J Emerg Med
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Review
Macrolide Resistance in Cases of Community-Acquired Bacterial Pneumonia in the Emergency Department.
Emergency physicians are under pressure to prescribe an antibiotic early in the treatment course of a patient with community-acquired pneumonia (CAP). Macrolides are recommended first-line empirical therapy for the outpatient treatment of CAP in patients without associated comorbidities; however, resistance rates to macrolides in the United States are on the rise. ⋯ Currently available macrolides are now facing resistance rates that cloud their recommendation as a first-line treatment for CAP. Clinicians need a better understanding of their own local resistance rates, while hospitals need to do a better job in describing low- and high-level resistance rates to better inform their physicians.
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Multicenter Study
Effectiveness of a Rural Emergency Department (ED)-Based Pain Contract on ED Visits Among ED Frequent Users.
Caring for patients with chronic pain in emergency departments (EDs) can be particularly challenging, for both patients and physicians. ⋯ A pain contract protocol was associated with a significant reduction in the number of ED visits to multiple rural EDs.
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Tube thoracostomy has long been the standard of care for treatment of tension pneumothorax in the hospital setting yet is uncommon in prehospital care apart from helicopter emergency medical services. ⋯ Our data show that properly trained paramedics in ground-based emergency medical services were able to safely and effectively perform ST in patients with traumatic cardiac arrest. We found a significant (32%) presence of pneumothorax in our sample, which supports previously reported high rates in this patient population.
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Observational Study
Single-Use Laundry Detergent Pack Exposures in Children Under 6 Years: A Prospective Study at U.S. Poison Control Centers.
After the widespread introduction of single-use liquid laundry detergent packs (LLDPs), a prospective observational study was initiated among 12 U.S. poison control centers (PCCs), serving 25% of the population. ⋯ There was a significant reduction in exposures that resulted in major/moderate outcomes, and the majority of patients did not require intervention in an emergency department setting.
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Recurrent abdominal pain, particularly in the right upper quadrant (RUQ) in a patient with a history of cholecystectomy, known as postcholecystectomy syndrome, requires a broad differential diagnosis. Pathology of a retained gallbladder remnant is an exceedingly rare etiology of this pain. ⋯ A 49-year-old woman who had previously undergone an open cholecystectomy presented to the emergency department with several hours of postprandial RUQ pain and emesis. Liver function tests and lipase were not significantly elevated. RUQ ultrasonography revealed a cystic structure containing a stone with mild prominence of the common bile duct at 7 mm, and magnetic resonance cholangiopancreatography confirmed the presence of a remnant gallbladder without common bile duct obstruction. Her pain subsided, she tolerated a diet, and was discharged with a referral for an elective cholecystectomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Abdominal pain is the most common chief complaint of patients presenting to the emergency department in the United States, and emergency physicians routinely encounter patients with postcholecystectomy syndrome. Emergency physicians should not exclude the possibility of remnant gallbladder pathology, such as symptomatic cholelithiasis or cholecystitis, in patients presenting with symptoms concerning for biliary colic, even if the patient has undergone previous cholecystectomy.