J Emerg Med
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Review Case Reports
Risk stratification of the potentially septic patient in the emergency department: the Mortality in the Emergency Department Sepsis (MEDS) score.
The prompt recognition and management of septic patients remains a challenge within the busy Emergency Department (ED). Prognostic screening aids have traditionally required time-delayed laboratory measurements not validated upon the emergency medicine population. Recently, a brief prognostic tool has been derived and subsequently validated in heterogeneous ED populations. ⋯ The MEDS score is an accurate and reliable prognostic tool for 28-day mortality in ED SIRS patients, but may not be optimal for those with severe sepsis.
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Multicenter Study
Feasibility of emergency physician diagnosis of hypertrophic pyloric stenosis using point-of-care ultrasound: a multi-center case series.
Hypertrophic pyloric stenosis (HPS) is an acute abdominal emergency in infants that often presents to Emergency Departments. The clinical diagnosis of HPS relies on palpation of an olive-sized mass in the right upper quadrant of an infant with a history of projectile vomiting. However, studies have shown that clinicians cannot detect the olive in 11% to 51% of cases. ⋯ To our knowledge, there have been no reports documenting the ability of Emergency Physicians to diagnose HPS using point-of-care ultrasound. We present a multi-center case series (n = 8) of HPS diagnosed by Emergency Physician-performed ultrasound. We review the technique of incorporating point-of-care ultrasound into the physical examination of infants with suspected HPS and discuss the possible role of point-of-care ultrasound in the management of these patients.
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The initial management of distal radius fractures in children is part of the usual practice of Emergency Medicine. However, no data are available evaluating the outcome of pediatric forearm fractures that undergo closed reduction and casting by emergency physicians. ⋯ Our results suggest that emergency physicians may be able to successfully provide restorative care for distal forearm fractures using closed reduction technique. Care rendered by emergency physicians was associated with a shorter length of stay and lower facility charges.
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Measurement of time to first antibiotic dose (TFAD) in the emergency department (ED) in community-acquired pneumonia (CAP) has been controversial. ⋯ Given inconsistent evidence to demonstrate that improving TFAD in CAP improves outcomes or that TFAD is associated with antibiotic overuse, a Class C indication has been assigned (not acceptable/not appropriate) for ED TFAD measurement. The American Academy of Emergency Medicine recommends that measurement of TFAD in CAP be discontinued.
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Pulmonary embolus (PE) can be fatal, but is often treatable if recognized early. Unfortunately, the clinical presentation of PE is often variable and misleading. The D-dimer assay has recently come into favor as a method to exclude PE; however, this test has an acceptable safety margin only in low-risk populations. ⋯ This report highlights the risk of misdiagnosing PE if relying solely on ELISA D-dimer for exclusion. The approach to PE should include a measure of clinical probability. This report documents the presentation of PE despite having two unremarkable ELISA D-dimer measurements, and highlights the importance of clinical suspicion.