The American journal of emergency medicine
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Nephrostomy tubes are commonly placed for urinary obstruction, urinary diversion, or future endourologic procedures. While the technical success of nephrostomy tube placement is high, nephrostomy tube complications may occur. ⋯ This narrative review highlights general nephrostomy tube care, minor complications, and troubleshooting in the emergency department. The majority of these minor complications can be managed at the bedside without specialty consultation. However, in patients with more serious complications including dislodgement, obstruction, infection, bleeding, and pleural injury, laboratory assessment and advanced imaging to include ultrasound and computed tomography with specialty consultation are essential in the patient's evaluation and management, particularly in cases of immune compromise and worsening renal function.
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Case Reports
Traumatic splenic laceration with delayed rupture secondary to coughing in a patient with Von Willebrand disease.
We describe the case of a 54-year-old male with Von Willebrand Disease who presented to the Emergency Department (ED) with 2 weeks of worsening abdominal pain after falling on his left flank while boating. On his initial presentation, he was found to have a Grade II splenic injury that was managed non operatively by the trauma service. Four days later, he returned to the ED when he developed severe abdominal pain after coughing and was found to have active extravasation from the splenic parenchyma with hemoperitoneum on CT angiography and a grossly positive FAST exam. Intraoperatively, he was found to have a Grade V splenic injury and subsequently underwent splenectomy.
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Randomized Controlled Trial Comparative Study
Comparing two doses of intramuscular ketorolac for treatment of acute musculoskeletal pain in a military emergency department.
The goal of the study was to assess a low-dose versus a high-dose of intramuscular (IM) ketorolac for non-inferiority in adults with acute MSK pain in an emergency department (ED). ⋯ A 15 mg dose of IM ketorolac was found to be non-inferior to a 60 mg dose for acute MSK pain in adults presenting to the ED. Discontinuing the practice of ordering 60 mg doses of IM ketorolac in place of a lower dose for acute MSK pain should be considered.
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Acute heart failure (HF) exacerbation is a serious and common condition seen in the Emergency Department (ED) that has significant morbidity and mortality. There are multiple clinical decision tools that Emergency Physicians (EPs) can use to reach an appropriate evidence-based disposition for these patients. ⋯ This article discusses evidence-based disposition of patients in acute decompensated HF presenting to the ED. Knowledge of these factors and risk tools can assist emergency clinicians in determining appropriate disposition of patients with HF.
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Meta Analysis
Prevalence of myocardial infarction among patients with chest pain and cocaine use: A systematic review and meta-analysis.
Cocaine abuse is a public health burden. Cocaine is known to cause vasospasm and acute myocardial infarction (AMI). The prevalence of AMI in patients presenting with chest pain and concurrent cocaine use (CPCC) varies among studies. We performed a systemic review and meta-analysis to assess the current literature for the prevalence of AMI in patients with CPCC. ⋯ The overall prevalence of AMI and death among patients with cocaine-associated chest pain was relatively low, although high risk patients were still associated with high prevalence of AMI. Clinicians should consider risk-stratify these patients and treat them accordingly.