J Emerg Med
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Emergency Departments (ED) and Emergency Medical Services (EMS) are relied on to address nonemergent needs causing long ED wait times. Baltimore City EMS provided over 100,000 transports, many for low-acuity medical needs. ⋯ This innovative model of on-scene evaluation and treatment can potentially reduce transports, decrease ED wait times, and reduce costs, in an effective and efficient way.
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Empyema necessitans is a rare complication of pleural empyema characterized by the dissection of pus through the soft tissues of the chest wall and eventually through the skin. The skin manifestation may appear as a superficial abscess. ⋯ A 63-year-old woman presented to the Emergency Department (ED) with a chief complaint of dyspnea, dry cough, and a cutaneous nodule on her right chest wall. Three weeks prior to her ED visit, she underwent an exploratory thoracotomy and chest tube placement. The chest tube was removed 2 weeks later. Her physical examination was significant for decreased breath sounds over her right lung fields and a painful, fluctuant, and erythematous nodule on the right chest wall where the chest tube had previously been inserted. Externally, the dermal findings appeared to be a superficial abscess. A chest X-ray study showed a large pleural effusion in her right hemithorax. Point-of-care ultrasound (POCUS) performed by an emergency physician showed evidence of a tract extending from the nodule toward the pleural space that led to the correct diagnosis and treatment of empyema necessitans. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is important to distinguish between a superficial abscess, which requires local drainage, and empyema necessitans, which requires either chest tube drainage, open drainage, or even decortication in specific cases. In such cases, POCUS can facilitate a rapid, accurate diagnosis, and lead to the correct treatment.
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Solomon Islands is a country in the South Pacific Ocean with excellent scuba diving, particularly among its remote islands that can be accessed by liveaboard dive boats. Blacktip reef sharks (Carcharhinus melanopterus) are found throughout the island nation and rarely attack humans. ⋯ We present the case of a 42-year-old man who sustained a hand laceration after being bitten by a blacktip reef shark. He underwent complex primary wound closure in an austere environment and received prophylactic antibiotics. No infection developed and he recovered fully. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We discuss our rationale in closing the wound aboard the dive boat, the choice of antibiotics, and review marine pathogens.
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Observational Study
Prehospital Naloxone and Emergency Department Adverse Events: A Dose-Dependent Relationship.
The purpose of this study was to evaluate prehospital and emergency department (ED) interventions and outcomes of patients who received prehospital naloxone for a suspected opioid overdose. ⋯ Our results suggest that an increasing number of prehospital naloxone doses was significantly associated with an increased likelihood of an ED adverse event.
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The coronavirus disease 2019 (COVID-19) pandemic has contributed to an increase in intimate partner violence (IPV), posing challenges to health care providers who must protect themselves and others during sexual assault examinations. Victims of sexual assault encountered in prehospital and emergency department (ED) settings have legal as well as medical needs. A series of procedures must be carefully followed to facilitate forensic evidence collection and law enforcement investigation. A literature review detected a paucity of published guidance on the management of sexual assault patients in the ED, and no information specific to COVID-19. ⋯ There is a lack of clinical guidance for ED providers that integrates the many aspects of sexual assault patient care, particularly during the COVID-19 pandemic. A SAFET-I Tool is presented to assist emergency health care providers in the treatment and advocacy of sexual assault patients during a period with increasing rates of IPV.