J Emerg Med
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It has been speculated that freestanding emergency departments (FEDs) draw more affluent, better-insured patients away from urban hospital EDs. It is believed that this leaves urban hospital-based EDs less financially secure. ⋯ There were less privately insured patients and more self-pay, Medicaid, and Medicare patients at the main ED compared to the FEDs. Privately insured patients decreased at both the FEDs and main ED during the study. Insurance distribution was significantly different between the main ED, and three FEDs, and between individual FEDs.
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Fractures are a frequent reason for emergency department visits and evaluation for abusive head trauma is an associated concern in infants. Recent guidelines have suggested that retinal examination may not be necessary in the absence of intracranial injury, but there is a lack of empirical evidence in infants < 1 year of age. ⋯ In infants < 1 year of age presenting with isolated long bone fractures, a dilated eye examination to evaluate for retinal hemorrhages is not likely to yield additional information. Our results support recent studies that a subset of children and infants may not require dilated eye examinations in the evaluation of possible abuse.
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As decontamination trends have evolved, gastric lavage (GL) has become a rare procedure. The current information regarding use, outcomes, and complications of GL could help refine indications for this invasive procedure. ⋯ Toxic agents for which GL was performed reflected a broad spectrum of potential hazards, some of which are not life-threatening or have effective treatments. Continuing emergency physician and poison center staff education is required to assist in patient selection.
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Lingual abscess is a rare clinical entity, with posterior involvement being much less common than anterior involvement. Typical inciting events include trauma or direct inoculation to the area. The clinical diagnosis can be difficult, and early imaging and specialist consultation should be pursued to make a definitive diagnosis and to prevent patient deterioration. ⋯ We present a case of posterior lingual abscess in a 62-year-old man after he received antibiotic injections to the lower molars for periodontal disease. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Lingual abscess is a rare condition that is difficult to diagnose clinically. Misdiagnosis or delayed diagnosis can lead to acute airway compromise and increased morbidity.
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In 1998, emergency medicine-pediatrics (EM-PEDS) graduates were no longer eligible for the pediatric emergency medicine (PEM) sub-board certification examination. There is a paucity of guidance regarding the various training options for medical students who are interested in PEM. ⋯ EM-PEDS graduates found combined training to be an asset in their career. They felt that it provided flexibility in job searches, and that it was ideal training for the skill set required for the practice of PEM. EM-PEDS graduates' practices varied, including mixed settings, free-standing children's hospitals, and community emergency departments.