The American journal of emergency medicine
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Case Reports
Erector spinae plane block for management of acute opioid withdrawal in the emergency department: A case report.
Gastrointestinal symptoms of acute opioid withdrawal are distressing for patients and are often difficult to manage with conventional therapies. Insufficiently managed opioid withdrawal symptoms may lead patients to leave against medical advice, which can increase their risk of relapse and result in poor outcomes from untreated conditions. We assessed the impact of an erector spinae plane block on the acute gastrointestinal symptoms of opioid withdrawal. ⋯ Through blockade of the sympathetic chain, the erector spinae plane block could provide targeted symptomatic relief for patients presenting with severe gastrointestinal symptoms of opioid withdrawal. Future research should seek to evaluate the efficacy observed in this case in larger patient populations.
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Fibrinolysis is generally considered an alternative to percutaneous coronary intervention (PCI) for ST-Segment Elevation Myocardial Infarction (STEMI) when PCI is not immediately feasible. The COVID-19 pandemic may have impacted the timeliness of PCI. We sought to compare the rate of fibrinolysis use before vs. during the COVID-19 pandemic in US emergency departments (EDs). Characteristics of patients and EDs with fibrinolysis use prior to vs. during the COVID-19 pandemic were also compared. ⋯ Fibrinolytic therapy use increased, but only slightly, during the COVID-19 pandemic. This suggests that the healthcare system adapted quickly to changes during the pandemic in the setting of STEMI treatment.
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This study aims to evaluate the impact of serum magnesium (Mg) level on hospitalization and 28-day mortality in a nonspecific geriatric patient population. ⋯ While hypomagnesemia is more manageable than hypermagnesemia, the latter is an important predictor of hospitalization and 28-day mortality in individuals over 70 years old.
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Retained products of conception (RPOC) refers to residual intrauterine tissue in female patients after a recent birth, pregnancy termination, or miscarriage. Ultrasound is the primary diagnostic modality for RPOC, but the accuracy of point-of-care ultrasound (POCUS) has not been evaluated for this diagnosis. Our aim was to determine the test characteristics of POCUS in detecting RPOC, and to evaluate the management of RPOC in the Emergency Department. ⋯ POCUS demonstrated high specificity and low sensitivity for diagnosing RPOC in patients with a history concerning for RPOC. POCUS can be used to diagnose RPOC, but caution should be exercised when making the diagnosis in early pregnancy given the variable appearance of the endometrium on transabdominal POCUS during that timeframe.
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Critically ill ED patients on life support may undergo transition to comfort care as decided by the surrogate decision maker. When several hours are needed for loved ones to arrive and say farewell before initiating comfort care ("delayed comfort care"), these patients require prolonged ED stays or costly intensive care unit (ICU) admissions. ⋯ The EDOU-based delayed comfort care pathway is a feasible way to deliver compassionate end of life care for patients on life support. It can be considered in hospitals with an EDOU especially if their private ED beds and ICU resources are scarce.