Current Issue : April - June Volume : 2018 Issue Number : 2 Articles : 5 Articles
Objective. To identify factors, available at the time of trauma admission, associated with the development of chronic pain to allow testing of preventive approaches. Methods. In a retrospective observational cohort study, we included all patientsââ?¬â?°Ã¢â?°Â¥Ã¢â?¬â?°18 years old admitted for injury in 57 adult trauma centers in the province of Quebec (Canada) between 2004 and 2014. Chronic pain was defined as follows: treated in a chronic pain clinic, diagnosed with chronic pain, or received at least 2 prescriptions of chronic pain medications 3 to 12 months postinjury. Results. A total of 95,134 patients were retained for analysis. Mean age was 59.8 years (Ã?±21.7), and 52% were men. The causes of trauma were falls (63%) and motor vehicle accidents (22%). We identified 14,518 patients (15.3%; 95% CI: 15.1ââ?¬â??15.5) who developed chronic pain. After controlling for confounding factors, the variables associated with chronic pain were spinal cord injury (ORââ?¬â?°=ââ?¬â?°3.9; 95% CI: 3.4ââ?¬â??4.6), disc-vertebra trauma (ORââ?¬â?°=ââ?¬â?°1.6; 95% CI: 1.5ââ?¬â??1.7), history of alcoholism (ORââ?¬â?°=ââ?¬â?°1.4; 95% CI: 1.2ââ?¬â??1.7), history of anxiety (ORââ?¬â?°=ââ?¬â?°1.4; 95% CI: 1.2ââ?¬â??1.5), history of depression (ORââ?¬â?°=ââ?¬â?°1.3; 95% CI: 1.1ââ?¬â??1.4), and being female (ORââ?¬â?°=ââ?¬â?°1.3; 95% CI: 1.2ââ?¬â??1.3). The area under the receiving operating characteristic curve derived from the model was 0.80. Conclusions. We identified risk factors present on hospital admission that can predict trauma patients who will develop chronic pain. These factors should be prospectively validated....
Abdominal pain is a common presentation in emergency medicine.We describe the case of a 54-year-old female who presented to\nthe emergency department due to worsening abdominal pain. She had a history of right upper quadrant (RUQ) abdominal pain\nthat had been ongoing for several months. The pain had been thought by the primary care team to be related to gastritis and she\nhad been prescribed a proton pump inhibitor (PPI).Her abdominal pain increased in the three days prior to her presentation to the\nemergency department (ED). The computed tomography (CT) scan of the abdomen showed a foreign body (FB) in the liver which\nwas successfully removed surgically. Pathology results showed that the FB was consistent with a small bone fragment. Ingestions of\nFB are common but seldom result in complications.When complications do arise, perforation of a hollow viscous is typically seen.\nRarely, transmigration of the FB can occur....
Trauma is a leading cause of morbidity and mortality in infants and children worldwide. Trauma education is one of the most\ncommonly reported deficiencies in pediatric emergency medicine (PEM) training. In this study, we describe the creation of a\npediatric trauma boot camp in which trainees� basic knowledge, level of confidence, teamwork, and communication skills are\nassessed. The primary goal of this pilot study was to create a simulation-based pediatric trauma curriculum for PEM fellows\nand emergency medicine residents utilizing Kern�s curricular conceptual framework. This was a pilot, prospective, single cohort,\nexploratory, observational study utilizing survey methodology and a convenience sample.The curriculum consisted of a two-day\nexperience that included confidence surveys, a cognitive multiple-choice questionnaire, and formative and summative simulation\nscenarios. At the conclusion of this intensive simulation-based trauma boot camp participants reported increased confidence and\ndemonstrated significant improvement in the basic knowledge and performance of the management of pediatric trauma cases in a\nsimulated environment....
Objective. Sleep deprivation decreases work performance and predisposes workers to deleterious health outcomes. We sought to\nevaluate sleep hygiene and fatigue among emergency physicians. Methods. In Marchââ?¬â??June 2016, physicians and residents at an\nacademic emergency medicine program were invited to complete a survey evaluating sleep and alertness. Results. Six attending\nphysicians and 26 residents completed the survey. Among six personal priorities, sleep ranked fourth behind family, work, and\nleisure. 75% stated poor sleep impedes effectiveness as a physician while 53% noted difficulty falling asleep before a night shift.\nIn the last three months, 39% of subjects forgot driving home from a shift, and 34% had fallen asleep while driving. 34% used\nmedications to assist with sleep (including melatonin (36%), alcohol (27%), and prescription drugs (9%)). Most providers attested\nto phone (88%) and television exposure (69%) immediately prior to goal sleep onset. Conclusion. Despite sleep being identified\nas a priority among EM physicians, deleterious habits remain. Poor sleep affects perceived effectiveness and personal safety, as\nevidenced by a significant portion of providers falling asleep on the commute home. Night shift is the chief obstacle to optimal\nsleep hygiene....
Pain crisis in children with sickle cell disease (SCD) is typically managed with intravenous\nfluids and parenteral opioids in the pediatric emergency department. Electrical cardiometry (EC)\ncan be utilized to measure cardiac output (CO) and cardiac index (CI) non-invasively. Near-infrared\nspectroscopy (NIRS) measuring cerebral (rCO2) and splanchnic regional (rSO2) mixed venous\noxygenation non-invasively has been utilized for monitoring children with SCD. We studied the\nvalue and correlation of NIRS and EC in monitoring hemodynamic status in children with SCD\nduring pain crisis. We monitored EC and NIRS continuously for 2 h after presentation and during\nmanagement. Forty-five children participated in the study. CO (D = 1.72), CI (D = 1.31), rSO2\n(D = 11.6), and rCO2 (D = 9.3), all increased over time. CO max and CI max were achieved 1 h after\nstarting resuscitation. rCO2 max attainment was quicker than rSO2, as monitored by NIRS. CI max\ncorrelated with rCO2 max (r = âË?â??0.350) and rSO2 max (r = âË?â??0.359). In adjustment models, initial CI\nsignificantly impacted initial rCO2 (p = 0.045) and rCO2 max (p = 0.043), while initial CO impacted\nrCO2 max (p = 0.030). Cardiac output monitoring and NIRS monitoring for cerebral and splanchnic\noxygenation were feasible and improved the monitoring of therapeutic interventions for children\nwith SCD during pain crisis....
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