Severe phytophotodermatitis from fig sap: a little known phenomenon

A 46-year-old arborist with no medical history presented to the emergency department with a confluent blistering, erythematous, non-pruritic, painful rash covering both arms circumferentially and the back of his neck. He sought medical advice as his arms were becoming more painful and swollen with blister formation, despite aloe vera cream and wet towel wraps. He recalled that 2 days previously he had been pruning a fig tree on a hot sunny day. He was wearing a t-shirt and his forearms had been exposed to a large quantity of fig sap, while he was working under direct sunlight. On examination, there were several blisters with no superimposed infection. He was diagnosed with phytophotodermatitis and referred to a regional burns unit. He recovered well with simple dressings and a course of antibiotics. At present, he has made a good recovery with no long-term sequelae such as skin hyperpigmentation or hypopigmentation.

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The burns management pathway I: assessing and transferring patients with an acute burn injury

Burns (OSH Surgery) ◽

10.1093/med/9780199699537.003.0005 ◽

2019 ◽

pp. 35-42

Author(s):

Kayvan Shokrollahi ◽

Susie Yao

Keyword(s):

Emergency Department ◽

Burn Injury ◽

First Aid ◽

Trauma Centre ◽

Initial Management ◽

Intravenous Access ◽

Handover Process ◽

Key Steps ◽

Burns Unit

The initial management of patients with an acute burn injury is often undertaken by individuals with relatively little experience in this area. To optimize outcomes and minimize the risk of long-term sequelae, clinicians should understand the key steps in initial management and safe transfer of these patients to a specialist burns unit. These include safely extricating patients and providing prompt first aid at scene; rapidly and accurately assessing them at the nearest emergency department or trauma centre; appropriately managing their airway and oxygenation; obtaining intravenous access and initiating fluid resuscitation; assessing burn extent and depth and considering the potential need for escharotomies; providing analgesia and appropriate tetanus prophylaxis; and covering and warming the patient while temporarily dressing their burns. Once these measures are taken, any patient with a burn injury may be discussed with a specialist burns unit for advice. If deemed necessary and accepted, they should be promptly transferred to a burns unit with an appropriate escort. Prior to transfer, a systematic re-assessment should be undertaken, and any required treatments should be continued during the transfer. Copies of all referral information and the results of initial assessments and investigations should be sent with the patient to ensure a robust handover process.

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Factors Affecting Discharges against Medical Advice in an Emergency Department of a Tertiary Care Center

Journal of KIST Medical College ◽

10.3126/jkistmc.v2i2.33576 ◽

2020 ◽

Vol 2 (2) ◽

pp. 31-35

Author(s):

Trishna Shrestha ◽

Sneha Pradhananga ◽

Kabita Hada Batajoo ◽

Manjita Bajracharya

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Costs ◽

Medical Advice ◽

Health Concern ◽

Against Medical Advice ◽

Factors Affecting ◽

Tertiary Center ◽

Care Costs ◽

Leaving Against Medical Advice

Introduction: Patients leaving against the advice of the treating team before being certified as fit is a major concern and challenge for the treating professionals as it possesses adverse medical outcomes. This study hence aimed at identifying the prevalence and major factors affecting such discharges so that advocacy can be done to help prevent it. Methods: A descriptive cross-sectional study was conducted at emergency department of a tertiary center in Lalitpur from 15th May 2019 to 15th August 2019. All the patients visiting the emergency department were included in the study and a non-probability purposive sampling method was used excluding the patients who denied giving reasons for them leaving against medical advice. Data was collected using pre-structured questionnaire and analyzed using SPSS-v21 software. Results: A hundred and fifteen patients (4.08%) left against medical advice out of 2812 patients who presented to emergency department. There were 63 male patients (54.8%), 75 patients of the total patients in the age group of 15-44 years (65.2%) and those living within a distance of 1km from the hospital (53%). The most common reason for the patients leaving against medical advice was found to be due to financial constraint (38.3%) followed by preference to other hospitals (16.5%). Conclusion: Patients leaving against medical advice possesses a small percentage of actual hospital admissions but is still a major health concern as it drastically increases the morbidity, re-admission rates and total health-care costs. Hence, understanding the general characteristics and predictors of such discharges is of utmost importance to help improve the patient outcome and reduce the health-care costs.

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Rapid Emergency Medicine Score Can Predict Long-term Mortality in Nonsurgical Emergency Department Patients

Academic Emergency Medicine ◽

10.1197/j.aem.2004.05.027 ◽

2004 ◽

Vol 11 (10) ◽

pp. 1008-1013 ◽

Cited By ~ 19

Author(s):

T. Olsson

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Emergency Department Patients ◽

Long Term Mortality

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Discharge against medical advice from the emergency department in a university hospital

BMC Emergency Medicine ◽

10.1186/s12873-021-00422-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Feras H. Abuzeyad ◽

Moonis Farooq ◽

Salah Farhat Alam ◽

Mudhaffar Ismael Ibrahim ◽

Luma Bashmi ◽

...

Keyword(s):

Emergency Department ◽

Cross Sectional Study ◽

Small Sample ◽

Medical Advice ◽

University Hospital ◽

High Risk Population ◽

Cross Sectional ◽

Against Medical Advice ◽

Level 3 ◽

Collection Form

Abstract Background Patients discharged against medical advice (DAMA) act as a high-risk population for the Emergency Department (ED), regardless of their presentations, and can pose a serious burden for the hospital. This study examines the prevalence, demographic and clinical characteristics, reasons, and clinical outcomes of a small sample of DAMA patients in a teaching university hospital, including readmission, morbidity, and mortality. Methods A prospective, descriptive cross-sectional study was conducted in the ED of King Hamad University Hospital (KHUH) with 98,992 patient visits during a 1-year period from June 2018 to June 2019. Consenting DAMA patients were asked to complete a data collection form. Results Patients (n = 413) had a mean age of 44.1 years with a female majority (57.1%). The majority were categorized as triage level-3 (87.7%). The main reasons for DAMA included refusal of the procedure/operation (23.2%), long ED waiting time (22.2%), subjective improvement with treatment (17.7%), and children at home (14.8%), whereas the least selected reason was dissatisfaction with medical care (1.2%). Follow-up of DAMA patients revealed that 86 cases (20.8%) were readmitted to the ED within 72 h of which 41 (47.7%) cases were morbidity and 2 (2.3%) were mortality. Marital status was a predictor of DAMA patients who revisit the ED within 72 h. Conclusion The results act as a pilot study to examine a small sample of DAMA patients’ characteristics, diagnosis, and ED revisits. Hospitals should investigate further the DAMA population on a larger scale, reasons for refusing procedures, and utilize this knowledge to improve the healthcare process.

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A 22-year-old COVID-19 positive male with no prior medical history presented to the emergency department with pulmonary infarction

Journal of Community Hospital Internal Medicine Perspectives ◽

10.1080/20009666.2021.1922132 ◽

2021 ◽

Vol 11 (4) ◽

pp. 473-475

Author(s):

Islam Younes ◽

Ramez Alyacoub ◽

Onyeka Nwachukwu ◽

Anuraag Sah ◽

Remolina Carlos

Keyword(s):

Emergency Department ◽

Medical History ◽

Pulmonary Infarction

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G217(P) Improving paediatric asthma long-term management through the emergency department

10.1136/archdischild-2020-rcpch.185 ◽

2020 ◽

Author(s):

E Dyer ◽

K Viljoen ◽

A Iordanidou ◽

C Sidira ◽

M Butler

Keyword(s):

Emergency Department ◽

Paediatric Asthma ◽

Term Management

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A Rational Evaluation of the Syncope Patient: Optimizing the Emergency Department Visit

Medicina ◽

10.3390/medicina57060514 ◽

2021 ◽

Vol 57 (6) ◽

pp. 514

Author(s):

Tarek Hatoum ◽

Robert S. Sheldon

Keyword(s):

Emergency Department ◽

Diagnostic Yield ◽

Clinical Decision ◽

Emergency Department Visits ◽

Decision Tools ◽

Short And Long Term ◽

Electrocardiogram Ecg ◽

Structured Approach

Syncope accounts for up to 2% of emergency department visits and results in the hospitalization of 12–86% of patients. There is often a low diagnostic yield, with up to 50% of hospitalized patients being discharged with no clear diagnosis. We will outline a structured approach to the syncope patient in the emergency department, highlighting the evidence supporting the role of clinical judgement and the initial electrocardiogram (ECG) in making the preliminary diagnosis and in safely identifying the patients at low risk of short- and long-term adverse events or admitting the patient if likely to benefit from urgent intervention. Clinical decision tools and additional testing may aid in further stratifying patients and may guide disposition. While hospital admission does not seem to offer additional mortality benefit, the efficient utilization of outpatient testing may provide similar diagnostic yield, preventing unnecessary hospitalizations.

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US Emergency Department Visits for Adverse Drug Events From Antibiotics in Children, 2011–2015

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piy066 ◽

2018 ◽

Vol 8 (5) ◽

pp. 384-391 ◽

Cited By ~ 8

Author(s):

Maribeth C Lovegrove ◽

Andrew I Geller ◽

Katherine E Fleming-Dutra ◽

Nadine Shehab ◽

Mathew R P Sapiano ◽

...

Keyword(s):

Emergency Department ◽

Adverse Drug Events ◽

Emergency Department Visits ◽

Drug Event ◽

Injury Surveillance System ◽

Adverse Event Data ◽

Systemic Medication ◽

Ed Visits ◽

Pharmacy Dispensing Data

Abstract Background Antibiotics are among the most commonly prescribed medications for children; however, at least one-third of pediatric antibiotic prescriptions are unnecessary. National data on short-term antibiotic-related harms could inform efforts to reduce overprescribing and to supplement interventions that focus on the long-term benefits of reducing antibiotic resistance. Methods Frequencies and rates of emergency department (ED) visits for antibiotic adverse drug events (ADEs) in children were estimated using adverse event data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project and retail pharmacy dispensing data from QuintilesIMS (2011–2015). Results On the basis of 6542 surveillance cases, an estimated 69464 ED visits (95% confidence interval, 53488–85441) were made annually for antibiotic ADEs among children aged ≤19 years from 2011 to 2015, which accounts for 46.2% of ED visits for ADEs that results from systemic medication. Two-fifths (40.7%) of ED visits for antibiotic ADEs involved a child aged ≤2 years, and 86.1% involved an allergic reaction. Amoxicillin was the most commonly implicated antibiotic among children aged ≤9 years. When we accounted for dispensed prescriptions, the rates of ED visits for antibiotic ADEs declined with increasing age for all antibiotics except sulfamethoxazole-trimethoprim. Amoxicillin had the highest rate of ED visits for antibiotic ADEs among children aged ≤2 years, whereas sulfamethoxazole-trimethoprim resulted in the highest rate among children aged 10 to 19 years (29.9 and 24.2 ED visits per 10000 dispensed prescriptions, respectively). Conclusions Antibiotic ADEs lead to many ED visits, particularly among young children. Communicating the risks of antibiotic ADEs could help reduce unnecessary prescribing. Prevention efforts could target pediatric patients who are at the greatest risk of harm.

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Enhancing Patient Compliance in Pediatrics

Pediatrics in Review ◽

10.1542/pir.17.4.128 ◽

1996 ◽

Vol 17 (4) ◽

pp. 128-134

Author(s):

Gregory S. Liptak

Keyword(s):

Emergency Department ◽

Medical Education ◽

Rheumatic Fever ◽

Acute Otitis Media ◽

Streptococcal Pharyngitis ◽

Pediatric Care ◽

Pediatric Residency ◽

Health Advice ◽

Advanced Treatments

The Challenge Pediatric care has become exceedingly complex, but no matter how technologically advanced treatments become, they can be only as effective as compliance with their use. Compliance, or adherence, defined as the extent to which a person's behavior coincides with medical or health advice, is crucial for the treatment of illness, the prevention of disease, and the promotion of health. Unfortunately, noncompliance is extremely common. For example, in a study of the use of penicillin for acute otitis media and "strep" throat, Charney et al1 found that only 43% of the children complied with the regimen. Gordis and associates2 found that compliance with penicillin used for chronic rheumatic fever prophylaxis was only 36%. Eney and Goldstein3 showed that compliance with theophylline in children being evaluated in an emergency department for asthma was only 11%. Compliance decreases over the course of treatment, not only for long-term interventions, but for brief ones as well. For example, Bergman and Werner4 found that 56% of individuals being treated with penicillin for streptococcal pharyngitis had stopped taking the medication by day 3, 71% by day 6, and 82% by day 9 of the treatment course. Although compliance is so important, it is largely neglected in medical education, including pediatric residency training.

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