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A 2-year-old girl with upper respiratory infection symptoms — Brain Teaser. Do you know the answer? April 18, 2019

Posted by Andy Jagoda, MD in : Brain Tease , add a comment

Test your knowledge and see how much you know about diagnosing and managing pediatric community-acquired pneumonia.


Did you get it right? Click here to find out!

The correct answer: B.

Earn CME for this topic by purchasing this issue.

Clinical Pathway for Management of Sexually Transmitted Diseases in the Emergency Department April 15, 2019

Posted by Andy Jagoda, MD in : Feature Update , add a comment

Sexually transmitted disease can cause severe outcomes for patients, their partners, and their unborn babies, and swift and accurate diagnosis and treatment is essential to reduce morbidity and minimize the potential public health risks.

Sexually transmitted diseases are a growing threat to public health, but are often underrecognized, due to the often nonspecific (or absent) signs and symptoms, the myriad diseases, and the possibility of co-infection. Emergency clinicians play a critical role in improving healthcare outcomes for both patients and their partners. Optimizing the history and physical examination, ordering appropriate testing, and prescribing antimicrobial therapies, when required, will improve outcomes for men, women, and pregnant women and their babies.

This clinical pathway will help you improve care in the management of patients with sexually transmitted diseases. Download now.

Clinical Pathway for Management of Sexually Transmitted Diseases in the Emergency Department

Clinical Pathway for Management of Pediatric Patients With Community-Acquired Pneumonia April 15, 2019

Posted by Andy Jagoda, MD in : Feature Update , add a comment

A significant challenge in the management of pediatric community-acquired pneumonia is identifying children who are more likely to have bacterial pneumonia and will benefit from antibiotic therapy while avoiding unnecessary testing and treatment in children who have viral pneumonia.

Worldwide, pneumonia is the most common cause of death in children aged < 5 years. Distinguishing viral from bacterial causes of pneumonia is paramount to providing effective treatment but remains a significant challenge. For patients who can be managed with outpatient treatment, the utility of laboratory tests and radiographic studies, as well as the need for empiric antibiotics, remains questionable.

Clinical Pathway for Management of Pediatric Patients With Community-Acquired Pneumonia

This clinical pathway will help you improve care in the management of pediatric patients with community-acquired pneumonia. Click here to download yours today.

15-year-old girl presents with irregular periods — Brain Teaser. Do you know the answer? February 26, 2019

Posted by Andy Jagoda, MD in : Brain Tease , 3comments

Test your knowledge and see how much you know about treating and managing adolescent gynecologic emergencies.


Did you get it right? Click here to find out!

The correct answer: A.

Earn CME for this topic by purchasing this issue. 

Clinical Pathway for Emergency Department Management of Abnormal Uterine Bleeding in Adolescent Patients February 18, 2019

Posted by Andy Jagoda, MD in : Feature Update , 1 comment so far

In the emergency department, gynecologic complaints are common presentations for adolescent girls, who may present with abdominal pain, pelvic pain, vaginal discharge, and vaginal bleeding. The differential diagnosis for these presentations is broad, and further complicated by psychosocial factors, confidentiality concerns, and the need to recognize abuse and sexual assault.

This clinical pathway will help you improve care in the management of abnormal uterine bleeding in adolescent patients. Download now.

Clinical Pathway for Emergency Department Management of Abnormal Uterine Bleeding in Adolescent Patients

Adolescent Gynecologic Emergencies. What do you do? February 14, 2019

Posted by Andy Jagoda, MD in : What's Your Diagnosis , 1 comment so far

You are then called to the resuscitation room for a 17-year-old girl who was found unresponsive at home. On examination, she is ill-appearing, lethargic, has cool distal extremities, normal heart sounds, and clear lungs, and her abdomen is soft but tender in the left lower quadrant. Her vital signs are: blood pressure, 80/40 mm Hg; heart rate, 130 beats/min; respiratory rate, 25 breaths/min; and oxygen saturation, 95% on room air. What are the immediate first steps in managing this patient? What testing is needed for evaluation and management? What is the appropriate disposition?

Case Conclusion:
The 17-year-old girl presented in shock. IV access was obtained quickly for fluid resuscitation. Bedside abdominal ultrasound revealed free fluid on the suprapubic view. The following laboratory tests were sent: hCG, CBC, complete metabolic panel, type and screen, and blood culture. Her hCG resulted positive, raising concern for ectopic pregnancy. After she was resuscitated, gynecology was consulted and noted an empty uterus and free peritoneal fluid on ultrasound, in spite of a serum hCG of 10,000 mIU/mL. The patient was quickly transferred to the operating room where an ectopic pregnancy complicated by hemoperitoneum was found.

Would you have done it different? Tell us how you would have handled this case.

A 12-year-old boy presents to the ED with a flulike illness — Brain Teaser. Do you know the answer? December 26, 2018

Posted by Andy Jagoda, MD in : Brain Tease , 1 comment so far

Test your knowledge and see how much you know about treating and managing suspected bioterrorism in pediatric patients.


Did you get it right? Click here to find out!

The correct answer: A.

Earn CME for this topic by purchasing this issue. 

 

Using chemoprophylaxis in a child aged 1 year — Brain Teaser. Do you know the answer? December 24, 2018

Posted by Andy Jagoda, MD in : Brain Tease , add a comment

Test your knowledge and see how much you know about treating and managing influenza in the ED.


Did you get it right? Click here to find out!

The correct answer: A.

Earn CME for this topic by purchasing this issue. 

 

10 Risk Management Pitfalls in the Management of Suspected Bioterrorism in the Pediatric Patient December 19, 2018

Posted by Andy Jagoda, MD in : Feature Update , add a comment

10 Risk Management Pitfalls in the Management of Suspected Bioterrorism in the Pediatric Patient

1. “This isn’t New York City or Washington, DC; we don’t live in a target area. Bioterrorism preparedness is not a high priority for my practice.” Bioterrorism events often occur without warning—at any time, in any place. Many bioterrorism agents are highly contagious and can spread to remote areas of the country, due to travel of infected persons or wide dispersal of aerosolized agents. It is every emergency clinician’s obligation to become familiar with bioterrorism agents.

2. “If a bioterrorism patient shows up, I will be able to rely on the infectious disease and infection control teams for recommendations.” Recognizing suspicious illness patterns is an important responsibility of front-line emergency clinicians. While infectious disease and infection control specialists provide specific expertise, the protection of patients and staff depends on adherence to recommended protocols as early as possible.

3. “There are so many different agents that could be biological weapons. Trying to prepare for all the possibilities is overwhelming.” Many resources in print and online can support the emergency clinician. The CDC publishes clinical guidelines and manages electronic applications to support clinical decision making. The AAP also provides online resources for bioterrorism issues pertaining to children. (See Table 2.)

4. “Yes, he triggered the screening tool, but we have no rooms to isolate this patient. Besides, it is very unlikely that this is bioterrorism.” Failure to properly isolate patients can put other patients and staff at risk for any contagious illness. It is important to put safety first.

5. “Where would a child get anthrax? I haven’t heard anything in the news.” Children have particular physiologic and developmental vulnerabilities that put them at higher risk of being victims of bioterrorism agents. Therefore, children may show symptoms before public officials are aware that there has been an outbreak.

6. “Managing a surge from a bioterrorism event is similar to managing a mass casualty. We should be able to use similar protocols” Bioterrorism agents are often highly contagious and require public health support beyond the scope of any single healthcare facility. Specific protocols are important to best recognize and respond to the threat of bioterrorism.

7. “All children should receive postexposure pro-phylaxis after exposure to a bioterrorism agent. It’s the right thing to do.” Apply the recommended guidelines for PEP as recommended by the CDC. Not all medications or vaccines are safe for children and they should be considered in the context of the potential risks to the child.

8. “Yes, there has been a spike in pneumonic tularemia in the ED, but it’s endemic to this area, so that shouldn’t be cause for concern.” Any unusual cluster of presentations of Category A bioterrorism agents should be cause for concern. The inhalational form of any Category A illness should also be a red flag, as the aerosolized form of these agents is the most likely mechanism used for a bioterrorism attack.

9. “I don’t know how I would be able to tell if a cluster of patients had these unusual symptoms. There are at least 8 other hospitals in this city. I don’t have time to call them all to find out if they are seeing similar presentations.” Coordination with your local public health resources is essential in rare disease outbreaks. Since 2001, biosurveillance systems have been used to track unusual outbreaks and serve as a resource for health systems.

10. “Even though I have suspicions that this case could be due to a bioterrorism agent, I don’t want to cause the laboratory staff to panic. I’ll just send the culture and wait for the results.” Laboratory personnel are at high risk for exposure from the highly contagious bioterrorism agents. Most Category A agents require special reagents and tests only available in secured public health laboratories. Communicating concerns early and using appropriate personal protective gear consistently are essential to prevent further outbreak of a highly contagious illness.

 

Treatment Pathway for Managing a Patient Who Presents to the ED With an Influenza-Like Illness December 17, 2018

Posted by Andy Jagoda, MD in : Feature Update , add a comment

Patients presenting to the ED with “influenza-like illness” (cough, sore throat, fever) are typical in the fall and winter. How can you tell whether a patient might have influenza and infect others with a potentially dangerous strain?  Influenza can present with a wide range of nonspecific clinical signs and symptoms, making ED management challenging.

This clinical pathway will help you improve care in the management of patients who preset with an influenza-like illness. Download now.

Clinical Pathway for Managing a Patient Who Presents to the ED With an Influenza-Like Illness

 

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Last Modified: 04-22-2019
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