Resolution of Hydronephrosis and Pain to Predict Stone Passage for Patients With Acute Renal Colic.

Objective: To study patients who presented to the Emergency Department with acute renal colic to determine if resolution of hydronephrosis and pain accurately predicts stone passage on follow-up CT.

Materials And Methods: This is a secondary analysis of a multicenter prospective randomized clinical trial of patients diagnosed by computed tomography (CT) scan with a symptomatic ureteral stone < 9 mm in diameter. Participants were followed after randomization to evaluate for analgesic use and to assess stone passage and hydronephrosis on a repeat CT scan obtained at 29-36 days.

Analgesic and Opioid Use for Patients Discharged from the Emergency Department with Ureteral Stones.

The aim of this study was to describe and characterize the analgesic and opioid use for patients discharged from the emergency department (ED) with renal colic due to ureteral stone. This is a secondary analysis of a multicenter prospective trial of ED patients diagnosed by CT scan as having a symptomatic ureteral stone <9 mm in diameter. Participants were contacted after randomization on days 2, 7, 15, 20, and 29 and reported opioid and nonopioid analgesic use and stone passage.

Accuracy of Patient Reported Stone Passage for Patients With Acute Renal Colic Treated in the Emergency Department.

Objective: To study patients who initially presented to the Emergency Department with acute renal colic to determine if patient-reported stone passage detects stone expulsion as accurately as follow-up computed tomography (CT) scan.

Methods: This is a secondary analysis of a multi-center prospective trial of patients diagnosed by a CT scan with a symptomatic ureteral stone <9 mm in diameter. Patient-reported stone passage, defined as capture or visualization of the stone, was compared to CT scan-confirmed passage performed 29-36 days after initial presentation.

The Dangers of Spear Tackling: A Case Report of a NEXUS-negative High School Football Player.

Background: Although "spear tackling" is known to be a risk factor for cervical spine injury due to axial loading of the neck, and although this technique was officially banned from American football in 1976, football-associated cervical spine injuries continue to be reported. This case highlights the importance of recognizing high-risk mechanisms for cervical spine injury, and specifically the danger of spear tackling among football players at all levels.

Case Report: A 16-year-old male high school football player presented to the pediatric emergency department for a neck injury sustained after spear tackling during a football game.

Implementation of a Novel Conference Series on Clinical Practice Variations Provides an Opportunity for Constructive Discussion of Faculty Practice Patterns:

Background: Although evidence-based medicine (EBM) is routinely used to guide management in the emergency department, there is still considerable variation in clinical practice. Trainees may not fully appreciate the reasons for these clinical practice variations (CPVs) and may find it frustrating when they encounter them. We used areas of CPV among our faculty as the basis for resident educational sessions and assessed the perceived utility of these sessions.

Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial.

Importance: Urinary stone disease is a common presentation in the emergency department, and α-adrenergic receptor blockers, such as tamsulosin, are commonly used to facilitate stone passage.

Objective: To determine if tamsulosin promotes the passage of urinary stones within 28 days among emergency department patients.

Design, Setting, And Participants: We conducted a double-blind, placebo-controlled clinical trial from 2008 to 2009 (first phase) and then from 2012 to 2016 (second phase).

Design and challenges of a randomized clinical trial of medical expulsive therapy (tamsulosin) for urolithiasis in the emergency department.

Urolithiasis or urinary stone disease has been estimated to affect about 1 in 11 Americans. Patients with urinary stone disease commonly present to the emergency department for management of their acute pain. In addition to providing analgesia, administration of drug (medical expulsive therapy) is often prescribed to assist passage of the urinary stone.

A descriptive study of myoclonus associated with etomidate procedural sedation in the ED.

Background: Myoclonus is a well-recognized side effect of etomidate when given in induction doses for rapid sequence intubation. Most of the data reported on myoclonus with emergency department (ED) sedation doses are reported as a secondary finding.

Study Objectives: Our objective was to prospectively quantify the incidence and duration of myoclonus associated with the administration of etomidate in the lower doses given for procedural sedation in the ED.

Urolithiasis in the emergency department.

Urolithiasis commonly presents to the emergency department with acute, severe, unilateral flank pain. Patients with a suspected first-time stone or atypical presentation should be evaluated with a noncontrast computed tomography scan to confirm the diagnosis and rule out alternative diagnoses. Narcotics remain the mainstay of pain management but in select patients, nonsteroidal anti-inflammatories alone or in combination with narcotics provide safe and effective analgesia in the emergency department.

Direct observation of residents in the emergency department: a structured educational program.

Objectives: The objective was to describe the implementation of a program of structured direct observation of emergency medicine (EM) residents during clinical shifts in the emergency department (ED).

Methods: The authors developed a program in which an observer spent 4 to 5 hours with each resident, without intervening in the clinical encounters. A structured data form was developed to document the resident's performance in a number of defined clinical areas relevant to patient care and mastery of the core competencies.

The prevalence and factors associated with QTc prolongation among emergency department patients.

Study Objective: Previous studies have suggested that QTc prolongation may lead to significant morbidity and mortality. The prevalence of QTc prolongation among emergency department (ED) patients is unknown. The purpose of this study is to determine the prevalence of QTc prolongation among ED patients.

Can patients with brain herniation on cranial computed tomography have a normal neurologic exam?

Objectives: Herniation of the brain outside of its normal intracranial spaces is assumed to be accompanied by clinically apparent neurologic dysfunction. The authors sought to determine if some patients with brain herniation or significant brain shift diagnosed by cranial computed tomography (CT) might have a normal neurologic examination.

Methods: This is a secondary analysis of the National Emergency X-Radiography Utilization Study (NEXUS) II cranial CT database compiled from a multicenter, prospective, observational study of all patients for whom cranial CT scanning was ordered in the emergency department (ED).

Frequency and follow-up of incidental findings on trauma computed tomography scans: experience at a level one trauma center.

Objectives: Incidental findings found on computed tomography (CT) scan during the Emergency Department evaluation of trauma patients are often benign, but their presence must always be communicated to patients, who should be referred for follow-up care. Our objective was to quantify the frequency of these incidental CT findings in trauma patients. A secondary goal was to determine how often these lesions were communicated to patients and how often patients were referred for follow-up.