Pharmacologically-induced Recreational Priapism: Case Report and Review.

INTRODUCTION: Priapism, a time-sensitive urologic emergency, is associated with hematologic disorders, malignancies, trauma, pharmaceuticals, and recreational drugs. CASE REPORT: A 51-year-old male presented with 36 hours of priapism after recreational use of nonprescribed pharmaceuticals including an oral phosphodiesterase inhibitor and intracorporally injected erectile medications, together with unspecified quantities of cocaine and alcohol. Venous blood gas confirmed ischemic priapism. Detumescence was achieved with intracavernosal phenylephrine injection, aspiration, and irrigation. CONCLUSION: This case highlights the risk that recreational use of vasoactive medications by patients who seek to prolong sexual activity may lead to delayed presentation for ischemic priapism.

Preliminary Assessment of a Telehealth Approach to Evaluating, Treating, and Discharging Low-Acuity Patients With Suspected COVID-19.

BACKGROUND: Telemedicine is uniquely positioned to address challenges posed to emergency departments (EDs) by the Coronavirus Disease 2019 (COVID-19) pandemic. By reducing in-person contact, it should decrease provider risk of infection and preserve personal protective equipment (PPE). OBJECTIVES: To describe and assess the early results of a novel telehealth workflow in which remote providers collaborate with in-person nursing to evaluate and discharge well-appearing, low-risk ED patients with suspected COVID-19 infection. METHODS: Retrospective chart review was completed 3 weeks after implementation. Metrics include the number of patients evaluated, number of patients discharged without in-person contact, telehealth wait time and duration, collection of testing, ED length of stay (ED-LOS), 72-h return, number of in-person health care provider contacts, and associated PPE use. RESULTS: Among 302 patients evaluated by telehealth, 153 patients were evaluated and discharged by a telehealth provider with reductions in ED-LOS, PPE use, and close contact with health care personnel. These patients had a 62.5% shorter ED-LOS compared with other Emergency Severity Index level 4 patients seen over the same time period. Telehealth use for these 153 patients saved 413 sets of PPE. We observed a 3.9% 72-h revisit rate. One patient discharged after telehealth evaluation was hospitalized on a return visit 9 days later. CONCLUSION: Telehealth can be safely and efficiently used to evaluate, treat, test, and discharge ED patients suspected to have COVID-19. This workflow reduces infection risks to health care providers, PPE use, and ED-LOS. Additionally, it allows quarantined but otherwise well clinicians to continue working.

Score at the Door: A retrospective data analysis of sepsis scoring criteria in the Emergency Department.

The goal of this study was to assess the availability of the criteria of eight sepsis scoring methods (SIRS, NEWS, PRESEP, SOFA, qSOFA, SPEED, MEDS, and PIRO) within six hours of triage in the emergency department (ED). Data was analyzed through a retrospective collection of adult (age >18 years) patients presenting to the MedStar Washington Hospital Center (MWHC) emergency department between June 1, 2017 and May 31, 2018 and admitted with a sepsis or sepsis-related diagnosis that progressed to sepsis before discharge. Vital signs are frequently available upon arrival to the ED, while laboratory values tend to be available within three hours and often are not repeated again within the first six hours after arrival. The availability of patient data at different time points in a patient's ED visit suggests that different scoring methods could be utilized to more effectively diagnose and accurately risk-stratify patients within the sepsis spectrum as more information about the patient becomes available.

Trends in and predictors of hydromorphone administration in US emergency departments (2007-2014).

OBJECTIVE: To examine recent trends in and predictors of hydromorphone administration in US emergency departments (EDs) compared with other opioids. DESIGN: Retrospective review of data from the National Hospital Ambulatory Medical Care Survey from 2007 to 2014. PARTICIPANTS: All adult ED visits where an opioid analgesic was administered were included. MAIN OUTCOME MEASURES: Trends in and predictors of hydromorphone administration were assessed using survey-weighted logistic regression, comparing hydromorphone visits with ED visits where other opioids were administered. RESULTS: From 2007 to 2014, in an estimated 128.9 million US ED visits where opioids were administered, hydromorphone use increased significantly from 30.2 percent in 2007 to 36.8 percent of visits in 2014 (p = 0.027). Hydromorphone accounted for a greater proportion of opioids administered by the end of the study period, compared to other opioids. Patient characteristics associated with hydromorphone were age <65 years, white race, private insurance or Medicare, and severe pain. Patients who received hydromorphone also had indicators of higher severity illness, including more laboratory testing, procedures, and higher admission rates. Common conditions where hydromorphone was administered were headache, back pain, musculoskeletal pain, and abdominal pain. CONCLUSION: From 2007 to 2014, hydromorphone was administered to more than one in three US ED patients who were administered opioids, and several factors predicted its use. High use was found in some conditions where opioid use is inappropriate, suggesting a need for additional initiatives to promote rational prescribing of high-potency opioids.