J Emerg Med
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Pneumonia antibiotic timing performance measures can result in unnecessary antibiotic administration to patients in whom a diagnosis of pneumonia remains possible but has not been confirmed. ⋯ Unnecessary antibiotic administration to ED CHF admissions did not increase as institutional scrutiny of pneumonia antibiotic timing intensified, although neither did compliance with pneumonia antibiotic timing.
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Comparative Study
Bedside whole-blood clotting times: validity after snakebites.
Venomous snakebites contribute to morbidity and mortality throughout the world, most commonly in resource-poor areas, with about 2.5 million humans sustaining snakebites annually. Coagulopathy is a significant cause of both morbidity and mortality in these patients. In the absence of more sophisticated hematological studies or obvious physical findings, many clinicians must rely on whole-blood clotting times to assess whether their patients are coagulopathic. Alternative (bedside) methods to assess clotting times are often officially recommended and used, but have not been validated. ⋯ Both the syringe and ceftriaxone bottle bedside clotting test methods appear to be accurate enough to help guide therapy after potential snake envenomations when formal laboratory testing is unavailable.
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Carbon monoxide exposure is an important, but frequently undiagnosed, cause for Emergency Medical Services (EMS) response. Its elusive characteristics and non-specific symptoms make detection difficult without monitoring devices. Consequently, both patients and EMS providers are at increased risk of harm from such exposures. ⋯ This case series highlights the importance of environmental surveillance for carbon monoxide by EMS providers, particularly in such cases where its presence is not suspected. This was, in fact, the case in all the encounters presented herein.
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Choriocarcinoma is an aggressive malignant tumor. It commonly invades the uterus, causing necrosis and hemorrhage through vascular invasion. Metastasis is also common, with the main areas affected being the lung, brain, liver, pelvis, vagina, spleen, intestine, and kidney. ⋯ Gestational choriocarcinoma with metastasis to the eye is a rare disease and a rare cause of exudative retinal detachment. In general, metastatic choriocarcinoma is highly curable with chemotherapy. However, metastasis to the eye, regardless of the type of tumor, portends a poor prognosis.
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Physicians deployed to austere environments often encounter the challenge of needing to make clinical decisions based upon rudimentary history and physical examination. These skills, however, can be difficult for many to rely on, with the many subtleties of examining the eye, when they are normally accustomed to relying on sophisticated modalities to establish diagnosis. ⋯ This case illustrates that even under austere conditions, a focused history and evaluation can reveal the likelihood of occult intraocular foreign body, thereby triaging the patient for emergency surgery.