The American journal of emergency medicine
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Observational Study
Low peripheral perfusion index values may indicate the need for antivenom in the early phase of scorpion envenomation.
Scorpion envenomation may cause local symptoms as well as life-threatening situations including shock, and death. Antivenom administration is the cornerstone of therapy, meticulous patient selection is needed because of the possible side effects of the antivenom including anaphylaxis. Peripheral perfusion index (PPI) is a simple, non-invasive test that is widely used for the detection of peripheral hypoperfusion. We aimed to investigate the value of using PPI to predict the need for antivenom administration for scorpion envenomation. ⋯ PPI can better reflect the ongoing systemic inflammation and the need for antivenom compared to other vital parameters. Therefore, we suggest this noninvasive and objective test may have a significant role in detecting patients who need antivenom in the early phase of scorpion envenomation. However, more studies are needed to elucidate the role of PPI in scorpion envenomation.
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The COVID-19 pandemic was superimposed upon an ongoing epidemic of opioid use disorder and overdose deaths. Although the trend of opioid prescription patterns (OPP) had decreased in response to public health efforts before the pandemic, little is known about the OPP from emergency department (ED) clinicians during the COVID-19 pandemic. ⋯ Our study demonstrated that emergency clinicians increased the prescribed amount of opioids per prescription during the COVID-19 pandemic compared to the pre-pandemic period. Etiologies for this finding could include lack of access to primary care and other specialties during the pandemic, or lower volumes allowing for emergency clinicians to identify who is safe to be prescribed opioids.
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In 2014 the Center for Disease Control and Prevention recommended emergency departments (EDs) implement triage travel screening to identify persons at risk for Ebola Virus Disease (EVD). EVD remains rare in the United States, and in practice the triage travel screen serves as a de facto screen for all travel-related illnesses. This study seeks to determine the current use and effectiveness of the triage travel screen to detect travel-related illness in the pediatric ED. ⋯ This study highlights the limitations of the current pediatric ED triage travel screen to detect travel-related illness and reinforces the importance of a provider-taken travel history. Strategies to increase provider-administered travel history documentation and revisions to increase triage travel-screen efficacy should be considered.
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Controversy exists regarding the closed treatment of distal radius fractures. Circumferential casting of acute distal radius fractures has been shown to be safe in children, however, little research has demonstrated its safety in adults. The purpose of this study was to assess the risk of complications associated with casting acute distal radius fractures in adult patients. ⋯ Retrospective comparative study, Level III.
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Spinal arteriovenous malformations (sAVM) are abnormally developed spinal blood vessels with an increased risk of hemorrhage. Current literature regarding sAVMs is sparse and describes classic presentations in very young children or adults. We report a unique case of a sAVM in an adolescent patient. ⋯ The sAVM was successfully resected with thoracic laminectomy with reconstructive laminoplasty. The patient experienced complications with development of right lower extremity motor and sensory deficits intra-op, but is showing continued improvement. This unique case encourages emergency medicine clinicians to expand the differential diagnoses for pediatric patients presenting with a headache and intracranial hypertension without a clear intracranial cause.