J Emerg Med
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Patients with acute bacterial skin and skin structure infections (ABSSSI) commonly present to Emergency Departments (EDs) where physicians encounter a wide spectrum of disease severity. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has increased in the past decade, and CA-MRSA is now a predominant cause of purulent ABSSSI in the United States (US). ⋯ The growing prevalence of CA-MRSA associated with ABSSSI in the US has a significant impact on clinical management decisions in the ED. Recent availability of new diagnostic testing and therapeutic options may help meet the demand for effective antistaphylococcal agents.
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Review Case Reports
Fishhook removal: case reports and a review of the literature.
Fishhook injuries are common among people who fish for recreation, but can be encountered in anyone who has handled a fishhook. They represent a unique challenge for Emergency Physicians who seek to remove them without causing further tissue damage from the barbed nature of the hook. ⋯ Understanding the unique nature of fishhook injuries and awareness of techniques to manage them are essential to the practicing Emergency Physician.
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Prothrombin complex concentrate (PCC) is an inactivated concentrate of factors II, IX, and X, with variable amounts of factor VII. Guidelines recommend the use of PCC in the setting of life-threatening bleeds, but little is known on the most effective dosing strategies and how the presenting international normalized ratio affects response to therapy. ⋯ Health care professionals must remain aware of the differences in products and interpret how three- versus four-factor products may affect patients, and interpret literature accordingly. The clinician must be cognizant of how to progress when treating a bleeding patient, propose a supported dosing scheme, and address the need for appropriate factor VII supplementation. At this point, PCC cannot be recommended for first-line therapy in patients with traumatic hemorrhage, and should be reserved for refractory bleeding until more data are available.
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Acute subdural hematoma without subarachnoid hemorrhage or intraparenchymal hematoma is rare. ⋯ Ruptured intracranial aneurysm should be considered as a cause of nontraumatic subdural hematoma. Immediate subdural hematoma removal after aneurysm coiling can be performed in such patients, even those in poor neurological condition.
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A growing number of novel substances have been abused as recreational drugs by young people in the United States (US), Europe, and Australia. Called "legal highs," these substances range from plant-based to completely synthetic compounds. Spice, Salvia, mephedrone, methylenedioxypyrovalerone (MDPV), and other cathinone derivatives have psychotropic effects and are marketed for recreational use through exploitation of inadequacies in existing controlled substance laws. ⋯ "Legal highs" continue to increase in use in the US, Europe, and Australia. These substances are powerful, can mimic effects of more traditional drugs of abuse, and are intentionally manufactured to circumvent existing controlled substance laws. As controlled substance legislation may be inadequate in the face of the quickly evolving legal highs, physicians are likely to see an increase in the prevalence of legal highs.