J Emerg Med
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Randomized Controlled Trial
Injectable Lidocaine Provides Similar Analgesia Compared to Transdermal Lidocaine/Tetracaine Patch for the Incision and Drainage of Skin Abscesses: A Randomized, Controlled Trial.
Local anesthesia used for incision and drainage of abscesses is known to be painful. ⋯ Local injection of lidocaine provided clinically similar analgesia compared to the lidocaine/tetracaine patch during I&D of skin abscesses in the ED. Pain at presentation and after the procedure was similar in both groups. Emergency physicians should continue to use a local injected anesthetic for I&D of skin abscesses until a less painful alternative is identified.
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Multicenter Study
Identifying Frequent Users of Emergency Department Resources.
There is growing focus on frequent users of acute care resources. If these patients can be identified, interventions can be established to offer more consistent management plans to decrease inappropriate utilization. ⋯ A community-wide identification method resulted in greater numbers of individuals being identified as frequent and super ED users than when utilizing individual hospital data.
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Review Case Reports
Cannabis-associated Myocardial Infarction in a Young Man with Normal Coronary Arteries.
The use of cannabis is not usually regarded as a risk factor for acute coronary syndrome. However, several cases of myocardial infarction (MI) associated with cannabis use have been reported in the scientific literature. The etiology of this phenomenon is not known. ⋯ Cannabis-associated MI is increasingly recognized. The etiology is unclear, but we believe this is the first report of the phenomenon where atherosclerotic plaque rupture has been excluded as the cause with a high degree of confidence.
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Review
Understanding the Value of Emergency Care: A Framework Incorporating Stakeholder Perspectives.
In the face of escalating spending, measuring and maximizing the value of health services has become an important focus of health reform. Recent initiatives aim to incentivize high-value care through provider and hospital payment reform, but the role of the emergency department (ED) remains poorly defined. ⋯ The value of emergency care varies by perspective, and a better understanding is achieved when specific outcomes and costs can be identified, quantified, and measured. Using this framework can help stakeholders find common ground to prioritize which costs and outcomes to target for research, quality improvement efforts, and future health policy impacting emergency care.
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Children's pain is frequently underrecognized and undertreated. This study focuses exclusively on children's perspectives of and satisfaction with their pain management in the emergency department (ED). ⋯ Despite continued pain upon discharge, most children were satisfied with their pain management. However, it is important that emergency physicians not interpret patient satisfaction as equivalent to adequate provision of analgesia. The relationship between children's pain management and self-reported satisfaction needs to be further explored.