J Emerg Med
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Currently, no laboratory test can identify children with intussusception. Lactic acid is a marker of ischemia in gastrointestinal emergencies. ⋯ Lactic acid levels cannot identify children with intussusception.
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As the numbers of emergency department (ED) visits and inpatient admissions continue to increase, there is growing interest in alternatives to inpatient hospitalization. ⋯ In this pilot study, a novel approach to expediting discharges from the ED with multidisciplinary discharge services was feasible and resulted in fewer admissions to the hospital.
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African tick-bite fever is an increasingly common cause for fever in the returning traveller. It needs to be considered in the febrile returning traveller with a characteristic rash: a black eschar. ⋯ We describe a 51-year-old man returning from South Africa who presented to our emergency department with fever, headache, myalgia, and chills. On careful history and skin examination, a black eschar was found on the patient's left lateral shoulder, pointing toward a diagnosis of African tick-bite fever. The patient was treated with doxycycline and rapidly improved. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In the emergency department, the diagnosis of African tick-bite fever is often overlooked in the pursuit of ruling out other travel-related illnesses, such as malaria. A thorough history, a complete physical examination, and a high level of suspicion are essential to the timely diagnosis and treatment of African tick-bite fever in the returning traveller.
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Hyperglycemia is frequently encountered in the emergency department (ED), and insulin and intravenous fluid are commonly administered to reduce glucose prior to discharge. ⋯ In patients with type 2 diabetes who present with moderate to severe hyperglycemia, both insulin and intravenous fluids are associated with a modest glucose reduction. Intravenous fluids were associated with a significant increase in ED LOS, but insulin was not. These results should be considered when determining whether to administer therapies that reduce glucose in the ED.