The American journal of emergency medicine
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In July of 2017, after more than 15 months of negotiations, an academic teaching hospital in Boston failed to reach an agreement on the terms of contract renewal with its nursing union resulting in a strike. Replacement nurses were hired by the hospital to fulfill nursing duties for five days. ⋯ Although rare, nursing strikes do occur. These data may be useful for hospitals preparing for a strike.
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Acute appendicitis is one of the most common reasons for abdominal surgery. Stump appendicitis, one of the rare complications of appendicitis surgery, is an inflammation that develops in the remaining part of the appendix following surgery and occurs at a rate of 1/50.000 in cases with appendectomy. ⋯ Complications such as perforation and peritonitis can develop if an early diagnosis cannot be made. In this article, we present the first case of recurrent stump appendicitis reported in the literature as far as we are aware.
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Euglycemic diabetic ketoacidosis (EuDKA) associated with Sodium-Glucose Cotransporter-2 inhibitor (SGLT2i) use has been described but remains poorly understood. Data on Emergency Department (ED) presentation, resource utilization, and safety outcomes for these patients are lacking. We report a case series of patients diagnosed with EuDKA in the ED. ⋯ We report a case series of ED patients with EuDKA associated with SGLT2i use, and describe presentation characteristics, resource utilization, and safety outcomes. Emergency physicians should be aware of the association between SGLT2i use and EuDKA. An appropriate work-up should be pursued for patients taking an SGLT2i who present with symptoms suggestive of DKA, including nausea, vomiting, malaise, and altered mental status, or are noted to have an unexplained elevated anion gap metabolic acidosis.
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Case Reports
Rapidly fatal necrotizing soft tissue infection due to Clostridium sordellii in an injection drug user.
Clostridium sordellii infections are known to be associated with high morbidity and mortality. To date, only a small number of cases with necrotizing soft tissue infection due to C. Sordellii have been reported. ⋯ C. sordellii necrotizing soft tissue infections are particularly virulent. Even in the context of appropriate surgical debridement, these infections can be rapidly fatal. This case highlights the importance of high suspicion for C. sordellii as potential pathogen of necrotizing soft tissue infection in injection drug users.
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ED referral of older adults on the initiative of their family or paid live-in caregiver is common but not previously studied. ⋯ ED referral of older adults from the community by laymen who know the patient well (family or caregiver) is non-inferior to a referral by their PCP. ED physicians should regard non-physician ED presentations as seriously as a referral by a physician, pending confirmation in future studies.