The American journal of emergency medicine
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The erector spinae plane block (ESPB) is a relatively new regional anesthetic procedure that provides analgesia below the erector spinae muscles in an interfascial plane. The indications for its use continue to expand as we learn more about this block. ⋯ The erector spinae block is a safe and cost-effective intervention in refractory postherpetic neuralgia.
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Leaving before medically advised (BMA) is a significant issue in the US healthcare system, leading to adverse health outcomes and increased costs. Despite previous research, multi-year studies using up-to-date nationwide emergency department (ED) data, are limited. This study examines factors associated with leaving BMA from EDs and trends over time, before and during the COVID-19 pandemic. ⋯ In this study, several demographics, socio-economic, and clinical characteristics were associated with higher incidences of leaving ED BMA. The COVID-19 pandemic also exacerbated BMA rates. These findings highlight the need for targeted interventions to improve patient-provider communication and ED triage efficiency, especially in resource-constrained facilities serving lower-income individuals.
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Primary varicella-zoster virus (VZV) infection typically occurs in childhood and is generally mild. However, in immunocompromised patients, VZV-related diseases can be more severe. Fatal cases of disseminated varicella are still rare. We report a fatal case of disseminated varicella in a young adult on long-term oral corticosteroids.
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Recent studies have validated the efficacy of point-of-care ultrasound (POCUS) as an alternative diagnostic imaging approach to computed tomography (CT) for patients with suspected acute diverticulitis. This study aimed to quantify the national impact of this approach in cost savings, ED length-of-stay (LOS), and radiation risk mitigation using a POCUS-first approach for acute diverticulitis in the emergency department (ED). ⋯ Both POCUS-first models can achieve substantial national annual cost savings, ED LOS reduction, and decreases in radiation exposure compared to the traditional CT-first approach. POCUS should be strongly considered as a first-line imaging modality for acute diverticulitis especially among low-risk patients.