J Emerg Med
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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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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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Aortoenteric fistula is a rare but serious cause of gastrointestinal bleeding. Early diagnosis and definitive treatment with fistula repair may improve patient outcomes. We report the use of point-of-care ultrasound to identify an aortoenteric fistula in a patient presenting with abdominal pain and shock. ⋯ A 78-year old man presented to the Emergency Department with abdominal pain and 5 days of minimal hematochezia. He was hypotensive and had diffuse abdominal tenderness. Point-of-care ultrasound was performed, demonstrating an abdominal aortic aneurysm with a hypoechoic projection into a segment of bowel abutting the aorta. Color flow was present through the structure, consistent with an aortoenteric fistula. After resuscitation with red blood cells, computed tomography was performed to confirm the diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinical ultrasound has a well-established role in the detection of aortic aneurysm. This case illustrates that point-of-care ultrasound can also be used to rapidly identify an aortoenteric fistula and expedite timely care and surgical evaluation.
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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.