Articles: emergency-department.
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JNMA J Nepal Med Assoc · Apr 2023
Case ReportsPerforated Caecum in a Left-sided Amyand's Hernia: A Case Report.
Amyand's hernia is a rare type of inguinal hernia with an appendix inside an inguinal hernia sac. Most cases are diagnosed intraoperatively during hernia repair. A 66-year-old male was received at the Emergency Department with complaints of acute onset abdominal pain, vomiting, and groin swelling. The patient was diagnosed with obstructed left inguinoscrotal hernia with suspected bowel perforation. Following the emergency laparotomy, the intraoperative picture depicted a leftsided Amyand's hernia with a perforated caecum in the hernia sac. Mobile caecum, malrotation, situs inversus, and excessively long appendix denoted it to be the prime factors for the left-sided Amyand's hernia. A diverse range of pathological features and presentations might complicate the diagnosis and management of Amyand's hernia and all in all treatment has to be individualized according to the intraoperative finding. ⋯ appendix; case reports; hernia.
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Emerg Med Australas · Apr 2023
Observational StudyRaising the D-dimer threshold for ruling out pulmonary embolism: A single-site, observational study with a historical comparison.
The objective of this study was to assess the impact of introduction of a new pulmonary embolism (PE) diagnostic guideline with a raised D-dimer threshold. ⋯ The introduction of the new guideline was associated with a reduction in overall imaging rates without evidence of missed PE. Further evaluation in other settings is recommended.
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Editorial Comment
Time to Treat Alcohol Use Disorder in the Emergency Department.
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Randomized Controlled Trial
Implementation of an Electronic Alert to Improve Timeliness of Second Dose Antibiotics for Patients With Suspected Serious Infections in the Emergency Department: A Quasi-Randomized Controlled Trial.
Delays in the second dose of antibiotics in the emergency department (ED) are associated with increased morbidity and mortality in patients with serious infections. We analyzed the influence of clinical decision support to prevent delays in second doses of broad-spectrum antibiotics in the ED. ⋯ The implementation of a clinical decision support alert reminding clinicians to reorder second doses of antibiotics was associated with a reduction in the length and frequency of antibiotic delays in the ED. There was no effect on the rates of ICU transfers, inpatient mortality, or hospital length of stay.
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Emerg Med Australas · Apr 2023
Observational StudyOutcome of reduction of paediatric forearm fracture by emergency department clinicians.
Paediatric forearm fractures are common. Anecdotally, there is a trend towards ED reduction of selected fractures under procedural sedation. We aimed to determine the rate of subsequent operative intervention for fracture re-displacement. ⋯ Reduction of paediatric forearm fractures under procedural sedation by ED clinicians is increasingly common and results in a low rate of subsequent operative intervention.