The American journal of emergency medicine
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The goal of our investigation was to describe the incidence of serious bacterial infection (SBI, defined as bacteremia, urinary tract infection (UTI), or meningitis) in young infants with and without documented viral pathogens. ⋯ The frequency of bacteremia and UTI was lower in young infants with respiratory viral infections compared to infants with negative respiratory viral testing.
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Case Reports
Traumatic splenic laceration with delayed rupture secondary to coughing in a patient with Von Willebrand disease.
We describe the case of a 54-year-old male with Von Willebrand Disease who presented to the Emergency Department (ED) with 2 weeks of worsening abdominal pain after falling on his left flank while boating. On his initial presentation, he was found to have a Grade II splenic injury that was managed non operatively by the trauma service. Four days later, he returned to the ED when he developed severe abdominal pain after coughing and was found to have active extravasation from the splenic parenchyma with hemoperitoneum on CT angiography and a grossly positive FAST exam. Intraoperatively, he was found to have a Grade V splenic injury and subsequently underwent splenectomy.
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Nephrostomy tubes are commonly placed for urinary obstruction, urinary diversion, or future endourologic procedures. While the technical success of nephrostomy tube placement is high, nephrostomy tube complications may occur. ⋯ This narrative review highlights general nephrostomy tube care, minor complications, and troubleshooting in the emergency department. The majority of these minor complications can be managed at the bedside without specialty consultation. However, in patients with more serious complications including dislodgement, obstruction, infection, bleeding, and pleural injury, laboratory assessment and advanced imaging to include ultrasound and computed tomography with specialty consultation are essential in the patient's evaluation and management, particularly in cases of immune compromise and worsening renal function.
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Observational Study
An emergency department-based intensive care unit is associated with decreased hospital length of stay for upper gastrointestinal bleeding.
Upper gastrointestinal bleeding (UGIB) is associated with substantial morbidity, mortality, and intensive care unit (ICU) utilization. Initial risk stratification and disposition from the Emergency Department (ED) can prove challenging due to limited data points during a short period of observation. An ED-based ICU (ED-ICU) may allow more rapid delivery of ICU-level care, though its impact on patients with UGIB is unknown. ⋯ For critically ill ED patients with UGIB, implementation of an ED-ICU was associated with reductions in rate of ICU admission and hospital LOS, with no differences in safety outcomes.
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COVID19 has raised concerns for resource allocation across various sectors of healthcare. At the frontlines, emergency departments are required to triage a wide range of acuity and non-specific symptomology. ⋯ Laboratory studies that otherwise are more commonly conducted inpatient, including markers of inflammation, tissue damage, and infection, may be useful in disposition planning of ED patients in conjunction with clinical correlation of presentation and chest imaging.