J Emerg Med
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Case Reports
Extremity Ischemia After Jellyfish Envenomation: A Case Report and Systematic Review of the Literature.
Extremity ischemia and necrosis after jellyfish envenomation can be mutilating and cause long-term functional deficits. The best way to manage these presentations is unknown. ⋯ Surgery for compartment syndrome and necrosis are common sequelae of extremity envenomation by marine cnidarians. Only prompt use of IV prostaglandins or intra-arterial thrombolytics can halt ischemic progression and avoid the need for surgery. An algorithm is proposed to guide management of these rare and mutilative presentations.
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Observational Study
Using Ultrasound to Determine Optimal Location for Needle Decompression of Tension Pneumothorax: A Pilot Study.
Chest injury can result in life-threatening complications like tension pneumothorax, in which rapid deterioration can occur without decompression. Traditionally, the second intercostal space (ICS) along the mid-clavicular line is taught as the site for decompression. However, this has been questioned due to high rates of treatment failure. The fifth ICS on the mid-axillary line (MAL) is hypothesized to have a shorter distance from skin to pleura based on recent studies. ⋯ The data support that patients have a smaller chest wall distance at the fifth ICS vs. the second ICS. We support performing needle decompression at the fifth ICS and believe POCUS can be used to determine the optimal location for decompression.
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Although ocular injuries are a major cause of ocular morbidity, ocular trauma secondary to consumer-related products is often preventable, and epidemiologic data can highlight potential avenues for intervention. ⋯ Although the overall incidence of product-related ocular injuries has decreased over the past 2 decades, not all age groups are affected equally. The data showed that the trends in frequency and cause of eye-related ED visits differ depending on the age of the patient and indicated avenues for age-specific interventions.
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Observational Study
Can I Send This Patient With Atrial Fibrillation Home From the Emergency Department?
Atrial fibrillation (AF) is one of the most common dysrhythmias managed in the emergency department (ED) setting. Due to the variety of patient presentations and disease severity, most patients in the United States are admitted to the hospital. ⋯ Based on the available literature, RED-AF, AFFORD, and the AFTER (complex, modified, and pragmatic) scores demonstrate modest predictive discrimination in predicting adverse events, but further validation is recommended.
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Emergency department (ED) crowding and hallway care has been a serious problem for the past three decades in the United States and abroad. Myriad articles highlighting this problem and proposing solutions have had little impact on its progression. ⋯ ED crowding and hallway care will continue to worsen unless hospital leadership is willing to listen to ED staff concerns and address the problem on all levels of the hospital using previously proposed solutions. Emergency physicians should not fear termination for discussing this issue and its potential for poor clinical outcomes and ED staff morale.