J Emerg Med
-
Case Reports
Accelerated Idioventricular Rhythm: A Rare Case of Wide-Complex Dysrhythmia in a Teenager.
Accelerated idioventricular rhythm (AIVR) is an uncommon and typically benign dysrhythmia with similarities to more malignant forms of ventricular tachycardia (VT). It is often seen in adults after myocardial infarctions, although it also arises in the newborn period, as well as in children with and without congenital heart disease. ⋯ We describe a presentation of AIVR in an otherwise healthy 13-year-old girl, discovered on arrival to the pediatric emergency department in the setting of post-tonsillectomy bleeding. The case reviews the diagnostic criteria of AIVR, associated symptoms, the pathophysiologic origin of AIVR, and potential treatment strategies. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given its morphologic similarities to life-threatening forms of VT, AIVR can be misdiagnosed in the emergency department or primary care settings. With an understanding of the dysrhythmia's unique features, emergency physicians can avoid unnecessary interventions and provide the correct diagnosis, workup, and management of AIVR for pediatric patients.
-
Interruptions are recognized as potentially harmful to safety and efficiency, and are especially prevalent in the emergency department (ED) setting. Policies urging immediate review of all electrocardiograms (ECGs) may lead to numerous and frequent interruptions. ⋯ Review of ECGs was a substantial driver of interruptions for emergency physicians. Interventions to integrate ECG review more naturally into physician workflow may improve patient safety by reducing these interruptions.
-
Case Reports
Successful Ultrasound-Guided Erector Spinae Plane Block for Herpes Zoster in the Emergency Department: A Case Report.
The varicella zoster virus, which lies dormant in the dorsal root ganglion, can be reactivated as herpes zoster in times of acute stress or immunosuppression. The herpes zoster lesions can be very painful, both at the time of eruption and after healing, as postherpetic neuralgia. During the acute outbreak time period, many patients visit the emergency department (ED) for pain control, often requiring opioids. ⋯ Here, we demonstrate two cases for which an erector spinae plane (ESP) nerve block with ropivicaine was used as an alternative to opioids, resulting in immediate and safe analgesia in the ED. Both patients had lesions across the back that were significantly impairing their daily lives; one with distribution in the thoracic region, one in the lumbar region. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ESP blocks can offer quick, easy, and effective analgesia in the ED and can be used in place of parenteral or oral analgesia. It also can be used to reduce opioid prescriptions issued from the ED. Further studies can be done to confirm the efficacy of ESP blocks against opioids through prospective trials.
-
Observational Study
Utility of HEART Pathway in Identifying Low-Risk Chest Pain in Emergency Department.
Chest pain is a common presenting symptom in the emergency department (ED). The HEART (history, electroencephalogram [ECG], age, risk factors, and troponin I) score, with addition of troponin at 3 h, helps to determine appropriate risk stratification of the patients. ⋯ Low-risk patients, as per the HEART pathway, can be discharged safely from the ED, which reduces ED stay and health care resource use.