Intranasal ketamine is noninferior to intranasal fentanyl for pain associated with pediatric extremity injuries. However, there is a higher risk of minor adverse events.
Although opioids are not first-line treatment for ankle sprains, an opioid was prescribed for 25% of emergency department patients diagnosed with an isolated ankle sprain. Prescribing varied widely among states. Additionally, patients prescribe greater quantities of opioids were more likely to transition to continued use.
Positive responses to "red flag" screening questions for back pain warranted further investigation, though the positive predictive value was poor. Negative responses to screening "red flag" questions were useless as a screening tool for ruling out serious disease, such as fracture, infection, malignancy, or cauda equina.
Getting an MRI for back pain does not reduce recurrent patient visits within a week. The only time we should get an MRI for back pain in the ED is if there is a clinical concern that the findings may prompt emergent surgery, such as for cauda equina, epidural abscess, or impinging mass (may need radiation), etc.
These 4 predictors are somewhat helpful in distinguishing transient synovitis of the hip from septic arthritis. Note the limitations of the Kocher Criteria when using it in practice, and err on the side of orthopedic consultation and/or admission.
Isolated posterior fat pad on x-ray for adults heals great even if you do nothing.
Short Attention Span Summary
A new shoulder reduction technique was highly successful, allowed patients to sit up, and required no sedation. It is called the Sool's method. See the video on You Tube.
Am J Emerg Med. 2016 Apr 9. pii: S0735-6757(16)30036-5. doi: 10.1016/j.ajem.2016.04.012. [Epub ahead of print]
The effectiveness of a newly developed reduction method of anterior shoulder dislocations; Sool's method.
1Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
2Department of Emergency Medicine, Seoul National Hospital, Seoul, Republic of Korea.
3Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea. Electronic address: email@example.com.
4Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
Nearly a dozen reduction methods for the treatment of anterior shoulder dislocation have been reported, but the majority are painful and require patients to be in the supine or prone position.
This retrospective cohort study was conducted in a university-affiliated emergency department (ED). Sool's method and traditional shoulder reduction methods (TSRMs) were performed for the patient with anterior shoulder dislocation. Fifty-nine eligible patients were recruited; 35 were treated with TSRMs, wherease 24 were treated with Sool's method.
The rate of successful reduction was 80% (26/35) in the TSRM group and 75% (18/24) in the Sool's method group (P=.75). The length of stay in the ED was 72.3 minutes in the Sool's method group and 98.4minutes in the TSRM group (P=.037). No significant difference was observed between the neurovascular deficit before and after reduction in either group. The procedural time of successfully reduced cases in patients treated by Sool's method was shorter than that of the failed cases (P=.015).
Sool's method was as successful as other methods at reducing shoulder dislocation and has demonstrated encouraging results, including significant reduction in length of stay in the ED and unnecessary use of sedation. Sool's method is technically easy and requires only a place to sit and a single operator.
Copyright © 2016 Elsevier Inc. All rights reserved.
PMID: 27117465 [PubMed - as supplied by publisher]