Health-care associated pneumonia (HCAP) is the term used to describe patients presenting with pneumonia who may be at higher risk of multi-drug resistant (MDR) pathogens than other patients presenting from the community due to recent contact with the health care system. What are the criteria for HCAP?
Emergent airway management and severe sepsis are both high-risk situations that are commonly encountered by emergency physicians. It is well known that complications can be high in both situations, which in turn can lead to increased morbidity and mortality. For instance, about 1/4 of patients who are hemodynamically stable prior to intubation get post-intubation hypotension (PIH) after rapid sequence intubation. Also septic patients may not be reliably identified by systemic inflammatory response syndrome (SIRS) markers early in their disease course. The Shock Index (SI) may be an adjunct that is easy to calculate and could predict both PIH and severe sepsis.
We sometimes hear information stated as fact that may not be entirely accurate. One such example is, “I’m going to use lorazepam because it isn’t metabolized by the liver.”
Let’s set the record straight.
ALL benzodiazepines are metabolized by the liver.
To provide a resource for evidence-based Emergency Medical education, this list of must-read landmark articles was created to supplement the Emergency Medicine (EM) internship year of training. There are 52 articles so that one article can be read at leisure each week of the year. I searched national databases and polled faculty at the University of Washington to identify articles that faculty would expect any EM resident to be familiar with or that they felt were practice-changing in EM. Articles were selected for the final list based on the quality of study design, sample size, and relevance for EM residents.
The CaseYou have a 54-year-old female who presents to the emergency department with a chief complaint of “just feeling out of it.” She has felt “off and on” for the past 12 hours and has had an occasional cough with some sputum production along with “the shakes and chills.” She also feels as if her heart was “going at a mile a minute” and because of this, she is very much out of breath.
Salicylate is among the top 25 substances that cause the greatest number of overdose fatalities in the United States. 1 Patients can present with a wide variety of complaints including tinnitus, dyspnea, vomiting, confusion, and coma. Significant toxicity occurs when a large amount of salicylate saturates the body’s protein-binding capacity and leaves free salicylate in the serum. 2 The American College of Medical Toxicology (ACMT) recently published a guidance document on management priorities in salicylate toxicity, and it’s definitely worth a read. 3 While not an official clinical guideline, it highlights some important concepts to consider when working up and treating patients after a significant salicylate exposure, and we’ll review five major concepts here and hopefully answer some questions that may cross your mind on shift.
There are several causes for the acutely painful scrotum. In the follow two short tutorial videos, Dr. Rahul Patwari reviews common causes, which include testicular torsion, epididymitis, orchitis, torsion of the testicular appendix, and testicular masses.