Articles: emergency-services.
-
Emerg Med Australas · Feb 2025
A pilot trial exploring the use of music in the emergency department and its association with delirium and other clinical outcomes.
To assess potential feasibility of a targeted music intervention trial in older ED patients and association with clinical outcomes. ⋯ Self-selected use of a targeted music intervention was feasible in a cohort of older ED patients. While we were likely underpowered to detect associations between intervention and outcome, collection of selected outcome measures proved feasible; these may be helpful in larger scale studies. Exploration of barriers and facilitators to use, as well as preferred delivery methods, are likely to be helpful in wider investigations of music therapy in this high-risk cohort.
-
Emerg Med Australas · Feb 2025
What proportion of women presenting to the emergency department with early pregnancy bleeding receive appropriate care?
To determine the proportion of women presenting to EDs across a regional health district, with early pregnancy bleeding, who received appropriate care. ⋯ Variation in care for women presenting with early pregnancy bleeding to ED was identified. There is an evidence-practice gap and need for inquiry into barriers and facilitators to prescribed clinical practice for this population.
-
Pediatric emergency care · Feb 2025
Subconjunctival Hemorrhages Are Rare Among Infants With Cough and Gastrointestinal Conditions.
Subconjunctival hemorrhages (SCHs) are uncommon injuries in young children beyond the neonatal period and have been associated with abuse. In otherwise well infants, they are sometimes attributed to commonly observed symptoms that invoke Valsalva maneuvers, such as cough, vomiting, and constipation. Our study aims to ascertain the prevalence of SCH among children presenting to emergency care with cough, vomiting, and constipation. ⋯ SCH is an uncommon finding in children under 3 years and is similarly uncommon among children with cough, vomiting, or constipation. It should not be attributed to uncomplicated presentations of cough, vomiting, or constipation, and alternative diagnoses, including abuse, should be carefully considered in the differential diagnosis of SCH.
-
Case Reports
A Novel Use of Terbutaline: Persistent Genital Arousal Disorder in the Emergency Department.
Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing, multifactorial disorder characterized by persistent unwanted physiologic genital arousal in the absence of sexual desire. This poorly understood disorder is thought to be derived from a complex dysregulation of biopsychosocial factors with common underlying neurological dysfunction that has yet to be adequately studied. With frequently evolving diagnostic criteria, lack of a standardized treatment algorithm, and few evidence-based treatment options, this disease is largely unrecognized and difficult to treat once identified. ⋯ A 25-year-old woman presented to the Emergency Department (ED) with persistent and refractory symptoms of genital arousal not responsive to previously documented treatments, and the novel use of a β-adrenergic agent, terbutaline, leading to cessation of symptoms. With her initial presentation, lorazepam, haloperidol, and viscous lidocaine intravaginally provided relief for approximately 24 h until the patient returned. At her subsequent presentation, the patient received additional doses of lorazepam and intravaginal lidocaine, as well as consults with Urology and Obstetrics and Gynecology. Her symptoms eventually ceased by administration of terbutaline. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although presentation of PGAD to the ED is rare, emergency physicians should be prepared with treatment options to assist patients with this distressing diagnosis. This case highlights the novel use of terbutaline, a β-agonist, in cessation of PGAD symptoms when first-line benzodiazepines and antipsychotics fail.
-
Case Reports
Neuro-Behcet's Masquerading as Status Epilepticus and Meningoencephalitis in the Emergency Department.
Behcet disease (BD) is a rare small vessel vasculitis that commonly manifests as recurrent painful oral or genital ulcerations, uveitis, and skin lesions. Some patients with BD develop neurological symptoms termed neuro-Behcet's disease. In the emergency department setting, these symptoms can be mistaken for other common acute issues including stroke, infection, epilepsy, multiple sclerosis, toxin ingestion, or psychiatric conditions. ⋯ We present a case of a 28-year-old male with neuro-BD mimicking status epilepticus and meningoencephalitis. He was actively seizing on arrival and febrile at 103.8 F. The patient also had a history of vasculitis, uveitis, and genital lesions which raised suspicion for a rheumatological process. Cerebrospinal fluid samples were obtained and computed tomography of the head revealed no acute findings. The patient was started on treatment for seizure and meningoencephalitis and admitted to neurology for continuous electroencephalogram monitoring with additional consults placed for rheumatology, ophthalmology, and infectious disease. The patient was ultimately diagnosed with neuro-Behcet's disease and treated appropriately. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In a patient presenting with neurological symptoms and signs of rheumatological disease providers should consider neuro-Behcet's disease as a differential diagnosis. This case exemplifies the vital role of reviewing past medical history to expand differential diagnoses and early coordination with specialists so treatment can be initiated early to prevent morbidity and mortality. The case will also review different presentations of this unfamiliar diagnosis for a more comprehensive understanding.