J Emerg Med
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Randomized Controlled Trial
The Effects of Dexamethasone on the Time to Pain Resolution in Dental Periapical Abscess.
Dental infections are frequently encountered in the emergency department (ED), with periapical abscesses being among the most painful. Traditional pain management strategies include local anesthetic injections, oral analgesics, and intravenous opioids. ⋯ Single-dose dexamethasone as adjunct to conventional medical management for pain caused by periapical abscess demonstrated a significant reduction in pain 12 h post treatment compared with placebo.
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Total hip arthroplasty (THA) is one of the most successful operations in all of medicine in improving patient pain and restoring function. However, complications do arise after primary and revision THA. Dislocation of a THA, also known as instability, occurs in 1-2% of primary THAs and up to 30% of revision THAs. Most dislocations in the United States are initially managed with closed reduction under procedural sedation in emergency departments (EDs) by on-call orthopedists or emergency medicine specialists. ⋯ Dislocation is one of the most common mechanical complications after primary and revision THA. In the majority of the cases, acute closed reduction can be achieved successfully in the ED setting. However, there are specific dislocation types that present unique challenges to acute reduction.
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In an effort to decrease length of stay (LOS) and reduce overcrowding, many emergency departments (ED) have implemented triage nurse-ordered testing. ⋯ Triage nurses have reasonably similar accuracy as physicians in ordering limb x-ray studies and moderate accuracy for laboratory testing. However, we did not identify a clinically meaningful decrease in ED LOS from the use of nursing triage orders.
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Review Case Reports
A Posttraumatic Dilated, Proptotic Eye Does Not Always Need a Lateral Canthotomy! A Review of Superior Orbital Fissure Syndrome for Emergency Physicians.
Superior orbital fissure syndrome (SOFS) is a rare constellation of findings consisting of ophthalmoplegia, ptosis, a fixed dilated pupil, forehead anesthesia, and loss of the corneal reflex. This syndrome, though rare, is most often encountered in trauma with individuals sustaining a facial fracture. ⋯ We present a case of a young woman who was diagnosed with SOFS after a fall in her house, hitting her face on a nightstand. Treatment consisted of high-dose i.v. steroids followed by a taper with close follow-up in the Ophthalmology clinic. We provide a brief review of SOFS, including treatment considerations and follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: SOFS can be easily overlooked in an individual presenting to the emergency department after facial trauma with proptosis. However, a thorough examination of the eye, visual acuity, and intraocular pressure will focus the physician on SOFS rather than the need for immediate decompression via lateral canthotomy. This report describes a traumatic cause of SOFS, the pathophysiology and treatment, and summarizes existing literature.
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Multicenter Study
Emergency Department Asthma "Spacing Trials": Institutional Variability and Time Cost.
Some admitting physicians request a medication-free interval ("spacing trial") in the emergency department (ED) to determine whether a patient with an acute exacerbation of asthma can be safely admitted to a hospital ward bed, where bronchodilators are only available every 4 h. ⋯ The practice of spacing varies widely between hospitals and is associated with substantial delay without an apparent benefit.