emergency department

Emergency care sick palliative and problems oncology in emergency department during the COVID-19 pandemic

Published on: 30th September, 2020

OCLC Number/Unique Identifier: 8873202033

Emergency medical care in palliative patients during the COVID-19 pandemic, it is important to provide a consistent treatment for stable patients that should be consistent with the goals and benefits, the perspective of these patients, but avoiding palliative patients with a poor prognosis that is unlikely to survive. Cancer is the second leading cause of death in the world around 8.8 million deaths a year. Worldwide, about 7-10 million patients are diagnosed with cancer each year, recently there has been a significant increase in the number of cases diagnosed with cancer. About 70% of cancer deaths are in low- and middle-income countries. The goals of emergency medical care based on the criteria of BLS and ACLS, that is should be done “Do not do resuscitation, do not intubate but continue medical treatment excluding endotracheal intubation without prospects for the patient, but offering BLS only treatment concentrated symptomatic. ED is often the only place that can provide the necessary medical interventions (e.g., intravenous fluids or pain management medications. Medications as well as immediate access to advanced diagnostic tests when needed such as CT, RM and other diagnostic and treatment procedures.
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Unilateral pleural effusion as the sole presentation of ovarian hyperstimulation syndrome (OHSS)

Published on: 3rd December, 2020

OCLC Number/Unique Identifier: 8875582680

A 44-year-old G4P2+1 presented to the emergency department on the 10th day following embryo transfer (with two fresh, day 5, blastocysts transferred in a hospital abroad) with the complaints of difficulty breathing, chest discomfort and cough for one day. These symptoms increased on lying on her side and were not related to exertion. She also mentioned having had abdominal discomfort over the preceding few days. On taking a past history, the patient revealed that all her prior pregnancies were the result of IVF treatment and she suffered OHSS with each. Her first pregnancy was a triplet gestation through IVF and complicated by OHSS; followed by her second pregnancy which was an IVF twin gestation also complicated by OHSS with ascites requiring paracentesis. With her third IVF treatment she conceived, had OHSS and miscarried spontaneously. However, these IVF treatments and pregnancies were all managed abroad and no medical records were available. 
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A rare case of abdominal pain and hematuria from retroaortic left renal vein

Published on: 7th December, 2019

OCLC Number/Unique Identifier: 9272398140

 62-year-old female with a history of arterial hypertension, attended the emergency department due to pain in the left flank. On physical examination no showed signs of peritoneal irritation. Urinalysis was indicated, that reported microscopic hematuria and negative abdominal ultrasound.
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Ketamine-related uropathy and cholangiopathy

Published on: 18th March, 2021

OCLC Number/Unique Identifier: 8982641312

 23-year-old man had a 2-year history of ketamine abuse and presented intermittent abdominal pain, urinary urgency and dysuria for one year. Two weeks ago, laboratory analysis showed within normal limits. This time, he visited our emergency department due to hematuria and bilateral flank pain. CT scan and MRI revealed bilateral hydronephrosis, hydroureter, irregular thickened wall of urinary bladder, and fusiform common bile duct with distal stenosis
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Inducible Laryngeal Obstruction/Vocal Cord Dysfunction and the Role It Plays in Refractory Asthma

Published on: 23rd August, 2017

OCLC Number/Unique Identifier: 7317595610

Chronic asthma accounts for a significant amount of unscheduled office and emergency department (ED) visits. According to the latest World Health Organization statistics, asthma worldwide affects 300 million individuals and creates a substantial health burden by restricting the patient’s lifetime activities. Data estimate that asthma causes a loss of disability-adjusted life years over 150,000/year [1]. While most individuals with asthma can be controlled with current therapies, 5-10% of patients have difficult-to-control/refractory asthma. Severe or refractory asthma places a significant burden on the patient and often requires treatment with systemic glucocorticoids, which have significant side effects. The American Thoracic Society and the European Respiratory Society define refractory asthma as asthma that requires treatment with high-dose inhaled corticosteroids (ICS) plus a second controller and/or systemic corticosteroids to prevent it from becoming ‘‘uncontrolled’’ or asthma that remains ‘‘uncontrolled’’ despite this aggressive therapy. To fully meet this definition the diagnosis of asthma needs to be confirmed and comorbidities addressed as well. The above are considered major criteria for severe asthma and only one needs to be present for considering the diagnosis of refractory asthma [2]. For these reasons, clinicians must learn to identify and formulate additional diagnoses of “asthma imitators” [3]. One of the more common disorders associated with difficult-to-control asthma is vocal cord dysfunction (VCD) [4]. This disorder is known by many names, but current nomenclature endorsed by European and American societies correctly refers it as “Inducible Laryngeal Obstruction” (ILO) [5]. The following case demonstrates the importance of recognizing the clinical and spirometric features of ILO when asthma remains “refractory” to multiple therapies.
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Unusual presentation of a bilateral basilar stroke: Bradycardia

Published on: 7th September, 2017

OCLC Number/Unique Identifier: 7905950909

We report a case of 79-year-old man who presented to our emergency department (ED) for lipothymia. The patient developed significant bradycardia with hypotension. His EKG objectified a slow atrial fibrillation .the patient rapidly installed a coma. A non-contrast CT brain scan showed a bilateral vertebrobasilar ischemic stroke. 
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Embolic Septic Emboli with MRSA: A different source

Published on: 12th December, 2019

OCLC Number/Unique Identifier: 9272395614

Septic Iliac vein thrombophlebitis with associated psoas abscess is a rare and severe entity, which diagnosis is challenging when no risk factor is clearly present. We are presenting a case of severe septic cavitary pulmonary emboli complicated with Acute Respiratory Distress Syndrome (ARDS) that evolved rapidly to respiratory distress and multi organ failure. A 61-year-old Hispanic male, had multiple emergency department visits due to back pain, being most of them intramuscular pain medications and steroids. In the history, he had back pain that worsened accompanied by poor mobility, generalized malaise, fever and chills. Computed tomography (CT) scan showed a paravertebral psoas abscess with L5 - S1 diskitis/spondylitis inflammatory changes, which was then later evidenced by a gallium study. Further imaging studies were done, showed bilateral cavitary lung lesions, consistent with septic emboli. Subsequent blood cultures were positive for Methicillin Resistant Staphylococcus Aureus (MRSA), for which a successful combined therapeutic regimen was used. Transthoracic and transesophageal echocardiogram were not suggestive of endocarditis. Staphylococcus aureus (SA) bacteremia is one of the most common serious bacterial infections with a high risk of metastatic complications, which makes this pathogen a unique one. The combination of factors iliac vein thrombophlebitis, psoas muscle abscess, diskitis/spondylitis with ARDS makes cavitary pulmonary disease a challenging perspective. After a 6-week antimicrobial treatment, full anticoagulation, his clinical condition and image findings improved, and he was recently admitted for physical rehabilitation. Major vessels thrombophlebitis should always be considered, when primary source of septic pulmonary emboli is not clear. This case illustrates the complexity of illness and complications that may arise from a source of infection as the one in this patient. Further therapeutic strategies were tailored accordingly.
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Management of acute tongue swelling

Published on: 14th July, 2020

OCLC Number/Unique Identifier: 8631718785

Background: Tongue swelling often presents as an acute upper airway obstruction. Aim: To present a case series of patients presenting with an acute tongue swelling sharing our experience in managing these patients. Subjects and methods: A retrospective analysis of consecutive patients presenting acutely to the emergency department (ED) at two institutions in Scotland. All patients were evaluated by an otolaryngologist for probable causes of tongue swelling. Data were collected on demographics, co-morbidities, clinical history, examination findings, acute airway management and subsequent care the patients needed. Results: A total of 32 patients (mean age ± STD, 61.6 ± 18.8; 65% male) were included in the study from two teaching hospitals. The most common presenting symptoms were difficulty in speaking (30/32, 94%) and dysphagia (27/32, 84%). Breathing difficulty was only observed in 8 of 32 patients (25%). Angiotensin converting enzyme (ACE) inhibitor’s induced angioedema was the most common cause (45%) for acute tongue swelling. Three (9.4%) patients required intubation; 2 (6.3%) on initial presentation. Two patients had emergency tracheostomy for breathing difficulties due to supraglottic swelling on flexible pharyngolaryngoscopy. Conclusion: Acute tongue swelling is a life-threatening condition. The patients on ACE inhibitors would appear to be at higher risk of developing acute tongue swelling. Such patients with potentially compromised airway need to be treated in a facility where emergency intubation and tracheostomy can be performed at a short notice.
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The evaluation of bandage soft contact lenses as a primary treatment for traumatic corneal abrasions

Published on: 25th May, 2020

OCLC Number/Unique Identifier: 8605482786

Background: Corneal abrasions are a common result of eye trauma. Corneal injuries are very common in both the adult and pediatric population and account for a significant proportion of the workload of most emergency departments. Although abrasion heals well with preservative treatment, it still causes pain and job lost. The abrasion result from the scrabble of the corneal epithelium. These injuries cause pain, tearing, lids spasm, light scare, foreign body sensation, decreased visual acuity/blurring, and a gritty feeling. The light, friction & wink was worse the condition. Most abrasion cure within 24-27 hours and seldom proceed to erosion or infection. The study aims to use bandage soft contact lens [BSCL] as a primary treatment for traumatic corneal abrasion [TCA] instead of traditionally use pressure patch [PP]. Patients and methods: The present prospective study has been conducted on 50 patients attending the out-patient department of ophthalmology in an Alyarmouk teaching hospital for six months after taking ethical permission. Before subjecting the patient to the treatment of bandage soft contact lens therapy, a detailed clinical history and thorough local examination have been done. A history indicating the occurrence of recent ocular trauma followed by severe pain, redness, lids spasm, photophobia, and tearing of the involved eye is suggestive of a corneal abrasion. Always we ask about contact lens wear as this can complicate the presence of an abrasion. To confirm the diagnosis of traumatic corneal abrasion we examine the cornea by slit-lamp under cobalt-blue filtered light after the application of tetracaine eye drops & fluorescein strips. The treatment of 50 consecutive patients presenting with traumatic corneal abrasion has been treated with anesthetic eye drop (tetracaine 0.5%) to relieve pain and lids spasm, antibiotic eye drop (ofloxacin 0.3%), therapeutic bandage soft contact lens was applied to provide pain relief and once again act as a splint to promote epithelial healing, then visual acuity was measured by Snellen chart, a cycloplegic eye drop (cyclopentolate 1%) was applied to relieve ciliary spasm & then preservative-free lubricant eye drop were applied lastly. This criterion dramatically relieves most, if not all of the pain the patient may be experiencing (which is a big plus for the patient and earns instantaneous trust), but it also allows the patient to return to work/school or any other daily activities. Patients have been evaluated after 24hours, 72hours and after 1week regarding pain, visual acuity, and complications. Though pressure patch [PP] occasionally advice in abrasion therapy, it does not assist and may prevent recovery. Employ the protective eyewear can preclude the traumatic corneal abrasion. Results: A total of 50 cases were enrolled in our study during the study period of 6 months. Out of 50 patients, there were 30males and 20 females and the male/female ratio was 3:2. The patient’s age was ranged from 5-35years. The commonest cause of injury was direct minor trauma (80% of cases), with cosmetic & optical contact lenses related problems accounting for 20% of presentations, visual acuity was documented correctly in 90% of adult and pediatric group and difficult to documented in children less than 6-year-old 10%. Traumatic corneal abrasion treated with bandage soft contact lens has an apparent advantage over the traditional pressure patch in terms of reduced pain, speedier healing, and an advantage of faster rehabilitation, facilitation epithelial healing, and proper surface hydration. Evaluation of pain revealed sufficient comfort with this regimen, allowing 45 patients (90%) to go back immediately to their occupations. Moreover, visual function is retained without any complication. Healing of the traumatic corneal abrasion occurred within 1 to 3 days in all patients, with minimal or no pain. The infection did not occur at the time of the follow up. We remove the bandage soft contact lens after 1 week to allow epithelial migration and attachment without the interference of the shearing forces of the upper lid. Conclusion: The use of bandage soft contact lens as a primary treatment for a traumatic corneal abrasion is a safe and effective method with anesthetic eye drop (tetracaine 0.5%), antibiotic eye drop (ofloxacin 0. 3%), cycloplegic eye drop (cyclopentolate 1%), preservative-free lubricant drop instead of traditionally pressure patch. Bandage soft contact lens causes dramatic improvement from pain, lid spasm, tearing & visual function is retained without any complication, and patients can immediately resume their regular activities.
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Actinomycosis of the appendix

Published on: 17th October, 2018

OCLC Number/Unique Identifier: 7906092415

A 40 year old woman presented to the emergency department with acute on chronic abdominal pain in her right iliac fossa. On history her pain had been present for over 6 months and had previously been investigated with ultrasound, CT and a diagnostic laparoscopy several months prior to presentation. Her pain had acutely worsened over the preceding two weeks. This was associated with two days of diarrhoea but nil other systemic symptoms. Her medical history was significant for immunosuppression with tacrolimus, azathioprine and prednisone post renal transplant for IgA nephropathy [1]. Her abdominal examination was unremarkable other than tenderness in her right iliac fossa and a palpable non-tender renal transplant. Her inflammatory markers, electrolytes and urine microscopy were unremarkable. She was further investigated with an ultrasound which demonstrated nil complications with her transplant and a non-contrast CT (due to contrast allergy). Her CT demonstrated a faecolith within the appendiceal lumen but no signs of acute appendicitis (Figure 1). Due to ongoing pain and CT finding of faecolith she was taken for a diagnostic laparoscopy with appendicectomy.   Figure 1: Non-contrast CT demonstrating faecolith. Intraoperatively she had a macroscopically normal appendix and no other cause for the patients symptoms could be identified. A laparoscopic appendicectomy was performed with no complications. Her pain persisted postoperatively and she was discharged post operative day two with analgesia. Histology subsequently revealed actinomyces-like organisms consistent with actinomycosis of the appendix (Figure 2). Her case was discussed with the Infectious diseases team and she was started on an extended course of oral amoxicillin [2].   Figure 2: High Powered H&E stain & gram stain of actinomyces like organisms
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Acute Appendicitis: Hispanics and the Hamburger Sign

Published on: 20th November, 2019

OCLC Number/Unique Identifier: 8405001290

Objective: To describe the presenting clinical findings of patients with acute appendicitis and compare them with those described in the medical literature. To corroborate a common medical myth among Hispanic physicians regarding the presentation of acute appendicitis. Methods: This was a retrospective multicenter chart review of patients diagnosed post-operatively with appendicitis after presenting to five different Emergency Departments in Southern Puerto Rico (PR). Results: A total of 1,540 patients with pathologically confirmed cases of appendicitis were enrolled in our study. Of the study population, 45% were female, and 55% were male, and 43% were over 21 years old. Reported symptoms in our study showed that 98% of the patients had abdominal pain, 47% had nausea, and only 17.6% presented with anorexia. Conclusion: It was our main objective to compare the presenting signs and symptoms of patients with acute appendicitis in our Hispanic population in southern PR with those found in primary medical textbooks and literature. We gathered information regarding signs and symptoms, as well as laboratory and radiographic data of patients with positive pathologic exams for appendicitis. Of the 1,540 patients with confirmed appendicitis, only 17.6% presented with anorexia. Our findings demonstrate that the rate of anorexia in the studied population is significantly lower when compared to current literature. The absence of anorexia, once considered a hallmark of appendicitis, must not lead the physician to rule out this diagnosis in the Hispanic population.
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Laparoscopic approach for acute right iliac fossa pathology: Our experience

Published on: 31st December, 2020

OCLC Number/Unique Identifier: 8882678494

Laparoscopic approach in emergency theatre is an irreplaceable tool to manage patients with acute surgical pathology. We retrospectively reviewed surgical access records from the Emergency Department for acute right iliac fossa pathology. We considered 51 patients (16 male, 35 female, mean age 23.8 years) access for acute right iliac fossa pathology over the last year. 44 patients underwent laparoscopic approach (86%); 8 patients were treated with an open approach. Outcomes evaluation was based on data comparison from open appendicectomy over 4 year time period. Variables considered for data analyses were: role of laparoscopic surgery for gangrenous/perforated appendicitis, Conversion rate, Laparoscopy appendicectomy for elderly patients. Our study demonstrated that a laparoscopic approach at acute right iliac fossa pathology is feasible, safe and can offer a low incidence of infectious complications, less post-operative pain, rapid recovery, and represent a valid diagnostic tool in doubtful cases, at the expense of longer operating time than OA. We suggest that LA should be the initial choice for all patients with acute right iliac fossa pathology.
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A rare case of acute necrotising pancreatitis in a paediatric patient

Published on: 8th December, 2020

OCLC Number/Unique Identifier: 8848126015

The diagnosis of acute necrotising pancreatitis is a rare event in the Paediatric Emergency Department (ED). We report a case of acute pancreatitis in a paediatric patient, diagnosed in our ED, a tertiary level paediatric hospital. This child presented with vague symptoms of constipation, abdominal pain and back pain, and on clinical examination had a distended abdomen with peritonism. She rapidly deteriorated and needed aggressive fluid resuscitation in the ED for treatment of septic shock. The diagnosis of acute pancreatitis (AP) was only considered once elevated amylase levels were apparent. Whilst AP is an important differential diagnosis in a patient who is presenting with acute abdominal symptoms, the diagnosis in children in particular is seldom and thus easily overlooked in the previously healthy child.
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An Audit on the implementation of administering Ondansetron in children with acute gastroenteritis and its effect on admission rate

Published on: 25th March, 2021

OCLC Number/Unique Identifier: 8984626581

Acute gastroenteritis (AGE) is a common presenting complaint in paediatrics. Most often, the reason for admission into hospital is to initiate intravenous rehydration in patients with severe dehydration and inability to tolerate oral intake. We found that Ondansetron acts as a potent antiemetic to support an increased number of children receiving oral hydration, and subsequently leading to decreased rates of admission. This study aims to audit the use of Ondansetron to Oral Rehydration Therapy (ORT) on children with acute gastroenteritis, and its effect on admission rates from the emergency department in University Hospital, Limerick (UHL). Data collected over a 3-month period from June to August 2017 in which Ondansetron was not used was compared to another 3-month period when Ondansetron was used. Several outcomes were measured including admission to hospital. The rate of admission decreased by 15% [26/74 (35%) in 2017 to 16/81 (20%) in 2019 p = 0.22]. 81 patients received Ondansetron, of which 79% were successfully rehydrated orally. The administration of Ondansetron reduced the need for intravenous fluids and hospital admission overall in these children with AGE. This reduction ultimately accounted for lower costs incurred by the Health Services Executive per patient, and also suggested the anti-emetic use as a cost effective measure for managing and treating patients with AGE.
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Factors associated with diagnostic delay in children with Wilms’ tumor

Published on: 15th April, 2021

OCLC Number/Unique Identifier: 9006870366

Background: In Wilms’ tumor, the time elapsed between clinical diagnosis and the start of treatment is clearly associated with morbidity and mortality. As treatment delay can influence patient survival, identification of possible causes can mitigate the consequences arising from prolonged diagnostic uncertainty. Objective: To ascertain whether an initial diagnosis of Wilms’ tumor in the emergency department influences patient prognosis depending on the type of referral for definitive treatment. Patients and methods: Retrospective chart review of 98 children receiving treatment for Wilms’ tumor at the Brazilian National Cancer Institute (INCA) between April 2003 and December 2016. Patients were categorized into two groups: those referred directly from an emergency public department to INCA and those first transferred to another hospital before being referred to INCA. Results: Of the 98 cases included in the study, 42.9% were direct referrals and 57.1% were indirect referrals. Presence of an abdominal mass was the most common presenting complaint, followed by abdominal pain. In cases with larger tumors, the mean tumor volume was greater than reported elsewhere in the literature, suggesting longer disease duration. Significantly higher tumor volumes were observed in patients with a palpable abdominal mass as compared to those with the second most frequent complaint (abdominal pain). Conclusion: The findings of this study support the hypothesis that patients diagnosed with kidney masses in the emergency department are at greater risk of delayed diagnosis when they are referred first to a non-specialized outside hospital than when referred directly to a specialized cancer treatment unit.
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Meclizine prescriptions in the Emergency Department and return visits in the elderly population

Published on: 11th June, 2021

OCLC Number/Unique Identifier: 9124652483

Background: Meclizine is a commonly prescribed medication for patients discharged from the Emergency Department (ED) with a diagnosis of peripheral vertigo, however it is on the Beers list of medications to avoid in elderly patients. Objectives: This study aims to determine the correlation between use of meclizine and return visits to the ED within 1 week in patients > 65 years old. Methods: This is a retrospective observational study conducted at 2 urban tertiary care EDs over 5 years. Inclusion criteria included patients > 65 years who were given meclizine in the ED or discharged with a prescription. Charts were reviewed for diagnosis, prescriptions and return visits within 7 days. Results: There were a total of 1608 patients over 65 years of age who met inclusion criteria, 669 patients identified as receiving meclizine in the ED and 962 who received no meclizine (ED or ED plus home prescription). Of the meclizine patients, 548 (84.8%) were given home prescriptions, of which there were 36 (6.6%) return visits within 7 days. Patients who were given meclizine while in the ED without home prescriptions (121) had 16 return visits (13.2%). Among the non-meclizine group, 102 patients (10.6%) had a return visit within 7 days. Conclusion: There was no increase in return visits in elderly patients discharged from the ED with a prescription for meclizine after a diagnosis of benign dizziness. Meclizine prescriptions at discharge were associated with fewer return visits to the ED within 1 week. Ongoing dizziness was the most common reason for return visits; there were no documented chief complaints of weakness, syncope/falls, or hypotension.
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Prevention of workplace violence in ED nursing using the implementation of an educational program and a new reporting tool

Published on: 7th January, 2022

The Emergency Department (ED) is a place that regularly deals with acute scenarios and people that are generally sensitive in nature. In a fast-paced environment such as this, people can be emotionally charged and react in different ways. Unfortunately, nurses in the ED tend to be most affected. Literature shows that workplace violence incidents that occur tend to involve ED nurses. Furthermore, ED nurses are more inclined to have an attitude that makes them think that any acts of transgression are “part of the job” and incidents usually go underreported. Moreover, reporting tools are usually difficult to use and tend to be a barrier to reporting workplace violence. In this evidence-based project, ED nurses will participate in an educational prevention program that will help equip them with the knowledge and awareness that is needed to decrease the incidence of workplace violence. Furthermore, a new, easy-to-use reporting tool will be implemented for ED staff. An implementation of an easier reporting tool and an education prevention program on the incidence of workplace violence will help reduce the number of future incidents of workplace violence. The purpose of this evidence-based project is to create a “zero tolerance” workplace culture for ED nurses that ultimately decreases the incidence of workplace violence. Based on research, an educational program and new reporting tool will be implemented at an urban community hospital in Westchester. Included is a purpose statement, and operational and conceptual definition, PICO questions, and an evidence-based practice protocol for workplace violence.
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Dalbavancin and moleculight in the COVID-19 pandemic

Published on: 11th April, 2023

The COVID-19 Pandemic, which began in March 2020, and its associated surges, had an immense impact on our medical staff and their ability to perform their daily duties.The COVID-19 Pandemic necessitated hospital modifications, including the expansion of the Emergency Department, ICU, and Isolation units. The overwhelmed staff and overburdened ER and ICU required adjustments to deal with the Inpatient impasse. For example, temporary patient care rooms needed to be set up for the overflow of patients. The tsunami of the Pandemic almost overwhelmed our hospital.With the challenges presented to our hospital during the Pandemic, we needed a fresh perspective to our multi-disciplinary approach. Thus, we fathomed that the use and cost-effectiveness of both Dalbavancin, a long-acting lipoglycopeptide antibiotic combined with the diagnostic Moleculight Imaging Device would be a sound decision.We hypothesized that with the use of this cost-effective antibiotic in conjunction with the use of the Moleculight Imaging Device, with its fluorescent imaging, we could detect the presence of bacteria and assist our wound treatment and decision-making.A shift in patients from the Emergency Room/Inpatient Department to the Outpatient Department/Wound Care Center was made possible with the use of these two novel products.
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Physiotherapy Can Help Recover Functional Status in Community-dwelling Seniors Assessed in Emergency Departments for Minor Injuries

Published on: 1st August, 2023

Background: Around 75% of seniors seeking treatment for injuries in Emergency Departments (ED) are discharged home with minor injuries that put them at risk of functional decline in the following months. Objectives: To 1) describe seniors’ characteristics using or not physiotherapy services following ED visits for minor injuries and 2) examine their functional status according to physiotherapy use. Methods: Secondary data analyses of the Canadian Emergency Team Initiative cohort study. Participants were 65 years and older, discharged home after consulting EDs for minor injuries and assessed three times: ED, 3- and 6-months. Physiotherapy use was recorded as yes/no. Functional status was measured using the Older American Resources Scale (OARS). Multivariate linear regressions were used to examine change in OARS scores over time, accounting for confounders. Results: Among the 2169 participants, 565 (26%) received physiotherapy, and 1604 (74%) did not. Physiotherapy users were more likely females (71% vs. 64%), more educated, and less cognitively impaired. The overall change in OARS at 6 months was -0.31/28 points (95% CI: -0.55; -0.28) with no difference across groups after adjustment. Subgroup analyses among frail seniors showed that physiotherapy users maintained their function while non-users lost clinically significant function (-0.02 vs. -1.26/28 points, p = 0.03). Among the severely injured (Injury Severity Scale ≥ 5), physiotherapy users’ results were higher by almost 1/28 points (p = 0.03) compared to non-users. Conclusion: These results suggest that among seniors discharged home after consulting the ED for minor injuries, the frail and severely injured may benefit from being systematically referred to physiotherapy services. 
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Cardiac Tamponade as the Cause of Pulmonary Edema: Case Report

Published on: 17th August, 2023

Introduction: Cardiac tamponade is an emergency syndrome that requires fast diagnosis and treatment; otherwise patient follows obstructive shock and cardiac arrest. Case report: A 70-year-old female was brought to the emergency department with hypoxemia. She had a history of progressive dyspnea over the past three weeks. Past medical history includes smoking. On physical examination: tachypnea, hypoxemia (SaO2 89%), jugular venous distention, arterial pressure 220/100 mmHg, heart rate rhythmic of 82 bpm. On pulmonary auscultation: diffuse and bilateral crackles. Lung ultrasound showed a bilateral B line and the echocardiogram demonstrated a pericardial effusion with signs of tamponade. A pericardiocentesis evacuated 620 ml of hemorrhagic fluid and the patient was transferred to the intensive care unit, hemodynamically stable, with SaO2 95%. At the ICU the echocardiogram, showed resolution of the cardiac tamponade and a tumor adhered to the lateral wall of the left ventricle. Chest CT demonstrated: a left lung tumor, infiltrating the pericardial sac. A pericardium biopsy demonstrated undifferentiated carcinoma. Discussion: Cardiac tamponade diagnosis requires a high level of suspicion. Respiratory failure, chest pain, and shock, observed in cardiac tamponade, are also present in different diseases. The most common finding of cardiac tamponade is dyspnea (78% of cases). Our patient had dyspnea due to pulmonary edema, secondary to left ventricle diastolic dysfunction caused by the tamponade. A bedside echocardiogram made the diagnosis of cardiac tamponade and guided the effective pericardiocentesis. Conclusion: Cardiac tamponade must be suspected in all cases of acute dyspnea. Echocardiogram is the method of choice for the diagnosis and for guiding the pericardiocentesis.
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