Infectious disease clinics of North America
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Infect. Dis. Clin. North Am. · Mar 2008
ReviewSevere sepsis and septic shock in the emergency department.
Increased attention has focused recently on the acute management of severe sepsis and septic shock, conditions that represent the end-stage systemic deterioration of overwhelming infection. Clinical trials have identified new therapies and management approaches that, when applied early, appear to reduce mortality. ⋯ Although many emergency departments (EDs) are now adopting treatment protocols for sepsis that are based on published treatment guidelines, recent research calls many of the initial recommendations into question, and validation trials of some of these approaches are ongoing. This article reviews the initial evaluation and treatment considerations of sepsis in the ED setting.
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Infect. Dis. Clin. North Am. · Mar 2008
ReviewEmergency department management of meningitis and encephalitis.
Bacterial meningitis and viral encephalitis are infectious disease emergencies that can cause significant patient morbidity and mortality. Clinicians use epidemiologic, historical, and physical examination findings to identify patients at risk for these infections, and central nervous system (CNS) imaging and lumbar puncture (LP) may be needed to further evaluate for these diagnoses. The diagnosis of bacterial meningitis can be challenging, as patients often lack some of the characteristic findings of this disease with presentations that overlap with more common disorders seen in the emergency department. This article addresses considerations in clinical evaluation, need for CNS imaging before LP, interpretation of cerebrospinal fluid results, standards for and effects of timely antibiotic administration, and recommendations for specific antimicrobial therapy and corticosteroids.
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Infect. Dis. Clin. North Am. · Mar 2008
ReviewAntimicrobial prophylaxis for wounds and procedures in the emergency department.
Emergency physicians are often confronted with situations in which a patient with an acute injury is at high risk for an infection. Although most traumatic wounds have a low risk for developing infection, certain types of high-risk trauma justify antimicrobial prophylaxis. This article reviews antimicrobial wound infection prophylaxis for high-risk traumatic wounds, including the prevention of rabies and tetanus. Prophylaxis to prevent infections related to invasive procedures in the emergency department is also addressed.
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Infect. Dis. Clin. North Am. · Mar 2008
ReviewManagement of skin and soft-tissue infections in the emergency department.
Skin and soft-tissue infections are among the most common infections encountered by emergency physicians. This article is written from the perspective of the initial evaluation and management of skin and soft-tissue infections in the emergency department. Management pitfalls and clinical dilemmas pertinent to emergency physicians that are not often encountered by infectious disease specialists are highlighted. Special emphasis is placed on the utility of wound and blood cultures, disposition, methicillin-resistant Staphylococcus aureus infections, animal and human bites, and necrotizing skin and soft-tissue infections.
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Infect. Dis. Clin. North Am. · Mar 2008
ReviewUrinary tract infections in the emergency department.
Urinary tract infection (UTI) is a commonly encountered clinical condition in the emergency department. Emergency physicians evaluate and treat UTIs in a wide spectrum of disease severity and patient populations. This article is written from the perspective of evaluating and managing UTIs in the emergency department. It highlights the pitfalls and clinical dilemmas pertinent to emergency physicians that are not often encountered by infectious disease specialists.