The American journal of emergency medicine
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The objective of this study was to measure the prevalence of and identify risk factors associated with hepatitis C virus (HCV) in emergency department (ED) patients. Adults presenting to an urban university teaching hospital, having blood drawn as part of their routine evaluation, had an extra tube drawn and tested for HCV. English-speaking adults consenting to participate in the survey portion of the study were administered an in-depth risk factor questionnaire. ⋯ Most of these patients have a constellation of risk factors including a history of injection drug use. Efforts to identify at risk patients for serologic testing and follow-up should be initiated. Identifying undiagnosed HCV can lead to interventions to decrease transmission as well as reduce the morbidity and mortality of disease.
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Multicenter Study
Reliability and validity of a visual analog scale for acute abdominal pain in the ED.
The objective of the study was to assess the validity and reliability of the visual analog scale (VAS) in the measurement of acute abdominal pain, and to identify the minimum clinically significant difference in VAS scores among patients with acute abdominal pain. The study was undertaken in preparation for a randomized clinical trial of opioid use in acute abdominal pain. A prospective, observational cohort study of a convenience sample of patients presenting to 2 urban EDs with the chief complaint of acute abdominal pain was conducted. ⋯ VAS measures of acute abdominal pain are valid and reliable. The 95% CI surrounding the minimum clinically significant difference of approximately 16 mm overlaps with the 95% CI of minimum clinically significant difference of approximately 13 mm reported previously in traumatic and other types of acute pain. We conclude that the VAS is a methodologically sound instrument for quantitative assessment of acute abdominal pain and for detecting clinically important changes in such pain.
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The objective was to describe patterns of analgesic use for trauma patients treated in our emergency department (ED). We reviewed analgesic use in consecutive patients meeting American College of Surgeons (ACS) Trauma Center Guidelines. A comprehensive database was abstracted from this institution's Trauma Registry and medical records of each patient. ⋯ Patients with head trauma and those admitted to the intensive care unit were least likely to receive analgesics. Morphine was the most frequent analgesic used with an average total dose of 14 milligrams. A majority of patients meeting ACS Trauma Center Guidelines did not receive analgesics in the ED.
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Case Reports
Dissection of the proximal thoracic aorta: a new ultrasonographic sign in the subxiphoid view.
Dissection of the thoracic aorta is a life-threatening event that presents with some regularity to emergency departments (EDs). Despite often nonspecific symptoms, it is critical to catch this disease process early, especially when the proximal aorta is involved because dissections involving the aortic root can lead to myocardial infarction and failure of the aortic valve resulting in death. ⋯ Although not as accurate as transesophageal echocardiography, transthoracic echocardiography (TTE) can be used to detect aortic dissection as well. We present a previously undescribed echocardiographic finding associated with proximal dissection of the thoracic aorta in 7 cases.