J Emerg Med
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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.
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It is challenging to detect posterior circulation strokes in patients presenting to the emergency department (ED) with acute dizziness. The current approach uses a combinatorial head-impulse, nystagmus, and test-of-skew method and is sensitive enough to differentiate central causes from peripheral ones. However, it is difficult to perform and underused. Further, magnetic resonance imaging (MRI) of the brain is not always available and can have low sensitivity for detecting posterior circulation strokes. ⋯ The BT is an easy, cheap, safe, and quick test that is feasible and sensitive to screen acutely dizzy patients for stroke in the ED.
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Seizure is a common reason for children to visit the emergency department (ED). Pediatric and general EDs may obtain computed tomography (CT) scans of the head for seizure at different rates. ⋯ Children with seizure are more likely to undergo CT scans of the head at general EDs compared with pediatric EDs.
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Case Reports
Hypoglycemia Worsened by Glucose Administration: A Case of Hypoglycemia Years After Gastric Surgery.
Noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is a rare syndrome characterized by postprandial hypoglycemia with neuroglycopenic symptoms occurring 1 to 3 h after a meal. Diagnosis can be elusive, as the vast majority of patients have normal fasting blood glucose levels, and onset of hypoglycemic episodes can be a late complication of gastric surgery. ⋯ We report the case of a 45-year-old woman presenting to the Emergency Department (ED) with new-onset seizures and hypoglycemia worsened by glucose administration. Surgical history is pertinent for a Roux-en-Y gastric bypass approximately 10 years prior to presentation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although rare, it is important for emergency physicians to be vigilant of this disease process as a traditional treatment approach for hypoglycemia may be detrimental. Although cases of NIPHS have been documented in literature, its presence in emergency medicine-specific literature is seemingly nonexistent. Noninvasive imaging techniques will be normal, and diagnosis is dependent on awareness of this disease entity coupled with a detailed history.
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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.