Emergency medicine clinics of North America
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Sexual assault is a problem that permeates all socioeconomic classes and impacts hundreds of thousands in the United States and millions worldwide. Most victims do not report the assault; those that do often present to an emergency department. ⋯ This article discusses the emergency medicine approach to history taking, physical examination, evidence collection, chain of custody, psychological and medical treatment, and appropriate follow-up. Special circumstances discussed include intimate partner violence, male examinations, pediatric examinations, suspect examinations, and drug-facilitated assaults.
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Patients with altered renal function are frequently encountered in the emergency department (ED) and emergency physicians often play an important role in the evaluation and management of renal disease. Early recognition, diagnosis, prevention of further iatrogenic injury, and management of renal disease have important implications for long-term morbidity and mortality. This article reviews basic renal physiology, discusses the differential diagnosis and approach to therapy, as well as strategies to prevent further renal injury, for adult patients who present to the ED with renal injury or failure.
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Injury to the genitourinary (GU) tract occurs in up to 10% of all traumas, with the kidneys being the most frequently affected. Trauma to different areas of the GU tract can be caused in a variety of ways, and the diagnostics and management of the injuries vary widely depending on the mechanism and location. ⋯ However, significant morbidity can occur without prompt recognition and appropriate intervention. A basic understanding of urologic trauma is necessary for all emergency practitioners when caring for trauma patients.
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Emerg. Med. Clin. North Am. · Aug 2011
ReviewDiagnosis and management of urinary tract infection and pyelonephritis.
Urinary tract infections (UTIs) are the most common bacterial infections treated in the outpatient setting and range in severity from minimally symptomatic cystitis to severe septic shock in a wide array of patients. Diagnosis of uncomplicated cystitis can be inferred from history and physical, and confirmed by urinalysis. ⋯ Treatment can be further tailored according to severity of illness, analysis of individualized risk factors, and antimicrobial resistance patterns. This article discusses treatment options in light of bacterial resistance in the twenty-first century.
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Emerg. Med. Clin. North Am. · Aug 2011
ReviewEmergency department management of sexually transmitted infections.
Patients seeking treatment for sexually transmitted infections (STIs) account for a large number of emergency department (ED) visits per year. Despite the large volume of patients, STIs are often missed or treated inappropriately. ⋯ This practice leads to overtreatment of STIs; however, when weighed against the public health risk and complications of untreated disease, empiric treatment is recommended. This article provides an overview of STIs encountered in the ED and recommendations for their treatment.