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Specialty: Emergency Medicine
Condition: Pain

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Total 103 results found since Jan 2013.

An EMS Guide to Wake-Up Ischemic Strokes
It’s 7:15 a.m. when the tones go off. “Squad 83 and ALS 83, respond for a 65-year-old female with a possible stroke,” squawks the dispatcher. Why did the last crew leave the radio on so loud? It’s too early for loud noises. Apparently your partner didn’t get the memo about loud noises either; he flips the siren to wail as soon as the wheels start to roll. You arrive to find Mrs. M, a pleasant older female who you’ve seen once or twice before for chest pain or palpitations. She seems to be staring into space, has an obvious facial droop, her arm drifts, her speech is slurred and the pleasant cheery lady you reme...
Source: JEMS Patient Care - November 20, 2015 Category: Emergency Medicine Authors: Michael Bohanske, MD Tags: Cardiac & Resuscitation Neurology Patient Care Source Type: news

Analgesia in Neurocritical Care: An International Survey and Practice Audit*
Conclusions: Opiates and acetaminophen are preferred analgesic agents, and gabapentin is a contextual third choice, in neurocritically ill patients. Other agents are rarely prescribed. The discordance in physician self-reports and objective audits suggest that pain management optimization studies are warranted.
Source: Critical Care Medicine - April 16, 2016 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Muhammed Ali's Death Underscores Importance of Prehospital Sepsis Detection
Muhammad Ali, one of the greatest athletes of all times and a world-class treasure, passed away on Friday, June 3, 2016, as result of sepsis. Imagine if an EMS crew could have detected that he was becoming septic and was able to treat him in the field, helping the hospital attack this deadly condition before it attacked his vital organs? Soon, crews all over the world will be capable of doing so. Severe sepsis is caused by overwhelming infection, and is responsible for significant morbidity and mortality among hospitalized patients. Clinical identification of sepsis includes two or more of the systemic inflammatory respons...
Source: JEMS Patient Care - June 6, 2016 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT-P Tags: Patient Care Source Type: news

Refractory thrombotic thrombocytopenic purpura following acute pancreatitis
Publication date: Available online 11 August 2016 Source:Journal of Acute Disease Author(s): Ebisa Bekele, Bethel Shiferaw, Alexandra Sokolova, Arpan Shah, Phillip Saunders, Alida Podrumar, Javed Iqbal Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder with an estimated incidence of 4–5 cases per million people per year. It is characterized by small-vessel platelet-rich thrombi that cause thrombocytopenia, microangiopathic hemolytic anemia and organ damage. There are reports in literature that TTP and acute pancreatitis are associated, indicating each can be the cause of the other. However, acute pancrea...
Source: Journal of Acute Disease - August 11, 2016 Category: Emergency Medicine Source Type: research

Muhammed Ali's Death Underscores Importance of Prehospital Sepsis Detection
Muhammad Ali, one of the greatest athletes of all times and a world-class treasure, passed away on Friday, June 3, 2016, as result of sepsis. Imagine if an EMS crew could have detected that he was becoming septic and was able to treat him in the field, helping the hospital attack this deadly condition before it attacked his vital organs? Soon, crews all over the world will be capable of doing so. Severe sepsis is caused by overwhelming infection, and is responsible for significant morbidity and mortality among hospitalized patients. Clinical identification of sepsis includes two or more of the systemic inflammatory respons...
Source: JEMS Patient Care - June 6, 2016 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT-P Tags: Patient Care Source Type: news

South Carolina EMS Integrates In-Hospital Sepsis Care into Protocols
Medic 29 is dispatched to a college dorm for a female with chief complaint of lower abdominal and flank pain for the past five days. The dorm room appears clean and well kept. The patient appears to be a typical 18-year-old college student. She's lying on her bed and is responsive to verbal stimuli, hot to touch, and tachycardic with weak and thready radial pulses at 128. She reports painful urinating for the past 48 hours, general malaise, weakness and nausea. She appears to have labored respirations with a room air SpO2 reading of 95% and is hypotensive with a systolic blood pressure of 88 mmHg that remains low during tr...
Source: JEMS Patient Care - September 1, 2016 Category: Emergency Medicine Authors: Jason G. Walchok, NRP, FP-C Tags: Patient Care Source Type: news

The Fault in our (Three) Stars
Conclusions Like it or not (I think only a minority of CEOs will be happy with their star rating and many physicians will chafe at the ED metrics being used) CMS has started rating your hospital on a five star scale. All of the ED metrics used in the star rating system are typically followed by the ED medical director and nursing leaders, but now you may notice hospital administration is more interested in your performance. The good news is that with added visibility, hospital admin may provide more support in helping to improve performance. We need to know which of our metrics are involved and how we’re contributing to ...
Source: EPMonthly.com - September 27, 2016 Category: Emergency Medicine Authors: Matt McGahen Tags: Uncategorized Source Type: news

A Paramedic's Repeated Encounters with Sepsis
Sepsis is a disease process that has been on the forefront lately, especially in the EMS community. Prehospital professionals are trained to recognize the symptoms, such as tachypnea above 22 breaths per minute, fever, tachycardia above 90bpm, and a possible source of infection. Thanks to special emphasis by JEMS in a far-reaching special sepsis section in September that points out how effectively prehospital providers are able to identify sepsis in the field, hospitals around the U.S. are now developing sepsis protocols and working with EMS providers to institute prehospital alerts to join the ranks of trauma, STEMI and s...
Source: JEMS Patient Care - November 29, 2016 Category: Emergency Medicine Authors: Jessica Edwards, NRP Tags: Patient Care Source Type: news

Trauma & Triage Geriatric Teaching Moments from A.J. Heightman, MPA, EMT-P – JEMS Editor-in-Chief relative to the Texas Church Mini Bus Crash that Killed 13 Senior Citizens
When 13 senior citizens were killed in a horrible head-on collision between a San Antonio church mini bus and a pickup truck in southwest Texas, the AP story noted that the elderly occupants “were more susceptible to internal injuries and damage to vulnerable organs because of their advanced ages.” (see below as presented by the Associated Press). As an educator who spends a lot of time educating crews about the unique impact trauma can have on geriatric patients, I thought I would take the opportunity to present a few important facts about geriatric trauma and assessment tips to remember when you are tasked with triag...
Source: JEMS Patient Care - April 2, 2017 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT P Tags: Major Incidents News Category Orientation Patient Care Source Type: news

Extracranial Cervical Artery Dissections
Cervical artery dissections (CeAD) include both internal carotid and vertebral artery dissections. They are rare but important causes of stroke, especially in younger patients. CeAD should be considered in patients with strokelike symptoms, a new-onset headache and/or neck pain, and/or other risk factors. Early imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is key to making the diagnosis. Treatment may vary depending on the extent of the dissection, timing of the dissection, and other comorbidities. The overall prognosis is good, but does depend on the initial severity of symptoms.
Source: Emergency Medicine Clinics of North America - August 23, 2017 Category: Emergency Medicine Authors: Jennifer J. Robertson, Alex Koyfman Source Type: research

Not as Simple as Canker Sores
BY ​NANA P. MATSUMOTO, & DEREK MEEKS, DO​​A 16-year-old boy presented to a rural ED with a swollen jaw, painful blisters in the mouth, and earache for the past day. One week before, he had a fever with chills, sore throat, and dry coughs. He was not taking any medications, and his immunizations were up-to-date. He had a mild learning disorder but no significant past medical or surgical history.​An apthous ulcer, the most common and one of the earliest signs of Behçet's disease.The patient's vital signs were within normal limits, and his physical examination revealed anterior cervical lymphadenopathy, sinus con...
Source: The Case Files - October 11, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Is it an Emergency? Insurer Asks Patients to Question ED Visits
INDIANAPOLIS (AP) — Alison Wrenne was making waffles for her two young children one morning when abdominal pain forced her to the floor. A neighbor who is a physician assistant urged her to go to the emergency room. Wrong decision, according to her health insurer. Wrenne was diagnosed with a ruptured ovarian cyst, but Anthem said that wasn't an emergency and stuck her with a $4,110 bill. "How are you supposed to know that?" said the 34-year-old from Lexington, Kentucky. "I'm not a doctor ... that's what the emergency room is for." In an effort to curb unnecessary and costly ER visits, the Blue Cross-B...
Source: JEMS Patient Care - November 10, 2017 Category: Emergency Medicine Authors: Tom Murphy, Associated Press Tags: Patient Care News Administration and Leadership Source Type: news