J Emerg Med
-
Bedside ultrasound has been suggested as a non-invasive modality to estimate central venous pressure (CVP). ⋯ The subxiphoid was the most reliably viewed of the three anatomic locations; however, the suprailiac view produced superior correlations to the CVP. Longitudinal views generally outperformed transverse views. A simple ultrasound measure of the IVC yields weak correlation to the CVP.
-
The Surviving Sepsis Campaign (SSC) guidelines recommend that broad-spectrum antibiotics be administered to severely septic patients within 3 h of emergency department (ED) admission. Despite the well-established evidence regarding the benefit of timely antibiotics, adoption of the SSC recommendation into daily clinical practice has been slow and sporadic. ⋯ Storing key antibiotics in an institution's severe sepsis antibiogram in the ED ADC can significantly reduce order-to-antibiotic times and increase the percentage of patients receiving antibiotics within the recommended 3 h of ED arrival.
-
Aortic dissections that present only with symptoms of lower extremity ischemia are rare. Few case reports exist documenting this phenomenon. ⋯ It is important to consider the connection between lower extremity symptoms and possible aortic dissection.
-
Should the placement of carbon monoxide (CO) detectors be influenced by CO's weight relative to air?
Numerous states and localities have recently passed legislation mandating the installation and use of residential carbon monoxide (CO) detectors/alarms. Interestingly, there seems to be confusion about the optimal placement, if any, of CO alarms inside the home. ⋯ As would have been predicted by the Second Law of Thermodynamics, CO infused anywhere within the chamber diffused until it was of equal concentration throughout. Mixing would be even faster in the home environment, with drafts due to motion or temperature. It would be reasonable to place a residential CO alarm at any height within the room.
-
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections commonly present as skin and soft-tissue infections (SSTIs). Treatment often includes incision and drainage with or without adjunctive antibiotics. Emergency department (ED) pharmacists wished to provide specific data to emergency physicians to better inform antibiotic choices for patients with SSTIs. ⋯ Cephalexin was often added to cover for potential cellulitis due to Streptococcus spp., however, the surrounding erythema may simply be an extension of the CA-MRSA infection. Department-specific antibiograms are useful in guiding empiric antibiotic selection and may help providers judiciously prescribe antibiotics only when necessary.