J Emerg Med
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Review Case Reports
Lemierre syndrome complicating otitis externa: case report and literature review.
Septic thrombophlebitis of the internal jugular vein, known as Lemierre syndrome, is a rare disorder usually caused by Fusobacterium necrophorum, a Gram-negative anaerobic organism that normally inhabits the oropharynx. Lemierre syndrome usually follows primary oropharyngeal infections and affects previously healthy adolescents and young adults in a characteristic manner, often with fatal results if left untreated. There have been a significantly increasing number of reported cases of Lemierre syndrome, possibly reflecting the trend to withhold antibiotics for initially uncomplicated oropharyngeal infections. ⋯ Septic thrombophlebitis of the IJV is associated with multiple sources and organisms. This case is unique in both the organism (Peptococcus anaerobius) and the source (otitis externa). This disease process must be identified early and aggressively treated to avoid significant morbidity and mortality.
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The prevailing teaching in medical school curricula and in medical textbooks is that if thiamine deficiency is suspected, thiamine supplementation should be given before administering glucose. ⋯ Mounting case report evidence suggests that prolonged glucose supplementation without the addition of thiamine can be a risk factor for the development of Wernicke encephalopathy. Based on our findings, a delay in giving glucose to hypoglycemic patients cannot be recommended at this time, although prompt thiamine supplementation after or concurrent with a return to normoglycemia is recommended.
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Current guidelines recommend door-to-balloon times of 90 min or less for patients presenting to the emergency department (ED) with ST-segment elevation myocardial infarction (STEMI). ⋯ EPh presence during STEMI presentation to the ED is independently associated with a decrease in door/diagnosis-to-CCL and door-to-balloon times.
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Score systems for severity of illness and organ dysfunction have been validated and used as tools to predict the risk of death in intensive care unit (ICU) patients, but their usefulness in patients with suspected infection in the emergency department (ED) or hospital ward is unclear. ⋯ The reviewed literature did not provide enough information to assess the accuracy of the prognostic models in patients with suspected infection admitted to the ED and hospital ward. Some reports suggest a better accuracy with new scores like the MEDS (Mortality in Emergency Department Sepsis score), but the results are not consistent.