scholarly journals Eye irrigation as a first-line treatment and diagnostic method for emergency department patients who complain of ocular foreign bodies

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hung-Da Chou ◽  
Kuan-Jen Chen ◽  
Eugene Yu-Chuan Kang ◽  
Jui-Yen Lin ◽  
Po-Han Yeh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Score ◽  
Diagnostic Method ◽  
Foreign Bodies ◽  
Retention Rate ◽  
First Line ◽  
Ocular Pain ◽  
Analog Scale ◽  
Before And After ◽  
Emergency Department Patients

AbstractThis prospective study aimed at determine whether eye irrigation removes ocular foreign bodies (FBs) and whether ocular pain predicts FBs. Emergency department patients complaining of ocular FBs were enrolled. In the irrigation group (n = 52), pain was evaluated with a visual analog scale before and after irrigation, and the presence of FBs was determined under a slit-lamp. In the nonirrigation group (n = 27), the evaluations were performed upon arrival. The corneal FB retention rate was found significantly lower in the irrigation (13/52, 25%) than in the nonirrigation groups (13/27, 48%; P = 0.04). After irrigation, those without FBs had more patients experiencing pain reduction (67%) compared to those with retained FBs (46%; P = 0.14) and had a greater magnitude of change in pain score (mean ± SD, − 2.6 ± 2.7 vs. − 0.7 ± 1.4; P = 0.02). An improvement in ocular pain score ≥ 5 points after irrigation predicted the absence of FBs with a negative predictive value of 100%. Eye irrigation significantly lowered corneal FB retention; if ocular pain decreased considerably, the probability of retained FBs was low, making irrigation-associated pain score reduction a feasible diagnostic method to exclude FB retention without needing specialized ophthalmic examinations.

Use of Ophthalmic Sonography to Evaluate for Intraocular Foreign Body in Both Outpatient and Emergency Department/Urgent Care Patients

2021 ◽  
pp. 875647932110332
Author(s):  
Patrick J. Fish
Keyword(s):  
Emergency Department ◽  
Foreign Body ◽  
Foreign Bodies ◽  
Outpatient Setting ◽  
Intraocular Foreign Body ◽  
Urgent Care ◽  
Posterior Chamber ◽  
Emergency Department Setting ◽  
Before And After ◽  
Glass Metal

Intraocular foreign bodies (IOFB) present differently depending on the type of material (wood, glass, metal) for the IOFB, extent of the injury, and location of the injury. IOFB and the injury can cause a perforation or penetration of the globe which can require more extensive treatment including surgery. Proper evaluation of the IOFB and injury can help to determine extent of the injury, the prognosis of the vision, and health of the eye before and after treatment but may be difficult for the physician depending on the view of the posterior chamber being compromised by media or simply by patient sensitivity. The extent of the injury may also prevent proper evaluation due to swelling, lacerations on the lids, or pain. Proper ophthalmic sonography can provide a quick evaluation of the globe for any IOFB in both the outpatient setting as well as emergency department setting. Evaluation via sonography may allow the physician to accurately diagnose and properly treat the patient to help restore and prevent further loss of vision.

scholarly journals Audit of documentation proficiency of emergency department patients who are discharged against medical advice before and after implementation of a checklist

2016 ◽  
Vol 5 (4) ◽  
pp. 28
Author(s):  
Sze Joo Juan ◽  
Ghee Hian Lim ◽  
Beng Leong Lim
Keyword(s):  
Emergency Department ◽  
Primary Outcome ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Documentation Quality ◽  
Before And After ◽  
Discharge Against Medical Advice ◽  
Emergency Department Patients ◽  
A Prospective Study

Objective: Documentation of the discharge against medical advice (AMA) is poorly performed in the emergency department (ED). Little is known about the impacts of a checklist on this. Our study aimed to compare the quality of AMA documentation before and after implementation of a checklist.Methods: A retrospective review was conducted followed by a prospective study; each over three months of AMA interactions in our ED pre and post implementation of a checklist. An 11-point checklist was used to determine documentation quality during these two periods. Quality was assessed based on the number of points fulfilled on this tool. Documentation was classified as “good” (8-11), “average” (4-7) and “poor” (0-3). The primary outcome measured was the proportions of discharged AMA records that showed “good”, “average” and “poor” documentation. Secondary outcomes were compliance rates to each of the categories of the checklist before and after its use.Results: 339 and 309 complete records were retrieved from the retrospective and prospective arms respectively. The proportions of case records in the three grades before and after use of the checklist respectively were: poor, 199/339 (59%) vs. 7/313 (2%); fair, 133/339 (39%) vs. 66/313 (21%) and good 7/339 (2%) vs. 240/313 (77%); all p-values were statistically significant. There were also statistically significant differences in compliance rates to each of the categories of the checklist pre and post checklist implementation.Conclusions: This study shows improvement in quality and compliance rates in the audit categories after the implementation of an AMA checklist.

The relationship between patient factors and the refusal of analgesics in adult Emergency Department patients with extremity injuries, a case-control study

2019 ◽  
Vol 20 (1) ◽  
pp. 87-94
Author(s):  
Milan L. Ridderikhof ◽  
Donica V. Lodder ◽  
Susan Van Dieren ◽  
Philipp Lirk ◽  
Helma Goddijn ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Score ◽  
Pain Treatment ◽  
Pain Medication ◽  
Related Factors ◽  
Analgesic Treatment ◽  
Patient Beliefs ◽  
Emergency Department Patients ◽  
Extremity Injuries ◽  
The Relationship

AbstractBackground and aimsPrevious studies have described the phenomenon of oligo-analgesia in Emergency Department patients with traumatic injuries, despite the high prevalence of pain among these patients. Besides aspects related to health care staff, patient related factors might also play a role in suboptimal pain treatment, however evidence is scarce. Therefore, the objective of the current study was to evaluate patient related factors in adult patients refusing offered analgesics during an Emergency Department presentation with extremity injuries.MethodsThis was a case control study in the Emergency Department of a level 1 Trauma Centre. Cases were defined as adult patients with an extremity injury who declined analgesia, when offered. They were matched to controls from the same population, who accepted analgesics, in a 1:2 ratio using gender as matching variable. Primary outcome was difference in NRS pain score. Secondary outcomes were the relationship between categorical severity of pain scores and refusal of analgesics, exploration of independent predictors of analgesia refusal utilizing multivariate logistic regression and the evaluation of eight beliefs among patients who refuse analgesics.ResultsBetween August 1st and 31st 2016, a total of 253 patients were eligible for inclusion of whom 55 declined analgesic treatment. They were included as cases and matched to 110 controls. Difference in median NRS pain score was significant between the groups: 5.0 (IQR 3.0–8.0) vs. 8.0 (IQR 6.0–9.0), respectively (p < 0.01). Nearly 20% of patients with severe pain declined analgesics, compared to 41% with moderate and 69% with mild pain (p < 0.01). The NRS pain score was the only independent predictor of refusal of analgesic treatment with a mean Odds Ratio of 0.67 (95%-CI 0.54–0.83). Most common patients’ beliefs were that pain medication should be used in extreme pain only, fear of decreasing the doctor’s ability to judge the injury and fear of addiction to analgesics.ConclusionsPain severity is the single independent predictor of refusal of analgesia, however the following patient beliefs are important as well: pain medication should be used in extreme pain only; fear of decreasing the doctor’s ability to judge the injury and the fear of becoming addicted to pain medication.ImplicationsIn case patients refuse offered analgesics, the health care provider should actively address patient beliefs that might exist and lead to suboptimal pain treatment.

scholarly journals Clinical Features And Prognostic Factors For Status Epilepticus In The Pediatric Emergency Department: A Retrospective Study

2021 ◽  
Author(s):  
Sohyun Eun ◽  
Hye Eun Kwon ◽  
Heoung Jin Kim ◽  
Seo Hee Yoon ◽  
Moon Kyu Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Status Epilepticus ◽  
Clinical Features ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
First Line ◽  
Before And After ◽  
Icu Management ◽  
The Brain

Abstract Background: Uncontrolled status epilepticus (SE) causes damage to all organs, especially the brain. Although there are guidelines regarding the management of convulsive SE, the timing for administering first-line rescue medications (RMeds) remains unclear. Therefore, we analyzed patients with persistent SE lasting for >30 min, who visited the pediatric emergency department (pED), to determine clinical features and risk factors and provide directions for management on arrival to the pED. Methods: This study was conducted by retrospectively reviewing medical charts of patients aged 0–19 years diagnosed with SE and accompanying motor seizures, who visited the pED between January 2010 and December 2019. After arrival at the pED, patients were divided into two groups, namely ≥30 min (n = 12) and <30 min (n = 13), according to the additional seizure time and administration of the first dose of RMeds before and after 5 min. Results: Seizures lasting for <30 min were mainly belonged to idiopathic SE in the pED. Among four SE patients who needed intensive care unit (ICU) management, three had delayed administration of RMeds of >5 min, which was statistically significant; hence, more hospitalizations in the ICU were observed when RMed administration was delayed (p = 0.047). In acute symptomatic SE such as encephalitis, more than three doses of RMeds were needed to control seizures. Conclusions: Patients with convulsive SE should arrive at the pED as soon as possible and immediately receive RMeds after arrival at the pED for good outcomes.

scholarly journals Efficacy and Safety of Tetrahydrocurcuminoids for the Treatment of Canker Sore and Gingivitis

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Muhammed Majeed ◽  
Shaheen Majeed ◽  
Kalyanam Nagabhushanam
Keyword(s):  
Clinical Trial ◽  
Pain Score ◽  
Vital Signs ◽  
Analog Scale ◽  
Clinical Trial Registry ◽  
Open Label ◽  
Chewable Tablet ◽  
Before And After ◽  
Therapeutic Activities ◽  
Clinical Trial Methods

Background. Tetrahydrocurcuminoids (THCs) are among the major metabolites of curcuminoids with a higher bioavailability and physiological stability and exhibit a broad spectrum of therapeutic activities. The objective of this study was to evaluate the efficacy of THCs in patients suffering from canker sore and gingivitis designed as an exploratory clinical trial. Methods. This is an open label prospective pilot clinical trial carried out at two clinical centers: Noble Hospital, Pune, Maharashtra, and Sri Venkateshwara Hospital, Bangalore, Karnataka in India. Participants were assigned to 21 days of treatment with chewable oral THCs supplement. Patients were instructed to self-administer one chewable tablet containing 100 mg of THCs twice daily for up to 21 days. This clinical trial was registered at a public Clinical Trial Registry in India (http://www.ctri.nic.in). Thirty-one canker sore and twenty-nine gingivitis patients participated in this study. Body mass index, throat numbness/relief, Visual Analog Scale (VAS) pain score, canker sore lesions, gingival appearance, inflammation and bleeding were assessed before and after treatment, at 14 and 21 days. Vital signs and laboratory parameters were assessed for safety. Results. THCs treatment significantly reduced the reddening at the site, difficulty in chewing, swallowing, and VAS pain score in the canker sore patients. Further, both single and multiple lesions were completely healed. In gingivitis patients, gingival appearance, bleeding, and inflammation were significantly reduced. No adverse effects were observed during the study. Conclusion. Overall, the findings of this study show that supplementation of THCs for 21 days reduced the pain and prevented the progression of the disease in patients suffering from canker sore and gingivitis without adverse side effects.

scholarly journals Clinical features and prognostic factors for status epilepticus in the pediatric emergency department: A retrospective study

2021 ◽  
Author(s):  
Sohyun Eun ◽  
Hye Eun Kwon ◽  
Heoung Jin Kim ◽  
Seo Hee Yoon ◽  
Moon Kyu Kim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Status Epilepticus ◽  
Clinical Features ◽  
Pediatric Emergency ◽  
Convulsive Status Epilepticus ◽  
Pediatric Emergency Department ◽  
First Line ◽  
Before And After ◽  
Icu Management ◽  
The Brain

Abstract Background: Uncontrolled seizures cause damage to all organs, especially the brain. Although there are guidelines regarding the management of status epilepticus (SE) involving motor seizures, the timing for administering first-line rescue medications (RMeds) remains unclear. Therefore, we analyzed patients with persistent SE lasting for >30 min and who visited the pediatric emergency department (pED) to determine clinical features and risk factors and provide directions for management on arrival to the pED. Methods: This study was conducted by retrospectively reviewing medical charts of patients aged 0–19 years who were diagnosed with SE accompanying motor seizures and who visited the pED between January 2010 and December 2019. After pED arrival, patients were divided into two groups, namely ≥30 min (n = 12) and <30 min (n = 13), according to the additional seizure time and receipt of the first dose of RMeds before and after 5 min.Results: Seizures lasting for <30 min were mainly observed for the etiology of idiopathic SE in the pED. Among four SE patients who needed intensive care unit (ICU) management, three had delayed administration of RMeds of more than 5 min, which was statistically significant because more hospitalizations in the ICU were observed when RMed administration was delayed. (p = 0.047). In acute symptomatic SE such as encephalitis, more than three doses of RMeds were needed to stop seizures.Conclusions: Patients with convulsive status epilepticus should receive RMeds after arrival at the pED.

Ketamine as a first-line treatment for severely agitated emergency department patients

2017 ◽  
Vol 35 (7) ◽  
pp. 1000-1004 ◽  
Author(s):  
Jeff Riddell ◽  
Alexander Tran ◽  
Rimon Bengiamin ◽  
Gregory W. Hendey ◽  
Patil Armenian
Keyword(s):  
Emergency Department ◽  
Line Treatment ◽  
First Line ◽  
Emergency Department Patients ◽  
First Line Treatment
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