J Emerg Med
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The local anesthetic dosages used in the current literature in regional applications of local anesthetics are frequently high for surgical purposes, and there are no sufficient dosage studies for emergency department (ED) management. ⋯ The administration of 5 mL 2% prilocaine for pain control in FNFs in elderly patients in the ED can reduce systemic analgesic requirements by establishing effective analgesia in both intracapsular and extracapsular fractures.
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Outpatient referrals constitute a critical component of emergency medical care. However, barriers to care after emergency department (ED) visits have not been investigated thoroughly. ⋯ This study provides an overview of the impact of sociodemographic and departmental factors on attendance at outpatient follow-up referrals. Significant disparities exist with respect to referral attendance after emergency medical care. Informed resource allocation may be utilized to improve care for these at-risk patient populations.
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Ingestion of cylindrical batteries is uncommon. Management can include removal via upper endoscopy, surgical excision, or observation. This case demonstrates the rare phenomenon of cylindrical battery ingestion causing an electrocardiogram (ECG) artifact that mimics ST segment myocardial infarction (STEMI). ⋯ A 51-year-old man who ingested 13 small pencils and 18 AA batteries was found to have ST segment elevation in the inferior leads of the ECG. Further cardiac workup including cardiac biomarkers and transthoracic echocardiogram was negative, and his ECG changes resolved after extraction of the batteries. The ST segment changes were most likely caused by electrical artifact from battery ingestion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: When faced with an ECG finding that is unexpected and that does not fit the patient's overall clinical picture, emergency physicians should consider artifact as a possible cause. Recognition of artifact as the cause of an ECG abnormality can obviate the need for a prolonged and potentially invasive cardiac workup.
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Discharge against medical advice (AMA) is an important, yet understudied, aspect of health care-particularly in trauma populations. AMA discharges result in increased mortality, increased readmission rates, and higher health care costs. ⋯ Insurance status, race, and ethnicity are associated with a patient's decision to leave AMA. Uninsured and Medicaid patients have more than twice the odds of leaving AMA. These findings demonstrate that racial and socioeconomic disparities are important targets for future efforts to reduce AMA rates and improve outcomes from blunt and penetrating trauma.
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Many emergency department (ED) patients in diabetic ketoacidosis (DKA) are admitted to an inpatient intensive care unit (ICU), while ICU capacity is under increasing strain. The Emergency Critical Care Center (EC3), a hybrid ED-ICU setting, opened with the goal of providing rapid initiation of ICU care in the ED. ⋯ Management of patients with DKA in an ED-ICU was associated with decreased ICU and hospital utilization with similar safety outcomes. Managing rapidly reversible critical illnesses in an ED-ICU may help obviate increasing strain facing many health care systems.