The American journal of emergency medicine
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Facial trauma and orbital fractures are common reasons for ophthalmology consultation in the emergency department (ED). The purpose of this study is to assess intervention rates and evaluate the acuity of ophthalmology consultation for orbital fractures in the ED. ⋯ Orbital fractures can be associated with severe ocular complications. Most cases, however, do not require emergent evaluation by an ophthalmologist. We propose the South Texas Orbital Fracture Protocol (STOP) for proper assessment and triaging of orbital fractures in the ED. While this clinical decision-making tool requires validation, it may offer improved healthcare efficiency, reduced costs, fewer unnecessary inter-facility transfers, and less burnout for ophthalmology residents.
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Lyme disease is the most frequently reported vector-borne illness in the United States. It is caused by infection with Borrelia burgdorferi via the bite of an infected blacklegged tick (Ixodes spp.) Lyme disease has three stages: early localized, early disseminated, and late. Early disseminated Lyme disease may include neurologic manifestations such as cranial nerve palsy, meningitis, and radicular pain (also called radiculoneuritis). ⋯ The symptoms resolved with oral doxycycline. Neuropathic pain should raise suspicion for neurologic manifestations of Lyme disease in North America even in the absence of meningitis and cranial nerve palsy. We report how timely recognition of this rare syndrome in North America is important and may prevent progression to late disease.
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Vital signs (VS) are used to triage and identify children at risk for severe illness. Few studies have examined the association of pediatric VS at emergency department (ED) discharge with patient outcomes. ⋯ Although many children were discharged from the ED with abnormal VS, few returned and required admission. Having 2 or more abnormal VS, age less than 3 years and higher acuity increased odds of revisit. Few children suffered serious adverse outcomes.
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The S100ß protein (PS100ß) is a biomarker, which has demonstrated its importance in diagnoses ruling out intracranial hemorrhages in people with light head traumas This study aims to evaluate if the PS100ß presents an interest in the diagnostic strategy for subarachnoid hemorrhages (SAH). ⋯ S100ß protein assay with a discriminating threshold of 0,10 μg/L does not demonstrate any interest in the diagnostic strategy for non-traumatic SAH.