J Emerg Med
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Increasing emergency department (ED) utilization has contributed to ED overcrowding, with longer ED length of stay (EDLOS) and more patients leaving without being seen (LWBS), and is associated with higher morbidity and mortality rates. Previous studies of provider in triage (PIT) have shown decreased LWBS, but variable improvements in EDLOS. ⋯ We found significantly lower LWBS rates, shorter EDLOS, and shorter door-to-doctor times after PIT implementation. Compared with previous studies in a variety of settings, we found that PIT significantly improved LWBS and all throughput metrics in a safety net setting.
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Case Reports
Ultrasound-Guided Serratus Anterior Plane Block for Intractable Herpes Zoster Pain in the Emergency Department.
Herpes zoster (HZV) is a painful vesicular rash that occurs after reactivation in immunosuppressed patients. Analgesia in this patient population has been notoriously difficult. The serratus anterior and erector spinae plane block have both been described as effective thoracic analgesic techniques, but data are limited on their use in HZV. ⋯ A middle-aged man with a history of hypertension and hyperlipidemia presented to the emergency department (ED) with chest and back pain associated with cutaneous rash. Traditional pain regimens were not effective; therefore, a serratus anterior plane block was performed using 25 mL of 0.25% of bupivacaine. The patient's pain decreased from 10 to 2 in 20 min and the patient was discharged without further analgesia. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As opiate use decreases in prevalence and utility in the ED, alternatives to analgesia are sought. We describe the technique of regional anesthesia using a serratus anterior plane block as another modality that physicians can use to address HZV-related pain.
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Retrocecal appendicitis may be challenging to find. We present the first case series in which retrocecal appendicitis was found on point-of-care ultrasound (POCUS). ⋯ In each of the five cases, appendicitis was found by a pediatric emergency physician in the right periumbilical region or right upper quadrant. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The POCUS practitioner should scan both the right upper and right lower quadrant of the abdomen in search of appendicitis, as well as in search of signs of perforation.
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Diabetic ketoacidosis (DKA) is a hyperglycemic emergency that presents commonly to the emergency department. Severe DKA has the potential for significant morbidity and mortality if not recognized early and treated appropriately. It is incumbent on the emergency clinician to be vigilant in the management of these critically ill patients. ⋯ DKA is a medical condition that has the potential for significant morbidity and mortality if not recognized and managed appropriately.
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Falls into small water bodies can cause drowning and trauma. Such falls, especially into irrigation canals, and the subsequent trauma are common in Japan. However, few studies have investigated their characteristics, costs, and prognosis. ⋯ Trauma due to falls into irrigation canals can be severe and even fatal, and the related costs are high. Our study highlights the importance of implementing appropriate measures to prevent falls into irrigation canals and of promoting awareness among citizens.