painful syphilitic periostitis. As Emergency Medicine physicians, it is important to be aware of the growing burden of syphilis infection and reacquaint ourselves with its numerous presentations in the young infant.