The American journal of emergency medicine
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Among the causes of limping gait in children, septic arthritis (SA) and transient synovitis (TS) are the 2 most likely etiologies. The aim of this study was to determine the medical histories, physical examinations, and other studies to use to create a clinical guideline for differential diagnosis between SA and TS in children in the emergency department (ED). The pediatric orthopedic emergency committee of our institution addressed the issue of developing a guideline for differential diagnosis. ⋯ A diagnostic guideline for evaluating SA and TS in children in the ED was achieved using combined empirical evidence together with expert opinion, potentially resulting in a diagnostic strategy to be incorporated into existing guidelines or used on its own.
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Ulinastatin is protective against organ dysfunction in severe disease. We investigated the extent of gastrointestinal tract injury and the potential protective effect of ulinastatin in a 2-hit porcine model of septic shock. ⋯ Gastrointestinal injury and abnormal energy metabolism are remarkable following septic shock. Ulinastatin can improve energy metabolism and ameliorate injury to the gastrointestinal mucosa in the early stage of septic shock.
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Observational Study
The effect of surgical consult in the treatment of abdominal pain in older adults in the ED.
The objective was to determine whether need for surgical consult contributes to delayed or reduced analgesic administration in older adults presenting to the emergency department with abdominal pain. ⋯ Need for abdominal surgical consult is associated with decreased administration of analgesics in older patients, possibly indicating a continued need to improve management in this setting. This difference, however, did not impact pain score reductions.
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The purpose of the present study was to investigate the diagnostic value of lactate for predicting bacteremia in female patients with acute pyelonephritis (APN). ⋯ The initial serum lactate level showed poor discriminative performance for predicting bacteremia in female patients with APN.