The American journal of emergency medicine
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This study attempted to evaluate the efficacy of ultra-low-dose intravenous (IV) naloxone combined with IV morphine, as compared to IV morphine alone, in terms of reducing pain and morphine-induced side effects in patients with renal colic. ⋯ Compared to patients who only received IV morphine, co-treatment of ultra-low-dose naloxone with morphine could not provide better analgesia and sedation/agitation states in renal colic patients.
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Case Reports
Tungiasis, a rare case of plantar inflammatory disease, a review of travelers skin lesions for emergency providers.
Parasitic infections while common in underdeveloped nations are rarely seen in developed urban centers. We report a case of a thirty-three-year-old male with no past medical history who presented to the emergency department with a chief complaint of "eggs coming out of my foot" after returning home from Brazil. Based on clinical presentation, travel history, and appearance of the lesion, diagnosis was most consistent with tungiasis infection which was confirmed by the pathology examination. It is important to make the appropriate diagnosis when skin lesions are found in returning travelers and emergency providers should take broad differential diagnosis into consideration.
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We aimed to describe the analgesic efficacy, duration of analgesia, and adverse event profile associated with intranasal hydromorphone in children with acute pain presenting to an emergency department. ⋯ Intranasal hydromorphone led to rapid, clinically significant and frequently sustained decreases in pain intensity in children. No major adverse events were observed in this preliminary sample. Clinical Trials Registration Number: NCT02437669.
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There have been various interventions to reduce ED utilization. Little is known about the sustainability of outcomes of interventions to reduce ED overcrowding. We sought to investigate whether the outcomes from one of successful interventions to reduce ED utilization, specialist physician level reporting were sustained over time and how this practice change was sustained over time. ⋯ Physician-level reporting reduced ED utilization over a four year period. The outcomes could be sustained over time with sustained leadership and physicians' engagement.
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In the Emergency Department (ED) setting, clinicians commonly treat severely elevated blood pressure (BP) despite the absence of evidence supporting this practice. We sought to determine if this rapid reduction of severely elevated BP in the ED has negative cerebrovascular effects. ⋯ While this small cohort did not find an overall substantial change in cerebral blood flow, it demonstrated adverse cerebrovascular effects from rapid BP reduction in the emergency setting.