The American journal of emergency medicine
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Urine microscopy is a common test performed in emergency departments (EDs). Urine specimens can easily become contaminated by different factors, including the collection method. The midstream clean-catch (MSCC) collection technique is commonly used to reduce urine contamination. The urine culture contamination rate from specimens collected in our ED is 30%. We developed an instructional application (app) to show ED patients how to provide a MSCC urine sample. We hypothesized that ED patients who viewed our instructional app would have significantly lower urine contamination rates compared to patients who did not. ⋯ We did not see a lower contamination rate for patients who viewed our instructional app compared to patients who did not. It is possible that MSCC is not effective for decreasing urine specimen contamination.
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To evaluate the efficacy of soluble programmed death-1 (sPD-1) for risk stratification and prediction of 28-day mortality in patients with sepsis, we compared serum sPD-1 with procalcitonin (PCT), C-reactive protein (CRP), and the Mortality in Emergency Department Sepsis (MEDS) score. ⋯ Serum sPD-1 is positively correlated with the severity of sepsis, and it is valuable for risk stratification of patients and prediction of 28-day mortality. Combining sPD-1 with PCT and the MEDS score improves the prognostic evaluation.
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Systemic erythematosus lupus (SLE) affects multiple organs and involves complex immune dysfunction. Because vaccinations are inherently designed to stimulate the immune response, they have been linked with increased risk for flare of SLE and other autoimmune disorders, and their association with new-onset autoimmune disease has been postulated in several case reports. To our knowledge, this is the first reported case of the meningococcal vaccine precipitating SLE in a previously undiagnosed patient. ⋯ Initial labs showed pancytopenia, bandemia, proteinuria, elevated erythrocyte sedimentation rate, and elevated d-dimer. Both the antinuclear antibodies (ANA) and anti-double stranded DNA were positive and cervical lymphadenopathy was present. This case highlights the importance of considering acute autoimmune reactions such as SLE in the differential diagnosis when assessing previously healthy patients presenting with systemic symptoms such as fever and rash in the setting of recent vaccination.
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Observational Study
Effects of advanced life support on patients who suffered cardiac arrest outside of hospital and were defibrillated.
The effects and relative benefits of advanced airway management and epinephrine on patients with out-of-hospital cardiac arrest (OHCA) who were defibrillated are not well understood. ⋯ In defibrillated patients with OHCA, advanced airway management and/or epinephrine are related to reduced long-term survival, and advanced airway management is less beneficial than epinephrine. However, the proportion of patients with OHCA who responded to an initial shock was very low in the study subjects, and the external validity of our findings might be limited.
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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. ⋯ 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.