J Emerg Med
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The study objective was to derive and validate a clinical decision rule for obtaining blood cultures in Emergency Department (ED) patients with suspected infection. This was a prospective, observational cohort study of consecutive adult ED patients with blood cultures obtained. The study ran from February 1, 2000 through February 1, 2001. ⋯ Only 4 (0.6%) low-risk patients in the derivation set and 3 (0.9%) low-risk patients in the validation set had positive cultures. The sensitivity was 98% (95% confidence interval [CI] 96-100%) (derivation) and 97% (95% CI 94-100%) (validation). We developed and validated a promising clinical decision rule for predicting bacteremia in patients with suspected infection.
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Case Reports
Diagnosis of a preputial cavity abscess with bedside ultrasound in the emergency department.
Bedside ultrasound has become an important diagnostic tool for emergency physicians. Clinical investigators have demonstrated that evaluating soft tissue infections with ultrasound is useful for the detection of subcutaneous abscesses. ⋯ A preputial cavity abscess, a rare complication of balanoposthitis, is a collection of pus between the foreskin and the distal penis. This case report describes the use of ultrasound to diagnose a penile abscess and reviews the related literature.
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Randomized Controlled Trial Comparative Study
Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial.
Headache is a very common medical complaint. Four to six percent of the population will have a debilitating headache in their lifetime; and 1-2% of all Emergency Department (ED) visits involve patients with headaches. Although promethazine is used frequently, it has never been studied as a single-agent treatment in undifferentiated headache. ⋯ Prochlorperazine provided a faster rate of pain resolution and less drowsiness when compared to promethazine. Both medications were individually effective as abortive therapy for headache. Prochlorperazine was superior to promethazine in the rate of headache reduction and rate of home drowsiness, with similar rates of akathesia, nausea resolution, patient satisfaction, and headache recurrence within 5 days of discharge.
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Acute sinusitis is a common childhood illness most often involving the ethmoid and maxillary sinuses. Diagnosis is usually based on a history of an upper respiratory tract infection lasting longer than 7 days with a prominent nasal component. Treatment involves 10-14 days of antibiotics. ⋯ Children with these complications may experience significant morbidity from their infection. In such cases, delay in diagnosis and treatment may lead to irreparable brain damage or death. We report a case of sinusitis causing a subdural empyema in an otherwise healthy immunocompetent adolescent boy.