International journal of emergency medicine
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Perforation of a Meckel diverticulum (MD) is a rare complication that can often mimic appendicitis. This case report identifies a child who presented to our Emergency Department (ED) with right lower quadrant abdominal pain, free fluid and air in the abdomen and pelvis, and inflammatory changes visualized on Ultrasonography (US) and computer tomography (CT) scan. In our patient, ruptured appendicitis was suspected, and the diagnosis of ruptured MD was ultimately made by laparoscopy. This case demonstrates that a healthy degree of suspicion for complicated MD should be present when dealing with a questionable diagnosis of appendicitis, particularly in the pediatric population.
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Central venous access and nerve blockade are essential skills in the practice of emergency medicine, and the utility of emergency ultrasound to guide these procedures has been well demonstrated. ⋯ A time- and cost-effective alternative using polony and common household items is presented.
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This study examined the safety and effectiveness of the procedural sedation analgesia (PSA) technique carried out in the emergency department (ED) of a university hospital over a period of 1 year. The research was done to compare the effectiveness and efficacy of moderate sedation of fentanyl combined with either midazolam or propofol for any brief, intense procedure in the ED setting. ⋯ This study had proven that there was no difference in adverse event occurrence between the studied drugs during PSA. Propofol can be recommended for use in PSA if the operator is well trained and familiar with the drug.
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Hypocalcemia with stridor is a well-known condition in the pediatric age group but has rarely been reported in the elderly. We report an elderly patient who presented with dyspnea and laryngeal stridor attack caused by hypocalcemia. ⋯ The cause of stridor was hypocalcemia secondary to thyroidectomy. Complete resolution of stridor was achieved by calcium replacement therapy.
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Observation evaluation is an alternate pathway to inpatient admission following Emergency Department (ED) assessment. ⋯ There was wide variation in use of observation across six common emergency conditions in Massachusetts in this pilot analysis. This variation may have a substantial impact on hospital resource utilization. Further investigation into the patient, provider and hospital-level characteristics that explain the variation in observation use could help improve hospital efficiency.