The American journal of emergency medicine
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Mondor disease is a form of superficial thrombophlebitis affecting the subcutaneous veins, specifically of the anterolateral thoracoabdominal wall. Clinical presentation is commonly a subcutaneous, tender, painful cordlike induration, usually founded in the breast or axilla. It affects typically middle-aged women. ⋯ In the past, symptomatic approach with anti-inflammatory drugs was proposed. Recent guidelines suggest prophylactic or intermediate doses of low-molecular-weight heparin for at least 4 weeks. Although uncommon, Mondor disease has to be recognized to avoid useless diagnosis testing and to deliver a specific treatment.
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Agitation has significant consequences for patients and staff. When verbal techniques fail, expert guidelines recommend the use of second-generation antipsychotics (SGAs). Perhaps out of familiarity with haloperidol and benzodiazepines, emergency department (ED) clinicians often pair SGAs with benzodiazepines as well. Use of SGAs such as olanzapine in alcohol-intoxicated (ETOH+) patients or with benzodiazepines is not well studied and may be associated with vital sign abnormalities. ⋯ Oral olanzapine was not associated with significant vital sign changes in ED patients. Intramuscular olanzapine also was not associated with vital sign changes in ETOH- patients. In ETOH+ patients, i.m. olanzapine was associated with significant oxygen desaturations. In ETOH+ ED patients, oral olanzapine (with or without benzodiazepines) or haloperidol may be safer choices. ETOH+ patients may have differential effects with the use of i.m. SGAs such as olanzapine and should be studied separately in drug trials.
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Case Reports
The ultrasound-guided superficial cervical plexus block for anesthesia and analgesia in emergency care settings.
The ultrasound-guided superficial cervical plexus (SCP) block may be useful for providers in emergency care settings who care for patients with injuries to the ear, neck, and clavicular region, including clavicle fractures and acromioclavicular dislocations. The SCP originates from the anterior rami of the C1-C4 spinal nerves and gives rise to 4 terminal branches--greater auricular, lesser occipital, transverse cervical, and suprascapular nerves--that provide sensory innervation to the skin and superficial structures of the anterolateral neck and sections of the ear and shoulder. ⋯ We present the first case description of its successful use to manage pain for a patient with an acute clavicle fracture. This case is presented to highlight one of several potential applications of this promising new technique in the emergency department.
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Comparative Study
Comparison of conservative management and laparotomy in the management of stable patients with abdominal stab wound.
The management of the hemodynamically stable patients with penetrating abdominal stab wounds is a problematic issue among trauma surgeons. ⋯ Our study showed that conservative management of asymptomatic and stable patients with anterior abdominal stab wound with physical examination can decrease the rate of normal laparotomy and the length of hospitalization and help to start diet earlier. This study made this hypothesis that after 17 hours of observation, diet can be started for the stable asymptomatic patients.
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Studies on humeral placement of the EZ-IO (Vidacare, Shavano Park, TX, USA) have shown mixed results. We performed a study to determine the first-attempt success rate at humeral placement of the EZ-IO by paramedics among prehospital adult cardiac arrest patients. ⋯ The results of this study suggest a high degree of paramedic proficiency in establishment of IO access in the proximal humerus of the out-of-hospital cardiac arrest. Few complications suggest that proximal humeral IO access is a reliable method for vascular access in this patient population.