Articles: emergency-department.
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Alcohol withdrawal syndrome (AWS) is a common condition prompting emergency department (ED) presentation. However, there are limited recent, large-scale, robust data available on the incidence, admission, and medical treatment of AWS in the ED. ⋯ AWS represents a common reason for ED presentation, with most patients being admitted. We identified a rising incidence with a shift in management to include agents such as phenobarbital and gabapentin. These findings provide important evidence on current trends in AWS to inform health policy and knowledge translation efforts as well as emphasizing the need for ongoing research and evaluation of clinical practices to optimize outcomes for patients with AWS.
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The emergency physician (EP) workforce has been a recent focus after a workforce projection predicted a surplus of EPs by 2030. A previous study of Iowa emergency departments (EDs) demonstrated wide variability in ED staffing patterns and attributed it to the lack of EP job candidates. With the recent increase in emergency medicine (EM) residency positions, the objectives of this study were to understand how Iowa ED physician staffing has changed in regard to presence of board-certified EPs and what operational differences in Iowa EDs may be associated with staffing to provide insight into what may be occurring in other predominantly rural states. ⋯ Iowa EDs are predominantly staffed by non-EPs, and this remains unchanged despite a decade of increasing EM residency positions nationally. There remains a significant disparity between CAHs and non-CAHs. This study demonstrates that EM residency position increases have not penetrated rural Iowa EDs, where there remains both a substantial shortage and desire for EP staffing.
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Case Reports
Underreporting Supplements: A Case of Drug-induced Liver Injury Due to a Testosterone Booster.
Acute liver injuries (ALIs) are caused by a wide range of etiologies, and determining the cause can often be challenging. Detailed history taking is essential in patients with liver injuries to promptly determine the underlying source of injury and for timely treatment and prognosis. A 27-year-old active duty man presented to the emergency department (ED) with jaundice. ⋯ Hepatotoxicity is a major concern in supplement use; however, it is largely underreported. Supplements are often not recognized or reported as medications by patients, leading to failure to identify them as potential toxicants. This case highlights the importance of including supplement education and questioning in the evaluation of ALI and maintaining a high index of suspicion when other common etiologies of liver disease are negative.
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Alcohol, a significant public health concern, contributes to a substantial burden on emergency services. Identifying avoidable causes of Emergency Department (ED) presentations may reduce hospital overcrowding and benefit public health. ⋯ The findings indicate a growing trend in patients presenting to the ED as "Apparently Drunk". The high incidence among people experiencing homelessness and the substantial resource utilisation underscores the need for targeted public health interventions and integrated services. Policymakers should consider these findings in the context of potential legislative changes that may impact alcohol availability.