J Emerg Med
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Multicenter Study
Opioid Analgesics and Persistent Pain After an Acute Pain Emergency Department Visit: Evidence from a Cohort of Suspected Urolithiasis Patients.
Severe acute pain is still commonly treated with opioid analgesics in the United States, but this practice could prolong the duration of pain. ⋯ Opioid analgesic prescription doubled the odds of persistent pain among ED patients with suspected urolithiasis. Limiting opioid analgesic prescribing at ED discharge for these patients might prevent persistent pain in addition to limiting access to these medications.
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Syncope is a common presentation to the emergency department (ED). A significant minority of these patients have potentially life-threatening pathology. Reliably identifying that patients require hospital admission for further workup and intervention is imperative. ⋯ Syncope remains a difficult chief symptom to disposition from the ED. The CSRS is modestly effective at establishing a low probability of actionable disease or need for intervention. However, CSRS might not reduce unnecessary hospitalizations. The FAINT score has yet to undergo validation; however, the initial derivation study offers less diagnostic accuracy compared with the CSRS.
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Black widow spiders are distributed worldwide and, although rarely fatal, account for significant morbidity. Diagnosis can be challenging, and children are at risk of increased morbidity due to their small size. ⋯ We present a case of a 3-year-old boy who was brought to our emergency department because of sudden ear pain followed by labored breathing, abdominal pain, refusal or inability to speak, and grunting respirations. A black widow spider bite was suspected based on additional history obtained, and the spider was found in his helmet, confirming the diagnosis. The patient had progressive respiratory distress and somnolence and was intubated and transferred to a local pediatric intensive care unit. Antivenom was not initially available and eventually declined by the family. The child received supportive care and recovered after several days. Why Should an Emergency Physician Be Aware of This? This case illustrates the potentially deadly effects a black widow envenomation could cause in a child, and that bite location can affect the constellation of symptoms. It is a reminder that toxins, including that of the black widow spider, should be on the differential for acute abdominal pain, especially with autonomic features.
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Contact-Free Monitoring of Pulse Rate For Triage of Patients Presenting to the Emergency Department.
The evaluation of a patient's pulse rate (PR) plays a key role in emergency triage and is commonly measured in a contact-dependent way. ⋯ Our study found that CBPA seems to be a viable alternative to the current method of measuring PR at triage. ClinicalTrials.gov identifier: NCT03393585.