The American journal of emergency medicine
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Review
Procalcitonin-guided therapy for the initiation of antibiotics in the ED: a systematic review.
Procalcitonin (PCT) is a new biomarker with a higher accuracy in the diagnosis of bacterial infections. Utilization of PCT may reduce the number of unnecessary antibiotics prescribed to patients and consequently may decrease the rise in antibiotic resistance. The aim of this systematic review is to determine if a PCT-guided algorithm can safely reduce the number of antibiotics prescribed to all patients with a suspected of infection in the emergency department (ED). ⋯ Procalcitonin-guided therapy in the ED is only studied in subpopulations, where it was effective and safe in adult patients with respiratory tract infections and not effective but safe nonetheless in specific pediatric populations. Nonadherence is a significant problem in prospective PCT-guided therapy studies. There is not enough evidence to use PCT-guided therapy in a general ED population.
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Review Case Reports
The emergency management of ventricular assist devices.
Heart failure is a common condition in the United States. When medical therapy fails, ventricular device (LVAD) therapy may be required. With increasing use of LVADs, emergency physicians should understand how to manage problems that may arise with these devices. ⋯ With an increasing number of LVADs, emergency physicians should expect to see patients with complications directly or indirectly related to LVADs. This review provides physicians with an extensive review of LVAD physiology and the evaluation and management of potential complications related to the device.