J Emerg Med
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Analyses of patient flow through the emergency department (ED) typically focus on metrics such as wait time, total length of stay (LOS), or boarding time. Less is known about how much interaction a patient has with clinicians after being placed in a room, or what proportion of their in-room visit is also spent waiting. ⋯ Approximately 75% of a patient's time in a care area is spent not interacting with providers. Although some of the time waiting is out of the providers' control (eg, awaiting imaging studies), this significant downtime represents an opportunity for both process improvement efforts and innovative patient-education efforts to make use of remaining downtime.
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Concentrated laundry detergent packs are new products that may be more likely to cause adverse effects and serious medical outcomes among young children than traditional laundry detergent products. ⋯ Pediatric exposures to laundry detergent packs were more likely to be referred to health care facilities if the laundry detergent pack brand was Purex(TM), the exposure was ocular, or particular ocular, respiratory, dermal, or neurologic clinical effects were present.
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Obese and overweight people have higher rates of ankle injury, particularly operative ankle fractures. The initial management of unstable ankle fractures includes closed reduction and splinting to limit soft tissue injury and articular cartilage damage until definitive operative fixation can be performed. Adequate reduction can be more difficult in the obese patient due to the weight and additional padding provided by the larger soft tissue envelope. ⋯ Obese patients have unique musculoskeletal injury profiles and special considerations in their management. The authors have found this technique useful in the management of their ankle fractures.
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Cerebral aneurysms most commonly present with subarachnoid hemorrhage (SAH), a catastrophic event. However, 11-15% of unruptured aneurysms are symptomatic, with presentations including seizures, unilateral cranial nerve deficits, visual loss, headache, and ischemia. Of patients presenting with seizures, the semiology described includes speech arrest, "feelings of dread," localized pins and needles, and tonic clonic episodes. We report the case of a patient who presented to the emergency department (ED) with complex partial seizures secondary to a cerebral aneurysm. ⋯ A 54-year-old woman presented to the ED after an episode where she had noticed a "bad smell" and sensations of nausea and dizziness. This was the third episode she had experienced in 2 weeks, and other than migraine, she had no significant medical or family history. Physical examination was normal, but a computed tomography (CT) scan of the brain revealed a 15-mm aneurysm of the right middle cerebral artery. The patient was subsequently transferred for urgent neurosurgical intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The emergency physician should strongly consider the use of head CT in the evaluation of adults presenting with a first unprovoked seizure, as rarely they can be caused by urgent pathologies including cerebral aneurysms. If a patient is found to have a possible symptomatic unruptured aneurysm, they should be referred for urgent neurosurgical consultation, as these lesions have an increased risk of rupture.