This post is part two of a two-part series. You may review the previous post here. In the last post, we followed Lucas, a 26 year old male who presented to the ED with bizarre behaviour and aggression. When we left off, he was becoming increasingly agitated and paranoid despite your best efforts in de-escalating the situation. He is beginning to yell at staff and refuses to cooperate with any questioning. Approach to …
Managing Agitation in the ED: Part 1 – Overview and Deescalation Strategies
Lucas is a 26 year old male who presents to the ED by his parents for bizarre behaviour and increasing aggression at home. He has a history of IV drug use but is not forthcoming about which drugs he has used and how recently he has used them. There are two hospital security employees behind him. He is frequently looking behind and around him, and appears dishevelled and unkempt. Lucas appears quite anxious …
Clinical Question: When should patients be allowed to eat in the Emergency Department?
You have just finished seeing a 12-year-old boy who fell off the monkey bars about an hour ago. He has an obvious deformity to his right elbow and you suspect a displaced fracture that will require reduction. You would like to use procedural sedation to facilitate the reduction, but an empty granola bar wrapper stops you in your tracks. “We missed dinner rushing here and he couldn’t resist,” his mom says. Staring at …
Hyperthermic Conditions in the Psychiatric Patient
A 32 year-old female presents to your Emergency Department one afternoon with the presenting complaint of altered level of consciousness. On examination you find her to be agitated and confused, as well as tachycardic and febrile at 39.5o C. Collateral history from EMS is negative for any substance misuse. When reviewing her chart, you find that she has recently been started on Risperidone for her schizoaffective disorder… Fever vs Hyperthermia It is important …
Clinical Question: What is the Role of Contrast in Abdominal CT for Adult Patients presenting with Acute Abdominal Pain?
Clinical Question: Role of Contrast in Abdominal CT for Adult Patients presenting with Acute Abdominal Pain A 73-year-old male presents to your Emergency Department with vague LLQ abdominal pain. Your differential includes stones/pyelonephritis, diverticulitis, obstruction, and neoplasm. You want a CT scan to assist in diagnosis. A colleague mentions you need oral contrast to diagnose obstructions, and intravenous contrast to diagnose diverticulitis but intravenous contrast hinders the diagnoses of stones. What is the …
Methoxyflurane- an alternative to opioid and NSAID analgesia in the Emergency Department?
Introduction Methoxyflurane, also known as Penthrox, is an inhaled analgesic that was first used in the early 1960s for general anaesthesia.1 While initially popular, reports of serious side effects including hepatotoxicity and irreversible dose-dependent nephrotoxicity led to its reduced usage as a general anesthetic by the 1970s.2 Nevertheless, due to its non-opioid nature and short half-life, methoxyflurane has found new life as a short acting analgesic for moderate to severe pain in several …
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