A survey of patients with bed bugs in the emergency department

Bed bugs are one of the most important human ectoparasites in the United States, and a growing problem in the emergency department. We evaluated 40 emergency department (ED) patients found with a bed bug. The data show that ED patients with bed bugs are statistically more likely to be male, older, more likely to be admitted to the hospital, have higher triage emergency severity index (ESI) scores, and arrive by ambulance than the general ED patient population (p < 0.05). On average bed bugs were found 108 min after a patient arrived to the ED, after 35% of subjects had already received a blood draw, and after 23% had already received a radiology study; putting other ED patients and staff at risk for acquiring the infestation. We found that 13% and 18% of subjects had wheezing and a papular rash, respectively on physical exam. Of those patients found with a bed bug in the ED, 42% reported having bed bugs at home and 21% reporting having a possible home infestation.     

Diagnostic accuracy of the Extended Focused Abdominal Sonography for Trauma (E-FAST) performed by emergency physicians compared to CT

Introduction

The diagnostic accuracy of the FAST exam performed by EM residents were shown to be similar to radiology residents. However, in the last 2 decades, an extended-FAST (E-FAST) protocol including thoracic examination to exclude pneumo- and hemothorax was introduced. The accuracy of emergency physicians (EPs) while performing E-FAST is a less studied area, especially in Europe. The aim of this study was to compare the diagnostic accuracy of the E-FAST exam performed by EM residents with the results of CT scan as a gold standard.

Association between ambient PM2.5 and emergency department visits for psychiatric emergency diseases

BackgroundWhether or not short-term exposure to particulate matter <2.5 μm in diameter (PM_2.5) increases the risk of psychiatric emergency diseases is unclear.MethodsThe study was performed in a metropolis from January 2015 to December 2016. The exposure was PM_2.5, and the confounders were weather (temperature and humidity) and other pollutants (PM₁₀, SO₂, CO, O₃, and NO₂). The outcomes were emergency department (ED) visits with psychiatric disease codes (F00-F99 in ICD10 codes). General additive models were used for the statistical analysis to calculate the adjusted relative risks (ARRs) and 95% confidence intervals (95% CIs) for the daily number of ED visits with a lag of 1 to 3 days following a 10 μg/m³ increase in PM_2.5.ResultsDuring the study period, a total of 67,561 ED visits for psychiatric diseases were identified and tested for association with PM_2.5. Daily ED visits for all psychiatric diseases were not associated with PM_2.5 in the model that was not adjusted for other pollutants. The ARR (95% CI) in the model adjusted for SO₂ was 1.011 (1.002–1.021) by 10 μg/m³ of PM_2.5 on Lag 1 for all psychiatric diseases (F00-F99). The ARR (95% CI) in the model adjusted for O₃ was 1.015 (1.003–1.029) by 10 μg/m³ of PM_2.5 on Lag 1 for F40-F49 (Neurotic, stress-related and somatoform disorders).ConclusionAn increase in PM_2.5 showed a significant association with an increase in ED visits for all psychiatric diseases (F00-F99) and for neurotic, stress-related and somatoform disorders (F40-F49) on lag day 1.     

Impact of scribes on emergency department patient throughput one year after implementation

Objectives

Assess the impact of scribes on an academic emergency department's (ED) throughput one year after implementation.

Intravenous paracetamol versus dexketoprofen in acute musculoskeletal trauma in the emergency department: A randomised clinical trial

Introduction

Musculoskeletal system traumas are among the most common presentations in the emergency departments. In the treatment of traumatic musculoskeletal pain, paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are frequently used. Our aim in this study is to compare the efficacy of intravenous dexketoprofen and paracetamol in the treatment of traumatic musculoskeletal pain.

Propofol versus midazolam for procedural sedation in the emergency department: A study on efficacy and safety

Background

Procedural sedation for painful procedures in the emergency department (ED) can be accomplished with various pharmacological agents. The choice of the sedative used is highly dependent on procedure- and patient characteristics and on personal- or local preferences.

Gestalt for shock and mortality in the emergency department: A prospective study

Objective

The diagnosis of shock in patients presenting to the emergency department (ED) is often challenging. We aimed to compare the accuracy of experienced emergency physician gestalt against Li's pragmatic shock (LiPS) tool for predicting the likelihood of shock in the emergency department, using 30-day mortality as an objective standard.

The relationship between ocular trauma and substance abuse in emergency department patients

Introduction

Eye injury is the second most common cause of visual impairment and a leading cause of monocular blindness in the United States. There are approximately 6 million ED visits related to drug use annually, including misuse or abuse of pharmaceuticals and illicit drug use. The purpose of this study was to assess the relationship between ocular trauma and substance abuse among emergency department patients and to assess that relationship with demographic factors, including age and gender.

High-thoracic ultrasound-guided erector spinae plane block for acute herpes zoster pain management in emergency department

Herpes zoster is a painful, eruptive, viral condition occurring with reactivation in immunosuppressed individuals. The selection of an effective analgesic method in the acute phase of herpes zoster can decrease the incidence of postherpetic neuralgia by reducing neural sensitization. The erector spinae plane block has been reported to provide diffuse and effective analgesia in the cervical, thoracic, and lumbar regions. We report an effective decrease in pain with the application of the high-thoracic erector spinae plane block in the emergency department in a patient with herpes zoster pain in the cervicothoracic and shoulder region.     

The critical care literature 2017

An emergency physician (EP) is often the first health care provider to evaluate, resuscitate, and manage a critically ill patient. Between 2001 and 2009, the annual hours of critical care delivered in emergency departments (EDs) across the United States increased >200% [1]! This trend has persisted since then. In addition to seeing more critically ill patients, EPs are often tasked with providing critical care long beyond the initial resuscitation period. In fact, >33% of critically ill patients who are brought to an ED remain there for >6?h [1]. Longer ED boarding times for critically ill patients have been associated with a negative impact on inpatient morbidity and mortality [2]. During these crucial early hours of illness, detrimental pathophysiologic processes begin to take hold. It is during these early hours of illness where lives can be saved, or lost. Therefore, it is important for the EP to be knowledgeable about recent developments in critical care medicine. This review summarizes important articles published in 2017 pertaining to the resuscitation and care of select critically ill patients in the ED. We chose these articles based on our opinion of the importance of the study findings and their application to clinical care. The following topics are covered: sepsis, vasolidatory shock, cardiac arrest, post-cardiac arrest care, post-intubation sedation, and pulmonary embolism.