J Emerg Med
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Randomized Controlled Trial
Injectable Lidocaine Provides Similar Analgesia Compared to Transdermal Lidocaine/Tetracaine Patch for the Incision and Drainage of Skin Abscesses: A Randomized, Controlled Trial.
Local anesthesia used for incision and drainage of abscesses is known to be painful. ⋯ Local injection of lidocaine provided clinically similar analgesia compared to the lidocaine/tetracaine patch during I&D of skin abscesses in the ED. Pain at presentation and after the procedure was similar in both groups. Emergency physicians should continue to use a local injected anesthetic for I&D of skin abscesses until a less painful alternative is identified.
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Orbital injury secondary to petroleum-based products is rare. We report the first case, to our knowledge, of a combined compressed air and chemical orbital injury, which mimicked necrotizing fasciitis. ⋯ A 58-year-old man was repairing his motorcycle engine when a piston inadvertently fired, discharging compressed air and petroleum-based carburetor cleaner into his left eye. He developed surgical emphysema, skin necrosis, and a chemical cellulitis, causing an orbital compartment syndrome. He was treated initially with antibiotics and subsequently with intravenous steroid and orbital decompression surgery. There was almost complete recovery by 4 weeks postsurgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Petroleum-based products can cause severe skin irritation and necrosis. Compressed air injury can cause surgical emphysema. When these two mechanisms of injury are combined, the resulting orbitopathy and skin necrosis can mimic necrotizing fasciitis and cause diagnostic confusion. A favorable outcome is achievable with aggressive timely management.
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Night shift work is an integral component of the practice of emergency medicine (EM). Previous studies have demonstrated the challenges of night shift work to health and well being among health care providers. ⋯ Emergency physicians report negative impacts of night shift work, including fatigue, poor quality of sleep, mood decrement, irritability, and health challenges. Night shifts have a negative influence on job satisfaction and can be a factor in the decision to retire.
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Increasing numbers of emergency medicine (EM) residents and fellows are completing additional training with the intention of pursuing careers in global emergency medicine (GEM). At the same time, many academic emergency departments (EDs) are investing in the development of GEM divisions and global/international EM fellowship programs. However, the path for a successful career in this subspecialty has still not been defined. ⋯ Our survey provides an understanding of the amount of time that emergency physicians in GEM spend abroad and the types of activities in which they are currently engaged, as well as the barriers that need to be overcome in order to achieve fulfilling careers in this field.