J Emerg Med
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Observational Study
PREDICTION OF MULTIDRUG-RESISTANT BACTERIA IN URINARY TRACT INFECTIONS IN THE EMERGENCY DEPARTMENT.
Urinary tract infections (UTI) due to multidrug-resistant bacteria are a frequent reason for visiting the emergency department (ED). ⋯ The use of the predictive model evaluated is a useful tool in real clinical practice to improve the success of empirical treatment of patients presenting to the ED with a diagnosis of UTI and positive urine culture pending identification.
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Lyme disease is one of the most common vector-borne illnesses in the United States. It is caused by Borrelia burgdorferi infection transmitted via the Ixodes tick. Rarely, it can progress to early disseminated Lyme disease with cardiac or neurologic manifestations, or both. ⋯ A 41-year-old previously healthy man presented to the emergency department (ED) by ambulance after an episode of syncope. Electrocardiogram revealed right bundle branch block with borderline first-degree atrioventricular nodal block. During his admission he was noted to have night sweats and elevated procalcitonin. Infectious workup revealed positive Borrelia enzyme-linked immunosorbent assay. Further testing revealed positive Borrelia immunoglobulin M with negative immunoglobulin G, indicating a recent infection. Why should an emergency physician be aware of this? Lyme disease should be on the differential for patients presenting with vague, flu-like symptoms in the summer months in endemic areas. Treatment of early Lyme disease with doxycycline can prevent progression to secondary Lyme, which can present as a true cardiac or neurologic emergency.
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Observational Study
A NOVEL EQUATION SUCCESSFULLY CALCULATES TIDAL VOLUMES FOR LUNG PROTECTIVE VENTILATION.
Early application of low-tidal-volume ventilation (LTVV) has been associated with improved outcomes in the emergency department (ED) and intensive care unit (ICU), but is not consistently applied. The perceived complexity of calculating an ideal body weight (IBW)-based tidal volume (Vt) may contribute to this disparity. We hypothesized that a simplified equation could successfully predict LTVV. ⋯ A novel equation successfully predicted a 6-8-mL/kg IBW Vt in a cohort of patients with height ≥ 60 inches.
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Remediation of medical trainees is a universal challenge, yet studies show that many residents will need remediation to improve performance. Current literature discusses the importance and processes of remediation and investigates how to recognize residents needing remediation. However, little is known about trainees' attitudes and perception of remediation. ⋯ Trainees have limited knowledge and understanding of remediation and strong negative perceptions and attitudes toward the remediation process. Trainees suggested that reframing of remediation using more positive terminology and including residents in creating individualized plans, may improve attitudes and perceptions of this process.
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The complexity of older patients along with trends in poorer outcomes in the emergency department (ED) has prompted research into how EDs can adapt to meet the needs of an aging population. A separate Older People's Emergency Department (OPED) has been proposed to improve care at the front door. ⋯ Assessment in the OPED was not associated with a significantly reduced likelihood of hospitalization. However, patients had a shorter wait for clinical assessment, with concomitant reduction in department length of stay.