The American journal of emergency medicine
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Case Reports
Intubation and intensive care after laminaria anaphylaxis in second-trimester abortion.
Laminaria are cervical dilators inserted for several days preceding second-trimester abortions and other uterine procedures. Our patient was intubated after a life-threatening anaphylactic reaction to laminaria prior to her surgical abortion. ⋯ Patients may present obtunded, in shock, without records or proxy, and with no external evidence of the allergen's location or continued presence. Emergency and critical care physicians may consider this etiology in obtunded women with anaphylaxis who are responding poorly to standard care.
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Randomized Controlled Trial
A randomized trial of ultrasound-guided peripheral IV catheter placement in difficult access patients using a guidewire approach.
The purpose of this pilot study was to investigate whether use of a guidewire improves successful placement of ultrasound-guided peripheral IVs (PIV) in difficult intravenous access patients in the emergency department (ED). ⋯ In this pilot study comparing ultrasound-guided PIV placement in ED patients using an integrated guidewire versus no guidewire, there was no significant difference in first-pass success, number of attempts, or complication rates. This study provides preliminary data for further investigations.
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Patients with hypertensive acute heart failure (H-AHF) can decompensate rapidly and require immediate medical attention; the use of high-dose nitroglycerin is a topic of growing interest in this patient population. ⋯ High-dose nitrates are likely safe and may be effective, as demonstrated in the studies reviewed. High-dose NTG may be appropriate in H-AHF patients presenting with severe respiratory distress and SBP ≥160 mmHg or MAP ≥120 mmHg. Future well-designed randomized controlled trials are needed to elucidate optimal dosing strategies and confirm safety and efficacy of high-dose nitrates.
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There is an increasing focus in the emergency department (ED) on addressing the needs of persons with cognitive impairment, most of whom have multiple chronic conditions. We investigated which common comorbidities among multimorbid persons with cognitive impairment conferred increased risk for ED treat and release utilization. ⋯ These results show that multimorbid cognitively impaired older adults with depression or osteoarthritis or rheumatoid arthritis are at higher risk of ED treat and release visits. Future ED research with multimorbid cognitively impaired persons may explore behavioral aspects of depression and/or pain and flairs associated with osteoarthritis or rheumatoid arthritis, as well as the role of informal caregivers in the care of these conditions.
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Case Reports
Ultrasound-guided analgesic injection for acromioclavicular joint separation in the emergency department.
We present the first documented case of an emergency clinician treating the pain of an acute Acromioclavicular (AC) joint separation through ultrasound (US) guided injection of an anesthetic agent. A 41 year old male presented with an acute traumatic grade III AC joint separation after falling off a scooter, and his pain was not significantly improved with oral medication. ⋯ In orthopedics and physiatry literature, US guided AC joint injections have been shown to be far more efficacious than landmark guided AC joint injections, yet this is the first known case documenting injection in the Emergency Department (ED). The superficial location of the AC joint, its ease of identification by US, and the rapid onset of analgesia by intra-articular injection makes the US-guided anesthetic injection of the AC joint an ideal tool to incorporate into a multimodal approach to pain management in AC joint separations.