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1.
Einstein (Sao Paulo) ; 18: eAO4739, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553355

RESUMO

OBJECTIVE: To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray. METHODS: We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described. RESULTS: Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries. CONCLUSION: There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.


Assuntos
Traumatismos do Tornozelo/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Traumatismos do Tornozelo/diagnóstico por imagem , Brasil/epidemiologia , Cartilagem Articular/lesões , Criança , Feminino , Humanos , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
2.
Medicine (Baltimore) ; 98(38): e17229, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567985

RESUMO

RATIONALE: Abdominal pain in pregnancy represents a demanding diagnostic challenge in the emergency department (ED) due to the extensive list of differential diagnoses to be considered, coupled with the possibility of each disease having nonclassical, atypical signs and symptoms, resultant from the patient's pregnant state. Additionally, emergency physicians (EPs) face limitations on investigative imaging modalities because of the need to minimize fetal radiation exposure. EPs have to tackle this diagnostic challenge while performing a balancing act to maximize both maternal and fetal outcomes in a time-sensitive manner, becauser any delays in decision-making at the ED may threaten the safety of mother and child. Two common causes of abdominal pain in pregnancy presenting to the ED are acute appendicitis and ectopic pregnancy. The latter is almost always diagnosed by 10 weeks of gestation. Here, we report an extremely rare case of unilateral live spontaneous twin tubal ectopic pregnancy presenting past 12 weeks of gestation, diagnosed after magnetic resonance imaging (MRI) of the abdomen. PATIENT CONCERNS: A 37-year-old gravida 2 para 1 at 12 weeks and 6 days of gestation presented to our ED with a 2-day history of right iliac fossa pain, not associated with vaginal bleeding, fever, diarrhea, and vomiting. On examination, she was tachycardic (pulse rate 124 beats/min) and hypertensive (blood pressure 142/88 mm Hg). There was marked tenderness and guarding at the lower abdomen. DIAGNOSES: Blood investigations were unremarkable, while abdominal ultrasonography found a live twin gestation with foetal heartbeats of 185 and 180 beats/min. MRI of the abdomen revealed an empty uterine cavity; 2 amniotic sacs and fetuses of diameter 10 cm, and a single placenta were noted in the right uterine adnexa. The patient was diagnosed with right live monochorionic diamniotic twin tubal pregnancy. INTERVENTION: Our patient underwent emergency laparoscopic right salpingectomy. OUTCOMES: The operation was successful and her postoperative care remained uneventful up to discharge. LESSONS: Ectopic pregnancy cannot be ruled out based on prior normal antenatal examinations and gestational age of >10 weeks. EPs should not hesitate to order MRI scans for further evaluation if ultrasonography and laboratory findings are equivocal.


Assuntos
Gravidez Tubária/diagnóstico , Gravidez de Gêmeos , Adulto , Serviço Hospitalar de Emergência , Feminino , Idade Gestacional , Humanos , Gravidez , Gravidez Tubária/diagnóstico por imagem , Gravidez Tubária/cirurgia , Salpingectomia , Ultrassonografia
9.
J Glob Health ; 9(2): 020403, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31489186

RESUMO

Background: There is a need to develop sustainable emergency health care systems in low-resource settings, but data that analyses emergency health care needs in these settings are scarce. We aimed at assessing presenting complaints (PCs) and post-discharge mortality in a large emergency department population in Nepal. Methods: Characteristics of adult patients who entered the emergency department (ED) in a hospital in Nepal were prospectively recorded in the local emergency registry from September 2013 until December 2016. To assess post-ED mortality, patient households were followed-up by telephone interviews at 90 days. Results: In 21892 included adults, the major PC categories were injuries (29%), abdominal complaints (23%), and infections (16%). Median age was 40 years and sex distribution was balanced. Among 3793 patients followed at 90 days, 8% had died. For respiratory and cardiovascular PCs, 90-day mortality were 25% and 23%. The highest mortality was in individuals with known chronic lung disease, in this group 32% had died by 90 days of ED discharge, regardless of PC. In women, illiteracy compared to literacy (adjusted odds ratio (aOR) = 7.0, 95% confidence interval (CI) = 2.1-23.6) and being both exposed to tobacco-smoking and traditional cooking stove compared to no smoke (aOR = 2.8, 95% CI = 1.6-4.9) were associated with mortality. The mortality was much higher among family-initiated discharged patients (17%, aOR = 5.4, 95% CI = 3.3-8.9) compared to doctor-initiated discharged (3%). Conclusions: Our report suggests that nearly one in ten patients seeking emergency health care died within 90 days. This finding is alarming and novel. Post-discharge studies need to be replicated and appropriate follow-up programs in low-resource settings where primary health care is underdeveloped are urgently needed.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade/tendências , Adulto , Idoso , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Estudos Prospectivos
10.
J Glob Health ; 9(2): 020404, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31489187

RESUMO

Background: Displacement after a war or an armed conflict always leads to unexpected health problems, both among migrating people and in places to which new people have migrated. This study aimed to determine the health care needs and trends of Syrian patients. Methods: This retrospective study was conducted in a secondary care hospital in the city of Nevsehir, in central Turkey, between January 2013 and December 2017. All Syrian patients who visited the outpatient clinics and emergency department (ED) were enrolled in the study. Results: Over a span of five years, 41 723 Syrian patients visited the hospital's outpatient clinics and ED. The patients' median age was 23 (inter-quartile range (IQR) = 7-34), and 57.7% of them were female. In 2017, one-third of the Syrian patients visited the ED, a rate that was higher than that found among local patients (30.3% vs 25.0%, P < 0.001, respectively). The rate of pediatric clinic admissions among Syrian patients was about four times greater than the rate of local patients (20.1% vs 5.2%, P < 0.001, respectively), and Syrians' rate of admission to the obstetrics and gynecology clinic was about three times greater than the rate of local patients' admissions (12.3% vs 4.3%, P < 0.001, respectively). Conclusions: This study showed that Syrian patients' visits to the hospital, and especially the ED, are increasing. Further, the needs and expectations of these patients in terms of health care are different from local demands. New approaches should be applied to provide an appropriate use of health care facilities.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Síria/etnologia , Turquia , Adulto Jovem
11.
Stud Health Technol Inform ; 267: 215-223, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483275

RESUMO

Emergency department (ED) care for frail elderly patients is associated with an increased use of resources due to their complex medical needs and frequently difficult psycho-social situation. To better target their needs with specially trained staff, it is vital to determine the times during which these particular patients present to the ED. Recent research was inconclusive regarding this question and the applied methods were limited to coarse time windows. Moreover, there is little research on time variation of frail ED patients' case complexity. This study examines differences in arrival rates for frail vs. non-frail patients in detail and compares case complexity in frail patients within vs. outside of regular GP working hours. Arrival times and case variables (admission rate, ED length of stay [LOS], triage level and comorbidities) were extracted from the EHR of an ED in an urban German teaching hospital. We employed Poisson time series regression to determine patterns in hourly arrival rates over the week. Frail elderly patients presented more likely to the ED during already high frequented hours, especially at midday and in the afternoon. Case complexity for frail patients was significantly higher compared to non-frail patients, but varied marginally in time only with respect to triage level and ED LOS. The results suggest that frailty-attuned emergency care should be available in EDs during the busiest hours. Based on EHR data, hospitals thus can tailor their staff needs.


Assuntos
Idoso Fragilizado , Fragilidade , Idoso , Serviço Hospitalar de Emergência , Humanos , Tempo de Internação , Triagem
12.
Stud Health Technol Inform ; 267: 238-246, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483278

RESUMO

The German Emergency Department Data Registry (GEDD-registry, AKTIN) provides an infrastructure for collecting and querying up-to-date medical records in a distributed manner. Within this framework, a benchmark report on cross-institutional comparison using the program R is prepared using routine data of participating hospitals. Currently, 16 emergency departments (EDs) routinely transfer data of 1,200 to approximately 5,000 patients per month to a federated GEDD-registry datawarehouse. Using various packages in the R environment, hospitals receive a monthly visual report on their data among all participating hospitals. Graphical representations are implemented using column diagrams and box plots. Reports currently contain 25 tables and 40 graphs. Benchmark reports are created in R-Studio and exported using Portable Document Format, PDF. Quarterly expert meetings with the heads of participating EDs are currently performed for further improvements. Preparation of external benchmarking reports with R enables a detailed data presentation for participating hospitals and ED managers.


Assuntos
Benchmarking , Serviço Hospitalar de Emergência , Hospitais , Humanos , Sistema de Registros
13.
Emerg Med Clin North Am ; 37(4): 661-677, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563201

RESUMO

This article is an evidence-based overview of acute kidney injuries in patients seen in the emergency department setting. The article outlines the current definition of acute kidney injuries and most common causes of injuries. Furthermore, it details clinical evaluations important to appreciate and intervene on, such as volume overload, hypertension, life-threatening electrolyte derangements, and threshold for urgent dialysis. Finally, the article describes special populations that are at higher risk for acute kidney injuries and acute conditions, such as rhabdomyolysis, and the controversy of contrast-induced acute kidney injuries in patients seen in the emergency department.


Assuntos
Lesão Renal Aguda/diagnóstico , Serviço Hospitalar de Emergência , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Humanos , Fatores de Risco
14.
Emerg Med Clin North Am ; 37(4): 679-705, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563202

RESUMO

Renal transplants are becoming more and more frequent in the United States and worldwide. Studies demonstrate that these patients inevitably end up visiting an emergency department. In addition to typical medical and surgical problems encountered in the general population, this group of patients has unique problems arising from their immunocompromised state and also due to side effects of the medications required. This article discusses these risks and management decisions that the emergency department physician should be aware of in order to prevent adverse outcomes for the patient and transplanted kidney.


Assuntos
Serviço Hospitalar de Emergência , Transplante de Rim/efeitos adversos , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/terapia , Humanos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/terapia
15.
Emerg Med Clin North Am ; 37(4): 707-723, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563203

RESUMO

Urinary tract infection (UTI) affects patients of all ages and is a diagnosis that emergency physicians might make multiple times per shift. This article reviews the evaluation and management of patients with infections of the urinary tract. Definitions of asymptomatic bacteriuria, uncomplicated UTI, and complicated UTI are presented, as well as techniques for distinguishing them. The pathophysiology and clinical and laboratory diagnoses of UTI are described. Treatment of UTI is reviewed, with attention to bacteriuria and special populations, including pregnant, elderly/geriatric, and spinal cord injury patients.


Assuntos
Serviço Hospitalar de Emergência , Infecções Urinárias/diagnóstico , Antibacterianos/uso terapêutico , Bacteriúria/diagnóstico , Bacteriúria/terapia , Cistite/diagnóstico , Cistite/terapia , Humanos , Pielonefrite/diagnóstico , Pielonefrite/terapia , Infecções Urinárias/terapia
16.
Emerg Med Clin North Am ; 37(4): 725-738, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563204

RESUMO

The diagnosis and treatment of sexually transmitted infections is a crucial component of providing evidence-based care in the emergency department. Understanding how to make the diagnosis and implement effective treatment is essential to maintaining and improving public health. Providers should also be adept at giving care to sexual assault survivors and seeking out the expertise of specially trained professionals within networks known as SANE, SAFE, or SART. These networks are critical to providing standardized care to sexual assault patients. Prophylaxis remains a key element for the prevention of sexually transmitted infections in all patients who are considered high risk.


Assuntos
Doenças Sexualmente Transmissíveis/diagnóstico , Serviço Hospitalar de Emergência , Infecções por HIV/prevenção & controle , Humanos , Profilaxia Pós-Exposição , Profilaxia Pré-Exposição , Estupro , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/terapia
17.
Emerg Med Clin North Am ; 37(4): 755-769, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563206

RESUMO

Hematuria is common; whether gross or microscopic, it is incumbent on emergency providers to consider life-threatening and benign processes when evaluating these patients. Most workup is driven by a focused history and physical, including laboratory studies and diagnostic imaging. The cause originates in the genitourinary tract and, as long as the patient remains stable, they can be discharged with close outpatient follow-up. The importance of this cannot be stressed enough because hematuria, especially in the elderly, frequently signals the presence of urologic malignancy. In addition, the workup occasionally yields a nongenitourinary tract cause, and these patients often require emergent management.


Assuntos
Hematúria/diagnóstico , Serviço Hospitalar de Emergência , Hematúria/etiologia , Hematúria/terapia , Humanos
18.
Emerg Med Clin North Am ; 37(4): 771-784, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563207

RESUMO

The emergency medicine provider sees a broad range of pathology involving the female genitourinary system on a daily basis. Must-not-miss diagnoses include pelvic inflammatory disease and ovarian torsion, because these diagnoses can have severe complications and affect future fertility. Although most patients with abnormal uterine bleeding are hemodynamically stable, it can present as a life-threatening emergency and providers should be adept managing severe hemorrhage. Bartholin gland cysts are common complaints that often require procedural intervention. This article discusses these diagnoses and appropriate evaluation and management in the emergency department.


Assuntos
Serviço Hospitalar de Emergência , Doenças dos Genitais Femininos/diagnóstico , Doenças Urológicas/diagnóstico , Emergências , Feminino , Doenças dos Genitais Femininos/terapia , Humanos , Doenças Urológicas/terapia
19.
Emerg Med Clin North Am ; 37(4): 785-809, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563208

RESUMO

Emergency physicians rely on a multitude of different imaging modalities in the diagnosis of genitourinary emergencies. There are many considerations to be taken into account when deciding which imaging modality should be used first, as oftentimes several diagnostic tools can be used for the same pathologic condition. These factors include radiation exposure, sensitivity, specificity, age of patient, availability of resources, cost, and timeliness of completion. In this review, the strengths and weaknesses of different imaging tools in the evaluation of genitourinary emergencies are discussed.


Assuntos
Serviço Hospitalar de Emergência , Doenças dos Genitais Femininos/diagnóstico por imagem , Doenças dos Genitais Masculinos/diagnóstico por imagem , Doenças Urológicas/diagnóstico por imagem , Emergências , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Radiografia , Tomografia Computadorizada por Raios X , Ultrassonografia
20.
Emerg Med Clin North Am ; 37(4): 811-819, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563209

RESUMO

Emergency medicine providers may encounter serious GU conditions that need rapid diagnosis and early intervention to avoid severe life- and limb-threatening complications. A fundamental knowledge of several key procedural interventions is incredibly important to optimal patient outcomes.


Assuntos
Serviço Hospitalar de Emergência , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Masculinos/diagnóstico , Doenças Urológicas/diagnóstico , Cuidados Críticos/métodos , Feminino , Doenças dos Genitais Femininos/patologia , Doenças dos Genitais Femininos/terapia , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/terapia , Humanos , Masculino , Doenças Urológicas/patologia , Doenças Urológicas/terapia
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