Study of pediatric appendicitis scores and management strategies.

Abdominal pain is a common reason for children to attend the emergency department (ED). Acute appendicitis is the most frequent surgical cause of abdominal pain, with the highest incidence occurring in 10- to 20-year-olds. The diagnosis of appendicitis in children can be challenging due to the different causes of abdominal pain and varying presentations of appendicitis in different age groups. Traditionally the diagnosis of appendicitis is primarily based on history and clinical examination, with laboratory biomarkers and imaging being valuable adjuncts albeit with their own limitations.

Severe and sudden chest or back pain that feels like tearing is the most common symptom of aortic dissection. This study aimed to investigate if chest or abdominal pain alone is a marker of aortic dissection and to determine its patient characteristics. This was a retrospective, single-center observational study. It was conducted in the emergency department (ED) of a tertiary university hospital in Turkey. During three years, patients admitted to the ED and underwent contrast-enhanced thoracic and abdominal computed tomography angiography (CTA) were detected through the hospital computer system.

Transient and hardly traceable signs of diminished consciousness might be the only signs that are apparent and reported during the scrutinous care of intensive care unit (ICU) staff. Unfortunately, most transient loss of consciousness (TLoC) episodes occur elsewhere. This review aims to help recognize TLoC and identify situations when these conditions mean that certain legal privileges should be held. With this aim, the current literature was scoped for conceptualizing consciousness, its alterations, and loss as regarded in the legal system. This review was partly inceptive for increasing the use of unconsciousness as a defense against criminal charges.

The European Society of Cardiology issued updated syncope guidelines in 2018 which included recommendations for managing syncope in the emergency department (ED) setting. However, these guidelines lack detailed process-oriented instructions regarding the fact that ED syncope patients initially present with a transient loss of consciousness (TLOC), which can have a broad spectrum of causes. This study aims to establish a European consensus on the general process of the workup and care for patients with suspected syncope and provides rules for sufficient and systematic management of the broad group of syncope (initially presenting as TLOC) patients in the ED.

This is a large, prospective, multicentre study to derive a clinical decision tool to identify elderly patients who can safely forgo a CT scan of their head after a ground level fall or out of a bed.
Patients were assess for the following predictors:
age; sex; head impact on falling; loss of consciousness; amnesia; history of previous major bleed; cirrhosis; previous ischemic stroke; chronic renal impairment; Glasgow Coma Scale reduced from baseline; bruise or laceration on the head; new abnormality on neurologic examination; hemoglobin < 10 g/L; platelet count < 80 × 109/L; anticoagulant therapy; antiplatelet therapy; and Clinical Frailty Scale ≥ 5 (impairment of high order IADLs – see scale below)
Clinicians had to fill out these variables before they could view CT head results (if one was ordered). 
Patients were followed up to 42 days (based on expert consensus) by chart review.

The study was conducted at 11 different EDs in Canada and the USA, with 4308 patients enrolled. 

Pacijentkinja u srednjim 60-im se prijavila u bolnicu sa povremenim epizodama bola u grudima koje se javljaju više puta dnevno, često uz napor.

Imala je infarkt miokarda i dve nedelje ranije su joj postavljena dva stenta. Takođe je primljena oko nedelju dana ranije zbog dvočasovne epizode ​​bola u grudima koja se povukla nitroglicerinom. Njeni troponini su u to vreme bili povišeni oko tri puta iznad gornje granice normale, ali su bili u opadanju, tako da je medicinski zbrinuta bez još jedne kateterizacije.

The emergency department (ED) is a demanding and time-pressured environment where doctors must navigate numerous team interactions. Conflicts between health care professionals frequently arise in these settings leading to potential adverse patient events and exacerbating access block issues.6 While individual studies have identified contributing factors to conflict, a comprehensive review that explores and summarizes these issues is either lacking, or not specific to the ED

Opioids are effective analgesics, but they can have harmful adverse effects, such as addiction and potentially fatal respiratory depression. Naloxone is currently the only available treatment for reversing the negative effects of opioids, including respiratory depression.

More than half of physicians reported feeling burned out this year and nearly 1 in 4 doctors reported feeling depressed — the highest percentages in 5 years, according to the ‘I Cry but No One Cares’: Physician Burnout & Depression Report 2023.
Burnout can persist for months to even years — nearly two thirds of doctors surveyed said their burnout lasted for at least 13 months, and another 30% said it lasted for more than 2 years.
The majority of doctors attributed their burnout to too many bureaucratic tasks, although more than one third said it was because their co-workers treated them with a lack of respect.

Bol u grudima je drugi vodeći uzrok svih poseta urgentnom centru kod odraslih u Sjedinjenim Državama, sa skoro 11 miliona poseta godišnje. Dok je identifikacija pacijenata sa niskim rizikom ključna za rano otpuštanje, identifikacija pacijenata sa visokim rizikom u ED je od vitalnog značaja za pravovremeno i odgovarajuće lečenje akutnog koronarnog sindroma (AKS). Tradicionalne metode kao što su fizički pregled, kardijalni markeri i razne imaging tehnike ne mogu pouzdano potvrditi ili isključiti ACS

Migrena je čest epizodični poremećaj, čiji je obeležje onesposobljavajuća glavobolja koja je generalno povezana sa mučninom i/ili osetljivošću na svetlost i zvuk.
Simptomatska terapija migrene se kreće od upotrebe jednostavnih analgetika kao što su nesteroidni antiinflamatorni lekovi (NSAID) ili acetaminofen do triptana, antiemetika, dihidroergotamina itd. Izbor specifičnog agensa zavisi od faktora specifičnih za pacijenta, uključujući težinu i karakter simptoma, komorbidne uslove i prethodni odgovor na lečenje

Prethodno zdravu 23-godišnju ženu prijatelji su doveli u bolnicu. Pacijentkinja se žalila na iznenadni početak dispneje, anksioznosti i vrtoglavice. Njeni prijatelji su bili zabrinuti nakon što je izgledalo da joj koža postaje siva. Koja je dijagnoza?

Tretman bola je vitalna komponenta nege pacijenata, posebno u hitnim slučajevima gde bol može da ometa mogućnosti lečenja. Bol je i dalje jedan od primarnih razloga da pacijenti potraže hitnu medicinsku pomoć, ali uprkos tome često ostaje nedovoljno priznat, procenjen i lečen. Akutni bol je sam po sebi veoma stresan, a ako je nerešen može dovesti do komplikacija i, dugoročno gledano, generisanja hroničnih bolova. Efikasno i brzo lečenje bola je stoga od suštinskog značaja.