J Emerg Med
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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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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.