The American journal of emergency medicine
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Multicenter Study
Antiseizure medication practices in the adult traumatic brain injury patient population.
Antiseizure medication (ASM) use in traumatic brain injuries (TBI) reduces the risk of early post-traumatic seizure (PTS). Agent selection and dosing strategies remain inconsistent among trauma centers in the United States. ⋯ This multicenter, survey study, identified variances in practice for PTS prophylaxis for brain injured patients throughout the U.S. Interestingly, the overwhelming majority of trauma centers do not conform to the Brain Trauma Foundation guidelines and utilize LEV as their agent of choice. Further studies should evaluate ideal patient selection for PTS prophylaxis, optimal agent, and dosing schemes within this cohort.
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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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Marchiafava Bignami Disease (MBD) is a reversible neurological disorder with can be difficult to diagnose initially due to variable neurological presentations that can be seen in patients. Physicians need to consider this diagnosis as the readily available treatment of thiamine can help reverse symptoms and prevent long lasting effects. We present the case of a 52-year-old man with a history of alcohol use disorder who presented with concerns for a cerebrovascular accident. ⋯ MRI revealed restricted diffusion in the corpus callosum which helped confirm the diagnosis of MBD. Treatment with thiamine helped the patient get back to their usual state of health with no new neurological deficits. This case emphasizes that MBD is a rare neurological disorder that must be considered in patients with alcohol use disorder who present with varying neurological symptoms as early thiamine treatment can reverse symptoms.
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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.
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Intravenous thrombolysis remains the primary treatment for acute ischemic stroke (AIS); however, administration is time sensitive. Teleneurology services have increased in popularity in recent years due to their ability to aid in triaging patients with neurological conditions. Teleneurology services were implemented at this comprehensive stroke center, in August 2023 to aid in streamlining the administration of tenecteplase in AIS patients. Currently, there are no studies assessing whether the implementation of teleneurology services at a comprehensive stroke center influences tenecteplase door-to-needle time. The purpose of this study is to evaluate the difference in door-to-needle times when tenecteplase is administered with versus without a teleneurology consult. ⋯ Among patients who received tenecteplase for the treatment of AIS, there was a significant reduction in door-to-needle time with the use of teleneurology services. There was no difference in neurological improvement or rate of hemorrhagic conversion.