scholarly journals An Amputated Tongue—The Consequences of a Human Bite

Reports ◽  
2020 ◽  
Vol 3 (3) ◽  
pp. 19
Author(s):  
Constance Hardwick ◽  
Alice Cameron ◽  
James Puryer
Keyword(s):  
Emergency Department ◽  
Drug Use ◽  
Unusual Case ◽  
Hospital Admissions ◽  
Case Reports ◽  
Human Bite ◽  
Alcohol And Drug Use ◽  
Unknown Substance ◽  
Tissue Trauma

Drug-related hospital admissions are common, and up to 25% of patients presenting to emergency departments with injuries test positive for alcohol and drug use. This case reports on a 55-year-old male who attended the emergency department (ED) at the Royal United Hospital, Bath, UK. He presented after sustaining significant soft tissue trauma to his tongue, following recreational drug use of an unknown substance. His injuries included the amputation and loss of the anterior third of his tongue, having suffered a bite from another individual. This unusual case describes the patient’s injuries and subsequent management, both in the emergency department and during follow-up. This case will be of benefit to clinicians from many disciplines including dentists, oral and maxillofacial surgeons, ENT surgeons and speech and language therapists.

81 Integrating A Front Door Frailty Service in the Emergency Department: Results of A Pilot Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
L Dunnell ◽  
A Shrestha ◽  
E Li ◽  
Z Khan ◽  
N Hashemi
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Community Services ◽  
Service Improvement ◽  
Specialist Nurse ◽  
Front Door ◽  
Medication Changes ◽  
Health Service Improvement

Abstract Introduction Increasing old age and frailty is putting pressure on health services with 5–10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week. Methodology A two-week pilot (Monday–Friday 8 am-5 pm) was undertaken, with a “Front Door Frailty Team” comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward—opposed to the usual pathway of referral from the ED team to medical team. Data was captured using “Cerner” electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions. Results 95 patients were seen over two weeks. In the over 65 s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%). The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients. Conclusion The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, with more timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes.

Impact of alcohol and drug use on bicycle and electric scooter injuries and hospital admissions in the United States

Trauma ◽  
2021 ◽  
pp. 146040862110443
Author(s):  
Nikan K Namiri ◽  
Austin W Lee ◽  
Gregory M Amend ◽  
Jason Vargo ◽  
Benjamin N Breyer
Keyword(s):  
United States ◽  
Drug Use ◽  
Head Trauma ◽  
Hospital Admissions ◽  
Body Part ◽  
The United States ◽  
Severe Injuries ◽  
Injury Surveillance System ◽  
Alcohol And Drug Use ◽  
Awareness Campaigns

Introduction Bicycles and electric scooters (e-scooters) are convenient and accessible means of transportation. Participant safety is contingent on available infrastructure and safe riding practices including not riding while intoxicated. Understanding national prevalence and injury characteristics of bicycle and e-scooter riders who ride while intoxicated may promote awareness campaigns for safe riding practices and decrease morbidity. Methods The National Electronic Injury Surveillance System (NEISS) provides national estimates of injuries that present to emergency departments across the United States. We obtained case information on admitting status, body part injured, diagnosis of injury, age, sex, alcohol usage, and drug usage. We then queried NEISS for injuries related to bicycles and e-scooters in 2019. Results A weighted total of 270,571 (95% confidence interval (CI): 204,517–336,625) bicycle injuries occurred in the United States during 2019; alcohol and drug use were associated with 7% (95% CI: 6–9) and 2% (95% CI: 2–3) of all injuries, respectively. Twenty-four percent (CI: 18--31) of alcohol- and 29% (95% CI: 20–41) of drug-related bicycle injuries resulted in hospital admissions, compared to 15% (95% CI: 12–17) of non–alcohol- and 15% (95% CI: 13–18) of non–drug-related injuries ( p < .001 and p = .002, respectively). A total of 28,702 (95% CI: 13,975–43,428) e-scooter injuries occurred in 2019; alcohol and drug use were associated with 8% (95% CI: 5–12) and 1% (95% CI: 1–2) of injuries, respectively. Sixty percent (95% CI: 47–72) of alcohol-related e-scooter injuries resulted in head trauma, compared to 28% (95% CI: 24–32) of non–alcohol-related injuries ( p < .001). Conclusions Intoxication is associated with increasingly severe injuries, hospital admissions, and head trauma in bicycle and e-scooter riders. The findings support awareness campaigns to educate riders about risky practices, improve non-auto infrastructure, and promote helmet usage.

scholarly journals Alcohol and drug use among patients presenting to an inner-city emergency department: A latent class analysis

2011 ◽  
Vol 36 (8) ◽  
pp. 793-800 ◽  
Author(s):  
Frederic C. Blow ◽  
Maureen A. Walton ◽  
Kristen L. Barry ◽  
Regan L. Murray ◽  
Rebecca M. Cunningham ◽  
...  
Keyword(s):  
Emergency Department ◽  
Drug Use ◽  
Inner City ◽  
Latent Class Analysis ◽  
Latent Class ◽  
Class Analysis ◽  
Alcohol And Drug Use

scholarly journals Risk of injury from alcohol and drug use in the emergency department: A case-crossover study

2011 ◽  
Vol 31 (4) ◽  
pp. 431-438 ◽  
Author(s):  
CHERYL J. CHERPITEL ◽  
YU YE ◽  
KATIE WATTERS ◽  
JEFFREY R. BRUBACHER ◽  
ROB STENSTROM
Keyword(s):  
Emergency Department ◽  
Drug Use ◽  
Crossover Study ◽  
Alcohol And Drug Use ◽  
Case Crossover ◽  
Risk Of Injury

Roadside survey of alcohol and drug use among Norwegian drivers in 2016–2017: A follow-up of the 2008–2009 survey

2018 ◽  
Vol 19 (6) ◽  
pp. 555-562 ◽  
Author(s):  
Håvard Furuhaugen ◽  
Ragnhild E. G. Jamt ◽  
Galina Nilsson ◽  
Vigdis Vindenes ◽  
Hallvard Gjerde
Keyword(s):  
Drug Use ◽  
Alcohol And Drug Use ◽  
Roadside Survey

Pisiform dislocation

2021 ◽  
Vol 14 (1) ◽  
pp. e237482
Author(s):  
Faisal Mahmood ◽  
Milind Mehta ◽  
Rahul Kakkar
Keyword(s):  
Emergency Department ◽  
Closed Reduction ◽  
Case Reports ◽  
Dominant Male ◽  
Significant Morbidity ◽  
Right Hand

A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from case reports. In this case, we present a 51-year-old right-hand dominant male who sustained the injury after a fall. He attended the emergency department on the same day and a closed reduction was able to be performed under a haematoma block. On review in follow-up clinic the patient’s symptoms had completely resolved.

scholarly journals Emergency Department Screening for Unhealthy Alcohol and Drug Use with a Brief Tablet-Based Questionnaire

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Joshua W. Elder ◽  
Evan F. Wu ◽  
James A. Chenoweth ◽  
James F. Holmes ◽  
Aman K. Parikh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Drug Use ◽  
Screening Method ◽  
Severity Index ◽  
Willingness To Participate ◽  
Positive Screen ◽  
Face To Face ◽  
Alcohol And Drug Use ◽  
Unhealthy Alcohol ◽  
Drug Use Disorders

Background. Screening for unhealthy alcohol and drug use in the emergency department (ED) can be challenging due to crowding, lack of privacy, and overburdened staff. The objectives of this study were to determine the feasibility and utility of a brief tablet-based screening method in the ED and if patients would consider a face-to-face meeting with a certified alcohol and drug counselor (CADC) for more in-depth screening, brief intervention, and referral to treatment (SBIRT) helpful via this interface. Methods. A tablet-based questionnaire was offered to 500 patients. Inclusion criteria were age ≥18, Emergency Severity Index 2–5, and English comprehension. Subjects were excluded if they had evidence of acute intoxication and/or received sedating medication. Results. A total of 283 (57%) subjects were enrolled over a 4-week period, which represented an increase of 183% over the monthly average of patients referred for SBIRT by the CADC prior to the study. There were 131 (46%) who screened positive for unhealthy alcohol and drug use, with 51 (39%) and 37 (28%) who screened positive for solely unhealthy alcohol use and drug use/drug use disorders, respectively. There were 43 (33%) who screened positive for combined unhealthy alcohol and drug use. Despite willingness to participate in the tablet-based questionnaire, only 20 (15%) with a positive screen indicated via the tablet that a face-to-face meeting with the CADC for further SBIRT would be helpful. Conclusion. Brief tablet-based screening for unhealthy alcohol and drug use in the ED was an effective method to increase the number of adult patients identified than solely by their treating clinicians. However, only a minority of subjects screening positive using this interface believed a face-to-face meeting with the CADC for further SBIRT would be helpful.

scholarly journals LO14: Interdepartmental program to improve outcomes for acute heart failure patients seen in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S11-S12
Author(s):  
I. Stiell ◽  
M. Taljaard ◽  
A. Forster ◽  
L. Mielniczuk ◽  
G. Wells ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Control Period ◽  
Care Hospital ◽  
Index Visit ◽  
Rapid Access

Introduction: An important challenge physicians face when treating acute heart failure (AHF) patients in the emergency department (ED) is deciding whether to admit or discharge, with or without early follow-up. The overall goal of our project was to improve care for AHF patients seen in the ED while avoiding unnecessary hospital admissions. The specific goal was to introduce hospital rapid referral clinics to ensure AHF patients were seen within 7 days of ED discharge. Methods: This prospective before-after study was conducted at two campuses of a large tertiary care hospital, including the EDs and specialty outpatient clinics. We enrolled AHF patients ≥50 years who presented to the ED with shortness of breath (<7 days). The 12-month before (control) period was separated from the 12-month after (intervention) period by a 3-month implementation period. Implementation included creation of rapid access AHF clinics staffed by cardiology and internal medicine, and development of referral procedures. There was extensive in-servicing of all ED staff. The primary outcome measure was hospital admission at the index visit or within 30 days. Secondary outcomes included mortality and actual access to rapid follow-up. We used segmented autoregression analysis of the monthly proportions to determine whether there was a change in admissions coinciding with the introduction of the intervention and estimated a sample size of 700 patients. Results: The patients in the before period (N = 355) and the after period (N = 374) were similar for age (77.8 vs. 78.1 years), arrival by ambulance (48.7% vs 51.1%), comorbidities, current medications, and need for non-invasive ventilation (10.4% vs. 6.7%). Comparing the before to the after periods, we observed a decrease in hospital admissions on index visit (from 57.7% to 42.0%; P <0.01), as well as all admissions within 30 days (from 65.1% to 53.5% (P < 0.01). The autoregression analysis, however, demonstrated a pre-existing trend to fewer admissions and could not attribute this to the intervention (P = 0.91). Attendance at a specialty clinic, amongst those discharged increased from 17.8% to 42.1% (P < 0.01) and the median days to clinic decreased from 13 to 6 days (P < 0.01). 30-day mortality did not change (4.5% vs. 4.0%; P = 0.76). Conclusion: Implementation of rapid-access dedicated AHF clinics led to considerably increased access to specialist care, much reduced follow-up times, and possible reduction in hospital admissions. Widespread use of this approach can improve AHF care in Canada.

Abstract P1: Limitations of Self-Reported Readmission Data After Acute Myocardial Infarction: Insights from the TRIUMPH Registry

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Philip G Jones ◽  
Adam C Salisbury ◽  
Carole Decker ◽  
Harlan M Krumholz ◽  
John A Spertus
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Coronary Intervention ◽  
Self Report ◽  
Readmission Rates ◽  
Hospital Records ◽  
Outpatient Visits ◽  
Patient Reported ◽  
Reason For Admission

Background: Self-reported readmission rates are frequently reported in the medical literature, yet the validity of these data is controversial. Few studies describe the accuracy of self-report of readmission following an AMI in comparison with physician-adjudicated data. Methods: We studied 4,340 AMI patients enrolled in the 24-US center TRIUMPH registry. Patients were interviewed at 1, 6 and 12 months after their AMI, and were asked to report all hospitalizations since their last contact, including the hospital name, date and reason. After obtaining consent from the patient and each hospital, all hospitalization records within the first year after the patient's index MI were requested and adjudicated by a physician panel. Accuracy of patients’ report of hospitalization and reason for admission (sensitivity, specificity) were assessed. Results: Of 4,340 patients, 3,633 (84%) completed follow-up interviews, reporting a total of 2,016 readmissions. Of these, hospital records were successfully obtained on 1,373. Record review revealed that 501 (36%) were not actual rehospitalizations (e.g., emergency department only, outpatient visits, admissions prior to study enrollment). Interestingly, when obtaining hospital records, we identified another 394 readmissions that were not reported by patients. Sensitivity of self-reported reason for admission was modest to poor for cardiac-cause rehospitalization, AMI and percutaneous coronary intervention (Table). Conclusions: We identified several limitations of self-reported readmission rates in this multi-center AMI cohort. Emergency department and outpatient visits were frequently reported as hospital admissions, nearly 400 hospitalizations were not reported to study personnel at the time of the follow-up interview, and accuracy of patient-reported reason for admission was modest at best. These data underscore the importance of verifying self-reported follow-up outcomes data. Accuracy of Patient Self-Reported Reason for Admission Adjudicated Reason for Admission Sensitivity Specificity Any cardiac 37% 88% AMI 43% 94% PCI 66% 93%

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