History, Physical Examination, and Laboratory Findings Associated with Infection and the Empiric Treatment of Gonorrhea and Chlamydia of Women in the Emergency Department

We present a case of a 41-year-old woman who visited the emergency department (ED) with acute abdomen. She was diagnosed with perforated appendicitis and abscess formation on CT. She was treated conservatively with antibiotics and discharged. On control CT 3 months later, the appendix had healed, but signs of thickening of the terminal ileum were noticed and colonoscopy was performed, which was uneventful and showed no signs of inflammation. Twelve hours later, she developed pain in the right lower quadrant, followed by fever, and visited the ED. Physical examination and blood work showed signs consistent with acute appendicitis, and appendectomy was performed laparoscopically 6 hours later. The patient recovered remarkably shortly afterwards. Whether colonoscopy resulted in de novo appendicitis or exacerbated an already existing inflammation remains unknown. However, endoscopists should be aware of this rare, yet serious complication and consider it in the workup of post-colonoscopy abdominal pain.

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Empiric treatment of gonorrhea and chlamydia in the emergency department

Annals of Emergency Medicine ◽

10.1016/s0196-0644(99)80243-1 ◽

1999 ◽

Vol 34 (4) ◽

pp. S41-S42

Author(s):

DR Weist ◽

SJ Spear ◽

JM Bartfield

Keyword(s):

Emergency Department ◽

Empiric Treatment

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Recém-nascido com deficiência de glicerol quinase: um caso clínico

Scientia Medica ◽

10.15448/1980-6108.2018.3.31385 ◽

2018 ◽

Vol 28 (3) ◽

pp. 31385

Author(s):

Cristina Duarte P. V. G. Madureira ◽

Cláudia Teles-Silva ◽

Cláudia Melo ◽

Susana Gama de Sousa

Keyword(s):

Emergency Department ◽

Metabolic Acidosis ◽

Birth Weight ◽

Physical Examination ◽

Laboratory Tests ◽

Neonatal Period ◽

Glycerol Kinase ◽

Glutamic Pyruvic Transaminase ◽

Glycerol Kinase Deficiency ◽

Hypernatremic Dehydration

AIMS: To report the case of a newborn with glycerol kinase deficiency, in which an isolated mutation not yet described in the GK gene was identified.CASE DESCRIPTION: A neonate with 10 days of age was brought to the emergency department for refusal to feed with 24 hours of evolution. Physical examination showed a loss of 31% of birth weight and signs of dehydration. Laboratory tests revealed a metabolic acidosis with increased anion gap, creatinine 2.41 mg/dL, urea 306 mg/dL, hypernatremia (182 mEq/L), hyperkalemia (6.8 mEq/L), hyperchloremia (151 mEq/L), glutamic-oxalacetic transaminase 879 U/L, glutamic-pyruvic transaminase 243 U/L, triglycerides 725 mg/dL. Chromotagraphy of organic acids revealed hyperglycerolemia and glyceroluria compatible with glycerol kinase deficiency. The genetic study revealed a mutation not yet described: c.187T> C (p.S63P) as hemizygote status in the GK gene.CONCLUSIONS: The most frequent cause of hypernatremic dehydration in the neonatal period is maternal hypogalactia. In more severe cases of dehydration, other etiologies should be considered, including metabolic causes such as glycerol kinase deficiency. In this case a mutation not yet described in the GK gene was found.

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Herpes Zoster pada Anak – Laporan Kasus

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.10.1.2018.19005 ◽

2018 ◽

Vol 10 (1) ◽

Author(s):

Thigita A. Pandaleke ◽

Herry E. J. Pandaleke ◽

Ratna I. Susanti ◽

Julieta D. P. Dotulong

Keyword(s):

Herpes Zoster ◽

Physical Examination ◽

Primary Infection ◽

Giant Cells ◽

Lumbar Region ◽

Sensory Ganglia ◽

Laboratory Findings ◽

Varicella Zoster ◽

History Of ◽

The Right

Abstract: Herpes zoster (HZ) is an acute vesicular eruption caused by latent varicella zoster virus (VVZ) reactivation in sensory ganglia after primary infection. Its incidence increases with age and it is rarely found in children. We reported a case of 10-year-old male with blisters on the right side of his stomach and back 3 days ago. The patient was suffered from fever, common cold, and cough a week before, and had a history of varicella at 5 years old. Dermatologic status showed multiple vesicles on erythematous base at the anterior dan posterior sides of his right lumbar region. The Tzank test showed multinucletaed giant cells. Acyclovir resulted in significant improvement after 7- day therapy. Conclusion: Diagnosis of herpes zoster was based on anamnesis, physical examination, and laboratory findings. Antiviral drugs was aimed to reduce complications and viral shedding.Keywords: Herpes zoster, childAbstrak: Herpes zoster (HZ) merupakan erupsi vesikuler akut yang disebabkan oleh reaktivasi dari virus varisela zoster (VVZ) laten pada ganglia sensoris yang sebelumnya terpajan dengan infeksi primer varisela. Insiden HZ meningkat seiring pertambahan usia dan jarang ditemukan pada anak-anak. Kami melaporkan kasus seorang anak laki-laki, 10 tahun, dengan bintil-bintil berair di perut dan punggung sebelah kanan sejak 3 hari lalu. Riwayat demam, batuk dan pilek 1 minggu sebelum timbul lesi. Riwayat varisela pada usia 5 tahun. Status dermatologis ditemukan vesikel multipel berisi cairan jernih yang tersusun bergerombol di atas kulit yang eritema di regio lumbar dekstra anterior dan posterior. Tes Tzank memperlihatkan sel raksasa berinti banyak. Pasien diterapi dengan asiklovir oral selama 7 hari dan menunjukkan perbaikan yang bermakna. Simpulan: Anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang kasus ini khas untuk herpes zoster. Pemberian obat antiviral bertujuan untuk mengurangi komplikasi dan menurunkan viral shedding.Kata kunci: herpes zoster, anak

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Perichondritis: inspect the lobule

International Journal of Emergency Medicine ◽

10.1186/s12245-020-00310-z ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Eli Bress ◽

Jason E. Cohn

Keyword(s):

Emergency Department ◽

Physical Examination ◽

Marked Improvement ◽

Otitis Externa ◽

Left Auricle ◽

Case Presentation ◽

Physical Examination Finding ◽

Examination Finding ◽

History Of ◽

Caucasian Female

Abstract Case presentation This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule. Diagnosis The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged on an oral and otic fluoroquinolone. In this case, the diagnosis of perichondritis was made by a classic physical examination finding: erythema and edema with sparing of the fatty lobule. This key finding helps to distinguish perichondritis from otitis externa.

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Assessment and Optimization of the Empiric Treatment of Urinary Tract Infections in an Academic Emergency Department Observation Unit

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2019.12.021 ◽

2020 ◽

Vol 58 (2) ◽

pp. 203-210

Author(s):

Shivali K. Patel ◽

Ramy H. Elshaboury ◽

Ronak G. Gandhi ◽

Bryan D. Hayes ◽

Brian J. Yun ◽

...

Keyword(s):

Emergency Department ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Observation Unit ◽

Empiric Treatment ◽

Tract Infections

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Modification of Glasgow-Blatchford scoring with lactate in predicting the mortality of patients with upper gastrointestinal bleeding in emergency department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918783159 ◽

2018 ◽

Vol 26 (1) ◽

pp. 31-38

Author(s):

Zeynep Konyar ◽

Ozlem Guneysel ◽

Fatma Sari Dogan ◽

Eren Gokdag

Keyword(s):

Emergency Department ◽

Blood Transfusion ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Venous Blood ◽

Erythrocyte Suspension ◽

Laboratory Findings ◽

Significant Difference ◽

Lactate Levels ◽

Upper Gastrointestinal

Background: Gastrointestinal bleeding is a commonly seen multidisciplinary clinical condition in emergency departments which has high treatment cost and mortality in company with hospital admission. Risk evaluation before endoscopy is based on clinical and laboratory findings at patient’s emergency visit. Objective: The purpose of this study is to investigate the efficacy of “Glasgow-Blatchford scale + lactate levels” to predict the mortality of patients detected with gastrointestinal bleeding in the emergency department. Methods: A total of 107 patients with preliminary diagnosis of upper gastrointestinal bleeding included in the study after approval of the ethics committee were prospectively evaluated. Glasgow-Blatchford scale scores were calculated and venous blood lactate levels were assessed. Need for blood transfusion in the follow-up, the amount of transfusion, and mortality in the next 6 months were evaluated. Results: A statistically significant difference was found in mortality rates between the lactate and Glasgow-Blatchford scale cohorts in our study (p = 0.001 and p < 0.01, respectively). The mortality rate was significantly higher in the lactate(+) GBS(+) cases compared to the lactate(–) GBS(+), lactate(+) GBS(–), and lactate(–) GBS(–) cases compared to the bilateral comparisons (p = 0.004, p = 0.001, p = 0.001, and p < 0.01, respectively). There was a statistically significant relationship between the rate of erythrocyte suspension replacement in the cases according to Glasgow-Blatchford scale levels (p = 0.001 and p < 0.01, respectively). The incidence of erythrocyte suspension replacement was 7.393 times greater in patients with Glasgow-Blatchford scale score of 12 and above. Conclusion: Glasgow-Blatchford scale is highly sensitive to the determination of mortality risk and the need for blood transfusion in upper gastrointestinal bleeding. Glasgow-Blatchford scale with lactate evaluation is more sensitive and more significant than Glasgow-Blatchford scale alone. This significance provides us to establish “modified Glasgow-Blatchford scale.” In the future, studies which will use Glasgow-Blatchford scale supported by lactate could be increased and the results should be supported more.

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Experience-Based Guidance for Implementing a Direct Observation Checklist in a Pediatric Emergency Department Setting

Journal of Graduate Medical Education ◽

10.4300/jgme-d-11-00266.1 ◽

2012 ◽

Vol 4 (4) ◽

pp. 521-524 ◽

Cited By ~ 3

Author(s):

Michael FitzGerald ◽

Mia Mallory ◽

Matthew Mittiga ◽

Charles Schubert ◽

Hamilton Schwartz ◽

...

Keyword(s):

Emergency Department ◽

Physical Examination ◽

Direct Observation ◽

Task Force ◽

Educational Innovation ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Implementation Challenges ◽

Observation Methods ◽

Pilot Implementation

Abstract Background The importance and benefits of direct observation in residency training have been underscored by a number of studies. Yet, implementing direct observation in an effective and sustainable way is hampered by demands on physicians' time and shrinking resources for educational innovation. Objective To describe the development and pilot implementation of a direct observation tool to assess the history and physical examination skills of interns in a pediatric emergency department rotation. Methods A task force developed specific history and physical examination checklists for a range of common conditions. For the pilot implementation, 10 pediatric emergency medicine faculty attendings conducted the initial observations of 34 interns during the course of 1 academic year. At the conclusion of the pilot, the faculty observers and interns were interviewed to assess the feasibility and benefits of the process. Results A total of 33 of the 34 interns were observed during their rotation, with 26 of the observations conducted when the faculty observer was off shift, and it took approximately 20 minutes to complete each observation. In terms of learning benefits, interns and faculty observers reported that it facilitated clear and useful feedback and revealed gaps that would not have otherwise been identified. Faculty observers also mentioned that it helped them focus their teaching effort, built empathy with learners, and gave them a way to demonstrate a true concern for their learning. Conclusion Our results offer evidence for the feasibility and benefits of the direct observation checklists. The description of the implementation, challenges, and response to those challenges may help others avoid some of the common problems faced when implementing direct observation methods.

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P629 An uncommon cause for a frequent problem

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.313 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

H Miranda ◽

H Santos ◽

I Almeida ◽

M Santos ◽

C Sousa ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Emergency Department ◽

Ischemic Stroke ◽

Mitral Regurgitation ◽

Physical Examination ◽

Lupus Erythematosus ◽

Clinical Case ◽

Systemic Lupus ◽

Brain Ct ◽

Valvular Surgery

Abstract Introduction Libman-Sacks endocarditis is the most characteristic cardiac manifestation of the autoimmune disease systemic lupus erythematosus. Embolic phenomena, although uncommon, can also complicate valvular abnormalities and can cause neurologic and systemic complications. Case Report Man, 52 years old. Active smoker and with previous peptic ulcer history. Admitted to our emergency department due to sudden onset of confusion and incoherent speech. The physical examination showed only a Glasgow Coma Scale of 9 and the presence of expressive aphasia. Normal pulmonary and cardiac auscultation, without any other pathological findings on physical examination. Investigations showed a normal EKG, chest X-Ray and arterial-blood gas test. Blood test showed only the presence of thrombocytopenia, leucocytosis and renal disfunction. Brain CT revealed left-sided thalamic lacunar lesion. We assumed an ischemic stroke and admitted the patient in our emergency department. Neurological deterioration in the first 24h. A new brain CT was performed and showed multiple lesions in the middle cerebral artery territory. The echocardiogram was performed and showed the presence of multiples vegetations in both mitral leaflets with moderate to severe mitral regurgitation associated. We assume an ischemic stroke in the context of possible infective endocarditis. Medical therapy was optimized and empirical antimicrobial therapy was started (ampicillin + gentamicin + flucoxacillin). The patient never had fever during hospital stay. Duke criteria with only 1 major criteria. Persistent negative microbiological cultures with decreasing inflammatory parameters. Blood tests revealed a progressive increase level of INR (2-4) and renal function deterioration. Patient began with massive episodes of diarrhea and sudden decrease of haemoglobin level (sudden reduction of 3g/dl). Endoscopic studies were performed and multiple ischemic lesions of embolic etiology and small vessel disease had been described. Serology test revealed a positive IgG for Mycoplasma pneumoniae. Autoimmune lab tests showed positivity for lupus anticoagulant, anticardiolipin and anti–beta-2 glycoprotein I. We discussed the clinical case with our autoimmune experts team and the diagnosis of Systemic Lupus Erythematosus + Antiphospholipid Syndrome + Libman-Sacks Endocarditis was assumed. The patient started immunosuppressive therapy (Azathioprine + Mycophenolate Mofetil + Prednisolone). Despite the used therapy the size of vegetation persisted and mitral regurgitation didn’t improve. In this context, the patient was presented to our cardiac surgery team and underwent surgical intervention (vegetation removal + mitral valve repair). Evaluation one year after surgery revealed progressive functional and echocardiographic improvement. Conclusion The authors presented a didactic clinical case where valvular surgery was required thanks to a hemodynamically significant valvular dysfunction and embolic events.

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