J Emerg Med
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Lyme disease is one of the most common vector-borne illnesses in the United States. It is caused by Borrelia burgdorferi infection transmitted via the Ixodes tick. Rarely, it can progress to early disseminated Lyme disease with cardiac or neurologic manifestations, or both. ⋯ A 41-year-old previously healthy man presented to the emergency department (ED) by ambulance after an episode of syncope. Electrocardiogram revealed right bundle branch block with borderline first-degree atrioventricular nodal block. During his admission he was noted to have night sweats and elevated procalcitonin. Infectious workup revealed positive Borrelia enzyme-linked immunosorbent assay. Further testing revealed positive Borrelia immunoglobulin M with negative immunoglobulin G, indicating a recent infection. Why should an emergency physician be aware of this? Lyme disease should be on the differential for patients presenting with vague, flu-like symptoms in the summer months in endemic areas. Treatment of early Lyme disease with doxycycline can prevent progression to secondary Lyme, which can present as a true cardiac or neurologic emergency.
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Observational Study
Peripheral Insertion of Pediatric Central Venous Catheters in Adults with Difficult I.V. Access.
Difficult intravenous access is a frequent occurrence in critical care and emergency medicine. Prior intravenous access, chemotherapy use, and obesity are a few factors associated with difficult access. Alternatives to peripheral access are often contraindicated, not feasible, or not readily available. ⋯ PIPCVC placement seems to be a feasible option in patients in whom peripheral intravenous access is difficult. The safety of this technique needs to be evaluated in prospective studies.
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Faculty development (FD) encompasses structured programming that aims to enhance educator knowledge, skill, and behavior. No uniform framework for faculty development exists, and academic institutions vary in their faculty development programming, ability to overcome barriers, resource utilization, and achievement of consistent outcomes. ⋯ EM faculty report generally high satisfaction with the overall faculty development they have received, although only half express satisfaction with their education-related faculty development. Faculty developers in EM may incorporate these results to inform future faculty development programs and frameworks.
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Observational Study
PREDICTION OF MULTIDRUG-RESISTANT BACTERIA IN URINARY TRACT INFECTIONS IN THE EMERGENCY DEPARTMENT.
Urinary tract infections (UTI) due to multidrug-resistant bacteria are a frequent reason for visiting the emergency department (ED). ⋯ The use of the predictive model evaluated is a useful tool in real clinical practice to improve the success of empirical treatment of patients presenting to the ED with a diagnosis of UTI and positive urine culture pending identification.
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Observational Study
A NOVEL EQUATION SUCCESSFULLY CALCULATES TIDAL VOLUMES FOR LUNG PROTECTIVE VENTILATION.
Early application of low-tidal-volume ventilation (LTVV) has been associated with improved outcomes in the emergency department (ED) and intensive care unit (ICU), but is not consistently applied. The perceived complexity of calculating an ideal body weight (IBW)-based tidal volume (Vt) may contribute to this disparity. We hypothesized that a simplified equation could successfully predict LTVV. ⋯ A novel equation successfully predicted a 6-8-mL/kg IBW Vt in a cohort of patients with height ≥ 60 inches.