Can J Emerg Med
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Lactate levels are increasingly used to guide resuscitation efforts. Some surgical literature suggests that tourniquet use during phlebotomy falsely elevates results, although studies in healthy volunteers have not demonstrated this. The purpose of this study was to determine in clinical practice whether tourniquet use during the drawing of a lactate results in significantly altered levels compared to the result of a level drawn without a tourniquet. ⋯ Tourniquet use appears to have no impact on measured lactate levels. Our findings suggest that current practices at many institutions regarding lactate collection are likely too stringent and should be changed.
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There is evidence to suggest that point-of-care ultrasound assessment of the lungs has a higher sensitivity and specificity than chest radiography for the diagnosis of pneumonia. It is unknown if the same is true for pneumonia complications. ⋯ An ultrasound of the patient's lungs was performed, and revealed a complex loculated fluid collection consistent with an empyema. A chest CT confirmed the diagnosis, and immediate percutaneous drainage was performed.
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Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation. ⋯ Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts.