J Emerg Med
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Assessing volume responsiveness, defined as an increase in cardiac index after infusion of fluids, is important when caring for critically ill patients in septic shock, as both under- and over-resuscitation can worsen outcomes. This review article describes the currently available methods of assessing volume responsiveness for critically ill patients in the emergency department, with a focus on patients in septic shock. ⋯ Cardiac filling pressures may be misleading if used to determine volume responsiveness. Assessment of cardiopulmonary interactions has superior performance characteristics, and should be preferentially used for septic shock patients in the emergency department.
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Review Case Reports
Accidental Acute Alcohol Intoxication in Infants: Review and Case Report.
Acute alcohol intoxication in children younger than 18 months old is both rarely documented and rarely fatal. Previous case reports suggest hypoglycemia and faster than normal rates of alcohol elimination found in children with acute alcohol intoxication compared with adults, but data are lacking. ⋯ A 2-month-old infant presented with a decreased mental status after accidental ingestion of alcohol. He was diagnosed with acute alcohol intoxication, with a blood alcohol level of 330 mg/dL and was hyperglycemic (167 mg/dL). Alcohol elimination rate was calculated to be 21.6 mg/dL/h, similar to that in adults. To our knowledge, this case is the second youngest documented patient with accidental alcohol intoxication via ingestion in the United States. We present a rare case report of acute alcohol intoxication in an infant and a review of the literature. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although rare in the literature, poison control data suggests that alcohol poisoning in very young children is not rare. Emergency physicians should be prepared for the management of infants with alcohol poisoning. This case report and review brings attention to this subject and briefly discusses ethanol metabolism in infants.
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Observational Study
Septic Shock and Adequacy of Early Empiric Antibiotics in the Emergency Department.
Antibiotic resistance is an increasing concern for Emergency Physicians. ⋯ In this population of ED patients with septic shock, empiric antibiotic coverage was inadequate in a small group of uroseptic patients with recent health care exposure. Current guidelines for UTI treatment do not consider health care setting exposure. A larger, prospective study is needed to further define this risk category and determine optimal empiric antibiotic therapy for patients.