J Emerg Med
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Parapharyngeal space abscesses (PPSA) are deep-space neck infections that are associated with significant morbidity and, rarely, mortality if not promptly diagnosed and treated. The diagnosis is often difficult, as the clinical presentation can mimic peritonsillar abscesses (PTA). Transoral point-of-care ultrasound (POCUS) may be a useful tool to help distinguish PTAs from other deep-space infections such as PPSAs. ⋯ A woman presented to the Emergency Department (ED) with fever, sore throat, trismus, and unilateral tonsillar swelling from a walk-in clinic with a preliminary diagnosis of PTA for drainage. A POCUS performed by the emergency medicine resident in the ED demonstrated normal tonsils. However, it revealed evidence of a PPSA. A computed tomography scan was performed, which confirmed the diagnosis. The patient was admitted to the otolaryngology service for antibiotics and steroids, with subsequent improvement and discharge home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In this case, the use of POCUS in the ED avoided an unnecessary invasive procedure, and facilitated the correct diagnosis of an uncommon condition.
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Ohio has the fifth highest rate of prescription opioid overdose deaths in the United States. One strategy implemented to address this concern is a state-wide opioid prescribing guideline in the emergency department (ED). ⋯ Emergency physicians interviewed generally supported the state-wide opioid prescribing guideline but felt hospitals needed to take additional organizational responsibility for addressing inappropriate opioid prescribing.
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Central vein catheter (CVC) placement using the modified Seldinger technique is a common procedure in the emergency department, but can be time consuming due to the multiple pieces of equipment included in central line kits and the number of steps in the procedure. Preassembled devices combine a needle, guidewire, dilator, and sheath into one unit and potentially simplify the process and reduce time required for CVC placement using the accelerated Seldinger technique. ⋯ In the simulated setting, the accelerated Seldinger technique using combination CVC devices is a faster and easier method for CVC placement compared to the modified Seldinger technique.
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Historical Article
A Historical Perspective of Lateral Canthotomy and Its Adoption as an Emergency Medicine Procedure.
The treatment of orbital compartment syndrome has a rich history rooted in surgery and emergency medicine. It is a rare but acute and vision-threatening condition that most commonly occurs secondary to facial trauma or as a postoperative complication, and was first recognized in 1950. Surgical techniques and medical management were developed and refined soon afterwards to eventually become the modern-day treatment, lateral canthotomy, and inferior cantholysis. ⋯ Lateral canthotomy is a procedure adopted by emergency physicians from the surgical literature. The history of its adoption is a representative example of how emergency medicine evolves as a field.