J Emerg Med
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Review Case Reports
Idiopathic Infant Pyocele: A Case Report and Review of the Literature.
Pyocele is a rare emergent urologic condition that requires rapid recognition and treatment to prevent testicular loss. Cases of pediatric pyocele have not been previously reported in the emergency medicine literature. ⋯ We describe a case of a 6-week-old male who presented to the emergency department for a sepsis evaluation. The patient displayed subtle scrotal findings but had an otherwise benign physical examination. Subsequent sonographic imaging suggested a possible scrotal abscess and surgical exploration revealed a pyocele. A literature review of previously reported cases of patients with pyocele is also presented. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A pyocele is a rare cause of both an acute scrotum and neonatal fever. It is important for emergency physicians to consider this entity when evaluating pediatric patients with fever, particularly those with symptoms related to the scrotum.
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For medical students, the emergency department (ED) often presents ethical problems not encountered in other settings. In many medical schools there is little ethics training during the clinical years. The benefits of reflective essay writing in ethics and professionalism education are well established. ⋯ Medical students encounter patients with numerous ethically based issues. Frequently, they note conflicts between ethical principles. Such essays constitute an important resource for faculty, resident, and student ethics training.
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Observational Study
Agreement Between Resident and Faculty Emergency Physicians in the Application of NEXUS Criteria for Suspected Cervical Spine Injuries.
The National Emergency X-Radiography Utilization Study (NEXUS) developed a decision rule for when cervical spine radiographs are required in the setting of trauma. To our knowledge, inter-rater reliability between resident and faculty emergency physicians has not been studied. ⋯ Based on our findings, there was considerable difference in agreement between staff physicians and residents. This could be due to the level of experience of the provider or the subjectiveness of components the criteria.
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Observational Study
Bacteriology of Urinary Tract Infections in Emergency Patients Aged 0-36 Months.
Because urinary tract infection (UTI) is the most frequent source of serious bacterial infections in young children, we studied the bacteriology of such infections in our institution. ⋯ Age- and sex-based assumptions guiding evaluation for and treatment of UTIs in young children should be reevaluated. We may not be culturing enough young boys, risking missed UTIs with potential for renal injury in this vulnerable group. Based on their significant rate of Gram-positive infections, those boys we treat empirically might benefit more from trimethoprim/sulfamethoxazole or amoxicillin/clavulanic acid than from third-generation cephalosporins. The persistence of positive cultures in 2-year-olds suggests we should be culturing beyond 24 months in both sexes. Urine Gram stains should be more frequently considered.