J Emerg Med
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There exists a significant amount of misinformation regarding methadone and buprenorphine, and a belief that toxicity associated with nonmedical use of methadone and nonmedical use of buprenorphine is similar in severity and outcomes. ⋯ Patients who use methadone nonmedically have higher hospitalization rates, greater ICU utilization rates, and considerably worse medical outcomes when compared with patients who use buprenorphine nonmedically.
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Focused, proximal compression ultrasound (FPCUS) is a commonly used point-of-care study in the Emergency Department (ED). Pelvic vein deep venous thrombosis (DVT) is a rare presentation, and Emergency Physicians need to be aware of the limitations and pitfalls of FPCUS. ⋯ Emergency physicians using FPCUS in the evaluation of lower-extremity pain or swelling need to be aware of the pitfalls, limitations, and advanced techniques to avoid misdiagnosis while evaluating for DVT.
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Review Case Reports
ST-elevation myocardial infarction in the presence of biventricular paced rhythm.
In the diagnosis of acute myocardial infarction (AMI), the presence of baseline left bundle branch block or a permanent pacemaker rhythm poses a challenge. ⋯ Despite proposed criteria that aid in the recognition of AMI with underlying left bundle branch block and paced rhythm; the advent of new pacing modalities and the potential variability of pacing sites impose additional diagnostic challenges requiring higher level of suspicion and better physician awareness.
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Practice Guideline
Customizing anaphylaxis guidelines for emergency medicine.
Most episodes of anaphylaxis are managed in emergency medical settings, where the cardinal signs and symptoms often differ from those observed in the allergy clinic. Data suggest that low recognition of anaphylaxis in the emergency setting may relate to inaccurate coding and lack of a standard, practical definition. ⋯ We believe that this working definition and the supporting Consensus Statements are a first step to better management of anaphylaxis in the emergency medical setting.