European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Observational Study
Impact of the diagnostic process on the accuracy of source identification and time to antibiotics in septic emergency department patients.
Timely administration of effective antibiotics is important in sepsis management. Source-targeted antibiotics are believed to be most effective, but source identification could cause time delays. ⋯ Diagnostic tests are associated with delayed administration of antibiotics to septic ED patients while increasing the diagnostic accuracy to only 68-85%. In one-third of septic ED patients, the choice of antibiotics could have been accurately determined solely on the basis of patient history and physical examination.
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Liberal oxygen therapy has been a cornerstone in the treatment of critically ill patients. Recently, awareness of hyperoxia toxicity has emerged. We investigated the partial pressure of oxygen in arterial blood (PaO2) in sepsis patients admitted to the emergency department treated with a reduced inspired oxygen fraction of 0.4 instead of 0.6-0.8. ⋯ Of the hyperoxic patients, 8% died in hospital versus 6% with normoxia. Less than 8% of patients had hypoxia with 10 l O2/min; 66% were hyperoxic. Titration of oxygen therapy to normoxia in the emergency department should be evaluated.
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Review Comparative Study
Are two penicillins better than one? A systematic review of oral flucloxacillin and penicillin V versus oral flucloxacillin alone for the emergency department treatment of cellulitis.
Flucloxacillin either alone or combined with penicillin V is still the first-line antibiotic drug of choice for the treatment of cellulitis in emergency departments (EDs) in Ireland. The rationale for this antibiotic regimen is their anti-staphylococcal and anti-streptococcal activity. ⋯ Despite its common use, there are no published randomized-controlled trials comparing flucloxacillin monotherapy with a combination of flucloxacillin and penicillin V in the ED management of cellulitis. We discuss existing European and North American prescribing rationale and current guidelines.
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Patients who have undergone a total laryngectomy have altered anatomy and physiology. This results in unique and specific issues that must be recognized in order to ensure that this group of patients experience appropriate care. This article looks at the current literature and attempts to highlight specific areas of concern, so that emergency care providers can deliver an equally high standard of care to this patient group as they do to others. ⋯ The results were analyzed to identify the most relevant articles that meet our objective. Articles were then organized into the different subheadings used within the article and reviewed. The most up-to-date articles or those that were in the opinion of the authors the most appropriate to convey our objective were included in our review.