The American journal of emergency medicine
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Multicenter Study Observational Study
Sensitivity of a bedside reagent strip for the detection of spontaneous bacterial peritonitis in ED patients with ascites.
To determine the sensitivity of a highly sensitive bedside leukocyte esterase reagent strip (RS) for detection of spontaneous bacterial peritonitis (SBP) in emergency department (ED) ascites patients undergoing paracentesis. ⋯ Bedside use of the RS in ED ascites patients demonstrated high sensitivity for SBP. Given the wide confidence intervals, we cannot currently recommend it as a stand-alone test. We recommend further study with a larger number of SBP patients, potentially combining a negative RS result with low clinical suspicion to effectively rule out SBP without formal laboratory analysis.
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Letter Multicenter Study
Cost-related medication nonadherence among elderly emergency department patients.
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Ultrasound has been increasingly utilized for the identification of endotracheal tube (ETT) location after an intubation attempt, particularly among patients in cardiac arrest. However, prior studies have varied with respect to the choice of transducer and no studies have directly compared the accuracy between transducer types. Our study is the first to directly compare the accuracy of ETT confirmation between the linear and curvilinear transducer. ⋯ The diagnostic accuracy of ultrasound for ETT confirmation did not significantly differ between ultrasound transducer types, but the curvilinear transducer was associated with a longer time to confirmation and lower operator confidence. Further studies are needed to determine if the accuracy would change with more novice providers or in specific patient populations.
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Case Reports
An alternative plane block for multiple rib fractures: Rhomboid Intercostal and Sub-Serratus block (RISS).
Rib fractures are a common injury, which occur after severe blunt chest trauma. Sufficient and early pain control is essential to avoid respiratory complications. ⋯ The Rhomboid Intercostal and Sub-Serratus (RISS) block can be utilized for pain control in patients with multiple rib fractures. We report two cases of patients with multiple rib fractures in which pain reduction was achieved with application of the RISS block.
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We report a patient with a massive hydroxychloroquine overdose manifested by profound hypokalemia and ventricular dysrhythmias and describe hydroxychloroquine toxicokinetics. ⋯ We present a massive hydroxychloroquine overdose treated with early intubation, activated charcoal, epinephrine, high dose diazepam, aggressive electrolyte repletion, and lidocaine. The apparent 11.6 hour half-life of hydroxychloroquine was shorter than previously described.