J Emerg Med
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In emergency department (ED) chest pain patients, it is believed that the diagnostic accuracy of the electrocardiogram (ECG) for acute coronary syndrome (ACS) is higher during ongoing than abated chest pain. ⋯ Our results indicate that ED chest pain patients with ongoing pain at arrival are younger, healthier, and have less ACS and 30-day MACE than patients with abated pain, but that there is no difference in the diagnostic accuracy of the ECG for ACS between the two groups.
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Randomized Controlled Trial
Reducing Pain During Emergency Arterial Sampling Using Three Anesthetic Methods: A Randomized Controlled Clinical Trial.
Taking a sample of arterial blood is widely reported as a cause of significant pain. ⋯ The results of this study encourage the use of anesthetic methods like cryoanalgesia or mepivacaine for their proven effectiveness in reducing or eliminating pain during arterial puncture.
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The anatomic course of the phrenic nerve runs in the fascia covering the anterior scalene muscle. Interscalene blocks are commonly performed by an anesthesiologist for shoulder surgery, such as a rotator cuff repair, total shoulder replacement, humeral fracture, or other arm surgery. Phrenic nerve palsy or paralysis is a known complication from interscalene block and is covered in multiple case reports and series in both Anesthesia and Neurosurgical literature, but only one case report in the Emergency Medicine literature. ⋯ This case involves a 57-year-old man who had an uncomplicated arthroscopic rotator cuff repair with placement of interscalene block under care of anesthesia. He was discharged with a pain pump in place and then subsequently presented to the Emergency Department (ED) later that same day for evaluation of dyspnea. Using point-of-care ultrasound, his right diaphragm did not appear to be moving. Chest x-ray study revealed an elevated right hemidiaphragm. He was diagnosed with iatrogenic right phrenic nerve paralysis from interscalene block. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergent diagnosis of phrenic nerve paralysis in the ED is complicated by a distressed patient and need for quick intervention. Most formal tests for this diagnosis are not immediately available to emergency physicians. Ultrasound is a rapid and reproducible, noninvasive resource with high sensitivity and specificity, making it an ideal imaging modality for the emergent evaluation of possible phrenic nerve palsy or paralysis.
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Differentiating pneumonia from chronic heart failure (HF) in normothermic subjects in the emergency department (ED) is significantly difficult. ⋯ The predictive value of the NLR was significantly higher than that of WBCs, neutrophils, lymphocytes, and CRP. Therefore, NLR may be a useful adjunctive marker to establish the early diagnosis of pneumonia in normothermic patients with chronic HF in the ED.
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Abdominal pain is a common presenting symptom with a broad array of potential etiologies. Meckel diverticulum (MD), the most common congenital gastrointestinal malformation, classically presents with painless gastrointestinal bleeding. However, it can also lead to diverticulitis, intussusception, or obstruction, manifesting as abdominal pain. ⋯ A 2-year-old boy presented to the emergency department with intermittent abdominal pain, vomiting, and loose stools. Abdominal ultrasound findings were consistent with ileitis and ileocolic intussusception, but no such intussusception was seen during fluoroscopic air enema. The patient was admitted for serial abdominal examinations and subsequently developed an acute abdomen. Emergent laparotomy revealed a perforated MD. Small bowel resection and primary anastomosis were performed and no complications developed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The presence of an MD can lead to diverticulitis, intussusception, or obstruction, putting the patient at risk of bowel perforation. As such, it is important to consider MD in the differential diagnosis of patients with abdominal pain. In cases in which sonographic findings are ambiguous or transient, additional observation or alternative imaging, such as computed tomography, should be strongly considered.