Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The incidence of cutaneous abscesses has increased markedly since the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Injection drug use is a risk factor for abscesses and may affect the microbiology and treatment of these infections. In a cohort of patients hospitalized with cutaneous abscesses in the era of CA-MRSA, the objectives were to compare the microbiology of abscesses between injection drug users and non-injection drug users and evaluate antibiotic therapy started in the emergency department (ED) in relation to microbiologic findings and national guideline treatment recommendations. ⋯ Compared with non-injection drug users, cutaneous abscesses in injection drug users were less likely to involve S. aureus, including MRSA, and more likely to involve streptococci and anaerobes; however, MRSA was common in both groups. Antibiotic regimens started in the ED were discordant with national guidelines in over half of cases and often lacked activity against MRSA when this pathogen was present.
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The objective was to assess the relationship between emergency department (ED) admission rates for Medicare beneficiaries with chest pain and outcomes, specifically 30-day rates of acute myocardial infarction (AMI) and mortality. ⋯ Considerable variation exists across U.S. hospitals in ED admission rates for Medicare patients with chest pain. Hospitals that approach admissions more conservatively (i.e., higher admission rates) in this population have lower rates of AMI and mortality.
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Some subcutaneous foreign bodies (FBs) are not easily visualized during physical examination and may not be detected on radiographic evaluation. Ultrasound (US) is capable of visualizing FBs of varying compositions. Previous studies have examined the use of US to detect FBs in deceased animal or human tissue. This study used live anesthetized porcine tissue to more closely model clinical conditions. ⋯ Ultrasound was sensitive, specific, and accurate in identifying FBs in live anesthetized porcine tissue. Surrounding edema or hematoma 2 hours after placement was so infrequently observed that it was not possible to determine its influence on the test characteristics.
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The diagnosis of pulmonary embolism (PE) in the emergency department still poses difficulties because symptoms and signs are nonspecific. There is a need for more reliable noninvasive diagnostic tests to support clinical suspicion before the costly invasive procedures with complication risks still used in the diagnosis of PE. Signal peptide-CUB (complement C1r/C1s, Uegf, and Bmp1)-EGF (epidermal growth factor) domain-containing protein 1 (SCUBE1) is a novel, secreted cell surface protein expressed during early embryogenesis. The goal of this study was to compare the SCUBE1 levels between PE patients and healthy subjects and also investigate the value of SCUBE1 in the diagnosis of PE. ⋯ This preliminary study suggests that plasma SCUBE1 values have a good level of specificity for PE and may be of use in the diagnosis of PE. Further studies involving larger case series and also clinical studies are needed to corroborate these findings.