The American journal of emergency medicine
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Type I AV fistulas of the spinal cord are exceedingly rare. The average age at diagnosis is 50. Clinical presentation is often very non-specific, and sensory deficits and sphincter dysfunction may also occur. ⋯ Symptoms may be misinterpreted as a peripheral nerve lesion and delay time to diagnosis. Early diagnosis remains critical to prevent permanent neurologic sequelae. AV fistula should remain high on the differential of patients presenting with back pain and focal neurologic complaints.
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Randomized Controlled Trial
Intravenous subdissociative-dose ketamine versus morphine for acute geriatric pain in the Emergency Department: A randomized controlled trial.
We compare the analgesic efficacy and safety of subdissociative intravenous-dose ketamine (SDK) versus morphine in geriatric Emergency Department (ED) patients. ⋯ SDK administered at 0.3 mg/kg over 15 min provides analgesic efficacy comparable to morphine for short-term treatment of acute pain in the geriatric ED patients but results in higher rates of psychoperceptual adverse effects. ClinicalTrials.gov Registration #: NCT02673372.
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Meta Analysis
Interleukin-6 as a diagnostic marker for infection in critically ill patients: A systematic review and meta-analysis.
The ability of blood levels of interleukin (IL)-6 to differentiate between infection and non-infection in critically ill patients with suspected infection is unclear. We assessed the diagnostic accuracy of serum IL-6 levels for the diagnosis of infection in critically ill patients. ⋯ Blood levels of IL-6 have a moderate diagnostic value and a potential clinical utility to differentiate infection in critically ill patients with suspected infection.
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Emergency Medicine providers are grappling with the dual challenges of adequately treating pain while avoiding the risks associated with opioid pain relievers. The aggressive treatment of pain with opioids for the last three decades has resulted in an epidemic of opioid use disorder and opioid related mortality. This editorial discusses the findings in a study of emergency department (ED) opioid prescribing by Yang et al. and explores the changing landscape of opioid prescribing in emergency medicine. We specifically discuss risks associated with opioid prescribing, strategies to reduce risks while improving pain management, the role of advanced practice providers in ED opioid prescribing, and the importance of further education on opioid sparing pain management strategies.
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Multicenter Study
Gender-based outcome differences for emergency department presentation ofnon-STEMI acute coronary syndrome.
It is known that women generally have worse mortality outcomes than men with regards to ST-segment elevation myocardial infarction. However, less is known about contemporary gender differences in non-STEMI acute coronary syndrome, particularly those presenting to emergency departments within a regionalized system of care with standardized protocols. ⋯ Emergency department NSTEMI protocols should consider potential gender disparities that exist for women. Overall, women had worse outcomes, which persist even in an urban system of care with standardized protocols.