Clinical profile of injection drug users presenting to the ED Daniel R. Kievlan, Meri Gukasyan, Julie Gesch, Robert M. Rodriguez
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.020
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 19 2015
x Injection drug users (IDUs) commonly use the emergency department (ED) as their primary health care access point.
Antibiotics for methicillin-resistant Staphylococcus aureus skin and soft tissue infections: the challenge of outpatient therapy Amy J. Pate, Reno Giovonni Terribilini, Farzaneh Ghobadi, Alaleh Azhir, Andre Barber, Julie Marie Pearson, Hossein Kalantari, Getaw W. Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.026
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: November 14 2013
x Methicillin-resistant Staphylococcus aureus (MRSA) infections are becoming increasingly prevalent in both community and hospital settings. Certain strains are notorious for causing skin and soft tissue infections in patients with no established risk factors. In this article, we report our findings on the dynamic antibiotic resistance pattern of MRSA and outpatient prescription trend for skin and soft tissue infections within our community.
Timing and appropriateness of initial antibiotic therapy in newly presenting septic patients Antonia L. Vilella, Charles F. Seifert
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.008
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: October 21 2013
x To determine the effectiveness of antibiotic regimens and time to antibiotics in septic patients admitted to an intensive care unit from the emergency department.
Pediatric abscess characteristics associated with hospital admission from the ED Michael W. Sauer, Daniel A. Hirsh, Harold K. Simon, Shervin A. Kharazmi, Jesse J. Sturm
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.015
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: August 16 2010
x To determine the characteristics of pediatric soft tissue abscesses that result in hospital admission.
A survey of emergency medicine residents’ perspectives of the choosing wisely campaign Stuart E. Greene, Richard Massone
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.067
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: April 6 2015
x Many initiatives have been proposed to reduce health care expenditures in the United States because of the continued rise in medical care costs. The Choosing Wisely campaign has been developed by physicians and for physicians; and its primary aim is to provide care that is “supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary” [1]. Through guidelines, it is the hope that Choosing Wisely will reduce unnecessary testing and treatment, thereby reducing wasteful spending and potential harm to patients.
Acute Generalized Exanthematous Pustulosis: An Uncommon Cause of Fever and Rash Jeffrey Gordon
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.063
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: June 27 2015
x Fever and rash are common presenting complaints to the Emergency Department. This report documents an uncommon diagnosis involving this presentation. The patient presented with signs and symptoms consistent with severe sepsis. Once the diagnosis of Acute Generalized Exanthematous Pustulosis was recognized, the outcome was favorable. (See Figs. 1 and 2.)
A fish-stunning wound infection with acute cardiac injury Khee-Siang Chan, Kuo-Chen Cheng, Mei-Feng Lee, Wen-Liang Yu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.040
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: October 31 2013
x Vibrio vulnificus typically causes septicemia and necrotic wound infection. Among V vulnificus– related complications, acute nonthrombotic myocardial damage has not been reported. The most effective antibiotic treatment of V vulnificus infection includes combination of a third-generation cephalosporin and a tetracycline or its analogue. However, recommendations of a fourth-generation cephalosporin-based regimen for treating the disease are not established. A 67-year-old diabetic man acquired V vulnificus infection via a fish-stunning wound on the right foot.
Acute neck infections in children: who is likely to undergo surgical drainage? Michael W. Sauer, Sujit Sharma, Daniel A. Hirsh, Harold K. Simon, Beesan S. Agha, Jesse J. Sturm
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.043
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: May 15 2013
x Superficial neck infections including lymphadenitis and abscesses are commonly encountered in pediatric emergency departments (PEDs). It is often unclear which patients are likely to develop an abscess that necessitates surgical drainage. In evaluating these patients, computed tomography (CT) and ultrasound are often used to identify/confirm abscess formation. The criteria for determining the need for imaging studies are not well defined.
Rapid Emergency Medicine Score as a main predictor of mortality in Vibrio vulnificus –related patients Sheng-Hung Kuo, Chin-Feng Tsai, Chi-Rong Li, Shih-Jei Tsai, Wai-Nang Chao, Khee-Siang Chan, Yuan-Ti Lee, Ruey-Hong Wong, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.030
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 22 2013
x Vibrio vulnificus causes potentially life-threatening and rapidly progressing infections. Therefore, the severity-of-illness assessment appears to be important for V vulnificus –infected patients at the time of admission. The aim of our study was to evaluate the performance of the severity-of-illness scoring model on admission in V vulnificus –infected patients.
Practice patterns and management strategies for purulent skin and soft-tissue infections in an urban academic ED Larissa May, Katherine Harter, Kabir Yadav, Ryan Strauss, Jameel Abualenain, Amy Keim, Gillian Schmitz
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.033
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: January 31 2011
x Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is the most common cause of purulent skin and soft-tissue infections (SSTIs) in the Unites States. Little is known regarding health care provider management strategies for abscesses in the emergency department (ED). Understanding variability in practice patterns could be an important step in implementing evidence-based guidelines.
Diagnosing poststernotomy mediastinitis in the ED Jan J. van Wingerden, Mario Maas, Richard L. Braam, Bas A. de Mol
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.048
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 21 2015
x Poststernotomy mediastinitis (PSM), the severe chest wall and mediastinal infection that may arise at any time after a sternotomy, causes significant morbidity and mortality globally. Late recognition and diagnosis are the major contributors to a poor outcome. This review focuses on recent advances in diagnosing PSM (particularly after cardiovascular surgery) at the earliest opportunity—in the emergency department.
Red cell distribution width is an independent predictor of mortality in necrotizing fasciitis Chia-Lung Weng, Cheng-Hsien Wang, I-Chuan Chen, Kuang-Yu Hsiao, Kung-Pin Chang, Shih-Yun Wu, Hong-Mo Shih
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.001
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: August 7 2014
x Necrotizing fasciitis (NF) is a rapidly progressing and potentially lethal infectious disease of the soft tissue. An elevated red blood cell distribution width (RDW) is associated with increased risk of death in patients with heart disease and infectious disease. We retrospectively assessed the association of elevated RDW with in-hospital mortality due to NF.
Administration of first dose antibiotic in the ED in patients with minor skin and soft tissue infections Ahmed Altyar, Hussain T. Bakhsh, Abdulaziz Mohammed, Grant Skrepnek, Asad E. Patanwala
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.035
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: May 29 2015
x Patients who present to the emergency department (ED) with mild skin and soft tissue infections (SSTIs) are often given a single dose of an antibiotic before being discharged home on oral antibiotics. The objective of this study was to determine if administration of antibiotics in the ED increases length of stay.
Temperate pyomyositis: a pain in the belly Joseph R. Pare, Elissa M. Schechter-Perkins
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.016
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: July 29 2014
x Pyomyositis is a rare disease in temperate climates. This case is a unique presentation of pyomyositis of the rectus abdominal muscle mimicking an acute abdominal process. Most reported cases of pyomyositis are of extremity infections with Staphylococcus aureus . This report presents a case of polymicrobial pyomyositis from Haemophylus parainfluenza and Steptococcus viridians infection.
Magnitude of national ED visits and resource utilization by the uninsured Jestin N. Carlson, James J. Menegazzi, Clifton W. Callaway
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.001
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 1 2013
x For nearly 51 million persons in the United States who lack health care insurance, the emergency department (ED) functions as a safety net where no patient is denied care based on ability to pay, and much public rhetoric has characterized ED utilization by uninsured patients. We estimated national ED utilization by uninsured patients and compared uninsured and insured ED patients in terms of demographics, diagnostic testing, disposition and final diagnoses.
Foot pain and swelling after minor traumatic injury Patrick Olivieri, Gabriel Rose, Sebastian Siadecki, Rachel Berkowitz, Turandot Saul
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.049
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: December 29 2014
x Necrotizing fasciitis is a rare bacterial infection of the fascia and surrounding soft tissue, which carries a mortality rate as high as 20%, even in well-appearing patients [1]. Classically, this diagnosis must be made with computed tomography or magnetic resonance, but recent literature shows that ultrasonography, readily available in the emergency department, may be adequate for diagnosis [2]. We present a case of a 48-year-old man who presented with a painful rash. We used his clinical presentation and ultrasound to make the diagnosis, which was later corroborated with plain radiograph findings.
A fatal case of necrotizing Aeromonas schubertii fasciitis after penetrating injury Ta-Lun Kao, Man-Ling Kao
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.028
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: January 19 2011
x Necrotizing fasciitis is an uncommon but life-threatening condition with a high associated mortality and morbidity. Most infections are polymicrobial, another distinct form of necrotizing fasciitis that occurred by penetrating freshwater trauma, such as fishing or wading in wet fields. Aeromonas species are responsible. The rapidity of the infectious process is similar to that of clostridial infection, but gas production is not a consistent feature. We report a patient who presented with fever, chills, and bullae on left forearm, despite antibiotics and wound debridement; the infection extend to mid humerus with a rapid onset of skin necrosis and progressive sepsis.
Dog bites in children: Epidemiology, microbiology, and penicillin prophylactic therapy Douglas A. Boenning, Gary R. Fleisher, Joseph M. Campos
DOI: http://dx.doi.org/10.1016/0735-6757(83)90032-3
The American Journal of Emergency Medicine , Vol. 1 , Issue 1 ,
Published in issue: July 1983
x Fifty-five children with nonfacial dog bites were prospectively studied. Patients were assigned to an experimental group receiving oral penicillin or a control group receiving local wound care only. Wounds were cultured for anaerobic and aerobic flora prior to cleansing. Results showed that most children were bitten on an extremity by a familiar dog, sustained simple injuries, and sought prompt medical attention. The overall infection rate was 3.6%, with one patient in each group developing an infection.
A comparison of the prophylactic uses of topical mupirocin and nitrofurazone in murine crush contaminated wounds Bulent Erdur, Gurkan Ersoy, Osman Yilmaz, Aydan Ozkutuk, Banu Sis, Ozgur Karcioglu, Ismet Parlak, Cuneyt Ayrik, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2007.03.030
The American Journal of Emergency Medicine , Vol. 26 , Issue 2 ,
Published in issue: February 2008
x This work was conducted to study the prophylactic efficacy of 2 topical antibiotic ointments (mupirocin and nitrofurazone) against wound infection in experimental contaminated crush wounds.
Hemorrhagic bullae are not only skin deep Cheng-Ting Hsiao, Leng-Jye Lin, Chi-Jei Shiao, Kuaing-Yu Hsiao, I-Chuan Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2007.07.014
The American Journal of Emergency Medicine , Vol. 26 , Issue 3 ,
Published in issue: March 2008
x Dermatologic complaints are common presentations in the ED. Hemorrhagic bullae are an example of dermatologic manifestation caused by variable etiologies. The life-threatening skin lesion usually is an external sign of a systemic or immune response stimulated by an infection, toxin, medication, or disease process. Although most patient with life-threatening skin lesion, such as hemorrhagic bullae, may appear ill, patients who present in the early course of illness may appear well but deteriorate rapidly.
