J Emerg Med
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In 2000, a series of cases of necrotizing fasciitis (NF) among injection users of black tar heroin was observed in our Emergency Department (ED). The description of these cases characterizes the ED presentation of NF, focusing on the sensitivity of physical signs and ED diagnostic tests. All cases of pathologically determined NF in 2000 were prospectively and retrospectively identified and analyzed. ⋯ Thirty-seven percent of blood cultures and 75% of surgical wound cultures were positive, revealing a variety of organisms. Although tachycardia, leukocytosis, and elevated lactate levels are common in NF patients, fever and soft tissue gas are not. Tests and traditional teaching regarding the "classic" findings of NF should be amended to reflect differences seen in the setting of injection drug use with black tar heroin.
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This article reviews the empirical literature on patient satisfaction in the Emergency Department (ED). It explores the implications for clinical practice, discusses limitations and weaknesses of the literature, and provides direction for future research. Articles resulting from a comprehensive electronic search were obtained, their references examined, and all other relevant articles not already discovered via the electronic search were acquired and reviewed. ⋯ Promising interventions include: providing information on how the ED functions through visual media, improving ED processes through performance improvement methodologies, and improving the interpersonal skills of providers. Interventions designed to reduce actual waiting times have not been sufficiently studied, but results from several well-designed studies suggest that such a strategy is unlikely to have as great an impact as those targeting perceived waiting times. To advance this area of research, investigators must use: 1) larger, more representative samples; 2) reliable and valid assessment instruments; 3) theory-driven hypothesis testing; and 4) randomized, controlled trials.
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Although pediatric cardiac disorders are not commonly seen in the Emergency Department, they are important to identify to prevent further morbidity or mortality. Diagnosis may be complicated by the lack of classic complaints such as chest pain or palpitations that are commonly associated with cardiac disorders. ⋯ This article reviews pertinent issues concerning diagnosis and management of pediatric cardiac disorders including supraventricular tachycardia, congenital heart disease, prolonged QT syndrome, pericarditis, myocarditis, rheumatic fever, and endocarditis. It also reviews abnormal findings in pediatric electrocardiograms.
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Review Case Reports
Spinal epidural abscess presenting as intra-abdominal pathology: a case report and literature review.
Spinal epidural abscess is a rare infectious disease. However, if left unrecognized and untreated, the clinical outcome of spinal epidural abscess can be devastating. ⋯ However, early in its course, spinal epidural abscess can also present with vague and nondescript manifestations. In this report, we describe a case of spinal epidural abscess presenting as abdominal pain, and review the literature describing other cases of spinal epidural abscess presenting as intra-abdominal pathology.