Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2018
ReviewInfection Prevention for the Emergency Department: Out of Reach or Standard of Care?
The emergency department (ED) presents unique challenges to infection control and prevention. Hand hygiene, transmission-based precautions, environmental cleaning, high-level disinfection and sterilization of reusable medical devices, and prevention of health care-associated infections (catheter-associated urinary tract infection, ventilator-associated pneumonia, central line-associated bloodstream infection) are key priorities in ED infection prevention. Effective and sustainable infection prevention strategies tailored to the ED are necessary and achievable. Emergency clinicians can and already play an invaluable role in infection prevention.
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Emerg. Med. Clin. North Am. · Nov 2018
ReviewSkin and Soft Tissue Infections in the Emergency Department.
This article covers the diagnosis and treatment of skin and soft tissue infections commonly encountered in the emergency department: impetigo, cutaneous abscesses, purulent cellulitis, nonpurulent cellulitis, and necrotizing skin and soft tissue infections. Most purulent infections in the United States are caused by methicillin-resistant Staphylococcus aureus. ⋯ Nonpurulent infections are usually caused by streptococcal species and initial empiric antibiotics need not cover methicillin-resistant Staphylococcus aureus. For uncommon but potentially lethal necrotizing skin and soft tissue infections, the challenge is rapid diagnosis in the emergency department and prompt surgical exploration and debridement.
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Infective endocarditis (IE) is an uncommon infection of cardiac valves associated with bacteremia. It increasingly affects elderly patients with chronic disease and artificial cardiac devices. ⋯ IE carries potential to cause significant morbidity and mortality through its impact on cardiac function and from embolic complications. Blood cultures prior to antibiotics and obtaining prompt echocardiography are key diagnostic steps, followed by proper selection of empiric antibiotics and, in many cases, collaboration with infectious disease, cardiology, and cardiothoracic surgery specialists.
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Emerg. Med. Clin. North Am. · Nov 2018
ReviewThe Emergency Department Diagnosis and Management of Urinary Tract Infection.
Urinary tract infection (UTI) is a common infection seen in the emergency department. The spectrum of UTI includes simple versus complicated infection and lower versus upper UTI. No one history or examination finding is definitive for diagnosis. ⋯ Imaging often is not required. Most patients with simple cystitis and pyelonephritis are treated as outpatients. A variety of potentially dangerous conditions may mimic UTI and pyelonephritis.
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Emerg. Med. Clin. North Am. · Nov 2018
ReviewBiothreat Agents and Emerging Infectious Disease in the Emergency Department.
The challenges faced by the emergency physician with recognizing and treating category A biothreat agents and emerging infectious disease are summarized and reviewed.