J Emerg Med
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Randomized Controlled Trial
A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits.
Increasing prescription overdose deaths have demonstrated the need for safer emergency department (ED) prescribing practices for patients who are frequent ED users. ⋯ This RCT showed the effectiveness of a citywide ED care coordination program in reducing ED visits and controlled substance prescribing.
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Case Reports
A "Shark Encounter": Delayed Primary Closure and Prophylactic Antibiotic Treatment of a Great White Shark Bite.
Shark bites are rare but sensational injuries that are covered in the lay press but are not well described in the medical literature. ⋯ We present the case of a 50-year-old man who sustained two deep puncture wounds to his thigh from a great white shark in the waters surrounding Isla de Guadalupe off the coast of Baja California, Mexico, during a caged SCUBA dive. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We discuss our strategy of closing the wounds in a delayed primary fashion 24 hours after injury, our antibiotic choices, and the patient's course and review marine pathogens and appropriate antibiotic coverage.
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Synthetic cannabinoids are swiftly gaining popularity and have earned a reputation of being relatively safer than other illicit drugs. However, there is a growing body of literature associating thromboembolic events with their use. ⋯ A 32-year-old woman presented on four separate occasions with a new thromboemoblic event after smoking synthetic cannabinoids. She had no medical history, and over the span of 9 months she developed two kidney infarcts, pulmonary emboli, and an ischemic stroke. Each of these events occurred within 24 hours of smoking synthetic cannabinoids. During periods of abstinence, she remained free of thrombotic events. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This report shows that an association between thrombosis and the use of synthetic cannabinoids is reproducible and involves both venous and arterial thrombosis, suggesting activation of coagulation or inflammatory pathways. As the popularity of this drug continues to grow, we can expect to see a growing number of these cases. Synthetic cannabinoid use should be included in the differential diagnosis of young patients with no risk factors who present with venous or arterial thrombosis.
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Bacteremia affects 200,000 patients per year, with the potential for significant morbidity and mortality. Blood cultures are considered the most sensitive method for detecting bacteremia and are commonly obtained in patients with fever, chills, leukocytosis, focal infections, and sepsis. ⋯ Blood cultures are commonly obtained but demonstrate low yield in cellulitis, simple pyelonephritis, and community-acquired pneumonia. The Shapiro decision rule for predicting true bacteremia does show promise, but clinical gestalt should take precedence. To maximize utility, blood cultures should be obtained before antibiotic therapy begins. At least two blood cultures should be obtained from separate peripheral sites.