The psoas hematoma is a rare complication of the anticoagulation therapy. It cause abdominal or lumbar pain, muscle dysfunction and sometimes nerve palsy. The optimal treatment is not well established, surgery or conservative treatment? We report here a case of psoas hematoma revealed by a lower limb palsy.
IntroductionIntranasal fentanyl provides rapid and powerful analgesia which is particularly interesting in patients without intravenous access. We propose to use it for analgesia in adults presenting renal colics.MethodsA prospective study was conducted from the 2nd January to February 2013 in our emergency department. Patients aged up to 18 years old who presented with renal colic were included in this audit. Patients were excluded if they had loss of consciousness, cognitive impairment, acute or chronic nasal problems. A formal written consent was obtained from patients. The research team was alerted by medical and nursing staff. A member of the research team would check with medical or nursing staff whether administration of Intra nasal (IN) fentanyl was required. It was administered at a pre-calculated dose of 1.5 mg/kg and 50 mg/ml concentration was used. Data was prospectively collected by one of the researchers at various intervals during the patient's presentation and recorded on a pre-formatted data sheet. Pain scores were collected at 5, 15, 30, 45 and 60 minutes following IN fentanyl using a visual analogue scale pain. Observations routinely collected for patients receiving IV opiates and any adverse events were also recorded.Results23 eligible patientswere enrolled; median age was 51,3years. 47,8% were women and the mean weight was 73 kg. Median dose of IN fentanyl was 106 μg. Two patients have required morphinic analgesia despite having received adapted dose of IN fentanyl. The initial pain scores before IN fentanyl were high with a median of 82,2 mm (59-100). Five minutes after IN fentanyl administration the median pain score dropped to 48mm(36-63) and achieved the lowest score of 8mm(0-22) at 30 min. Pain scores were significantly lower at 5 min (P < 0.001) and at all subsequent time points (P < 0.001). No side effects were recorded.ConclusionIntranasal fentanyl seems to be efficient for analgesia in adult patients with renal colic.
Guillain Barre Syndrome (GBS) is a challenging pathology which diagnosis is based essentially on the clinical examination and the results of lumbar puncture. Differential diagnosis must be discussed if the clinical picture is not complete. We present the case of a patient who presented to the emergency department with symptoms evoking both GBS and spinal cord compression. The Radiology showed a diffused spinal hydatidosis. The lumbar puncture must be carefully considered. In this case, it would have exposed the patient to hydatid dissemination.
Background:-Patient satisfaction with emergency department care is the most important predictor of overall satisfaction with their hospital care. The aim of the present study was to investigate the effective factors in Patients" satisfaction with the emergency department. Methods:-A cross-sectional survey was carried out from April 2014 to July 2014. The study sample consisted of 330 patients visiting the emergency department of an urban tertiary level teaching hospital in Rabat, Morocco. Subjects were selected through simple random sampling method. Data was collected using a questionaire. whose validity was determined using the content validity. Reliability of the questionnaire was checked using Cronbach α coefficient. To identify the most important factors affecting patient satisfaction, factorial analysis technique was used. Results:-More than 80% of patients expressed their positive overall satisfaction with the facility. The principal component analysis yielded 5 principal components with 82.6% of cumulative variance of patient satisfaction: (1) "pain management"; (2) "staffresponsiveness", (3) "Reception", (4) "waiting time", and (5) "administrative skills". Conclusion:-Pain management and staff-responsiveness were the major factors affecting satisfaction in emergency patients. Thus improving the quality of these factors will improve the quality of emergency services for patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.