Pediatric and Adolescent Obstetric and Gynecologic Encounters in US Emergency Departments: A Cross-Sectional Study.

STUDY OBJECTIVE: To describe pediatric and adolescent obstetric and gynecologic diagnoses presenting at emergency departments (EDs) in the United States. METHODS: This was a retrospective, cross-sectional study design that utilized the Nationwide Emergency Department Sample (NEDS), which comprised hospital-owned EDs throughout the United States in 2018. The participants included a sample set of female patients from birth to 18 years old. All obstetric and gynecologic (OB/GYN) International Classification of Disease (ICD-10) codes were categorized. Descriptive, bivariate, and multivariate analyses were used to assess diagnoses by age group, hospital type, ED disposition (eg, admission and transfer), payer, and median household income. RESULTS: In 2018, there were 518,244 OB/GYN ED visits by female patients aged less than or equal to 18 years. Vulvovaginal disorders and abnormal uterine bleeding were among the top 5 presentations in all age groups. The top diagnoses varied by age group. Diagnoses with higher morbidity and mortality (ovarian torsion and ectopic pregnancy) had higher admission and transfer rates compared with diagnoses that can be commonly managed in the outpatient setting (vulvar or vaginal disorders). CONCLUSIONS: This is the first study that evaluated OB/GYN diagnoses in pediatric and adolescent patients presenting to the ED. Educational and referral efforts should focus on not only emergency diagnoses, such as ovarian torsion, adnexal masses, and ectopic pregnancy, but also common presentations that can often be managed in the outpatient setting, such as vulvovaginal disorders and abnormal uterine bleeding.

Scalp laceration repair with hair apposition technique in the maritime environment under telemedicine guidance using free open-access medical resources.

Requests for medical advice to evaluate injuries sustained on board a shipping vessel make up a significant number of calls to Telemedical Maritime Assistance Services. As the maritime setting is an austere environment with regards to resources such as equipment and availability of medically trained personnel, it is important to have a set of skills and techniques to treat all manner of common injuries with the tools at hand. Here we discuss a case report of using telemedicine and free open-access medical education resources to teach the hair apposition technique to an on-board medical provider for the treatment of a scalp laceration with good outcome.

Remote patient monitoring for ED discharges in the COVID-19 pandemic.

COVID-19 has had a significant effect on healthcare resources worldwide, with our knowledge of the natural progression of the disease evolving for the individual patient. To allow for early detection of worsening clinical status, protect hospital capacity and provide extended access for vulnerable patients, our emergency department developed a remote patient monitoring programme for discharged patients with COVID-19. The programme uses a daily emailed secure link to a survey in which patients submit biometric and symptoms data for monitoring. Patients' meeting criteria are escalated to a physician for a phone or video visit. Here, we describe the development, implementation and preliminary analysis of utilisation of the programme.

An unusual cause of chest pain in a 33 year old male: neurofibromatosis.

Chest pain in low risk patients is a common ED presentation. Rarely, these patients can have life-threatening conditions requiring timely diagnosis and intervention. There are currently standardized protocols for diagnosing cardiac ischemia, pulmonary embolus, and aortic dissection in low risk patients. Even more rare entities such as esophageal perforation, hemo/pneumothorax, and cardiac tamponade must also be kept in mind. We present the case of chest pain in a 33 year old male reporting no significant past medical history who developed spontaneous massive hemothorax while being evaluated in the ED. Subsequent investigation revealed that the patient had neurofibromatosis; the etiology of aneurysmal rupture in neurofibromatosis is discussed.