J Emerg Med
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Increased scrutiny is occurring from regulatory agencies about the use of nonsterile enema preparations in the emergency department (ED) for constipation. This includes the "off-label" use of milk and molasses (M&M) enemas, as there are no reported data in the medical literature to determine safety and efficacy. ⋯ M&M enemas have a low complication rate when used in the ED.
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A clear command structure ensures quality patient care despite overwhelmed resources during a mass casualty incident (MCI). The American College of Surgeons has stated that surgeons should strive to occupy these leadership roles. ⋯ Errors in disaster triage have been known to increase mortality as well as the monetary cost of disaster response. Funding exists to improve hospital preparedness, but surgeons are lagging behind emergency physicians in taking advantage of these opportunities. Overall, it is imperative that physicians improve their understanding of the MCI response protocols they will be tasked to implement should disaster strike.
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Deep vein thrombosis (DVT) is commonly encountered in the emergency department. Clinical models, such as the Wells criteria, allow physicians to estimate the probability of DVT in a patient. Current literature suggests a low pretest probability combined with a negative D-dimer laboratory study rules out DVT approximately 99% of the time. ⋯ This case discusses a 37-year-old male patient who had a low pretest probability and a negative D-dimer, but was found to have a DVT on Doppler ultrasound. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The astute emergency physician must not discount clinical suspicion in order to decide when radiographic imaging is warranted for a possible venous thromboembolism. New adjuncts, such as bedside ultrasonography, can also be implemented to further risk stratify patients, potentially decreasing morbidity and mortality associated with DVT.
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Controlled Clinical Trial
Abnormal Urinalysis Results Are Common, Regardless of Specimen Collection Technique, in Women Without Urinary Tract Infections.
Voided urinalysis to test for urinary tract infection (UTI) is prone to false-positive results for a number of reasons. Specimens are often collected at triage from women with any abdominal complaint, creating a low UTI prevalence population. Improper collection technique by the patient may affect the result. At least four indices, if positive, can indicate UTI. ⋯ Contemporary automated urinalysis indices were often abnormal in a disease-free population of women, even using ideal collection technique. In clinical practice, such false-positive results could lead to false-positive UTI diagnosis. Only urine nitrite showed a high specificity. Culture contamination was common regardless of collection technique and was not predicted by urinalysis results.
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Babesiosis is a tick-borne, protozoal disease seen primarily in the northeastern and northern Midwest portions of the United States. It is primarily transmitted through the bite of the Ixodes scapularis tick and may cause hemolysis. ⋯ In the following case report, we present a 4-week-old male neonate with a temperature of 38.8°C (102.0°F) who presented to our pediatric emergency department with anemia, thrombocytopenia, and splenomegaly. Blood smear analysis demonstrated U-shaped parasitic rings within red blood cells consistent with babesiosis, confirmed by a positive Babesia microti antibody screen. Because the patient was never exposed to a vector for babesiosis, and never lived in an endemic area, the most likely exposure was in-utero transmission of the disease through transplacental migration of the parasite prior to birth. The patient was treated with atovaquone and azithromycin and discharged from the hospital after 6 days. The patient's mother also tested positive and was treated with the same medications. The evaluation of a febrile neonate includes a broad differential diagnosis. Although babesiosis is still uncommon in many areas of the United States, a specific constellation of laboratory findings and symptoms should prompt its consideration, even in patients who have not been exposed to an endemic area or a typical vector. Vertical transmission of babesiosis has been previously reported, but the occurrence is quite rare. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Practitioners should include babesiosis in their differential diagnosis where appropriate and be aware that it can be transmitted not only via tick bite, but also from mother to neonate during pregnancy.