J Emerg Med
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The herpes B virus is a zoonotic agent that is endemic among macaque monkeys only, but can cause fatal encephalomyelitis in humans. ⋯ A 26-year-old female presented to a U.S. emergency department after being bitten by a wild macaque monkey. The emergency medicine team administered rabies immunoglobulin and rabies vaccine. The team also prescribed acyclovir for prophylactic coverage against herpes B, a deadly zoonotic agent that is endemic among macaque monkeys. A discussion of background, exposure, transmission, symptoms, treatment for herpes B, including latest data available, literature, and Centers for Disease Control and Prevention guidelines are included. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Zoonotic exposures can cause infectious diseases, which are unfamiliar and deadly. The emergency physician's knowledge of the association between the deadly herpes B infection and wild macaque monkey may expedite treatment and be instrumental in patient morbidity and survival.
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Adolescents and young adults account for about half of the annual diagnoses of sexually transmitted infections (STI) in the United States. Screening and treatment for STIs, as well as prevention, are needed in health-care settings to help offset the costs of untreated STIs. ⋯ One in 10 sexually active youth in the ED reported a prior diagnosed STI. Previous STI was significantly higher among females than males. ED providers inquiring about inconsistent condom use and previous STI among male and female adolescents may be one strategy to focus biological testing resources and improve screening for current STI.
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Comparative Study
Comparison of COMPUTED TOMOGRAPHY Image Quality Using Intravenous vs. Intraosseous Contrast Administration in Swine.
Vascular access is essential in managing patients with significant injuries. It is required for medications, fluids, blood products, and radiographic contrast administration. Generally, this is accomplished through peripheral intravenous (i.v.) cannulation. In some patients, however, i.v. cannulation may be difficult or impossible. Intraosseous (i.o.) access is an acceptable alternative for many uses during resuscitation. However, adequacy of vascular enhancement with i.o. administration of contrast has not been studied. ⋯ In this model, injection of contrast through a proximal humerus i.o. resulted in adequate enhancement of trauma-protocol CT images. Our results suggest that i.o. administration of contrast merits further investigation of its potential utility in patients when i.v. access would delay diagnostic evaluation.
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Medicaid expansion under the Affordable Care Act (ACA) is intended to provide a framework for increasing health care access for vulnerable populations, including the 1.2 million who experience homelessness each year in the United States. ⋯ Homeless persons report having less knowledge of the ACA than their housed counterparts, poor understanding of ACA qualification criteria, and limited access to phone and internet. ED-based outreach and education regarding ACA eligibility may increase their enrollment.
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Ambulatory care sensitive (ACS) conditions are health problems that could be prevented or ameliorated with adequate access to primary care services. ⋯ Almost one in seven U.S. pediatric ED visits may be preventable by quality primary care. Patients with public insurance and lower income are more likely than other groups to present with ACS conditions. Better access to and use of primary care services could reduce health care costs and relieve ED overcrowding.