The American journal of emergency medicine
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Hand injuries represent the most common and potentially serious injuries associated with the use of snow blowers. Little research has been conducted on a national scale to examine these types of injuries. Therefore, the purpose of the study was to examine hand injuries among patients treated in an emergency department (ED) related to attempting to clear snow out of a clogged snow blower. ⋯ Hand injuries remain the main threat of injury among snow blower operators. While trends are declining, given the seriousness of the injuries involved, further public health education campaigns and design modifications are warranted.
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Unique weather patterns can dramatically increase the number of emergency department (ED) visits due to falls on snow or ice compared to winter averages. They can create "Orthomageddon" incidences; days when the number of orthopedic injuries dramatically exceeds average. The study objective was to identify weather-dependent differences in demographics, length-of-stay (LOS) predictors, and volume for fall-injury presenting to the ED. The authors placed emphasis on Chinook or Foehn phenomenon (rapid freeze-thaw cycles) common east of the Rocky Mountains. ⋯ Weather, particularly nighttime conditions, are highly predictive of winter, fall-related ED volume. This may inform future population-level alerts for dates of elevated fall risk and ED staffing patterns.
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Case Reports
A patient with lower extremity weakness after recent endovascular repair of an abdominal aortic aneurysm.
Thrombosis of an endovascular aortic repair (EVAR) is a devastating complication of a common surgical procedure that can lead to serious morbidity and mortality if not promptly recognized. This is the first case report of an EVAR graft thrombosis in the emergency medicine literature. ⋯ We present a case of a patient with lower extremity paraplegia secondary to thrombosis of an EVAR graft who presented to the emergency room with acute stroke-like symptoms after a recent EVAR procedure. Endovascular repair of abdominal aortic aneurisms is becoming more frequent, and an increased number of patients with recent abdominal aortic aneurism repair by endovascular grafts will be evaluated by emergency physicians in the future. Emergency physicians should be aware that signs of limb ischemia, which may masquerade as acute ischemic stroke-like symptoms, is one of the more serious complications that can occur with abdominal aortic vascular grafts. Among patients with lower extremity neurological deficits in the recent setting of EVAR presenting to an emergency department, there should be a high degree of suspicion for EVAR graft thrombosis, which can be diagnosed via the gold standard of CT angiography or ultrasonography. Prompt vascular surgery consultation is essential to minimize permanent disability.
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Emergency department (ED) crowding is a recognized issue and it has been suggested that it can affect clinician decision-making. ⋯ Increased ED occupancy was found to be associated with more patients being classified as higher acuity as well as higher hospital admission rates. As an example, for a commonly observed patient category, our model predicts that as the ED occupancy increases from 25 to 75 patients, the probability of a patient being triaged as high acuity increases by about 50% and the probability of a patient being categorized as admit increases by around 25%.