J Emerg Med
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Rib fractures are frequently diagnosed and treated in the emergency department (ED). Thoracic trauma has serious morbidity and mortality, particularly in older adults, with complications including pulmonary contusions, hemorrhage, pneumonia, or death. Bedside ED-performed ultrasound-guided anesthesia is gaining in popularity, and early and adequate pain control has shown improved patient outcomes with rare complications. ⋯ Thoracic nerve blocks (e.g., ESP, SANB, ICNB) can be performed safely by appropriately trained emergency physicians, provide excellent anesthesia for rib fractures and thoracic trauma, and should be strongly considered for improved patient-centered outcomes. Furthermore, performing regional nerve blocks in the emergency department can reduce complications including adverse effects from opioids or other delirium-inducing medications.
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Observational Study
Cardiopulmonary Ultrasound to Predict Care Escalation in Early Sepsis: A Pilot Study.
It is challenging to identify emergency department (ED) patients with sepsis who will require resources such as positive-pressure ventilation, vasopressors, or intensive care unit (ICU) admission. ⋯ In patients with concern for sepsis early findings of ≥4 B-lines is associated with care escalation. Combining this finding with LVF and RV size assessment improves the positive predictive power and may be useful in rapid identification of patients likely to require care escalation.
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Randomized Controlled Trial
Empathy Unmasked: Patient Perception of Physician Empathy in an Oncologic Emergency Setting. A Randomized Controlled Trial Comparing Personal Protective Equipment Wear versus Unmasked Video Communication.
Amidst the COVID-19 pandemic, telemedicine emerged as an important option that supports and facilitates clinical practice, however, its usefulness in emergency settings that treat patients with cancer is unclear. ⋯ Cancer patients presenting to the emergency department perceive empathy and compassion equally when approached by physicians virtually without PPE or in person while wearing PPE. Virtual services for specific aspects of clinical practice during emergency department visits in an oncology setting can be implemented to ensure safer interactions between patients and physicians without compromising the physician-patient relationship.
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Appendicitis is a common surgical emergency in the pediatric population, affecting over 70,000 children per year in the United States alone. While historically practitioners predominately used computed tomography (CT) as the main diagnostic imaging modality, multiple professional societies have released guidelines recommending an ultrasound (US) first strategy when using imaging to confirm suspected appendicitis in pediatric populations. To date, no studies have quantified the change in imaging trends for pediatric appendicitis across the spectrum of healthcare facilities in the United States utilizing the Nationwide Emergency Department Sample (NEDS). ⋯ While there is an increasing trend towards US being used as the first imaging modality to diagnose pediatric appendicitis across the spectrum of facilities included in the NEDS, continued utilization of CT to diagnose appendicitis remains unacceptably high in the pediatric population within the limits of this retrospective study.
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Emergency departments (EDs) around the world are facing a crippling crisis of overcrowding, a complex problem caused by a variety of factors. One contributing factor is the overutilization of EDs by patients with frequent visits. ⋯ The prevalence rate of high utilizers was found to be 3.9% in our study, falling within the range based on literature. Due to the parallel issues raised by many studies, the importance of developing convenient corrective strategies and conducting further national-based studies to get better insight of high utilizers is required.