When should urinary tract infections (UTI) be included in the differential diagnosis for febrile infants and young children? The EM Committee on Quality Transformation in the American Academy of Pediatrics (AAP) thoughtfully outlines a clinical algorithm to help guide clinicians towards a standardized, evidence-based approach. Thanks to the expert content team (Drs. Shabnam Jain, Anne Stack, Scott Barron, Pradip Chaudhari, and Kathy Shaw) for sharing this clinical algorithm.
The reported accuracy of the urinalysis (UA) for diagnosing urinary tract infections (UTI) is febrile infants ≤ 60 days has been widely variable. Some guidelines specifically exclude these patients due to this variability or recommend urine culture as the primary test.1
Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger, published in Pediatrics in February of 2018, addressed this topic head-on.2 The authors sought to evaluate the accuracy of the UA by analyzing data in a planned secondary analysis of a prospectively collected data set, as part of the Pediatric Emergency Care Applied Research Network (PECARN). We review this publication and present a behind-the-scenes podcast interview with lead author Dr. Leah Tzimenatos.
Have you ever performed a procedure, when suddenly, you are overcome by a sinking feeling that something just is not right? A mix of fear, guilt, and anger: Fear that you endangered a patient, guilt that you missed an important step in the procedure, and anger at yourself for being careless. The oath we take as physicians echoes loudly: Primum non nocere. First, do no harm.
Post-exposure prophylaxis (PEP) of patients who may have been exposed to HIV includes a combination HIV nucleoside analog reverse transcriptase inhibitor emtricitabine/tenofovir (Truvada) plus an integrase inhibitor. The CDC initially recommended the integrase inhibitor dolutegravir (Tivicay). However on May 18, 2018, the CDC placed an alert about the neural tube defect risk with dolutegravir.1 How does this change our ED practice?
Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this series, we focus on a real clinical case where point-of-care ultrasound changed the management or aided in the diagnosis. In this case, a 64-year-old man presents with acute onset scrotal pain and fever.
The definitions of sepsis and septic shock continue to evolve, but the management, including resuscitation and early antibiotics, remains a core skill of any successful EM provider. Dr. Augusto Saldana Miranda reviews these points, adding some parchment flare to his submission.
We are proud to present Capsules Module 10: Concepts in Infectious Disease, now published on ALiEMU. Here is a summary of the key points from a stellar module by Drs. Meghan Groth and Paul Takamoto. When you’re finished, head over to the Capsules page for even more practical pharmacology for the EM provider.