Emergency department

This chapter explores the emergency department, including trauma, head injury, neck injury, falls and collapse, acutely painful limb emergency, acute limb pain, chronic limb pain, limb swelling, joint pain, neck lumps, ENT, groin lumps, burns and burns emergency, anaphylaxis in adults, hypotension emergency, hypotension, shock, pyrexia, overdose emergency, overdose and deliberate self-harm, vaginal bleeding, gynaecological causes of pain, contraception, early pregnancy (1st trimester), later pregnancy (2nd/3rd trimester), delivery, and after delivery (post-partum).

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Emergency department

10.1093/med/9780199683819.003.0015 ◽

2014 ◽

Author(s):

Tim Raine ◽

James Dawson ◽

Stephan Sanders ◽

Simon Eccles

Keyword(s):

Emergency Department ◽

Head Injury ◽

Joint Pain ◽

Vaginal Bleeding ◽

Neck Injury ◽

Limb Pain ◽

Deliberate Self Harm ◽

Self Harm

TraumaHead injuryNeck injuryFalls and collapseAcutely painful limb emergencyAcute limb painChronic limb painLimb swellingJoint painNeck lumpsENTGroin lumpsBurns emergencyBurnsAnaphylaxis in adultsHypotension emergencyHypotensionShockPyrexiaOverdose emergencyOverdose and deliberate self-harmVaginal bleeding...

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United States emergency department visits for vaginal bleeding during early pregnancy, 1993-2003

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2007.11.011 ◽

2008 ◽

Vol 198 (5) ◽

pp. 523.e1-523.e6 ◽

Cited By ~ 26

Author(s):

Kathleen A. Wittels ◽

Andrea J. Pelletier ◽

David F.M. Brown ◽

Carlos A. Camargo

Keyword(s):

United States ◽

Emergency Department ◽

Early Pregnancy ◽

Vaginal Bleeding ◽

Emergency Department Visits

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Management of vaginal bleeding in early pregnancy in the emergency department

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2016.07.390 ◽

2016 ◽

Vol 206 ◽

pp. e155-e156

Author(s):

Jessica Gubbin ◽

Deborah Gould

Keyword(s):

Emergency Department ◽

Early Pregnancy ◽

Vaginal Bleeding

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LO01: What presenting features predict obstetrical outcomes in women who present to the emergency department with early pregnancy bleeding?

CJEM ◽

10.1017/cem.2020.57 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S6-S7

Author(s):

M. Burgoyne ◽

R. Clouston ◽

A. Banerjee ◽

J. Fraser ◽

P. Atkinson

Keyword(s):

Emergency Department ◽

Live Birth ◽

Early Pregnancy ◽

Vaginal Bleeding ◽

Strong Predictor ◽

Point Of Care Ultrasound ◽

Similar Clinical Outcome ◽

Optimal Outcomes ◽

Obstetrical Outcomes ◽

Obstetrical Outcome

Introduction: Vaginal bleeding in early pregnancy is a common emergency department (ED) presentation, with many of these episodes resulting in poor obstetrical outcome. These outcomes have been extensively studied, but there have been few evaluations of what variables are associated predictors. This study aimed to identify predictors of less than optimal obstetrical outcomes for women who present to the ED with early pregnancy bleeding. Methods: A regional centre health records review included pregnant females who presented to the ED with vaginal bleeding at <20 weeks gestation. This study investigated differences in presenting features between groups with subsequent optimal outcomes (OO; defined as a full-term live birth >37 weeks) and less than optimal outcomes (LOO; defined as a miscarriage, stillbirth or pre-term live birth). Predictor variables included: maternal age, gestational age at presentation, number of return ED visits, socioeconomic status (SES), gravida-para-abortus status, Rh status, Hgb level and presence of cramping. Rates and results of point of care ultrasound (PoCUS) and ultrasound (US) by radiology were also considered. Results: Records for 422 patients from Jan 2017 to Nov 2018 were screened and 180 patients were included. Overall, 58.3% of study participants had a LOO. The only strong predictor of outcome was seeing an Intra-Uterine Pregnancy (IUP) with Fetal Heart Beat (FHB) on US; OO rate 74.3% (95% CI 59.8-88.7; p < 0.01). Cramping (with bleeding) trended towards a higher rate of LOO (62.7%, 95% CI 54.2-71.1; p = 0.07). SES was not a reliable predictor of LOO, with similar clinical outcome rates above and below the poverty line (57.5% [95% CI 46.7-68.3] vs 59% [95% CI 49.3-68.6] LOO). For anemic patients, the non-live birth rate was 100%, but the number with this variable was small (n = 5). Return visits (58.3%, 95% CI 42.2-74.4), previous abortion (58.8%, 95% CI 49.7-67.8), no living children (60.2%, 95% CI 50.7-69.6) and past pregnancy (55.9%, 95% CI 46.6-65.1) were not associated with higher rates of LOO. Conclusion: Identification of a live IUP, anemia, and cramping have potential as predictors of obstetrical outcome in early pregnancy bleeding. This information may provide better guidance for clinical practice and investigations in the emergency department and the predictive value of these variables support more appropriate counseling to this patient population.

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Patient motivation for presenting to emergency department for vaginal bleeding in early pregnancy (VBEP)

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2019.10.011 ◽

2020 ◽

Vol 38 (5) ◽

pp. 1025-1030

Author(s):

Joshua Bucher ◽

Bhavesh Mody ◽

Meigra Chin ◽

Lara West ◽

Pamela Ohman-Strickland ◽

...

Keyword(s):

Emergency Department ◽

Early Pregnancy ◽

Vaginal Bleeding ◽

Patient Motivation

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Patients with first versus multiple episodes of self-harm: how do their profiles differ?

Annals of General Psychiatry ◽

10.1186/s12991-021-00351-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Philippe Golay ◽

Louise Ostertag ◽

Alessandra Costanza ◽

Bénédicte Van der Vaeren ◽

Yves Dorogi ◽

...

Keyword(s):

Emergency Department ◽

Personality Disorder ◽

Suicide Attempt ◽

Professional Activity ◽

Suicidal Risk ◽

Factors Influencing ◽

Several Variables ◽

French Speaking ◽

Self Harm ◽

Multiple Episodes

Abstract Background Self-harm (SH) is among the strongest predictors of further episodes of SH, suicide attempt, and death by suicide. People who repeteadly harm themselves are at even higher risk for suicide. Factors influencing the repetition are important to identify when assessing suicidal risk and thereafter to offer specific interventions. Therefore, this study aimed to compare first versus multiple episodes characteristics in a large sample of patients in french-speaking Switzerland. Method We used the database from the French-speaking Swiss program for monitoring SH. Data of the psychiatric assessment of all adults admitted for SH were collected in the emergency department of four Swiss city hospitals between December 2016 and October 2019. Results 1730 episodes of SH were included. Several variables were significantly associated with multiple episodes, including diagnosis (over representation of personality disorders and under representation of anxiety disorders), professional activity (Invalidity insurance more frequent) and prior psychiatry care. Conclusions Patients suffering from a personality disorder and those with invalidity insurance are at risk for multiple episodes of SH and should be targeted with specific interventions.

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Emergency Department Visits From 2014 to 2018 for Head Injuries in Youth Non-Tackle Football Compared With Other Sports

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120975402 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097540

Author(s):

Jessica M. Zendler ◽

Ron Jadischke ◽

Jared Frantz ◽

Steve Hall ◽

Grant C. Goulet

Keyword(s):

United States ◽

Emergency Department ◽

Head Injury ◽

Head Injuries ◽

The United States ◽

Emergency Department Visits ◽

Head Region ◽

Cerebral Contusion ◽

Common Diagnosis ◽

Tackle Football

Background: Non-tackle football (ie, flag, touch, 7v7) is purported to be a lower-risk alternative to tackle football, particularly in terms of head injuries. However, data on head injuries in non-tackle football are sparse, particularly among youth participants. Purpose: To describe the epidemiology of emergency department visits for head injuries due to non-tackle football among youth players in the United States and compare the data with basketball, soccer, and tackle football. Study Design: Descriptive epidemiology study. Methods: Injury data from 2014 to 2018 were obtained from the National Electronic Injury Surveillance System database. Injury reports coded for patients aged 6 to 18 years and associated with basketball, football, or soccer were extracted. Data were filtered to include only injuries to the head region, specifically, the head, ear, eyeball, mouth, or face. Football injuries were manually assigned to “non-tackle” or “tackle” based on the injury narratives. Sports & Fitness Industry Association data were used to estimate annual sport participation and calculate annual injury rates per 100,000 participant-years. Results: A total of 26,770 incident reports from 2014 to 2018 were analyzed. For head region injuries in non-tackle football, the head was the most commonly injured body part, followed by the face; the most common diagnosis was a laceration, followed by concussion and internal injury (defined as an unspecified head injury or internal head injury [eg, subdural hematoma or cerebral contusion]). The most common contacting object was another player. The projected national rate of head region injuries was lowest for non-tackle football across the 4 sports. In particular, the projected rate of injuries to the head for non-tackle football (78.0 per 100,000 participant-years) was less than one-fourth the rates for basketball (323.5 per 100,000 participant-years) and soccer (318.2 per 100,000 participant-years) and less than one-tenth the rate for tackle football (1478.6 per 100,000 participant-years). Conclusion: Among youth in the United States aged 6 to 18 years who were treated in the emergency department for injuries related to playing non-tackle football, the most common diagnosis for injuries to the head region was a laceration, followed by a concussion. Head region injuries associated with non-tackle football occurred at a notably lower rate than basketball, soccer, or tackle football.

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