Stories about: Emergency Medicine

Expert’s Corner: A guide to managing knee injuries in athletes

knee-pain

Knee pain and injuries are common among young athletes. Although some parents may think to bring their child to the emergency department (ED) when a knee injury occurs, there are many cases when the injury is better managed by either a primary care provider (PCP) or an orthopedic specialist.

The following guide will help you manage knee pain in athletes and provide guidance on when to refer your patient to an orthopedic specialist. …Read More

Challenging case: Enterovirus

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On Oct. 3, 2014, Elisa Holt was nursing her six-month-old son Noah when she realized he wasn’t moving his feet, legs or toes. Panicked, she called her pediatrician at Garden City Pediatrics and was directed to Beverly Hospital.

“We are so thankful for the emergency room doctor [Dr. Munirah Qualls] who told us, ‘I don’t know. I’m going to send you to Boston Children’s Hospital.’”

Within 15 minutes, an ambulance arrived to rush Noah to Boston Children’s where the emergency department was on high alert for EV D-68.

A bedside spinal tap and initial lab results narrowed Noah’s diagnosis to either Guillain Barre Syndrome or a type of myelitis possibly caused by EV-D68. Both conditions can be treated with immunotherapy, so Noah’s doctors moved forward with treatment.

Then an MRI confirmed Acute Flaccid Myelitis (AFM), a disorder caused by inflammation of the spinal cord. “We don’t know if EV D68 is the cause of AFM. There’s epidemiologic evidence that suggests it is, but we don’t have hard data to suggest that’s the case,” explains Mark Gorman, MD, from the Boston Children’s Hospital Department of Neurology.

The unproven link between enterovirus and AFM is not the only mystery associated with the virus.

…Read More

Poor areas of US have more deaths due to accidents — and things are getting worse

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What killed 488,015 people from 1999 to 2012?  A mega-crunch of data from the National Center for Health Statistics against national census data suggests that poverty may be to blame.

The study, published last week in PLOS One, looked at every U.S. fatality from unintentional injuries and income data for the entire U.S. population, for the 14-year period, down to the county level.

“This is national data — the highest quality data you could possibly have,” says investigator Eric Fleegler, MD, MPH, an emergency physician physician at Boston Children’s Hospital who is interested in socioeconomic factors in health. “It’s unusual to have data of this breadth and depth.”

Unintentional injuries are already known to be the fifth largest cause of death in the U.S., and these mortalities have been rising over the past decade. At the same time, more people are living in areas with high poverty levels.

Are these two trends connected?

…Read More

Racial disparities in analgesia: Who gets pain relief?

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(upixa/Shutterstock)

These are challenging times for clinicians who care for children and adults in pain. The general philosophy regarding the level of attention that should be paid to pain as well as its treatment has changed dramatically during the past 30 years, swinging wildly between extremes, and remains a moving target.

The first published recognition of pain undertreatment in adults occurred in the 1970s, with identification of similar and more dramatic concerns for children emerging a few years later. Research documenting the short- and long-term negative consequences of poorly-treated pain—coupled with the development and marketing of new opioid compounds—led to a dramatic increase in analgesia prescribing for essentially all painful conditions.

Unfortunately, although most patients who were prescribed opioids benefited, it became clear that these agents were not as benign as had been assumed, and that addiction, diversion, opioid hyperalgesia and other adverse effects were legitimate concerns. Although one would assume that these concerns would only limit the indiscriminate use of these drugs for inappropriate situations, in fact, the pendulum swung to the other extreme, with a wave of negative publicity leading to the scrutiny of essentially any use of narcotic analgesics.

As a result, at this time, we run the genuine risk of returning to a state of opiophobia and denying individuals in severe pain the mercy of access to these incredibly valuable drugs.

It is with these societal currents in mind that we read a recent article in JAMA Pediatrics that identified significant undertreatment of children with severe pain associated with appendicitis while in the emergency department (ED). …Read More

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