Misleading Mydriasis

The Cognitive Autopsy ◽

10.1093/med/9780190088743.003.0030 ◽

2020 ◽

pp. 201-206

Author(s):

Pat Croskerry

Keyword(s):

Emergency Department ◽

Pain Relief ◽

Task Switching ◽

Middle Aged ◽

Patient Reports ◽

Eye Pain ◽

Visual Blurring ◽

Middle Aged Male

In this case, a middle-aged male presents to an emergency department (ED) with eye pain, visual blurring, and photophobia following trauma to the eye the previous day. It is some time before the patient is seen because the ED is extremely busy. Some drops are instilled in the eye for pain relief. When the physician finally gets to see the patient, he finds that the pupil of the affected eye is fixed and dilated—ominous signs but not consistent with the trauma the patient reports. After further investigation, it is determined that the patient had earlier received the wrong medication. Several biases can be identified in the case, as well as the likely error-producing condition rapid task switching.

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Bilateral Luxatio Erecta Humeri

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.1.51255 ◽

2021 ◽

Vol 2 (5) ◽

pp. 249-250

Author(s):

Miguel Martinez-Romo ◽

Shahram Lotfipour ◽

C. Eric McCoy

Keyword(s):

Emergency Department ◽

Shoulder Pain ◽

Clinical Presentation ◽

Humeral Shaft ◽

Middle Aged ◽

Case Presentation ◽

Scapular Spine ◽

Luxatio Erecta ◽

Inferior Dislocation ◽

Middle Aged Male

Case Presentation: We describe a middle-aged male presenting to the emergency department with bilateral shoulder pain, holding both arms in abduction after trauma. Radiographs demonstrated a bilateral inferior dislocation of the glenohumeral joints consistent with luxatio erecta humeri. Discussion: We review the clinical presentation of luxatio erecta and its complications. We also describe the characteristic presentation on radiographs. Our case illustrates the hallmark findings of luxatio erecta of an abducted humeral shaft parallel to the scapular spine.

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The Backed-Up Bed Blocker

The Cognitive Autopsy ◽

10.1093/med/9780190088743.003.0007 ◽

2020 ◽

pp. 49-54

Author(s):

Pat Croskerry

Keyword(s):

Emergency Department ◽

Back Pain ◽

Urinary Retention ◽

Emergency Physician ◽

Chief Complaint ◽

Middle Aged ◽

Sphincter Tone ◽

Straight Leg Raising ◽

Middle Aged Male

In this case, a middle-aged male presents to a busy community emergency department with a chief complaint of constipation. The emergency physician cannot see him immediately and gives an order to a nurse for a saline enema. It proves ineffective (fortuitously). When the physician later assesses the patient, the patient is complaining of back pain and found to have weakness on straight leg raising, reduced sphincter tone, and urinary retention. His problems turn out to be more complicated than constipation.

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Genistein Increase Thyroid Hormone and 7 alpha-hydroxycholesterol concentrations in the liver of middle-aged male rats

Endocrine Abstracts ◽

10.1530/endoabs.56.gp246 ◽

2018 ◽

Author(s):

Branka Sosic-Jurjevic ◽

Dieter Lutjohann ◽

Dragana Miljic ◽

Jasmina Ciric ◽

Svetlana Trifunovic ◽

...

Keyword(s):

Thyroid Hormone ◽

Male Rats ◽

Middle Aged ◽

Middle Aged Male

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Adolescents’ pain and distress during peripheral intravenous cannulation in a paediatric emergency setting

European Journal of Pediatrics ◽

10.1007/s00431-021-04169-x ◽

2021 ◽

Author(s):

Giorgio Cozzi ◽

Marta Cognigni ◽

Riccardo Busatto ◽

Veronica Grigoletto ◽

Manuela Giangreco ◽

...

Keyword(s):

Emergency Department ◽

Pain Relief ◽

Local Anaesthesia ◽

Cross Sectional Study ◽

Emergency Setting ◽

Older Children ◽

Cross Sectional ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

Significant Difference

AbstractThe objective of the study is to investigate pain and distress experienced by a group of adolescents and children during peripheral intravenous cannulation in a paediatric emergency department. This cross-sectional study was performed between November 2019 and June 2020 at the paediatric emergency department of the Institute for Maternal and Child Health of Trieste, Italy. Eligible subjects were patients between 4 and 17 years old undergoing intravenous cannulation, split into three groups based on their age: adolescents (13–17 years), older children (8–12 years), and younger children (4–7 years). Procedural distress and pain scores were recorded through validated scales. Data on the use of topical anaesthesia, distraction techniques, and physical or verbal comfort during procedures were also collected. We recruited 136 patients: 63 adolescents, 48 older children, and 25 younger children. There was no statistically significant difference in the median self-reported procedural pain found in adolescents (4; IQR = 2–6) versus older and younger children (5; IQR = 2–8 and 6; IQR = 2–8, respectively). Furthermore, no significant difference was observed in the rate of distress between adolescents (79.4%), older (89.6%), and younger (92.0%) children. Adolescents received significantly fewer pain relief techniques.Conclusion: This study shows that adolescents experience similar pain and pre-procedural distress as younger children during peripheral intravenous cannulation. What is Known:• Topical and local anaesthesia, physical and verbal comfort, and distraction are useful interventions for pain and anxiety management during intravenous cannulation in paediatric settings. • No data is available on pain and distress experienced by adolescents in the specific setting of the emergency department. What is New:• Adolescents experienced high levels of pre-procedural distress in most cases and similar levels of pain and distress when compared to younger patients• The number of pain relief techniques employed during procedures was inversely proportional to patient’s age, topical or local anaesthesia were rarely used

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