J Emerg Med
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Case Reports
Ultrasound-Assisted Removal of A Fishbone Stuck in A Tongue in the Emergency Department.
Foreign body (FB) impaction in the oropharyngeal region-and specifically the tongue-is a common problem in the emergency department that often requires specialty consultation and admission for operative intervention. Over the years, the use of point of care ultrasound (POCUS) has increased ease and success of FB removal in other anatomic regions, but is only rarely reported for extraction of FB from the tongue outside of the operating room. ⋯ This case demonstrates a unique case of ultrasound-guided removal of a fishbone from the tongue in the emergency department after blind attempts failed. Operative intervention and admission were initially avoided; however, because of initial failed attempts and blind dissection before the use of POCUS, the patient presented a day later requiring admission for postprocedural tongue swelling and edema. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware that POCUS may assist in FB localization in the tongue.
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Recognition and diagnosis of concussion is increasing, but current research shows these patients are discharged from the emergency department (ED) with a wide variability of recommendations and instructions. ⋯ Documentation of discharge instructions given to ED patients with concussions was inadequate, overall.
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Observational Study
Can Patient Variables Measured on Arrival to the Emergency Department Predict Disposition in Medium-acuity Patients?
Emergency department crowding has led to innovative "front end" care models to safely and efficiently care for medium and lower acuity patients. In the United States, most treatment algorithms rely on the emergency severity index (ESI) triage tool to sort patients. However, there are no objective criteria used to differentiate ESI 3 patients. ⋯ We derived and validated a model and created a nomogram with acceptable discrimination of ESI 3 patients on arrival for purposes of predicting DD. Incorporating these variables into the care of these patients could improve patient flow by identifying patients who are likely to be discharged.
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Quick Sequential Organ Failure Assessment (qSOFA) is a prognostic score for patients with sepsis. ⋯ Among ED patients admitted to an ICU, the SIRS and qSOFA criteria had comparable prognostic value for predicting in-hospital mortality. These prognostic values are similar to those reported by the Sepsis-3 guidelines for ICU encounters.
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Thrombolysis for the treatment of pulmonary embolism (PE) has received significant attention in the literature over the past 10 years. ⋯ The use of thrombolysis increased between 2006 and 2011 in the United States. Patients who receive thrombolysis tend to be white men, live in higher-income ZIP codes, and receive the therapy at large academic teaching hospitals.