J Emerg Med
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Urgent care centers (UCCs) provide an alternative to emergency departments (EDs) for low-acuity acute care, as they are convenient with shorter wait time, but little is known about the quality of care at UCCs. ⋯ We found that after an urgent care visit, patients who were sent to the ED by a UCC provider were not more likely than self-referred patients to be admitted to an observation unit or hospital from the ED. Significant predictors for observation unit or hospital admission after UCC discharge were specialist consultation and type of insurance.
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Abdominal pain and constipation are common presenting symptoms of pediatric patients presenting to the emergency department. Sometimes these symptoms are related to uncomplicated constipation from stool burden, and other cases may be secondary to more serious pathologies, including obstruction from intra- or extra-intestinal compression. Point-of-care ultrasound (PoCUS) can be helpful in discerning the etiology for this undifferentiated symptomatology. ⋯ A 14-year-old girl presented with 3 days of constipation and abdominal pain. This was similar to previous symptoms that resolved with laxatives. This time, however, her symptoms were associated with one episode of vomiting. PoCUS expanded a narrow differential with the discovery of a large ovarian cyst. This finding helped to expedite her transfer to a pediatric hospital for definitive treatment in the operating room. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Constipation is one of the leading reasons pediatric patients present to the ED with abdominal pain. PoCUS can detect uncommon causes of constipation, especially pathologies associated with large volumes of fluid, such as a large ovarian cyst, bladder outlet obstruction, or small bowel obstruction.
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Little is known about prescription filling of pain medicine for children. In adult populations, race and insurance type are associated with differences in opioid prescription fill rate. We hypothesize that known disparities in pain management for children are exacerbated by the differential rates of opioid prescription filling between patients based on age and race. ⋯ Less than half of opioid prescriptions prescribed at discharge from a pediatric emergency department are filled. Patient age, insurance status, and race/ethnicity are not associated with opioid prescription filling. Patients with sickle cell disease and those with a primary care provider are more likely to fill their opioid prescriptions.
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Wilderness expeditions require extensive planning and the correct medical supplies to ensure clinical care is possible in the event of illness or injury. There are gaps in the literature regarding evidence-based methods for medical kit design. ⋯ The medical kit created using this method managed all medical events in the field. This report demonstrates the potential utility of using a tailored, evidence-based approach to design a medical kit for wilderness expeditions.
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COVID-19 has been associated with increased risk of thromboembolism in critically ill patients. ⋯ In contrast to other reports, results from this large, hetereogenous national sample of ED patients tested for SARS-CoV-2, showed no association between vascular thrombosis and COVID-19 test positivity.