J Emerg Med
-
A variety of clinicians practice in emergency departments (EDs). Although most ED patients prefer seeing physicians, a subset sees no physician. ⋯ A variety of patient and hospital characteristics influenced whether ED patients were seen by physicians. Diagnostic services, procedures, visit length, and hospital admission differed by physician presence. Findings have implications for ED practice and future research.
-
A wandering spleen (WS) is a rare clinical entity characterized by a spleen located in the lower part of the abdomen or the pelvic cavity rather than the normal anatomical site. The complications of a wandering spleen include splenic torsion, splenic infarction, and adjacent visceral injury. ⋯ We present a case of a male patient admitted to the emergency department with vomiting, nausea, and persistent lower abdominal pain. Computed tomography and ultrasound were performed and were used to diagnose a wandering spleen with torsion leading to splenic infarctions. Subsequently, laparoscopic surgery and pathology confirmed this diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ultrasound and computed tomography scans play a significant role in diagnosing WS and its complications, allowing an emergency physician to establish treatment options for WS.
-
Each year, roughly 20% of U.S. adults visit an emergency department (ED), but little is known about patients' choice of ED. ⋯ Fewer than half of patients visited the closest ED. Patients who chose a farther ED tended to seek higher-rated hospitals and report more favorable experiences.
-
Status epilepticus is associated with significant morbidity and mortality and is divided into convulsive status epilepticus and nonconvulsive status epilepticus (NCSE). ⋯ An understanding of the presentation and management of NCSE can assist emergency clinicians in the care of these patients.
-
Procedural sedation is commonly practiced by emergency physicians to facilitate patient care in the emergency department (ED). Although various guidelines have modernized our approach to procedural sedation, many procedural sedation guidelines and practices still often require that patients be discharged into the care of a responsible adult. ⋯ There is no pharmacodynamic or pharmacokinetic basis to require discharge in the care of a responsible adult after procedural sedation. Thoughtful medication selection and the use of evidence-based pre- and postprocedure protocols in the ED can help circumvent this requirement, which likely disproportionally impacts patients who are of low socioeconomic status or undomiciled.