IMAGES IN EMERGENCY MEDICINE Samuel J. Francis, MD; Joshua S. Broder, MD 0196-0644/$-see front matter Copyright © 2015 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2014.07.002
Figure. Computed tomography (CT) angiogram of the abdomen.
[Ann Emerg Med. 2015;65:492.] A 75-year-old male patient with a history of a ruptured abdominal aortic aneurysm repaired 13 years before, coronary artery disease, and hypertension presented to the emergency department after syncope at home. With the exception of tachycardia, his heart and lung examination results were unremarkable, and his abdomen was soft, with no tenderness to palpation. His rectal examination revealed hematochezia. A computed tomography (CT) angiogram of the abdomen was obtained (Figure).
For the diagnosis and teaching points, see page 499. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 492 Annals of Emergency Medicine
Volume 65, no. 5 : May 2015
Hoppe, Kim & Heard
2.
3. 4. 5. 6. 7. 8.
Emergency Department Opioid Initiation and Recurrent Opioid Use
Morbidity and Mortality Weekly Report. 2011;60(43): 1487-1492. Calcaterra S, Glanz J, Binswanger IA. National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999-2009. Drug Alcohol Depend. 2013;131(3): 263-270. Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013;309(7):657-659. Warner M, Chen LH, Makuc DM, et al. Drug poisoning deaths in the United States, 1980-2008. NCHS Data Brief. 2011;(81):1-8. Volkow ND, McLellan TA, Cotto JH, et al. Characteristics of opioid prescriptions in 2009. JAMA. 2011;305(13):1299-1301. Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med. 1980;302(2):123. Turturro MA. Pain management in the ED: prompt, cost effective state of the art strategies. Emerg Med Practice. 1999;1:1-16. Alam A, Gomes T, Zheng H, et al. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012;172(5):425-430.
Volume 65, no. 5 : May 2015
9. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. 10. Clarke H, Soneji N, Ko DT, et al. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. 2014;348:g1251. 11. Mazer-Amirshari M, Mullins PM, Rasooly I, et al. Rising opioid prescribing in adult US emergency department visits: 2001-2010. Acad Emerg Med. 2014;21(3):236-243. 12. Duale C. Prolonged use of opioids after surgery. BMJ. 2014;348:g1280. 13. McDonnell Norms Group. Antibiotic overuse: the influence of social norms. J Am Coll Surg. 2008;207(2):265-275. 14. Zgierska A, Miller M, Rabago D. Patient satisfaction, prescription drug abuse, and potential unintended consequences. JAMA. 2012;307(13): 1377-1378. 15. Lauffenburger JC, Balasubramaniam A, Farley JF, et al. Completeness of prescription information in US commercial claims databases. Pharmacoepidemiol Drug Saf. 2013;22(8):899-906.
Annals of Emergency Medicine 499
Figure. Computed tomography (CT) angiogram of the abdomen.
[Ann Emerg Med. 2015;65:492.] A 75-year-old male patient with a history of a ruptured abdominal aortic aneurysm repaired 13 years before, coronary artery disease, and hypertension presented to the emergency department after syncope at home. With the exception of tachycardia, his heart and lung examination results were unremarkable, and his abdomen was soft, with no tenderness to palpation. His rectal examination revealed hematochezia. A computed tomography (CT) angiogram of the abdomen was obtained (Figure).
For the diagnosis and teaching points, see page 499. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 492 Annals of Emergency Medicine
Volume 65, no. 5 : May 2015
Hoppe, Kim & Heard
2.
3. 4. 5. 6. 7. 8.
Emergency Department Opioid Initiation and Recurrent Opioid Use
Morbidity and Mortality Weekly Report. 2011;60(43): 1487-1492. Calcaterra S, Glanz J, Binswanger IA. National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999-2009. Drug Alcohol Depend. 2013;131(3): 263-270. Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013;309(7):657-659. Warner M, Chen LH, Makuc DM, et al. Drug poisoning deaths in the United States, 1980-2008. NCHS Data Brief. 2011;(81):1-8. Volkow ND, McLellan TA, Cotto JH, et al. Characteristics of opioid prescriptions in 2009. JAMA. 2011;305(13):1299-1301. Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med. 1980;302(2):123. Turturro MA. Pain management in the ED: prompt, cost effective state of the art strategies. Emerg Med Practice. 1999;1:1-16. Alam A, Gomes T, Zheng H, et al. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012;172(5):425-430.
Volume 65, no. 5 : May 2015
9. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. 10. Clarke H, Soneji N, Ko DT, et al. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. 2014;348:g1251. 11. Mazer-Amirshari M, Mullins PM, Rasooly I, et al. Rising opioid prescribing in adult US emergency department visits: 2001-2010. Acad Emerg Med. 2014;21(3):236-243. 12. Duale C. Prolonged use of opioids after surgery. BMJ. 2014;348:g1280. 13. McDonnell Norms Group. Antibiotic overuse: the influence of social norms. J Am Coll Surg. 2008;207(2):265-275. 14. Zgierska A, Miller M, Rabago D. Patient satisfaction, prescription drug abuse, and potential unintended consequences. JAMA. 2012;307(13): 1377-1378. 15. Lauffenburger JC, Balasubramaniam A, Farley JF, et al. Completeness of prescription information in US commercial claims databases. Pharmacoepidemiol Drug Saf. 2013;22(8):899-906.
Annals of Emergency Medicine 499
