The American journal of emergency medicine
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Cardiac point-of-care ultrasound (POCUS) can evaluate for systolic and diastolic dysfunction to inform care in the Emergency Department (ED). However, accurate assessment can be limited by user experience. Artificial intelligence (AI) has been proposed as a model to increase the accuracy of cardiac POCUS. However, there is limited evidence of the accuracy of AI in the clinical environment. The objective of this study was to determine the diagnostic accuracy of AI for identifying systolic and diastolic dysfunction compared with expert reviewers. ⋯ When compared with expert assessment, AI had high sensitivity and specificity for diagnosing both systolic and diastolic dysfunction.
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Case Reports
Rectus sheath nerve block for analgesia & incarcerated hernia reduction in the emergency department.
Patients who present to the emergency department (ED) with incarcerated or strangulated ventral hernias are often in significant pain. Furthermore, even with procedural sedation, reduction itself also causes substantial pain. Hernias that cannot be reduced at the bedside with intravenous opioids or procedural sedation will require emergent surgery, which contributes to morbidity and mortality, especially in high-risk populations. ⋯ Ultrasound can visualize and diagnose an incarcerated hernia, and a bilateral rectus sheath block can be performed in the ED to anesthetize the peritoneal wall, paralyze abdominal musculature, and achieve nearly painless hernia reduction.
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Case Reports
Treatment of shoulder pain with ultrasound-guided interfascial plane block: A case series.
Shoulder pain is a common presentation to the Emergency Department (ED). Despite an increasing volume of ED visits for shoulder pain, achieving adequate pain control can be challenging. Ultrasound-guided nerve blocks, such as the interscalene nerve block (ISB), are effective but can cause hemidiaphragmatic paresis and motor dysfunction. The interfascial plane block (IPB) is a simple and new regional anesthesia technique that spares the diaphragm, and most upper extremity motor function. ⋯ The ultrasound-guided IPB is a simple, safe, and effective alternative approach to treating shoulder pain in the ED, especially in patients who may not tolerate ISB.
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This cross-sectional analysis of 86,111 visits for sickle cell disease and vaso-occlusive episodes (VOE) in U.S. pediatric emergency departments between 2013 and 2023 shows increased use of NSAIDs, ketamine, and acetaminophen, with unchanged opioid use. Hospitals with a higher volume of VOE visits more frequently administered opioids. ⋯ Over the past decade, the use of NSAIDs, acetaminophen, and ketamine has increased in the management of VOE in pediatric SCD patients, while opioid use remains consistent. The co-administration of NSAIDs and opioids has also increased, reflecting guideline adherence. Variations in analgesia practices across hospitals underscore the need for standardizing pain management strategies in this population.