Articles: emergency-department.
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Prescription drug shortages have become increasingly common and more severe over the past decade. In addition, reported shortages are longer in duration and have had a greater effect on patient care. Some of the causes of current drug shortages are multifactorial, including the consolidation of drug manufacturers, quality problems at production plants that restrict the supply of drugs, and a lack of financial incentives for manufacturers to produce certain products, particularly generic medications. ⋯ Therefore, ED providers must learn to mitigate the effects of shortages locally, through active communication with pharmacy staff to identify safe and effective alternatives for commonly used medications when possible. Particularly given the effect on critical care medications, therapeutic alternatives should be clearly communicated to all staff so that providers have easy access to this information during resuscitations. This review focuses on the etiology of drug shortages, their effect on the ED, and potential solutions and mitigation strategies.
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Review Case Reports
Ophthalmic Presentation in the Emergency Department: A Case Report of a Girl With "Shimmering Eyes"
Ophthalmic complaints are commonplace in the emergency department (ED) and are often initial presentations of a systemic illness. We present a 2-year-old girl presenting to the ED with ataxia and "shimmering" eyes. ⋯ The patient was diagnosed with opsoclonus-myoclonus syndrome (OMS) involving involuntary, multi-vectorial (mostly horizontal), conjugate fast eye movements without intersaccadic intervals. The ophthalmic presentation led to a paraneoplastic work-up, which revealed an abdominal mass measuring 5.3 × 3.3 × 4.3 cm, suggestive of neuroblastoma. The patient's opsoclonus improved after a 5-day course of dexamethasone and intravenous immunoglobulin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case illustrates the importance of recognizing pathognomonic ophthalmic complaints in the ED. We present an overview of classic ophthalmic presentations associated with systemic illnesses.
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Mobile apps are increasingly being used at the bedside as a part of clinical care. With almost 300 emergency medicine-related apps available in the Apple App Store, it can be overwhelming deciding which are most useful for emergency department providers. A Top 10 list of apps is highlighted which illustrate the many ways that quality apps can positively impact the care of emergency department patients.
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In 2001, "The Model of the Clinical Practice of Emergency Medicine" was first published. This document, the first of its kind, was the result of an extensive practice analysis of emergency department (ED) visits and several expert panels, overseen by representatives from six collaborating professional organizations (the American Board of Emergency Medicine, the American College of Emergency Physicians, the Society for Academic Emergency Medicine, the Residency Review Committee for Emergency Medicine, the Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents' Association). Every 2 years, the document is reviewed by these organizations to identify practice changes, incorporate new evidence, and identify perceived deficiencies. For this revision, a seventh organization was included, the American Academy of Emergency Medicine.
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Acute coronary syndromes (ACS) are the leading cause of death in older adults, aged 65 years or older. The clinical presentation varies, and the absence of chest pain may occur. Our purpose was to synthesize the published literature (2000-2012) to (1) examine the initial ED presentation of older adults with confirmed ACS, (2) identify knowledge gaps, (3) determine whether gender differences exist in the presentation of ACS, and (4) describe recommendations for practice and research. ⋯ Older adults with ACS are at risk for higher mortality rates and delays in time to treatment modalities. Early recognition of symptoms suggestive of ACS by the emergency triage nurse can improve patient outcomes.