J Emerg Med
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The effectiveness of observation unit (OU) management of skin and soft tissue infections (SSTI) has not been fully evaluated. ⋯ SSTI can be successfully treated in the OU, though febrile children with SSTI are at risk for OU treatment failure and should be considered for inpatient admission.
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Prescription opioid abuse and overdose has steadily increased in the United States (US) over the past two decades, and current research has shown a dramatic increase in hospitalizations resulting from opioid poisonings. Still, much is unknown about the clinical and demographic features of patients presenting to emergency departments (EDs) for poisoning from prescription drugs. ⋯ There were over 250,000 visits to US EDs from 2006 through 2011 with a primary diagnosis of poisoning by a prescription opioid. Females made the majority of visits, and over half were admitted to the hospital, resulting in over $4 billion in charges. Future studies should examine preventative measures, optimal screening, and intervention programs for these patients.
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Hip fractures are common injuries, particularly among elderly patients. Although plain radiographs are the initial imaging modality of choice, approximately 10% of hip fractures are not radiographically evident. Failure to diagnose a hip fracture in the emergency department may result in delayed diagnosis and potentially devastating consequences. ⋯ We report the case of an 81-year-old woman with right hip pain after a fall. Although plain radiographs of the right hip and femur were negative for fracture, point-of-care ultrasound of the right hip demonstrated a cortical disruption in the femur consistent with a fracture. Given the clinical and ultrasound findings, computed tomography of the bony pelvis and proximal femurs was performed, which confirmed an oblique complex fracture of the right femur through the greater and lesser trochanters. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Point-of-care ultrasound, in conjunction with clinical suspicion, may help identify patients who require more advanced imaging to identify occult hip fractures.
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In 2011, the American Academy of Pediatrics revised practice parameters regarding febrile urinary tract infection (fUTI) in children aged 2-24 months. The Section on Urology opposed the omission of voiding cystourethrogram (VCUG), and expressed concern that potential untoward consequences of deferring VCUG may be most felt by children on Medicaid. ⋯ Abnormal ultrasound, non-Hispanic race, and public insurance were strongly associated with hospital admission in children presenting to the ED with initial febrile urinary tract infection.