The American journal of emergency medicine
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Acute bacterial skin and skin structure infections (ABSSI) are frequently encountered in the emergency department and compromise more than 700,000 hospital admissions annually. Dalbavancin is a single dose long acting semi-synthetic lipogylcopepitde antibiotic with coverage against gram-positive organisms including methicillin resistant Staphylococcus aureus. Recent data from large tertiary care centers have shown a decrease in hospital admissions and repeat emergency department visits for ABSSI's but little data is available for those who practice in a rural community setting. The primary objective of this study was to describe the use of dalbavancin at a single rural emergency department. ⋯ Following the administration of dalbavancin for ABSSI at a rural emergency department, few patients are subsequently admitted within the following 30 days. To further decrease this number and alleviate the burden on emergency departments and hospitals, local treatment algorithms should be developed to minimize the risk of representation and hospitalization following administration.
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Chest compression (CC) depth, CC rate and ventilatory rate (VR) are known to have an impact on end-tidal carbon dioxide (ETCO2) values. Chest compression release velocity (CCRV) is increasingly acknowledged as a novel metric in cardiopulmonary resuscitation (CPR). The objective of this study was to analyze whether CCRV would have any effect on ETCO2 values. ⋯ In OHCA patients, higher CCRV values resulted in higher ETCO2 values. This effect is independent of CC depth, despite the strong correlation between CCRV and CC depth.
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Procalcitonin (PCT) is a biomarker with greater specificity for bacterial infection than other current laboratory markers. However, PCT can also be elevated in the setting of several noninfectious conditions. A recent case report describes a patient with elevated PCT in the context of acute methamphetamine intoxication, but without evidence of infection. ⋯ The area under the ROC curve was 0.65. Additionally, we describe 8 patients with confirmed absence of infection but with elevated PCT, 4 of whom had serum values >10 ng/ml. The results suggest that PCT has poor diagnostic utility for bacterial infection in patients with active methamphetamine use presenting to the ED.
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Observational Study
Association of hypoxic ischemic brain injury on early CT after out of hospital cardiac arrest with neurologic outcome.
This study aimed to describe the prevalence of hypoxic-ischemic brain injury (HIBI) on head CT (HCT) obtained within two hours of return of spontaneous circulation (ROSC) care in the Emergency Department following out-of-hospital cardiac arrest (OHCA) and evaluate the association between early HIBI and neurologic outcome. ⋯ HIBI was present on 29% of HCTs obtained within 2 h of ROSC in the patients selected for early imaging by emergency physicians and was strongly and inversely associated with survival with a good neurologic outcome.
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The aim of this study was to define the population of pregnant women who presented to our clinic after drug exposure for suicidal purposes and to determine the effect of drug-induced poisoning on maternal and fetal outcomes. ⋯ Pregnant women attempting suicide with drug exposure are at high risk of many adverse obstetric outcomes. Providing these patients with appropriate clinical care is critical for the health of the mother and fetus.