J Emerg Med
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Case Reports
Ultrasound-guided Greater Auricular Nerve Block for Emergency Department Ear Laceration and Ear Abscess Drainage.
Adequate emergency department (ED) anesthesia for painful ear conditions, such as ear lacerations or ear abscesses, can be challenging. Much of the sensory innervation of the ear is supplied from the anterior and posterior branches of the greater auricular nerve (GAN). The GAN is a branch of the superficial cervical plexus, which arises from the C2/C3 spinal roots. The GAN innervation includes most of the helix, antihelix, the lobule, and the skin over the mastoid process and parotid gland. Anesthesia of the GAN is commonly performed in emergency medicine as part of a landmark-based ear "ring" block. Recently, a selective ultrasound-guided GAN block has been described. ⋯ We report the first cases of ultrasound-guided greater auricular nerve block (UGANB) successfully performed in the ED as the sole procedural anesthesia for both an ear laceration and abscess drainage. In addition, we review the relevant anatomy and technical details of the procedure. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Our cases suggest that UGANB is a potentially effective nerve block for ED management of acute ear pain related to procedures involving the tail of the helix and the lobule, such as ear lacerations or ear abscess incision and drainage. Advantages include real-time visualization of the GAN that may increase block success and the decreased volume of local anesthetic required for a block.
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Hereditary angioedema (HAE) is a rare disease characterized by C1-esterase inhibitor (C1-INH) deficiency, resulting in periodic attacks of acute edema, which can be life-threatening if they occur in the upper airway. No head-to-head comparisons of different treatment options for acute HAE attacks are available. Because immediate symptom relief is critical for potentially life-threatening laryngeal attacks, it is important to determine the treatment option that provides optimal treatment response. ⋯ Available data suggest that among different HAE treatments, body weight-adjusted pdC1-INH (20 U/kg) provides the most reliable treatment response for treatment of laryngeal HAE attacks.
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Heat stroke is an illness with a high risk of mortality or morbidity, which can occur in the young and fit (exertional heat stroke) as well as the elderly and infirm (nonexertional heat stroke). In the United States, from 2006 to 2010, there were at least 3332 deaths attributed to heat stroke. ⋯ Ice-water immersion has been shown to be highly effective in exertional heat stroke, with a zero fatality rate in large case series of younger, fit patients. In older patients with nonexertional heat stroke, studies have more often promoted evaporative plus convective cooling. Evaporative plus convective cooling may be augmented by crushed ice or ice packs applied diffusely to the body. Chilled intravenous fluids may also supplement primary cooling. Based on current evidence, ice packs applied strategically to the neck, axilla, and groin; cooling blankets; and intravascular or external cooling devices are not recommended as primary cooling methods in heat stroke.
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Observational Study
Evaluation of the Aortic Arch from the Suprasternal Notch View Using Focused Cardiac Ultrasound.
The suprasternal notch view (SSNV) is an additional echocardiographic view not routinely used by emergency physicians (EPs) performing focused cardiac ultrasound (FOCUS). ⋯ Our findings suggest that the SSNV is an easily attainable and accurate view of the thoracic aorta that can be obtained by EPs in the majority of ED patients.
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Observational Study
Performance of the Manchester Triage System in Adult Medical Emergency Patients: A Prospective Cohort Study.
Accurate initial patient triage in the emergency department (ED) is pivotal in reducing time to effective treatment by the medical team and in expediting patient flow. The Manchester Triage System (MTS) is widely implemented for this purpose. Yet the overall effectiveness of its performance remains unclear. ⋯ The MTS showed fair performance in predicting high treatment priority and adverse clinical outcomes across different medical ED patient populations. Future research should focus on further refinement of the MTS so that its performance can be improved.