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1.
Xiangming Yang Shiyu Xin Yajie Zhang Tiegang Li 《The American journal of emergency medicine》2018,36(6):926-930
Objectives
To investigate the clinical value of early hemoperfusion (HP) in emergency treatment of carbamazepine (CBZ) poisoning.Methods
104 patients with acute CBZ poisoning treated from August 2004 to October 2015 in the Emergency Department were reviewed. Patients were categorized into three groups: group A, who received HP treatment in the Emergency Department; group B, who received HP treatment in the blood purification room; and group C, who did not received HP treatment. Pharmacokinetic parameters of CBZ and remission of complications were compared among the three groups.Results
Both groups A and B had lower time to peak, area under curve and maximum concentration values than group C (P < 0.05), and these kinetics indexes were significantly lower in group A than in group B (P < 0.05). The mean retention times were 0.85 ± 0.08, 1.20 ± 0.15 and 2.52 ± 0.29 days in the three groups, respectively, and were significantly lower value in group A than in group B (P < 0.05). The incidences of respiratory depression and seizure in group A were significantly lower than those of groups B and C (P < 0.05). Group A had significantly higher Glasgow coma scale (GCS) scores at 4 h after admission than the other two groups (P < 0.05), and group B had significantly higher GCS scores than group C at 6 h after admission (P < 0.05).Conclusions
Initiation of HP in the early treatment stage of CBZ poisoning upon admission to an emergency department can significantly reduce the plasma concentration and retention period of CBZ, relieve the symptoms and shorten the overall treatment period. 相似文献2.
James B. Leonard Kashif M. Munir Hong K. Kim 《The American journal of emergency medicine》2018,36(6):1124.e1-1124.e2
Metoclopramide (MCP) is a commonly used anti-emetic in the emergency department (ED). Its use is generally well tolerated; although infrequent adverse reactions such as extrapyramidal reactions or tardive dyskinesia are reported. However, many ED providers are not familiar with the potentially life-threatening hypertensive emergency that can be precipitated by MCP administration in patients with pheochromocytoma. A previously healthy 36-year-old woman presented to the ED with headache and nausea. She developed acute hypertensive emergency (acute agitation, worsening headache, chest pain and wide complex tachycardia) when her blood pressure (BP) increased to 223/102 mm Hg (initial BP, 134/86 mm Hg) after receiving intravenous MCP. Her hospital course was complicated by multi-organ injury, including acute respiratory distress syndrome requiring venous-venous extracorporeal membrane oxygenation, non-ST elevation myocardial infarction, cardiogenic shock, acute liver failure, and oliguric kidney injury requiring continuous renal replacement therapy. CT scan showed previously undiagnosed large right adrenal mass (5.9 cm). The diagnosis of pheochromocytoma was confirmed after adrenalectomy. Drug-induced acute pheochromocytoma crisis is a rare event. Early recognition and appropriate blood pressure management with clevidipine, nicardipine, or phentolamine is essential. 相似文献
3.
Marianne K. Pop Farhad Farokhi Lela Iduna 《The American journal of emergency medicine》2018,36(3):531.e1-531.e2
A 66-year-old man presented to the emergency department with complaints of dark-colored stool and rash developing over the last couple of days. The patient was started on rivaroxaban and flecainide for months prior for atrial fibrillation. Upon arrival, he was awake, alert, and oriented with a blood pressure of 111/63 mm Hg, heart rate of 68 beats per minute, and oxygen saturation of 96% on room air. A review of systems was unremarkable with the exception of skin rash and light-headedness. The patient's initial laboratory results were significant for red blood cell (RBC) count of 4.05 × 106/mcL, hemoglobin of 12.1 g/dL, hematocrit of 35.6%, and platelet count of 1 × 103/mcL. Aggressive hydration was started in the ED, initially with two 1-L boluses of normal saline followed by an infusion of 10 mL/h. One unit of platelets was transfused. Rivaroxaban and flecainide were held on admission. Twenty-four hours after admission, the patient was initiated on immune globulin (IVIG) Gammagard (Baxter, West Lake, CA), 75 g on 3 consecutive days and steroids for possible immune thrombocytopenia. His platelet count steadily improved over the 6-day period to 119 × 103/mcL on the day of hospital discharge. This is the second reported case of possible rivaroxaban-induced thrombocytopenia. 相似文献
4.
Sangheon Shin Soo Hoon Lee Dong Hoon Kim Seong Chun Kim Tae Yun Kim Changwoo Kang Jin Hee Jeong Daesung Lim Yong Joo Park Sang Bong Lee 《The American journal of emergency medicine》2018,36(4):620-624
Introduction
Although consultations are essential for delivering safe, high-quality care to patients in emergency departments, they contribute to emergency department patient flow problems and overcrowding which is associated with several adverse outcomes, such as increases in patient mortality and poor quality care. This study aimed to investigate how time flow metrics including emergency department length of stay is influenced by changes to the internal medicine consultation policy.Method
This study is a pre- and post-controlled interventional study. We attempted to improve the internal medicine consultation process to be more concise. After the intervention, only attending emergency physicians consult internal medicine chief residents, clinical fellows, or junior staff of each internal medicine subspecialty who were on duty when patients required special care or an admission to internal medicine.Results
Emergency department length of stay of patients admitted to the department of internal medicine prior to and after the intervention decreased from 996.94 min to 706.62 min. The times from consultation order to admission order and admission order to emergency department departure prior to and after the intervention were decreased from 359.59 min to 180.38 min and from 481.89 min to 362.37 min, respectively. The inpatient mortality rates and Inpatient bed occupancy rates prior to and after the intervention were similar.Conclusion
The improvements in the internal medicine consultation process affected the flow time metrics. Therefore, more comprehensive and cooperative strategies need to be developed to reduce the time cycle metrics and overcrowding of all patients in the emergency department. 相似文献5.
Johnathan M. Sheele Stephanie Gaines Nicholas Maurer Katirina Coppolino Jennifer S. Li Amy Pound Jeffrey H. Luk Ed Mandac 《The American journal of emergency medicine》2017,35(5):697-698
Bed bugs are one of the most important human ectoparasites in the United States, and a growing problem in the emergency department. We evaluated 40 emergency department (ED) patients found with a bed bug. The data show that ED patients with bed bugs are statistically more likely to be male, older, more likely to be admitted to the hospital, have higher triage emergency severity index (ESI) scores, and arrive by ambulance than the general ED patient population (p < 0.05). On average bed bugs were found 108 min after a patient arrived to the ED, after 35% of subjects had already received a blood draw, and after 23% had already received a radiology study; putting other ED patients and staff at risk for acquiring the infestation. We found that 13% and 18% of subjects had wheezing and a papular rash, respectively on physical exam. Of those patients found with a bed bug in the ED, 42% reported having bed bugs at home and 21% reporting having a possible home infestation. 相似文献
6.
Ebru Biyikli Afsin Emre Kayipmaz Cemil Kavalci 《The American journal of emergency medicine》2018,36(4):647-650
Background
Sepsis is a potentially fatal condition with high treatment costs, and is especially common among the elderly population. The emergency management of septic patients has gained importance.Objective
Herein, we investigated the effect of admission lactate levels and the platelet-lymphocyte ratio (PLR) on the 30-day mortality among patients older than 65 years who were diagnosed with sepsis and septic shock according to the qSOFA criteria at our hospital's emergency department.Methods
This observational study was conducted retrospectively. We obtained information regarding patients' demographic characteristics, comorbid conditions, hemodynamic parameters at admission, initial treatment needs at the emergency department.Results
131 patients received a diagnosis of sepsis and septic shock at our emergency department in two years. Among these, 45% (n = 59) of the patients died within 30 days of admission. Forty (30.5%) patients required mechanical ventilation. There was a significant difference between the survival and non-survival groups with regard to systolic and diastolic blood pressures (p = 0.013 and 0.045, respectively). There were significant differences between the two groups with respect to the Glasgow Coma Scale score (p < 0.001) and BUN levels (p < 0.001). The mortality status according to qSOFA scores was revealed a significant difference between the two groups (p < 0.001).Conclusion
Our results showed that the patients who died within 30 days of admission and those who did not had comparable PLR and lactate levels (p = 0.821 and 0.120, respectively). We opine that serial lactate measurements would be more useful than a single admission lactate measurement for the prediction of mortality. 相似文献7.
Objective
We evaluated the effectiveness of point-of-care wrist ultrasonography compared with 3T-magnetic resonance imaging (MRI) for diagnosing triangular fibrocartilage complex (TFCC) injuries in trauma patients with ulnar-sided pain and instability. Moreover, we assessed the inter-observer variability between an emergency physician and a musculoskeletal radiology fellow.Material and methods
A prospective cross-sectional study was conducted in an emergency department; patients with ulnar-sided sprain and instability were recruited. An emergency physician and a musculoskeletal radiology fellow independently evaluated the TFC, meniscal homologue, volar and dorsal distal radioulnar ligaments, and extensor carpi ulnaris using point-of-care ultrasonography. Findings were classified as normal, partial rupture, or complete rupture. Wrist 3T-MRI was used as the reference standard. We compared the diagnostic values for point-of-care ultrasonography obtained by both reviewers using DeLong's test. Intra-class correlation coefficients (ICCs) were calculated for agreement between each reviewer and the reference standard, and directly between the two reviewers.Results
Sixty-five patients were enrolled. Point-of-care wrist ultrasonography showed acceptable sensitivity (97.2–99.1%), specificity (96.8–97.3%), and accuracy (96.9–97.9%); these diagnostic performance values did not differ significantly between reviewers (p = 0.58–0.98). Agreement between each reviewer and the reference standard was excellent (emergency physician, ICC = 0.964; musculoskeletal radiology fellow, ICC = 0.976), as was the inter-observer agreement (ICC = 0.968).Conclusion
Point-of-care wrist ultrasonography is as precise as MRI for detecting TFCC injuries, and can be used for immediate diagnosis and further preoperative imaging. Moreover, it may shorten the interval from emergency department admission to surgical intervention while reducing costs. 相似文献8.
Yan-ling Li Jun-rong Mo Nga-man Cheng Stewart S.W. Chan Pei-yi Lin Xiao-hui Chen Colin A. Graham Timothy H. Rainer 《The American journal of emergency medicine》2018,36(6):988-992
Objective
The diagnosis of shock in patients presenting to the emergency department (ED) is often challenging. We aimed to compare the accuracy of experienced emergency physician gestalt against Li's pragmatic shock (LiPS) tool for predicting the likelihood of shock in the emergency department, using 30-day mortality as an objective standard.Method
In a prospective observational study conducted in an urban, academic ED in Hong Kong, adult patients aged 18 years or older admitted to the resuscitation room or high dependency unit were recruited. Eligible patients had a standard ED workup for shock. The emergency physician treating the patient was asked whether he or she considered shock to be probable, and this was compared with LiPS. The proxy ‘gold’ or reference standard was 30-day mortality. The area under the receiver operating curve (AUROC) was used to predict prognosis. The primary outcome measure was 30-day mortality.Results
A total of 220 patients fulfilled the inclusion criteria and were included in the analysis. The AUROC for LiPS (0.722; sensitivity = 0.733, specificity = 0.711, P < 0.0001) was greater than emergency physician gestalt (0.620, sensitivity = 0.467, specificity = 0.774, P = 0.0137) for diagnosing shock using 30-day mortality as a proxy (difference P = 0.0229). LiPS shock patients were 6.750 times (95%CI = 2.834–16.076, P < 0.0001) more likely to die within 30-days compared with non-shock patients. Patients diagnosed by emergency physicians were 2.991 times (95%CI = 1.353–6.615, P = 0.007) more likely to die compared with the same reference.Conclusions
LiPS has a higher diagnostic accuracy than emergency physician gestalt for shock when compared against an outcome of 30-day mortality. 相似文献9.
Lauren Krowl Hassan Al-Khalisy Pratibha Kaul 《The American journal of emergency medicine》2018,36(5):908.e3-908.e5
A new diagnostic paradigm has been proposed to better categorize causes of Metformin-Associated Lactic Acidosis (MALA). The diagnostic criteria defines a link between Metformin and lactic acidosis if lactate is >5 mmol/L, Ph < 7.35 and Metformin assay > 5mg/L. Metformin assays are not readily available in emergency departments including nationwide Veteran’s Affairs Hospitals; thereby making this proposed classification tool difficult to use in today’s clinical practice. We describe a case report of a 45-year-old male, who took twice the amount of Metformin prescribed and presented with Metformin-induced lactic acidosis. According to the new criterion, our case would be classified as “Lactic Acidosis in Metformin-Treated Patients (LAMT).” However, the term LAMT does not distinguish between a septic patient taking Metformin with lactic acidosis, and a patient who ingested toxic amounts of Metformin and has lactic acidosis (in absence of Metformin assay). Our case highlights the importance of medication reconciliation done on arrival to emergency department. Timing and dosing of Metformin in patients who present to the emergency department with lactic acidosis may cinch the diagnosis of Metformin-Induced Lactic Acidosis (MILA) in the absence of a Metformin assay but in the right clinical context. 相似文献
10.
Peng Chong Liang Yong Li Zhang Ying Liu Yu Qing Wang Liu Lu Xia Bao Ling Ren Cai Rong Wang Yu Cao 《The American journal of emergency medicine》2018,36(5):910.e1-910.e4
There is often a delay in offering quality and prompt treatment after a stingray sting. We present 3 cases of stings and discuss the Poisoning Severity Score (PSS) and a simple tool to assess the severity of such injuries. A 34-year-old man, who worked as an aquarium keeper, presented a wound on the left fifth digit caused by a stingray. Acute myocardial injury and rhabdomyolysis were detected. After 6 weeks, the wound had almost healed. A 27-year-old man who experienced a stingray injury on the left second digit recovered without sequelae after 5 weeks. A 45-year-old man with a history of diabetes, who was accidentally stung in the right palm by a stingray, experienced rhabdomyolysis and returned to work after 2 months. We performed debridement, administered the tetanus toxoid and antibiotics, and immersed the wounded hand in warm water (about 43 °C) for all three cases. Meanwhile, patients with rhabdomyolysis were administered intravenous hydration. Upon presentation at the emergency department, we recorded the severity of the injury by using PSS. We found that relatively high PSSs were associated with lower platelet counts that happen due to various adverse events. We suggest that dynamic changes in platelet counts may be associated with the severity of the injury. Furthermore, lower platelet counts in the normal or abnormal range may indicate poor prognoses. 相似文献
11.
Background
The potential for ondansetron to cause QT prolongation and fatal dysrhythmia is well-reported, including a 2011 FDA report on the topic. Few clinical trials evaluating this phenomenon in the ED setting exist, and only one is pediatric.Objective
We have sought to determine the effect of a standardized dose of intravenous ondansetron on the QTc duration of children under 14 years of age treated for gastroenteritis-associated vomiting in a pediatric ED. This study is modeled closely after an FDA “thorough QT study”.Methods
EGCs were obtained before and 15, 30, 45, and 60 min after a 0.15 mg/kg IV dose of ondansetron given for gastroenteritis-associated vomiting. QT intervals were measured manually with digital calipers, and the QTc interval calculated both by Bazett's (QTcB) and Fridericia's (QTcF) correction. A paired t-test comparing QTc was conducted, and frequency of categorical outcomes of prolongation > 30 msec, > 60 msec, and absolute prolongation > 450 msec, > 480 msec, and > 500 msec were evaluated.Results
In a 4-month period, 134 patients were included in the study, 46% were male. The average QTc prior to ondansetron administration was: QTcB 415 msec (95% CI 343–565) and QTcF 373 (95% CI 304–499). The mean difference in QTc after ondansetron was 0.4 msec for QTcB (95% CI ? 35–45 msec) and 0.1 msec for QTcF (95% CI ? 40–18 msec).Conclusion
In these children, 0.15 mg/kg of intravenous ondansetron did not cause prolongation of QTcB or QTcF measured 15 min after administration, nor at later times. 相似文献12.
13.
Darren Yap Miane Ng Madhu Chaudhury Nik Mbakada 《The American journal of emergency medicine》2018,36(1):171.e1-171.e3
Introduction
Blunt chest injury is a common presentation to the emergency department. However, a delayed hemothorax after blunt trauma is rare; current literature reports a delay of up to 30 days. We present a case of 44-day delay in hemothorax which has not been previously reported in current literature.Case report
A 52-year-old Caucasian male first presented to the emergency department complaining of persistent right sided chest pain 2 weeks after having slipped on a wet surface at home. His initial chest X-ray showed fractures of the right 7th and 8th ribs without a hemothorax or pneumothorax.He returned 30 days after the initial consultation (44 days post-trauma) having increasing shortness of breath. A chest X-ray this time revealed a large right hemothorax and 1850 ml of blood drained from his chest.There was a complete resolution of the hemothorax within 48 h and the patient was discharged after a 6-week follow-up with the chest physicians.Discussion
Delayed hemothorax after blunt trauma is a rare clinical occurrence but associated with significant morbidity and mortality. The management of delayed hemothorax includes draining the hemothorax and controlling the bleeding.Why should an emergency physician be aware of this?
Emergency physicians should be vigilant and weary that hemothorax could be a possibility after a chest injury despite a delay in presentation. A knowledge of delayed hemothorax will prompt physicians in providing important advice, warning signs and information to patients after a chest injury to avoid a delay in seeking medical attention. 相似文献14.
Adam C. Patterson Shernaz A. Wadia Douglas J. Lorenz Michelle D. Stevenson 《The American journal of emergency medicine》2017,35(2):322-325
Background
Ketamine is commonly used in the emergency department for short, painful procedures. We describe changes in blood pressure (BP) and heart rate (HR) during procedural sedation with ketamine, as these changes have not been well described in children.Methods
We performed a secondary analysis of a prospective, observational study involving children aged 8 to 18 years who received procedural sedation with ketamine in a pediatric emergency department. Serial vital signs and sedation scores were recorded from baseline until recovery from ketamine procedural sedation. Time of orthopedic manipulation was also recorded. Linear mixed-effect models were used to evaluate changes in systolic BP (SBP), diastolic BP (DBP), and HR using 3 sedation strata: presedation (baseline), sedated (ketamine administered and patient deeply sedated), and recovery (ketamine administered with patient minimally sedated), controlling for age and weight.Results
Sixty children were enrolled; 10 were excluded due to missing manipulation time. A total of 394 observations were recorded. Mean sedated SBP, DBP, and HR were 8 mm Hg, 4 mm Hg, and 13 beats/min higher than presedation SBP (P < .001), DBP (P < .01), and HR (P < .001), respectively. Mean sedated SBP and DBP were 3 and 4 mm Hg higher than SBP (P = .006) and DBP (P < .01) during recovery. Manipulation increased mean SBP by 5 mm Hg (P < .001), mean DBP by 7 mm Hg (P < .001), and mean HR by 1 beat/min (P = .35).Conclusions
Ketamine administered during procedural sedation for painful procedures causes a statistically significant but modest increase in SBP, DBP, and HR. Orthopedic manipulation further increases BP. 相似文献15.
Amir Masoud Hashemian Hamid Zamani Moghadam Doloo Maziar Saadatfar Roya Moallem Maryam Moradifar Raheleh Faramarzi Mohammad Davood Sharifi 《The American journal of emergency medicine》2018,36(2):197-201
Objectives
To compare the effects of intravenous fentanyl and lidocaine on hemodynamic changes following endotracheal intubation in patients requiring Rapid Sequence Intubation (RSI) in the emergency department (ED).Methods
A single-centered, prospective, simple non-randomized, double-blind clinical trial was conducted on 96 patients who needed RSI in Edalatian ED. They were randomly divided into three groups (fentanyl group (F), lidocaine group (L), and fentanyl plus lidocaine (M) as our control group). M was administered with 3 μgr/kg intravenous fentanyl and 1.5 μgr/kg intravenous lidocaine, F was injected with 3 g/kg intravenous fentanyl and L received 1.5 mg/kg intravenous lidocaine prior to endotracheal intubation. Heart rate (HR) and mean arterial pressure (MAP) were assessed four times with the chi-square test: before, immediately after, 5 and 10 min after intubation. Intervention was discontinued for five people due to unsuccessful CPR.Results
HR was notably different in F, L and M groups during four time courses (p < 0.05). Comparison of MAP at measured points in all groups exhibited no significant difference (p > 0.05). In fentanyl group both HR and MAP increased immediately after intubation, and significantly decreased 10 min after intubation (p < 0.05).Conclusions
Overall, the result of this study shows that lidocaine effectively prevents MAP and HR fluctuations following the endotracheal intubation. According to our findings, lidocaine or the combination of fentanyl and lidocaine are able to diminish hemodynamic changes and maintain the baseline conditions of the patient, thus could act more effectively than fentanyl alone. 相似文献16.
Mohammad Reza Farnia Alireza Jalali Elnaz Vahidi Mehdi Momeni Javad Seyedhosseini Morteza Saeedi 《The American journal of emergency medicine》2017,35(3):434-437
Background
Various drugs have been used to relieve abdominal pain in patients with renal colic. Ketamine is a popular choice as an analgesic.Objective
To compare the effectiveness of intranasal (IN) ketamine versus intravenous (IV) morphine in reducing pain in patients with renal colic.Methods
A randomized double-blind controlled trial was performed in 53 patients with renal colic recruited from the emergency department (ED) in 2015. Finally, 40 patients were enrolled in this study. Patients in the ketamine group received IN ketamine 1 mg/kg and IV placebo while patients in the control group received IV morphine 0.1 mg/kg and IN placebo. Our goal was to assess visual analogue scale (VAS) changes between the 2 groups. Patients' VAS scores were reported before and 5, 15, 30 min after drug injection.Results
Before drug administration, the mean ± SD VAS score was 7.40 ± 1.18 in the morphine group (group A) and 8.35 ± 1.30 in the ketamine group (group B) (P-value = 0.021). After adjustment by the appropriate analysis, the mean ± SD VAS score in group (A) and (B) at 5 min were (6.07 ± 0.47 vs 6.87 ± 0.47; mean difference ? 0.79, 95% confidence interval (CI) ? 1.48 to ? 1.04) (P-value = 0.025), at 15 and 30 min, the mean ± SD VAS score in group (A) and (B) were (5.24 ± 0.49 vs 5.60 ± 0.49; mean difference ? 0.36, 95% CI ? 1.08 to 0.34) and (4.02 ± 0.59 vs 4.17 ± 0.59; mean difference ? 0.15, 95% CI ? 1.02 to 0.71) (P-value = 0.304 and 0.719) respectively.Conclusions
IN ketamine may be effective in decreasing pain in renal colic. 相似文献17.
Serkan Dogan Utku Murat Kalafat Bülent Yüksel Türker Karaboğa Mustafa Basturk Tarik Ocak 《The American journal of emergency medicine》2017,35(3):465-468
Purpose
To compare the diagnostic value of ultrasonography (USG), which is rapid, inexpensive, simple, and does not involve radiation, with that of direct radiography for identifying fractures in the nasal bones of pediatric patients presenting in the emergency department with nasal trauma.Equipment and methods
Patients under 18 years old presenting with nasal trauma at the emergency department included prospectively. The patients' age and sex distribution, trauma type, GCS, physical examination findings, direct radiography, and USG results were recorded. The physical examination made by the emergency medicine specialist on arrival was accepted as the gold standard for diagnosis.Findings
In total, 133 patients, 34.6% female and 65.4% male, were included in this study. The average patient age was 7.44 ± 5.05 years, with the greatest proportion (21.8%, n = 29) of patients in the age ranges of 0–2 and 6–8 years. The most frequently observed finding on physical examinations was swelling (51.1%, n = 68). In total, 50 (37.6%) patients had nasal fractures according to their first physical examination, which was performed by emergency medicine specialists. That is, fractures were detected by direct radiography in only 11 of the 34 cases who were diagnosed with fractures by USG.Conclusions
We consider that USG should be preferred over direct radiography for use at the bedside of pediatric patients who present at emergency department with nasal trauma, because of its superior diagnostic ability and the lack of a requirement for radiation. 相似文献18.
Sarah Jorgensen Mira Zurayk Samantha Yeung Jill Terry Maureen Dunn Paul Nieberg Annie Wong-Beringer 《The American journal of emergency medicine》2018,36(1):12-17
Background
Optimal management of urinary tract infections (UTIs) in the emergency department (ED) is challenging due to high patient turnover, decreased continuity of care, and treatment decisions made in the absence of microbiologic data. We sought to identify risk factors for return visits in ED patients treated for UTI.Methods
A random sample of 350 adult ED patients with UTI by ICD 9/10 codes was selected for review. Relevant data was extracted from medical charts and compared between patients with and without ED return visits within 30 days (ERVs).Results
We identified 51 patients (15%) with 59 ERVs, of whom 6% returned within 72 h. Nearly half of ERVs (47%) were UTI-related and 33% of ERV patients required hospitalization. ERVs were significantly more likely (P < 0.05) in patients with the following: age ≥ 65 years; pregnancy; skilled nursing facility residence; dementia; psychiatric disorder; obstructive uropathy; healthcare exposure; temperature ≥ 38 °C heart rate > 100; and bacteremia. Escherichia coli was the most common uropathogen (70%) and susceptibility rates to most oral antibiotics were below 80% in both groups except nitrofurantoin (99% susceptible).Cephalexin was the most frequently prescribed antibiotic (51% vs. 44%; P = 0.32). Cephalexin bug-drug mismatches were more common in ERV patients (41% vs. 15%; P = 0.02). Culture follow-up occurred less frequently in ERV patients (75% vs. 100%; P < 0.05).Conclusions
ERV in UTI patients may be minimized by using ED-source specific antibiogram data to guide empiric treatment decisions and by targeting at-risk patients for post-discharge follow-up. 相似文献19.
Rohit P. Shenoi Elizabeth A. Camp Daniel M. Rubalcava Andrea T. Cruz 《The American journal of emergency medicine》2017,35(12):1791-1797
Introduction
Blunt trauma is a leading cause of pediatric morbidity. We compared injuries, interventions and outcomes of acute pediatric blunt torso trauma based on intent.Methods
We analyzed de-identified data from a prospective, multi-center emergency department (ED)-based observational cohort of children under age eighteen. Injuries were classified based on intent (unintentional/inflicted). We compared demographic, physical and laboratory findings, ED disposition, hospitalization, need for surgery, 30-day mortality, and cause of death between groups using Chi-squared or Fisher's test for categorical variables, and Mann-Whitney test for non-normal continuous factors comparing median values and interquartile ranges (IQR).Results
There were 12,044 children who sustained blunt torso trauma: Inflicted = 720 (6%); Unintentional = 9563 (79.4%); Indeterminate = 148 (1.2%); Missing = 1613 (13.4%). Patients with unintentional torso injuries significantly differed from those with inflicted injuries in median age in years (IQR) [10 (5, 15) vs. 14 (8, 16); p-value < 0.001], race, presence of pelvic fractures, hospitalization and need for non-abdominal surgery. Mortality rates did not differ based on intent. Further adjustment using binary, logistic regression revealed that the risk of pelvic fractures in the inflicted group was 96% less than the unintentional group (OR: 0.04; 95%CI: 0.01–0.26; p-value = 0.001).Conclusions
Children who sustain acute blunt torso trauma due to unintentional causes have a significantly higher risk of pelvic fractures and are more likely to be hospitalized compared to those with inflicted injuries. 相似文献20.
Shervin Farahmand Hadid Hamrah Mona Arbab Mojtaba Sedaghat Hamed Basir Ghafouri Shahram Bagheri-Hariri 《The American journal of emergency medicine》2018,36(7):1231-1235