The American journal of emergency medicine
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Emergency departments (EDs) were the first application center for Covid-19 patients, as in almost all diseases. For this reason, a serious mental burden has arisen for ED workers. This study was conducted to determine the possible rate of Posttraumatic Stress Disorder (PTSD) and factors that may be associated with PTSD symptom severity in physicians and nurses working in EDs. ⋯ The results of our study showed that both profession groups are at risk for PTSD, and contrary to the existing literature, this rate may be higher in physicians than in nurses. HCWs in the EDs needed protective and supportive mental health models in terms of PTSD.
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Case Reports
Indirect signs of aortic dissection on POC-TTE despite an ADD-RS of 0 and D-dimer < 500 ng/mL: A case report.
Aortic dissection (AD) is a "can't miss" diagnosis for emergency physicians. An algorithm combining the Aortic Dissection Detection Risk Score (ADD-RS) with D-dimer has been proposed as a high-sensitivity clinical decision tool for AD that can determine the need for advanced imaging. Here we present a case of a 48-year-old male who presented to the emergency department (ED) with chest pain and dyspnea. ⋯ The patient successfully underwent surgical repair. This case demonstrates that the ADD-RS + D-dimer algorithm would have erroneously ruled out AD, without the inclusion of indirect findings of AD from the POC-TTE. This highlights the value of using POC-TTE as an adjunct to the ADD-RS + D-dimer algorithm in the diagnostic evaluation of AD and how giving more weight to indirect signs of AD on POC-TTE could potentially increase the sensitivity of the combined ADD-RS + D-dimer + POC-TTE algorithm.
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The diagnosis of Fitz-Hugh-Curtis syndrome (FHC) is often missed or delayed in patients with right upper quadrant pain (RUQ). ⋯ Our decision rule shows promise in allowing for the early identification of FHC in adolescent and young adult females. Additional study is needed to corroborate these findings and test its generalizability.
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The indications for prehospital hydroxocobalamin are not well defined. The aim of this study was to evaluate prehospital signs and symptoms in patients who received hydroxocobalamin to improve future use. ⋯ Prehospital hydroxocobalamin was used empirically however, indications are unclear. Using defined clinical indications may provide greater clarity for providers and reduce unnecessary use of hydroxocobalamin.
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We aimed to better understand variation in opioid prescribing practices by investigating physician factors at one academic suburban Emergency Department (ED). ⋯ This study could inform policymakers by describing patterns of variation in opioid prescribing over time and between providers. Although we did see significant differences in prescribing patterns from one provider to the next, those were not explained by the factors we examined. Further studies could investigate factors such as provider experience with pain and addiction, bias regarding particular pathologies, and concern around patient satisfaction scores.