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Porter, Joanne E., Nareeda Miller, Anita Giannis, and Nicole Coombs. "Family Presence During Resuscitation (FPDR): Observational case studies of emergency personnel in Victoria, Australia." International Emergency Nursing 33 (July 2017): 37–42. http://dx.doi.org/10.1016/j.ienj.2016.12.002.
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Featherstone, Kirsten. "Case Studies." Journal of Trauma Nursing 4, no. 2 (April 1997): 45–48. http://dx.doi.org/10.1097/00043860-199704000-00004.
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Miya, Pamela A. "Case Studies in Nursing Ethics. RM Veatch and ST Fry." Dimensions Of Critical Care Nursing 8, no. 2 (March 1989): 128. http://dx.doi.org/10.1097/00003465-198903000-00019.
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Cheney, Jean. "Pediatric Case Studies." Journal of Burn Care & Rehabilitation 10, no. 4 (July 1989): 379–80. http://dx.doi.org/10.1097/00004630-198907000-00018.
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Abarikwu, Kelechi, James Komara, and Andrej Urumov. "The Case of the Red Extremities." Clinical Practice and Cases in Emergency Medicine 6, no. 1 (January 28, 2022): 95–96. http://dx.doi.org/10.5811/cpcem.2021.10.52891.
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Case Presentation: A 37-year-old man with severe obstructive sleep apnea presented to the emergency department with burning pain, redness and swelling in his hands and feet, worsening for several weeks. Pertinent laboratory studies revealed polycythemia. Discussion: Erythromelalgia is a clinical diagnosis characterized by painful burning, erythema, warmth, and edema usually involving the distal extremities. Therapeutic goals are focused on symptom reduction, while also managing the underlying condition in cases of secondary erythromelalgia. Pharmacological and non-pharmacological therapies have proven to be of limited success.
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Bono, Michael, Dylan Woolum, A. Jones, and Francis Counselman. "Vaginal Swelling After Intercourse: A Case Report." Clinical Practice and Cases in Emergency Medicine 6, no. 2 (April 25, 2022): 169–72. http://dx.doi.org/10.5811//cpcem.2022.2.55284.
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Introduction: A vulvar hematoma is a hemorrhagic fluid collection in the female external genitalia. The majority occur as an obstetrical complication, especially during labor. Non-obstetrical vulvar hematomas are usually the result of trauma, with coitus being the most common etiology. Case Report: We present the case of a 25-year-old woman with significant vaginal pain and swelling after vigorous sexual intercourse. She exhibited tenderness and swelling of the left labia majora and minora. The differential diagnosis included bleeding, abscess, and deep venous thrombosis. Laboratory studies were normal and computed tomography of the pelvis indicated the swelling was most likely due to blood. The patient was taken to the operating room, and approximately 150 cubic centimeters of clot was evacuated. The patient had an uneventful recovery and was discharged home the next day. Conclusion: This case illustrates the unique presentation and challenges in making the diagnosis of vulvar hematoma.
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Hill, Alexandra, Marco Guillén, David Martin, and Andrea Dreyfuss. "Point-of-care Ultrasound Diagnosis of Pulmonary Hydatid Cyst Disease Causing Shock: A Case Report." Clinical Practice and Cases in Emergency Medicine 5, no. 4 (August 27, 2021): 403–6. http://dx.doi.org/10.5811/cpcem.2021.5.52264.
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Introduction: Point-of-care ultrasound (POCUS) is accepted as an important tool for evaluating patients presenting to the emergency department (ED) with dyspnea1 and undifferentiated shock. Identifying the etiology and type of shock is time-critical since treatments vary based on this information. Clinicians typically rely on the history, exam, and diagnostics tests to identify the etiology of shock. In resource-limited settings where there is reduced access to timely laboratory and diagnostic studies. The use of POCUS enables rapid classification and directed treatment of shock. Additionally, POCUS can aid in the diagnosis of rarer tropical diseases that can be important causes of shock in resource-limited settings. Case Report: We discuss a case of a pediatric patient who presented to an ED in Cusco, Peru, with acute dyspnea and shock. Point-of-care ultrasound was used to expedite the diagnosis of a ruptured pulmonary hydatid cyst, guide proper management of septic and anaphylactic shock, and expedite definitive surgical intervention. Conclusion: In resource-limited settings where there is reduced access to timely laboratory and diagnostic studies, the use of POCUS enables rapid classification and directed treatment of shock.
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Trumbetta, Christopher, and Michael Galuska. "Brugada-like ECG Changes After Conducted Electrical Weapon Exposure: A Case Report." Clinical Practice and Cases in Emergency Medicine 6, no. 2 (April 25, 2022): 194–97. http://dx.doi.org/10.5811/cpcem.2021.6.52893.
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Case Report: A 38-year-old male with no pertinent medical history presented with suicidal ideation and alcohol intoxication after an altercation with the police. The patient received two CEW exposures during an encounter with law enforcement prior to transport to the emergency department. He was asymptomatic, but an ECG was performed as part of the triage process given his reported CEW exposure. His initial ECG showed ST-segment and T-wave changes in the precordial leads similar to those found in Brugada syndrome. After a three-hour period of observation and resolution of the patient’s alcohol intoxication, a repeat ECG was performed that showed resolving Brugada morphology. Conclusion: Review of the literature surrounding the safety profile associated with CEW exposure shows few if any documented concerning cardiac electrophysiology changes and suggests that routine electrocardiographic studies or monitoring is not required. This case presents an isolated but interesting instance of a transient ECG abnormality associated with a CEW exposure.
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Fogam, Michael, Natasha Leigh, and Trent She. "Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus." Clinical Practice and Cases in Emergency Medicine 5, no. 4 (October 28, 2021): 463–65. http://dx.doi.org/10.5811/cpcem.2021.9.52682.
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Introduction: Adult intestinal malrotation with midgut volvulus is rare and most often diagnosed on abdominal imaging. Once the diagnosis is made, prompt surgical intervention is necessary. A finding suggestive of malrotation with midgut volvulus on abdominal imaging is the “whirlpool” sign where the superior mesenteric vein and superior mesenteric artery twist at the root of the abdominal mesentery. This sign was once thought to be pathognomonic, but recent studies have shown that it can be seen in asymptomatic patients. Case Report: A 20-year-old female presented to our emergency department with diffuse abdominal pain. Computed tomography demonstrated the “whirlpool” sign with a concern for malrotation with midgut volvulus. Surgical consultation was obtained and the patient was rushed to the operating room for an exploratory laparotomy. Normal mesenteric attachments were seen and no significant pathology was identified during the laparotomy. The patient was eventually diagnosed with gastritis and discharged in stable condition. Conclusion: Emergency physicians and surgeons alike should be cautious in confirming malrotation with midgut volvulus solely due to the “whirlpool” sign on abdominal imaging. Premature diagnostic closure can lead to unnecessary procedures and interventions for patients as in the case we report here.
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Ashdown, Brayden, and Emilie Hynes. "Thyroid Storm-induced Takotsubo Cardiomyopathy Presenting as Acute Chest Pain: A Case Report." Clinical Practice and Cases in Emergency Medicine 5, no. 4 (October 5, 2021): 399–402. http://dx.doi.org/10.5811/cpcem.2021.4.52005.
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Introduction: Stress-induced cardiomyopathy is a rare but serious cause of chest pain, which in recent studies has been shown to carry a similar in-hospital mortality to acute ST-elevation myocardial infarction. The pathophysiology of the disease is thought to be secondary to dysregulated catecholamine effects on myocardium. Case Report: We present a case of a previously healthy female without known thyroid disease who presented to the emergency department for acute chest pain and was found to have thyroid storm-induced cardiomyopathy in a typical stress-induced cardiomyopathy pattern without evidence of coronary disease on catheterization. Conclusion: Thyrotoxicosis can cause dysregulation of catecholamines and is a rare cause of stress-induced cardiomyopathy. It requires distinct therapies and should be considered by emergency physicians in the workup of acute chest pain with concern for stress-induced cardiomyopathy.
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Lentz, Brian, Sigmund Kharasch, Andrew Goldsmith, Joseph Brown, Nicole Duggan, and Arun Nagdev. "Diaphragmatic Excursion as a Novel Objective Measure of Serratus Anterior Plane Block Efficacy: A Case Series." Clinical Practice and Cases in Emergency Medicine 6, no. 4 (November 4, 2022): 276–79. http://dx.doi.org/10.5811/cpcem.2022.7.57457.
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Introduction: Pain scales are often used in peripheral nerve block studies but are problematic due to their subjective nature. Ultrasound-measured diaphragmatic excursion is an easily learned technique that could provide a much-needed objective measure of pain control over time with serial measurements. Case Series: We describe three cases where diaphragmatic excursion was used as an objective measure of decreased pain and improved respiratory function after serratus anterior plane block in emergency department patients with anterior or lateral rib fractures. Conclusion: Diaphragmatic excursion may be an ideal alternative to pain scores to evaluate serratus anterior plane block efficacy. More data will be needed to determine whether this technique can be applied to other ultrasound-guided nerve blocks.
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Powell, Christina, Lauren Rosenblatt, Laura Bontempo, and Zachary Dezman. "57-year-old Female with Unusual Left-arm Movements." Clinical Practice and Cases in Emergency Medicine 6, no. 1 (February 28, 2022): 1–7. http://dx.doi.org/10.5811/cpcem.2022.2.55676.
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Introduction: A 57-year-old, right-hand dominant female presented to the emergency department striking herself with her left hand. Case Presentation: The astute medical staff looked beyond a behavioral health etiology. A detailed history, physical examination, and workup reveals the fascinating final diagnosis. Discussion: This case takes the reader through the differential diagnosis and systematic workup of uncontrolled limb movements with discussion of the studies which ultimately led to this patient’s diagnosis.
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Patel, Kishan, Zara Khan, and John Costumbrado. "To Drain or not to Drain? Point-of-care Ultrasound to Investigate an Axillary Mass: Case Report." Clinical Practice and Cases in Emergency Medicine 6, no. 2 (April 18, 2022): 155–58. http://dx.doi.org/10.5811//cpcem.2022.2.53357.
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Introduction: Point-of-care ultrasound (POCUS) has great sensitivity in the diagnosis of abscesses and swollen lymph nodes. Many studies outline the characteristics that distinguish abscesses from lymph nodes on POCUS. Case Report: We present a case from the emergency department in which a patient presented with a potential abscess but was found to have a malignant lymph node on imaging. Conclusion: Point-of-care ultrasound can be used to differentiate an abscess from a swollen lymph node. Abscesses are generally anechoic or hypoechoic with septae, sediment or gas contents, and they lack internal vascularity. Benign lymph nodes are echogenic with hypoechoic cortex with hilar vascularity.
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Bahoosh, Masoud, and Hamed Akhavizadegan. "Scrotal dog bite and mismatch between the skin and testis injury: a case report and review of literature." Clinical and Experimental Emergency Medicine 9, no. 1 (March 31, 2022): 67–69. http://dx.doi.org/10.15441/ceem.20.012.
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Dog bite injury to the genitalia is a rare condition, regarding which most of the studies have focused on prevention of infection and management of severe cases; and small, superficial lacerations have not been taken into consideration. We present a case of a patient whose testis was severely injured with minimal scrotal injury and without significant clinical findings other than pain. We found two other case reports with similar features during review of the literature. We suggest that in case of genital dog bite, regardless of the lesion size and appearance, imaging is necessary to make sure that the testes, corpus cavernosum, and urethra are intact.
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Lee, Sangkil, and Sung-Hyun Lee. "Exertional heat stroke with reversible severe cerebral edema." Clinical and Experimental Emergency Medicine 8, no. 3 (September 30, 2021): 242–45. http://dx.doi.org/10.15441/ceem.19.085.
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Severe cerebral edema associated with exertional heat stroke is a major cause of death or disability. However, few studies on severe cerebral edema resulting from heat stroke have reported neuroradiological findings. Moreover, all the patients in these previous reports either died or remained severely disabled. Here, we report a case of exertional heat stroke with severe cerebral edema that probably developed or worsened due to delayed body temperature normalization. In contrast to previous reports, the patient showed complete clinical and neuroradiological recovery. This rare case suggests that severe cerebral edema could be reversed through meticulous supportive management. Moreover, it confirms the importance of rapid and effective cooling in heat stroke treatment.
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Yang, Jae Kwang, Yu Jin Kim, Joo Jeong, Jungeun Kim, Jeong Ho Park, Young Sun Ro, and Sang Do Shin. "Low serum cholesterol level as a risk factor for out-of-hospital cardiac arrest: a case-control study." Clinical and Experimental Emergency Medicine 8, no. 4 (December 31, 2021): 296–306. http://dx.doi.org/10.15441/ceem.20.114.
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Objective We aimed to identify the association between low serum total cholesterol levels and the risk of out-of-hospital cardiac arrest (OHCA).Methods This case-control study was performed using datasets from the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES) project and the Korea National Health and Nutrition Examination Survey (KNHANES). Cases were defined as emergency medical service-treated adult patients who experienced OHCA with a presumed cardiac etiology from the CAPTURES project dataset. Four controls from the KNHANES dataset were matched to each case based on age, sex, and county. Multivariable conditional logistic regression analysis was conducted to evaluate the effect of total cholesterol levels on OHCA.Results A total of 607 matched case-control pairs were analyzed. We classified total cholesterol levels into six categories (<148, 148-166.9, 167-189.9, 190-215.9, 216.237.9, and ≥238 mg/dL) according to the distribution of total cholesterol levels in the KNHANES dataset. Subjects with a total cholesterol level of 167-189.9 mg/dL (25th.49th percentile of the KNHANES dataset) were used as the reference group. In both the adjusted models and sensitivity analysis, a total cholesterol level of <148 mg/dL was significantly associated with OHCA (adjusted odds ratio [95% confidence interval], 6.53 [4.47.9.56]).Conclusion We identified an association between very-low total cholesterol levels and an increased risk of OHCA in a large, community-based population. Future prospective studies are needed to better understand how a low lipid profile is associated with OHCA.
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Lei, Yan, Linxiang He, and Houqiang Huang. "Enhancement of Nursing Effect in Emergency General Surgery Based on Computer Aid." Journal of Healthcare Engineering 2022 (March 10, 2022): 1–10. http://dx.doi.org/10.1155/2022/6745993.
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In order to improve the nursing effect of emergency general surgery, this paper combines computer algorithms to carry out the intelligent management of general surgery nursing, and realizes the standardization of nursing information, the electronic nursing file, the precision of nursing workload, and the intelligentization of nursing quality control by means of informatization. This truly and objectively reflects the nursing operation and treatment situation, prevents the occurrence of some adverse events, and effectively reduces the workload of nursing care. Moreover, this paper uses a standardized software design method to define the software concept, and then conducts a detailed demand analysis of the nursing display function through detailed investigation, class work, discussion and analysis, and comparison decision-making methods. In addition, this paper compiles the software through strict coding standards, and finally designs test cases to test and improve the software. Through actual case studies, it can be seen that the computer-assisted emergency general surgery nursing method proposed in this paper has a certain progress compared with the traditional nursing method.
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Schmidt, Shirley Jean, and Arthur Hernandez. "The Developmental Needs Meeting Strategy: Eight case studies." Traumatology 13, no. 1 (2007): 27–48. http://dx.doi.org/10.1177/1534765607299913.
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Greenwald, Ricky. "Progressive counting for trauma resolution: Three case studies." Traumatology 14, no. 4 (2008): 83–92. http://dx.doi.org/10.1177/1534765608319081.
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Livingston, Joshua, Savannah Gonzales, and Mark Langdorf. "Computed Tomography Appearance of the “Whirlpool Sign” in Ovarian Torsion." Clinical Practice and Cases in Emergency Medicine 5, no. 4 (October 5, 2021): 468–69. http://dx.doi.org/10.5811/cpcem.2021.7.53317.
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Case Presentation: A 28-year-old female presented to the emergency department complaining of right lower abdominal pain. A contrast-enhanced computed tomography (CT) was done, which showed a 15-centimeter right adnexal cyst with adjacent “whirlpool sign” concerning for right ovarian torsion. Transvaginal pelvic ultrasound (US) revealed a hemorrhagic cyst in the right adnexa, with duplex Doppler identifying arterial and venous flow in both ovaries. Laparoscopic surgery confirmed right ovarian torsion with an attached cystic mass, and a right salpingo-oophorectomy was performed given the mass was suspicious for malignancy. Discussion: Ultrasound is the test of choice for diagnosis of torsion due to its ability to evaluate anatomy and perfusion. When ovarian pathology is on the patient’s right, appendicitis is high in the differential diagnosis, and CT may be obtained first. Here we describe a case where CT first accurately diagnosed ovarian torsion by demonstrating the whirlpool sign, despite an US that showed arterial flow to the ovary. Future studies should determine whether CT alone is sufficient to diagnose or exclude ovarian torsion.
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Cordeiro de Carvalho, Henrique, OMAR PEREIRA DE ALMEIDA NETO, Suely Amorim de Araújo, and Ricardo Gonçalves de Holanda. "Academic League of Urgency and Emergency Nursing as A Health Educational Tool." International Journal for Innovation Education and Research 8, no. 9 (September 10, 2020): 36–46. http://dx.doi.org/10.31686/ijier.vol8.iss9.2377.
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Introduction: Academic leagues are created with the proposal of expanding the studies on certain fields as an educational tool. Objective: Describing experience of nursing students as member of activities in a Nursing Urgency and Emergency League in a Public University of Minas Gerais State, Brazil. Methodology: Exploratory and descriptive study of the type experience report of nursing student participating in the League of Urgency and Emergency in Nursing called “LUREEN”, within the scope of the Federal University of Uberlandia (UFU). Results: Nursing students have taught by two professors. One of them has multiprofessional degree (nurse, physician and dental surgeon, besides master degree) and other is PhD in Nursing. A total of 20 students make up league team, most female (n=14; 70%) with a mean age of 23.80±4.10 years and attending the 6th period of nursing course (n=6; 30%). The main activities performed were: Classes and realistic clinical simulations through educational methodologies as Team-Based Learning (TBL), Problem Based Learning (PBL) and Case‐based learning (CBL); Health Continuous Education; Extra hospital activities and Coverage of cultural and sportive events by league. Final Considerations: The outcomes presented in that experience report show a great way to improve and increasing learning of nursing students in undergraduate trough an academic league as well as one of the best methodologies to provide real training in urgency and emergency situations. It is expected that future studies approach similar issues to improve nurse education courses.
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Ranse, Jamie, Alison Hutton, Basseer Jeeawody, and Rhonda Wilson. "What Are the Research Needs for the Field of Disaster Nursing? An International Delphi Study." Prehospital and Disaster Medicine 29, no. 5 (August 27, 2014): 448–54. http://dx.doi.org/10.1017/s1049023x14000946.
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AbstractBackgroundInternationally there is an increasing amount of peer-reviewed literature pertaining to disaster nursing. The literature includes personal anecdotes, reflections, and accounts of single case studies. Furthermore, issues such as the willingness of nurses to assist in disasters, the role of nurses in disasters, leadership, competencies, and educational preparedness for nurses have been the focus of the literature.AimThe aim of this research was to determine the international research priorities for disaster nursing.MethodThis research used a three-round Delphi technique. The first round used a face-to-face workshop to generate research statements with nursing members of the World Association for Disaster and Emergency Medicine (WADEM). The second and third rounds included the ranking of statements on a 5-point Likert scale with nursing members of WADEM and the World Society of Disaster Nursing (WSDN). Statements that achieved a mean of four or greater were considered a priority and progressed.ResultsParticipants were from multiple countries. Research statements were generated in the areas of: education, training, and curriculum; psychosocial; strategy, relationship, and networking; and clinical practice. Psychosocial aspects of disaster nursing ranked the highest, with five statements appearing in the top ten research areas, followed by statements relating to: education, training, and curriculum; clinical practice; and finally, strategy, relationship, and networking.ConclusionsFuture disaster nursing research should focus on the area of psychosocial aspects of disaster nursing, in particular, both the psychosocial needs of a disaster-affected community and the psychosocial wellbeing of nurses who assist in disaster health activities.RanseJ,HuttonA,JeeawodyB,WilsonR.What are the research needs for the field of disaster nursing? An international Delphi study.Prehosp Disaster Med.2014;29(5):1-7.
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Cronin, Elaine Anne. "Actinomycosis: a case report of two patients treated for the condition who required stoma formation." British Journal of Nursing 30, no. 16 (September 9, 2021): S32—S37. http://dx.doi.org/10.12968/bjon.2021.30.16.s32.
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Actinomycosis is a rare bacterial condition that is seen infrequently and no studies have examined its prevalence or incidence globally. The author, a stoma care clinical nurse specialist (CNS), found herself caring for two such patients 3 weeks apart, both of whom were diagnosed with pelvic actinomycosis. Both patients had been fitted with copper intrauterine devices (IUDs) 10 years previously and were not aware that leaving IUDs in situ for a prolonged period increased their risk of infection. This article gives an overview of the condition, with discussion around the two patients the author cared for within her own specialty; not all aspects of the condition are included as the she has no clinical experience in microbiology and is not a gynaecological CNS. The case studies show how both women presented and were treated, with interventions including emergency surgery, long-term antibiotic therapy and stoma formation. Pelvic actinomycosis is often associated with the use of an IUD, and greater awareness about the risk of leaving IUDs in situ for prolonged periods is needed among gastrointestinal, colorectal and gynaecological practitioners.
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Cardin, Suzette, Sandra Kane, and Kathleen Koch. "Use of Patient Care Extenders in Critical Care Nursing." AACN Advanced Critical Care 3, no. 4 (November 1, 1992): 789–96. http://dx.doi.org/10.4037/15597768-1992-4007.
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This article explores the implementation and use of patient care extenders in two critical care units. Experimentation and diversity in changing the care-delivery system were the forces motivating the management team to redesign the existing nursing care-delivery system. The impetuses for the change process were the use of the role of the registered nurse and cost containment. Two case studies will illustrate from a practical perspective how the change occurred. Although the same nurse manager was responsible administratively for the two units, the patient care extender models were implemented differently. This was based on the conviction that each unit is unique with regard to patients and staff needs. The first case study occurred in an 18-bed cardiac telemetry unit in which the patient extender care model was integrated with direct patient care activities of the unit. In the second case study, which occurred in a ten-bed cardiac care unit, the patient care extender was integrated with indirect patient care activities. The approach to this article is practical, and it is intended for units that may be dealing with these issues in these changing times in health care
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Sherwen, Olivia, Madeleine Kate Baron, Natalie Strachan Murray, Paul Anthony Heaton, Jane Gamble, and Siba Prosad Paul. "The recognition and nursing management of common oncological emergencies in children." British Journal of Nursing 31, no. 1 (January 13, 2022): 20–27. http://dx.doi.org/10.12968/bjon.2022.31.1.20.
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An oncological emergency may be the initial presentation of a cancer, a sign of cancer progression, or a complication of cancer treatment. The most frequently encountered paediatric oncological emergencies include neutropenic sepsis, hyperleukocytosis, brain tumours presenting with raised intracranial pressure, tumour lysis syndrome and superior mediastinal syndrome. These are all life-threatening conditions that require urgent recognition and management. Health professionals working in an emergency department (ED) are likely to be involved in managing these children. This article brings together the current guidance and recommendations for these specific emergencies. It also includes two case studies that demonstrate the challenges health professionals can face while managing these situations. It is important that health professionals have an acute awareness of oncological emergencies. Confidence in recognising the presentations, diagnoses and initial management are essential because these conditions may be life-threatening and time critical.
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Hayat Makki, Muhammad Khizer, Ghulam Qadir Khan, Abdul Munaf Saud, Shahid Mehmood, Zulfiqar Ahmed, and Hafiz Muhammad Ahmad Qureshi. "Determination of Functional Outcomes of Displaced Olecranon Fracture Fixed with Intermedullary Partially Threaded Screw Augmented with Tension Band Wiring." Pakistan Journal of Medical and Health Sciences 15, no. 9 (September 30, 2021): 2594–97. http://dx.doi.org/10.53350/pjmhs211592594.
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Introduction: Orthopaedic injuries involving the olecranon are among the most often encountered in the emergency department. Objective: To determine the functional outcomes of displaced olecranon fracture fixed with intermedullary partially threaded screw augmented with tension band wiring Material and methods: This Descriptive/multicentric case series was conducted in Department of Orthopedics, Bahawal Victoria Hospital/Civil (Sadiq Abbasi) Hospital, Bahawalpur during June 2019 to June 2021. Patients who came through the emergency department and met the inclusion criteria were enrolled and given informed permission after clearance from the hospital's ethics committee. During general anesthesia or a biere’s block, all patients received tension band wire and intramedullary screw fixation. Results: Functional outcomes of displaced olecranon fracture fixed with intermedullary partially threaded screw augmented with tension band wiring was recorded as excellent in 57.39%(n=66), 32.17%(n=37) had good outcome, 10.44%(n=12) had fair outcome. Conclusion: We concluded that that functional outcomes of displaced olecranon fracture fixed with intermedullary partially threaded screw augmented with tension band wiring is good; however, validation is required through other local studies. Key words: Olecranon fracture, Intramedullary partially threaded screw, Tension band wiring, and Campbell’s posterolateral approach
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Crock, Elizabeth, and Judy-Ann Butwilowsky. "The HIV Resource Nurse Role at the Royal District Nursing Service (Melbourne): Making A Difference for People Living with HIV/AIDS in the Community." Australian Journal of Primary Health 12, no. 2 (2006): 83. http://dx.doi.org/10.1071/py06026.
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The care of people living with HIV/AIDS in the home and community can be complex and challenging, requiring high levels of knowledge, skill, preparedness and, importantly, the ability to engage with people belonging to marginalised groups. In 2003, the Royal District Nursing Service (RDNS) HIV/AIDS Team in Victoria, Australia, developed the new role of HIV Resource Nurse at two RDNS centres in Melbourne serving high numbers of people living with HIV/AIDS. Drawing from two case studies and interviews with two HIV Resource Nurses from one of the centres, this paper describes this practice innovation. Benefits (including a positive impact on client engagement with services, client care, relationships with other health care workers and job satisfaction) are outlined, along with challenges in the implementation and evolution of the role. Strategies to sustain and develop the HIV Resource Nurse role are proposed.
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Syrett-Page, Joanne, Paul Anthony Heaton, Lucy Jenner, and Siba Prosad Paul. "Acute abdominal surgical presentations in children." British Journal of Nursing 30, no. 13 (July 8, 2021): 780–86. http://dx.doi.org/10.12968/bjon.2021.30.13.780.
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Surgical conditions affecting the abdomen in children can be associated with significant morbidity and mortality if they are not recognised and managed appropriately. It is therefore important that the correct diagnosis is made quickly, and the appropriate intervention is initiated in a timely manner and, if necessary, rapid transfer is made to a specialist paediatric surgical facility. This article provides an overview of the different surgical presentations encountered in children, and outlines the most important points in the history, examination and management of such cases, whether encountered in the emergency setting or in the community. Two illustrative case studies have been included to demonstrate how these emergencies may present in clinical practice.
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Lam, Tina, Jane Hayman, Janneke Berecki-Gisolf, Paul Sanfilippo, Dan I. Lubman, and Suzanne Nielsen. "Comparing rates and characteristics of emergency department presentations related to pharmaceutical opioid poisoning in Australia: a study protocol for a retrospective observational study." BMJ Open 10, no. 9 (September 2020): e038979. http://dx.doi.org/10.1136/bmjopen-2020-038979.
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Introduction and aimsPharmaceutical opioids are an important contributor to the global ‘opioid crisis’, and are implicated in 70% of Australia’s opioid-related mortality. However, there have been few studies which consider the relative contribution of different pharmaceutical opioids to harm.We aim to compare commonly used pharmaceutical opioids in terms of (1) rates of harm, and (2) demographic and clinical characteristics associated with that harm.Method and analysisObservational study of emergency department presentations for non-fatal poisoning related to pharmaceutical opioid use. Data from 2009 to 2019 will be extracted from the Victorian Emergency Minimum Dataset which contains data from public hospitals with dedicated emergency departments in Victoria, Australia’s second most populous state. A combination of free-text and International Classification of Diseases 10th Revision codes will be used to identify relevant cases, with manual screening of each case to confirm relevance. We will calculate supply-adjusted rates of presentations using Poisson regression for all pharmaceutical opioid cases identified, separately for nine commonly prescribed pharmaceutical opioids (buprenorphine, codeine, fentanyl, methadone, morphine, oxycodone, oxycodone-naloxone, tapentadol, tramadol), and for a multiple opioid category. We will use multinomial logistic regression to compare demographic and clinical characteristics, such as triage category, across opioid types.Ethics and disseminationThis work is conducted under approval 21427 from the Monash University Human Research Ethics Committee for ongoing injury surveillance. As per conditions of approval, cells of <5 will not be reported, though zeroes will be preserved. We will present project findings in a peer-reviewed journal article as well as at relevant scientific conferences.
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Moone, Rajean. "Utilizing Peer Cohort Networks to Disseminate Information and to Prevent and Mitigate COVID-19 in Nursing Homes." Innovation in Aging 5, Supplement_1 (December 1, 2021): 58. http://dx.doi.org/10.1093/geroni/igab046.224.
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Abstract The COVID-19 pandemic disproportionately impacted residents, families, and staff of nursing homes and senior care communities. Even with federally mandated emergency planning, the pandemic highlighted the lack of preparation to meet the daily challenges faced in senior care. In response, the federal CARES Act including funding for a nationwide network of nursing home cohorts led by academic health centers to disseminate clinical guidance in infection control and pandemic mitigation strategies. We present a case study of a successful diffusion model as implemented in Minnesota with seven cohorts comprised of 242 nursing homes and 544 employees. Experts in geriatric care, long term care regulatory management, and public health led ninety-minute sessions held over the span of sixteen weeks. The session format included foundational evidence-based practices in pandemic management (including infection control, social isolation, leadership, and other topics), individual case studies, peer to peer knowledge diffusion, and expert guidance.
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Laferté, Catherine, Andréa Dépelteau, and Catherine Hudon. "Injuries and frequent use of emergency department services: a systematic review." BMJ Open 10, no. 12 (December 2020): e040272. http://dx.doi.org/10.1136/bmjopen-2020-040272.
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ObjectiveTo review all studies having examined the association between patients with physical injuries and frequent emergency department (ED) attendance or return visits.DesignSystematic review.Data sourceMedline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO databases were searched up to and including July 2019.Eligibility criteriaEnglish and French language publications reporting on frequent use of ED services (frequent attendance and return visits), evaluating injured patients and using regression analysis.Data extraction and synthesisTwo independent reviewers screened the search results, and assessed methodological quality using the Joanna Briggs Institute tool for prevalence studies. Results were collated and summarised using a narrative synthesis. A sensitivity analysis was performed to evaluate the repercussions of removing a study that did not meet the quality criteria.ResultsOf the 2184 studies yielded by this search, 1957 remained after the removal of duplicates. Seventy-eight studies underwent full-text screening leaving nine that met the eligibility criteria and were included in this study: five retrospective cohort studies; two prospective cohort studies; one cross-sectional study; and one case-control study. Different types of injuries were represented, including fractures, trauma and physical injuries related to falls, domestic violence or accidents. Sample sizes ranged from 200 to 1 259 809. Six studies included a geriatric population while three addressed a younger population. Of the four studies evaluating the relationship between injuries and frequent ED use, three reported an association. Additionally, of the five studies in which the dependent variable was return ED visits, three articles identified a positive association with injuries.ConclusionsPhysical injuries appear to be associated with frequent use of ED services (frequent ED attendance as well as return ED visits). Further research into factors including relevant youth-related covariates such as substance abuse and different types of traumas should be undertaken to bridge the gap in understanding this association.
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Leafloor, Cameron W., Patrick Jiho Hong, Muhammad Mukarram, Lindsey Sikora, Jesse Elliott, and Venkatesh Thiruganasambandamoorthy. "Long-term outcomes in syncope patients presenting to the emergency department: A systematic review." CJEM 22, no. 1 (October 1, 2019): 45–55. http://dx.doi.org/10.1017/cem.2019.393.
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ABSTRACTIntroductionLong-term outcomes among syncope patients are not well studied to guide physicians regarding outpatient testing and follow-up. The objective of this study was to conduct a systematic review for outcomes at 1-year or later among ED syncope patients.MethodsWe searched Cochrane Central, Medline, Medline in Process, PubMed, Embase, and the Cumulative Index to Nursing databases from inception to December 2018. We included studies that reported long-term outcomes among ED syncope patients. We excluded studies on patients <16 years old, studies that included syncope mimickers (pre-syncope, seizure, intoxication, loss of consciousness after head trauma), case reports, letters to the editor, non-English and review articles. Outcomes included death, syncope recurrence requiring hospitalization, arrhythmias and procedural interventions for arrhythmias. Meta-analysis was performed by pooling the outcomes using random effects model.ResultsInitial literature search generated 2,094 articles duplicate removal. Of the 50 articles selected for full-text review, 19 articles with 98,211 patients were included in this review: of which 12 were included in the 1-year outcome meta-analysis. Pooled analysis showed : 7.0% mortality; 16.0% syncope recurrence requiring hospitalization; 6.0% with device insertion. 1-year arrhythmias reported in two studies were 1.1 and 26.4%. Pooled analysis for outcome at 31 to 365 days showed: 5.0% mortality and 1% device insertion. Two studies reported 4.9% and 21% mortality at 30 months and 4.2 years follow-up.ConclusionsAn important proportion of ED syncope patients suffer long-term morbidity and mortality. Appropriate follow-up is needed and future research to identify patients at risk is needed.
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Hung, Kevin K. C., Sonoe Mashino, Emily Y. Y. Chan, Makiko K. MacDermot, Satchit Balsari, Gregory R. Ciottone, Francesco Della Corte, et al. "Health Workforce Development in Health Emergency and Disaster Risk Management: The Need for Evidence-Based Recommendations." International Journal of Environmental Research and Public Health 18, no. 7 (March 24, 2021): 3382. http://dx.doi.org/10.3390/ijerph18073382.
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The Sendai Framework for Disaster Risk Reduction 2015–2030 placed human health at the centre of disaster risk reduction, calling for the global community to enhance local and national health emergency and disaster risk management (Health EDRM). The Health EDRM Framework, published in 2019, describes the functions required for comprehensive disaster risk management across prevention, preparedness, readiness, response, and recovery to improve the resilience and health security of communities, countries, and health systems. Evidence-based Health EDRM workforce development is vital. However, there are still significant gaps in the evidence identifying common competencies for training and education programmes, and the clarification of strategies for workforce retention, motivation, deployment, and coordination. Initiated in June 2020, this project includes literature reviews, case studies, and an expert consensus (modified Delphi) study. Literature reviews in English, Japanese, and Chinese aim to identify research gaps and explore core competencies for Health EDRM workforce training. Thirteen Health EDRM related case studies from six WHO regions will illustrate best practices (and pitfalls) and inform the consensus study. Consensus will be sought from global experts in emergency and disaster medicine, nursing, public health and related disciplines. Recommendations for developing effective health workforce strategies for low- and middle-income countries and high-income countries will then be disseminated.
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Leafloor, C., P. Jiho Hong, L. Sikora, J. Elliot, M. Mukarram, and V. Thiruganasambandamoorthy. "LO58: Long-term outcomes among emergency department syncope patients: a systematic review." CJEM 20, S1 (May 2018): S27. http://dx.doi.org/10.1017/cem.2018.120.
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Introduction: Approximately 50% of patients discharged from the Emergency Department (ED) after syncope have no cause found. Long-term outcomes among syncope patients are not well studied, to guide physicians regarding outpatient testing and follow-up. The objective of this study was to conduct a systematic review for long-term (one year) outcomes among ED patients with syncope. We aim to use the results of this review to guide us in prospective analysis of one year outcomes with our large database of syncope patients. Methods: We searched Cochrane Central Register of Controlled Trials, Medline and Medline in Process, PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from the inception to June, 2017. We included studies that reported long-term outcomes among adult ED patients (16 years or older) with syncope. We excluded studies on pediatric patients, and studies that included syncope mimickers: pre-syncope, seizure, intoxication, loss of consciousness after head trauma. We also excluded case reports, letters to the editor and review articles. Outcomes included death, syncope recurrence requiring hospitalization, arrhythmias and procedural interventions for arrhythmias. We selected articles based on title and abstract review during phase-1 and conducted full article review during phase-2. Meta-analysis was performed by pooling the outcomes using random effects model (RevMan v.5.3; Cochrane Collaboration). Results: Initial literature search generated 2094 articles after duplicate removal. 50 articles remained after phase-1 (=0.85) and 16 articles were included in the systematic review after phase-2 (=0.86). The 16 included studies enrolled a total of 44,755 patients. Pooled analysis at 1-year follow-up showed the following outcomes: 7% mortality; 14% recurrence of syncope requiring hospitalization; one study reported that 0.6% of patients had a pacemaker inserted; and two studies reported 0.8 11.5% of patients suffered new arrhythmias. Conclusion: An important proportion of ED patients with syncope suffer outcomes at 1-year. Appropriate follow-up is needed to prevent long-term adverse outcomes. Further prospective research to identify patients at risk for long-term important cardiac outcomes and death is needed.
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Pahlevanzadeh, Mohammad Javad, Fariborz Jolai, Fariba Goodarzian, and Peiman Ghasemi. "A new two-stage nurse scheduling approach based on occupational justice considering assurance attendance in works shifts by using Z-number method: A real case study." RAIRO - Operations Research 55, no. 6 (November 2021): 3317–38. http://dx.doi.org/10.1051/ro/2021157.
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In this paper, a new binary integer programming mathematical model for scheduling nurses’ problems in the emergency department of Kamkar Hospital in Qom province is developed. The manual arrangement of nurses by the head nurse and its time-consuming, occasional absences during the period and protests against injustices in the arrangement of nurses’ work shifts were among the emergency department’s challenges before implementing the model. Most relevant studies aimed to enhance nurses’ satisfaction by creating a general balance considering occupational preferences. Thus, the present study pursued justice through considering preferences based on the results from periodical evaluations of each nurse’s performance with the ultimate goal of improving nurses’ satisfaction. Moreover, the lack of clarity in selecting shifts, which may cause irregular attendance, was improved using the Z-number method. After the run of the model, the rate of nurses’ absences decreased by 40%, the rate of complaints about the performance of the nursing unit decreased by 50%. Also, nurses’ satisfaction increased by 30% after the implementation of the model.
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Lund, Adam, Matthew Brendan Munn, Jamie Ranse, and Sheila Turris. "Core Curriculum for Event Medical Leaders." Prehospital and Disaster Medicine 34, s1 (May 2019): s112—s113. http://dx.doi.org/10.1017/s1049023x19002383.
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Introduction:The literature on mass gatherings has expanded over the last decade. However, no readily accessible curriculum exists to prepare and support event medical leaders. Such a curriculum has the potential to align event medical professionals on improving event safety, standardizing emergency response, and reducing community impacts.Methods:We organized collaborative expert focus groups on the proposed “core curriculum” and “electives.”Results:Key features of a mass gathering medical curriculum include operations-focused, evidence-informed, best-known practices offered via low barrier, modular, flexible formats with interactive options, and a multi-national focus.Core content proposed: Background (Definitions, Context, Risk, Legalities)Event Medical Planning - “The Seven Steps” - (1.) Assessment and Environmental Scan - Event Emergency Action Plan, (2.) Human Resources, (3.) Equipment/Supplies, (4.) Infrastructure/Logistics, (5.) Transportation (To, On, From), (6.)Communication (Pre, During, Post), and (7.) Administration/Medical DirectionEvent After-Action ReportingCase-based ActivitiesElectives mirror Core outline and serve as expanded case-studies of specific event categories. Initially proposed electives include: Concerts/Music FestivalsRunning EventsCycling EventsMulti-Sport EventsObstacle Adventure CoursesStaged Wilderness CoursesAmateur GamesPolitical Gatherings & OrationsReligious Gatherings & PilgrimagesCommunity Gatherings (e.g., Parades, Fireworks, etc.)Discussion:Complex team learning to standardize real-world approaches has been accomplished in other medical domains (e.g., ACLS, AHLS, ATLS, PALS, etc.). A course for event medicine should not re-teach medical content (i.e. first aid, paramedicine, nursing, medicine); it should make available a commonly understood, systematic approach to planning, execution, and post-event evaluation vis a vis health services at events. A ‘train the trainer’ model will be required, with business operations support for sustainable course delivery. The author team seeks community feedback at WCDEM 2019 in creating ‘the ACLS’ of Event Medicine.
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Booth, Andrew, Louise Preston, Susan Baxter, Ruth Wong, Duncan Chambers, and Janette Turner. "Interventions to manage use of the emergency and urgent care system by people from vulnerable groups: a mapping review." Health Services and Delivery Research 7, no. 33 (September 2019): 1–46. http://dx.doi.org/10.3310/hsdr07330.
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Background The NHS currently faces increasing demands on accident and emergency departments. Concern has been expressed regarding whether the needs of vulnerable groups are being handled appropriately or whether alternative methods of service delivery may provide more appropriate emergency and urgent care services for particular groups. Objective Our objective was to identify what interventions exist to manage use of the emergency and urgent care system by people from a prespecified list of vulnerable groups. We aimed to describe the characteristics of these interventions and examine service delivery outcomes (for patients and the health service) resulting from these interventions. Review methods We conducted an initial mapping review to assess the quantity and nature of the published research evidence relating to seven vulnerable groups (socioeconomically deprived people and families, migrants, ethnic minority groups, the long-term unemployed/inactive, people with unstable housing situations, people living in rural/isolated areas and people with substance abuse disorders). Databases, including MEDLINE and the Cumulative Index to Nursing and Allied Health Literature, and other sources were searched between 2008 and 2018. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. In addition, we searched for UK interventions and initiatives by examining press reports, commissioning plans and casebooks of ‘good practice’. We carried out a detailed intervention analysis, using an adapted version of the TIDieR (Template for Intervention Description and Replication) framework for describing interventions, and an analysis of current NHS practice initiatives. Results We identified nine different types of interventions: care navigators [three studies – moderate GRADE (Grading of Recommendations, Assessment, Development and Evaluations)], care planning (three studies – high), case finding (five studies – moderate), case management (four studies – high), front of accident and emergency general practice/front-door streaming model (one study – low), migrant support programme (one study – low), outreach services and teams (two studies – moderate), rapid access doctor/paramedic/urgent visiting services (one study – low) and urgent care clinics (one systematic review – moderate). Few interventions had been targeted at vulnerable populations; instead, they represented general population interventions or were targeted at frequent attenders (who may or may not be from vulnerable groups). Interventions supported by robust evidence (care navigators, care planning, case finding, case management, outreach services and teams, and urgent care clinics) demonstrated an effect on the general population, rather than specific population effects. Many programmes mixed intervention components (e.g. case finding, case management and care navigators), making it difficult to isolate the effect of any single component. Promising UK initiatives (front of accident and emergency general practice/front-door streaming model, migrant support programmes and rapid access doctor/paramedic/urgent visiting services) lacked rigorous evaluation. Evaluation should therefore focus on the clinical effectiveness and cost-effectiveness of these initiatives. Conclusions The review identified a limited number of intervention types that may be useful in addressing the needs of specific vulnerable populations, with little evidence specifically relating to these groups. The evidence highlights that vulnerable populations encompass different subgroups with potentially differing needs, and also that interventions seem particularly context sensitive. This indicates a need for a greater understanding of potential drivers for varying groups in specific localities. Limitations Resources did not allow exhaustive identification of all UK initiatives; the examples cited are indicative. Future work Research is required to examine how specific vulnerable populations differentially benefit from specific types of alternative service provision. Further exploration, using primary mixed-methods data and potentially realist evaluation, is required to explore what works for whom under what circumstances. Rigorous evaluation of UK initiatives is required, including a specific need for economic evaluations and for studies that incorporate effects on the wider emergency and urgent care system. Funding The National Institute for Health Research Health Services and Delivery Research programme.
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Roberts, Fiona, Frank Archer, and Caroline Spencer. "“We Just Want to Help” - Nonprofits Contributions to Community Resilience in the Disaster Space." Prehospital and Disaster Medicine 34, s1 (May 2019): s22. http://dx.doi.org/10.1017/s1049023x19000645.
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Introduction:The National Strategy for Disaster Resilience (NSDR) characterizes resilient communities as having strong disaster and financial mitigation strategies, strong social capacity, networks, and self-reliance. Nonprofit organizations (NPOs) embrace many characteristics of a disaster resilient community. NPOs do not operate for the profit of individual members. Community groups like Lions and Rotary Club have long histories, and while not established to respond to disasters, they frequently have heavy involvement in preparing for or recovering from, disasters.Aim:The study aims to address the question, “What is the potential role of nonprofit organizations in building community resilience to disasters?”Methods:An applied research project was carried out, using theories of resilience, social capital, and the Sendai framework to conceptualize the frameworks and guide the process. Qualitative research methods, thematic analysis, and case studies helped identify Lions, Rotary, and Neighbourhood Houses Victoria strengths, barriers, and enablers.Results:Research demonstrated how NPOs made significant contributions to building communities’ resilience to disasters. NPOs facilitate three Sendai guiding principles of engaging, empowering, and enabling the community to build disaster resilience. Actions included raising awareness to disaster risk, reducing disaster risk, helping prepare for disasters, and contributing to long term disaster recovery. NPO strengths included local knowledge, community trust, and connections, which matched characteristics listed in the NSDR for a disaster resilient community. However, barriers to participation included traditional emergency services ignoring NPOs, lack of role definition, and lack of perceived legitimacy.Discussion:As the first Australia research to scientifically analyze the contributions of these NPOs to build community resilience, before, during and after disaster, this study enhances understanding and recognition of NPOs and assists in identifying means to facilitate their disaster resilience activities and place them more effectively within Emergency Management strategic processes. Greater utilization of such assets could lead to better community outcomes.
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Heilbrunn, Emily, William Calo, Erica Francis, Lan Kong, Ellie Hogentogler, Abbey Fisher, Nancy Hood, and Jennifer Kraschnewski. "PROJECT ECHO FOR NURSING HOMES: A PATIENT-CENTERED, RCT TO IMPLEMENT INFECTION CONTROL BEST PRACTICES IN NHS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 232. http://dx.doi.org/10.1093/geroni/igac059.920.
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Abstract Nursing homes (NHs) have been devastated by COVID-19. Only 3% of designated infection preventionists in NHs have taken a basic infection control course. Little is known about the implementation of effective infection control practices in NHs. This study utilizes Project ECHO (Extension for Community Health Outcomes), an evidence-based tele-mentoring model, to connect subject matter experts with NH staff to proactively support evidence-based infection control guideline implementation. This study will determine how guidelines can be implemented effectively in NHs, including reducing COVID-19 diagnoses and improving other key patient-centered outcomes (e.g., quality of life) NHs (N=136) were recruited and assigned to ECHO or ECHO Plus using a randomized design. A multi-pronged approach to improving infection control and emergency preparedness in NHs is important. The ECHO model has significant strengths allowing for remote learning delivered by a multi-disciplinary team and utilizes case discussions that match the context and capacity of NHs.
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Yonezaki, Shun, Kazuya Nagasaki, and Hiroyuki Kobayashi. "Ultrasonographic Findings in Fat Embolism Syndrome." Clinical Practice and Cases in Emergency Medicine 2, no. 5 (March 12, 2021): 263–64. http://dx.doi.org/10.5811/cpcem.2021.2.51270.
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Case Presentation: A 93-year-old man living in a nursing home presented to our emergency department with altered mental status. Examination revealed hypotension and severe hypoxia. Chest radiograph showed infiltrates in the right upper lobe, and computed tomography of the abdomen and pelvis demonstrated a left femoral neck fracture. A point-of-care transthoracic echocardiogram (TTE) revealed an enlarged right ventricle, severe tricuspid regurgitation, and numerous white floating dots moving toward the right atrium from the inferior vena cava (IVC), leading to the diagnosis of fat embolism syndrome (FES). Discussion: Although imaging studies can facilitate diagnosis, the diagnosis of FES is typically made by clinical history and presentation, making a swift diagnosis often difficult in those who are critically ill. Recent case reports have described that TTE can detect fat emboli, seen as flowing hyperechoic particles in IVC. This image demonstrates the utility of TTE to diagnose FES.
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Nguyen, Vi, Deepal Dalal, and Mark Razzante. "Levamisole-Induced Vasculitis in the Lower Extremities: A Case Report." Journal of the American Podiatric Medical Association 109, no. 2 (March 1, 2019): 150–54. http://dx.doi.org/10.7547/17-047.
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Background: Since 2006 there have been increased reports of severe agranulocytosis and vasculitis associated with levamisole use. Historically, levamisole was an immunomodulatory agent used in various cancer treatments in the United States. Currently the drug is used as an antihelminthic veterinary medication, but it is also used as an additive in freebase cocaine. There are multiple reports of levamisole-induced vasculitis in the head and neck but limited reported cases in the lower extremities. This article describes a 60-year-old woman who presented to the emergency department with multiple painful lower-extremity ulcerations. Results: Radiographs, laboratory studies, and punch biopsy were performed. Physical examination findings and laboratory results were negative for signs of infection. Treatment included local wound care and education on cocaine cessation, and the patient was transferred to a skilled nursing facility. Her continued use of cocaine, however, prevented her ulcers from healing. Conclusions: Local wound care and cocaine cessation is the optimal treatment for levamisole-induced lesions. With the increase in the number of patients with levamisole-induced vasculitis, podiatric physicians and surgeons would benefit from the immediate identification of these ulcerations, as their appearance alone can be distinct and pathognomonic. Early identification of levamisole-induced ulcers is important for favorable treatment outcomes. A complete medical and social history is necessary for physicians to treat these lesions with local wound care and provide therapy for patients with addictions.
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Aggarwal, Jyoti, Zainab Mehdi, Baldeep Kaur, Yuvraj Singh Cheema, and Monica Gupta. "When numbers can be misleading: lithium induced irreversible neurotoxicity at therapeutic drug levels." Journal of Emergency Practice and Trauma 8, no. 1 (December 7, 2021): 69–73. http://dx.doi.org/10.34172/jept.2021.36.
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Objective: Lithium is a principal drug used in the treatment of bipolar disorder (BPD). Due to its narrow therapeutic index, serum levels need to be monitored regularly. In elderly patients with renal dysfunction lithium toxicity can develop paradoxically within the therapeutic range. This can lead to erroneous diagnosis and delayed treatment resulting in irreversible neurological sequelae as is described in our case. Case Presentation: A 65-year-old hypertensive female, with a 7-year history of BPD presented with decreased oral intake since 5-7 days, followed by altered sensorium. Neurological examination revealed coarse tremors in bilateral upper and lower limbs with spasticity, hyperreflexia, bilateral knee clonus. Twenty-five days earlier, she was prescribed Lithium carbonate. On evaluation she was found to have chronic kidney disease. Serum lithium levels came out to be 1.18 mg/dL (borderline high). After ruling out other differentials, a diagnosis of lithium toxicity was considered and she underwent two sessions of hemodialysis (HD) leading to significant improvement in sensorium; however, the patient had persistent dysarthria, difficulty in walking and proximal myopathy predominantly in the lower limbs. Nerve conduction studies confirmed the presence of axonal neuropathy. These findings of peripheral neuropathy (both sensory and motor) were suggestive of SILENT (syndrome of irreversible lithium-effectuated neurotoxicity). Conclusion: Unintended lithium toxicity can occur even at therapeutic levels especially in the elderlies owing to its narrow therapeutic window, complex pharmacokinetics and numerous drug interactions. Lithium can result in irreversible neurotoxicity including SILENT; therefore, a high level of suspicion is required to prevent such permanent disability.
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Seña, Arlene C., Anne Moorman, Levi Njord, Roxanne E. Williams, James Colborn, Yury Khudyakov, Jan Drobenuic, Guo-Liang Xia, Hattie Wood, and Zack Moore. "Acute Hepatitis B Outbreaks in 2 Skilled Nursing Facilities and Possible Sources of Transmission: North Carolina, 2009–2010." Infection Control & Hospital Epidemiology 34, no. 7 (July 2013): 709–16. http://dx.doi.org/10.1086/670996.
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Objective.Acute hepatitis B virus (HBV) infections have been reported in long-term care facilities (LTCFs), primarily associated with infection control breaks during assisted blood glucose monitoring. We investigated HBV outbreaks that occurred in separate skilled nursing facilities (SNFs) to determine factors associated with transmission.Design.Outbreak investigation with case-control studies.Setting.Two SNFs (facilities A and B) in Durham, North Carolina, during 2009–2010.Patients.Residents with acute HBV infection and controls randomly selected from HBV-susceptible residents during the outbreak period.Methods.After initial cases were identified, screening was offered to all residents, with repeat testing 3 months later for HBV-susceptible residents. Molecular testing was performed to assess viral relatedness. Infection control practices were observed. Case-control studies were conducted to evaluate associations between exposures and acute HBV infection in each facility.Results.Six acute HBV cases were identified in each SNF. Viral phylogenetic analysis revealed a high degree of HBV relatedness within, but not between, facilities. No evaluated exposures were significantly associated with acute HBV infection in facility A; those associated with infection in facility B (all odds ratios >20) included injections, hospital or emergency room visits, and daily blood glucose monitoring. Observations revealed absence of trained infection control staff at facility A and suboptimal hand hygiene practices during blood glucose monitoring and insulin injections at facility B.Conclusions.These outbreaks underscore the vulnerability of LTCF residents to acute HBV infection, the importance of surveillance and prompt investigation of incident cases, and the need for improved infection control education to prevent transmission.
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Lewis, Aislinn E., Joshua J. Horns, Irma D. Fleming, Giavonni M. Lewis, and Callie M. Thompson. "T1 Healthcare Utilization After Thermal Injury: An Analysis Using a Commercial Claims Database." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S1. http://dx.doi.org/10.1093/jbcr/irac012.000.
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Abstract Introduction Burn Injuries directly affect more than 500,000 people per year in the United States but no previous studies have looked at the impact on the healthcare system. Several prior studies have shown decrease in unplanned healthcare utilization after acute care discharge following burn injury and increased healthcare costs in patients who have undergone grafting for burn injury. The goal of this study is to describe post-acute care hospitalization healthcare use in burn patients. Methods A retrospective commercial claims database review was performed of the Truven MarketScan (MS) database. In a 10 year MS sample, 23,262 patients with burn injuries were identified and were matched to a control population in a 1:1 ratio based on age, sex, and total time in the MS database. For the burn patient population in the study, pre-burn and post-burn utilization of therapy, emergency department, nutritional support, psychiatry/psychology, home health, skilled nursing facility, inpatient, and outpatient visits were recorded. For controls, we defined their pre-burn and post-burn periods using the burn event date of the matched case adjusted by the pair’s relative difference in initial enrollment into the MS database, and then recorded the same utilization metrics. A series of negative binomial regressions were completed to evaluate the data. Results At the conclusion of the study, for every outcome, except skilled nursing facility, healthcare utilization was greater in the pre-injury burn group relative to controls. Healthcare utilization for the burn cohort post-injury was greater for every outcome compared to controls. Relative to controls, healthcare utilization remains higher for at least 25 months post-injury in the burn patients and does not return to pre-injury levels during this time frame. Conclusions In a commercial claims database study, the healthcare utilization of the burn patients is higher both before and after burn injury than matched controls. Utilization does not return to preburn levels in the 25-month follow-up period. Additionally, burn patients have higher healthcare utilization prior to injury compared to matched controls, which may indicate an important difference in baseline health of these patients, and an opportunity for injury prevention.
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Upadhye, S., P. Kapend, S. Brown, S. Speck, S. Weera, and C. Davies-Schinkel. "P130: Timely initial assessment by a physician (IAP) improves community emergency department wait times." CJEM 21, S1 (May 2019): S111. http://dx.doi.org/10.1017/cem.2019.321.
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Introduction: Prior Canadian Emergency Department (ED) studies have demonstrated variable benefits of initial assessment physician (IAP) to rapidly assess and initiate care of ED patients after triage. These studies have been conducted primarily in academic teaching and large urban hospitals. It is not clear if such an IAP role could be beneficial in an small community hospital. Our pilot study hypothesized that instituting a supported IAP role can reduce physician intial assessment (PIA) time, total ED length of stay (LOS), and left-without-being-seen (LWBS) rates. Methods: This was a pre and post interrupted time series observational study at a community ED in Niagara Health Systems (Welland Ontario, 4 MD shifts, 36hrs total coverage, 30000 annual visits). In July 2017, an IAP ED shift (with separate assessment/treatment area) was re-purposed, with nursing support, to reduce initial time to MD assessment after triage. For lower acuity cases, the IAP MD generally completed full case management & disposition. Higher acuity complex cases were initiated by IAP, and transferred into the main ED care areas for “inside” MD management. Administrative data was accessed for 6 months prior to intervention, and 4 months available post-intervention. Descriptive statistics were calculated for collected data. Results: A modest improvement in different administrative ED performance metrics was observed. The following changes were noted pre and post IAP intervention: PIA time reduced from 3.6hrs to 3.2hrs, total ED LOS reduced from 19.2hrs to 13.8hrs, and daily LWBS rate reduced from 4.2% to 3.7%. This pilot study demonstrated improvement trends in ED performance metrics, although there is insufficient data to show statistical significance. Aggregate data was not subgrouped based on CTAS categories. This pilot was not intended to collect patient or staff satisfaction data, adverse events, nor designed to demonstrate cost-effectiveness Conclusion: Introducing an IAP shift in a small community ED has shown improvement trends for various ED throughput measures pertaining to outcomes such as PIA time, total LOS and LWBS rates. Further research is required to determine statistical significance of time reductions, satisfaction (patients, staff), resource utilization impact and CTAS subgroup performance. This improvement demonstrates potential impact system-wide across Niagara region.
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Lakhani, Amar, Casey Fung, and Paul Strauss. "Cecal volvulus, a rare and late complication of a laparoscopic adjustable gastric band." Journal of Case Reports and Images in Surgery 8, no. 2 (December 22, 2022): 47–50. http://dx.doi.org/10.5348/100113z12al2022cr.
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Introduction: Laparoscopic adjustable gastric band (LAGB) surgery is one of the three most popular bariatric procedures worldwide due to its favorable risk benefit profile, reversibility, and low rates of morbidity and mortality. Recent studies have demonstrated a myriad of long-term complications including band slip, band erosion, intra-abdominal infection, port-site infection, port breakage, and pouch enlargement. All of which contribute to alarming rates of revision, adjustment, and removal of LAGB. Case Report: We describe a novel case of a 68-year-old female presenting to the Emergency Department with a one-day history of abdominal pain, obstipation, loss of appetite, nausea and vomiting. A computed tomography (CT) scan demonstrated a cecal volvulus. Subsequently an emergency right hemicolectomy was performed which identified a LAGB encircling the hepatic flexure. Conclusion: Clinicians should hold a high index of suspicion and a low threshold for operating when treating patients with a bowel obstruction with a known history of a LAGB.
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Arbour, Richard, Hanan Mesfer Saad AlGhamdi, and Linda Peters. "Islam, Brain Death, and Transplantation." AACN Advanced Critical Care 23, no. 4 (October 1, 2012): 381–94. http://dx.doi.org/10.4037/nci.0b013e3182683b1e.
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A significant gap exists between availability of organs for transplant and patients with end-stage organ failure for whom organ transplantation is the last treatment option. Reasons for this mismatch include inadequate approach to potential donor families and donor loss as a result of refractory cardiopulmonary instability during and after brainstem herniation. Other reasons include inadequate cultural competence and sensitivity when communicating with potential donor families. Clinicians may not have an understanding of the cultural and religious perspectives of Muslim families of critically ill patients who may be approached about brain death and organ donation. This review analyzes Islamic cultural and religious perspectives on organ donation, transplantation, and brain death, including faith-based directives from Islamic religious authorities, definitions of death in Islam, and communication strategies when discussing brain death and organ donation with Muslim families. Optimal family care and communication are highlighted using case studies and backgrounds illustrating barriers and approaches with Muslim families in the United States and in the Kingdom of Saudi Arabia that can improve cultural competence and family care as well as increase organ availability within the Muslim population and beyond.
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Bernardo, LM, R. Henker, and J. O'Connor. "Treatment of trauma-associated hypothermia in children: evidence-based practice." American Journal of Critical Care 9, no. 4 (July 1, 2000): 227–34. http://dx.doi.org/10.4037/ajcc2000.9.4.227.
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BACKGROUND: Hypothermia is a serious immediate consequence of traumatic injury in children. Although numerous studies have addressed the treatment of hypothermia in adults after trauma or surgery, few have examined this issue in injured children. OBJECTIVES: To evaluate the research literature on when and how to treat hypothermia during emergency care of children with trauma and to apply these findings to clinical nursing practice. METHODS: Electronic literature searches conducted periodically for 3 years yielded more than 50 publications on hypothermia and its treatment in trauma and surgical patients. Publications were grouped by cause of hypothermia and by warming methods. Single case reports and publications related to submersion injuries were excluded. RESULTS: Three clinical trials of patients with head injuries included adolescents aged 15 years and older. One study compared peripheral and core warming methods used during operative management of infants and young children. Only one study evaluated core warming in children with trauma. DISCUSSION: The treatments examined in the few research-based studies on the treatment of hypothermia during emergency care of children with trauma were given low recommendations. Although the warming methods were successful in selected surgical and adult patients, the methods cannot be recommended for treating children with trauma because of the lack of evidence-based findings. CONCLUSIONS: Caution should be used when extrapolating published data on the treatment of hypothermia in injured adults to injured children. Ongoing clinical trials should evaluate in children with trauma those warming methods that have been used successfully in surgical patients.
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Gordon, Morris, Taher Kagalwala, Karim Rezk, Chris Rawlingson, M. Idris Ahmed, and Achyut Guleri. "Rapid systematic review of neonatal COVID-19 including a case of presumed vertical transmission." BMJ Paediatrics Open 4, no. 1 (May 2020): e000718. http://dx.doi.org/10.1136/bmjpo-2020-000718.
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ObjectiveTo carry out a systematic review of the available studies on COVID-19 (coronavirus disease 2019) in neonates seen globally since the onset of the COVID-19 global pandemic in 2020. The paper also describes a premature baby with reverse transcription (RT)-PCR-positive COVID-19 seen at the Blackpool Teaching Hospitals NHS Foundation Trust, UK.DesignWe conducted a multifaceted search of the Cumulative Index to Nursing and Allied Health Literature, Embase, Medline and PubMed from 1 December 2019 to 12 May 2020 to harvest articles from medical journals and publications reporting cases of COVID-19 in neonates from anywhere in the world. Additional searches were also done so as not to miss any important publications. Write-up was in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the protocol for the review was registered with International Prospective Register of Systematic Reviews (PROSPERO), and risk of bias was analysed with the Newcastle-Ottawa tool. Additionally, the preterm neonate with COVID-19 from our hospital is also reported.ResultsThe systematic review has revealed eight studies where neonates have been described to have confirmed COVID-19, with low risk of bias. Of the 10 reported cases elsewhere, only three are likely to be vertically transmitted, while seven occurred in the postperinatal period and are likely to have been postnatally acquired. All neonates had a mild course, recovered fully and were negative on retesting. Our case of COVID-19 in a 32-week premature baby from the UK was delivered by emergency caesarean section, with the mother wearing a face mask and the family having no contact with the neonate, suggesting vertical transmission. On day 33, the neonate was asymptomatic but was still RT-PCR-positive on nasopharyngeal airway swab.ConclusionsNeonatal infection is uncommon, with only two previously reported cases likely to be of vertical transmission. The case we report is still RT-PCR-positive on day 28 and is asymptomatic. Ongoing research is needed to ascertain the epidemiology of COVID-19 in neonates.
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Gillum, Leslie A., and S. Claiborne Johnston. "Are Outcomes of Ischemic Strokes Improved When a Neurologist is Attending?" Stroke 32, suppl_1 (January 2001): 383. http://dx.doi.org/10.1161/str.32.suppl_1.383.
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P239 BACKGROUND: Whether admission of stroke patients to neurologists is associated with improved outcomes is uncertain. Though prior studies suggested ischemic stroke patients under the care of neurologists had lower rates of in-hospital mortality than those treated by internists, these studies were uncontrolled for the possibility that patients with better prognosis were admitted to neurologists. METHODS: The University HealthSystem Consortium administrative database contains patient information from 84 large academic health centers and associates. Discharge abstracts for ischemic strokes admitted through emergency rooms 1997–1999 were obtained. Database variables were validated by comparison with a detailed chart review of 927 patients at 36 institutions. Attending physician specialty was evaluated as a predictor of in-hospital mortality using chi-square statistics and multivariable logistic regression. To determine whether hospital rates of stroke admission to neurologists were predictive of in-hospital mortality, generalized estimating equations (GEE) were used. This multivariable method accounts for clustering of observations at institutions, which broadens confidence intervals (CI). All multivariable analyses were adjusted for age, gender, race, admission status, and treatment volume. RESULTS: Of 28,571 ischemic strokes admitted through the emergency department, 58% were admitted to neurologists. Univariate analyses demonstrated a lower risk of in-hospital mortality in cases admitted to neurologist (4.7%) compared to non-neurologists (9.4%; p<0.001). Adjustment for case-mix did not alter the association (odds ratio, 0.48; 95% CI, 0.43–0.53; p<0.001). However, risk of death was not lower at hospitals admitting a larger portion of ischemic stroke cases to neurologists (p=0.54) as would be expected if admission to neurologists led to improved outcomes. CONCLUSIONS: In academic medical centers, ischemic stroke patients admitted to neurologists are less likely to die in the hospital compared to those admitted to other services. However, this may be due to selection of patients with better prognosis for admission to neurologists.