J Emerg Med
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Auricular hematoma is a condition commonly seen in the emergency department among patients presenting with trauma to the ear. It may result in several complications such as perichondritis and cauliflower ear if not managed appropriately. ⋯ Emergency clinicians must be knowledgeable regarding the evaluation and management of auricular hematoma, including the various drainage techniques.
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Rib fractures are frequently diagnosed and treated in the emergency department (ED). Thoracic trauma has serious morbidity and mortality, particularly in older adults, with complications including pulmonary contusions, hemorrhage, pneumonia, or death. Bedside ED-performed ultrasound-guided anesthesia is gaining in popularity, and early and adequate pain control has shown improved patient outcomes with rare complications. ⋯ Thoracic nerve blocks (e.g., ESP, SANB, ICNB) can be performed safely by appropriately trained emergency physicians, provide excellent anesthesia for rib fractures and thoracic trauma, and should be strongly considered for improved patient-centered outcomes. Furthermore, performing regional nerve blocks in the emergency department can reduce complications including adverse effects from opioids or other delirium-inducing medications.
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Vestibular migraine (VM) is a subset of migraine and, as its name suggests, presents with both migrainous and vestibular symptoms. However, a more worrisome diagnosis that can present with similar features is posterior circulation transient ischemic attack (pc-TIA) presenting as episodes of isolated dizziness. ⋯ Medical decision making should be individualized. A new nontriggered episode of isolated dizziness or those with new transient neurological findings should be evaluated for pc-TIA. VM should be considered in younger patients who have had multiple episodes over a greater time period with other migraine-related symptoms.
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Meta Analysis
The Role of Troponin Testing in Patients with Supraventricular Tachycardia, Systematic Review and Meta-Analysis.
Supraventricular tachycardia (SVT) is commonly evaluated in the emergency department (ED). While troponin has been shown to be elevated in SVT, its usefulness for predicting coronary artery disease and future adverse cardiovascular outcomes has not been shown. ⋯ Troponin levels are frequently ordered for ED patients with SVT and are often elevated. However, this review suggests that they have low prognostic value in predicting MACE.
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Vital signs are an essential component of the emergency department (ED) assessment. Vital sign abnormalities are associated with adverse events in the ED setting and may indicate a risk of poor outcomes after ED discharge. ⋯ Based on the available evidence, the specific vital sign abnormality and the number of total abnormalities influence the risk of adverse outcomes after discharge. Vital sign abnormalities at the time of discharge also increase the risk of ED revisit. The most common abnormal vital sign at the time of discharge is tachycardia.