The American journal of emergency medicine
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Emergency department (ED)-initiated buprenorphine/naloxone has been shown to improve treatment retention and reduce illicit opioid use; however, its potential may be limited by a lack of accessible community-based facilities. This study compared one state's geographic distribution of EDs to outpatient treatment facilities that provide buprenorphine treatment and identified ED and geographic factors associated with treatment access. ⋯ Only half of Michigan EDs are within 10 miles of a buprenorphine treatment facility. Given these limitations, expanding access to ED-initiated buprenorphine in states similar to Michigan may require developing alternative models of care.
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Observational Study
Impact of COVID-19 lockdown on self-harm and violence among patients presenting to the emergency department.
Considering the resurgence of COVID19 and the rapid spread of new and deadlier strains across the globe understanding the incidence and pattern of violence and self harm tendencies during this period might help in formulating better contingency plans for future lockdowns. A deeper look at the available data shows that there is a significant dearth of research into self-harm & violence during the COVID-19 pandemic. ⋯ Increase in the incidence of cases of self-harm and violence reported to the ED was noted during the lockdown period. Upgradation of health-care and law enforcement infrastructure maybe needed to deal with similar circumstances in a more efficient manner.
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The Covid-19 pandemic has had dramatic consequences on the progression of numerous pathologies, especially neoplastic ones. The orientation of hospital activities toward the care of patients with SARS-Cov2 infection has caused significant delays in the diagnosis and therapy of many other pathologies. What about severe hypercalcemia? The aim of this work was to determine the clinical and biological presentation, etiologies, mortality, and the impact of the Covid-19 pandemic on severe hypercalcemia. ⋯ The Covid-19 pandemic caused an increase in both the incidence and severity of hypercalcemia and the hemodialysis practiced in this context remains efficient and safe.
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Case Reports
Needle decompression of the eye! Emergent management of a vision threatening surgical complication.
Acute angle-closure glaucoma (AACG) is a medical emergency that can cause permanent visual deficits without prompt recognition. From 2006 to 2011, nearly 12 million visits to emergency departments (ED) in the United States were ophthalmologic in nature, making it crucial for emergency physicians to be familiar with the diagnosis and treatment of ophthalmologic emergencies. AACG can be precipitated by several mechanisms including pupillary block, anticholinergic medications, and sympathomimetic medications. We present a rare case of angle-closure glaucoma status post pneumatic retinopexy with cryotherapy due to migration of an intravitreal gas bubble into the anterior chamber with emphasis on understanding how retinal surgery types lead to significant differences in management.
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Sepsis is a leading cause of mortality with more than 700,000 hospitalizations and 200,000 deaths annually in the United States. Early recognition of sepsis is critical for timely initiation of treatment and improved outcomes. We sought to evaluate. in-hospital mortality rates of patients diagnosed with sepsis before and after implementation of emergency department (ED) sepsis teams. ⋯ Implementation of ED sepsis teams decreased inpatient hospital mortality rates, ED length of stay and hospital length of stay.