Publication Date: March 2020 (Volume 22, Number 3)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 3/01/2023.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 2 Pharmacology CME credits, subject to your state and institutional approval.
There are approximately 178 million cases of acute gastroenteritis annually in the United States, resulting in 473,000 hospitalizations and 5000 deaths. The vast majority of these cases are of viral etiology, self-limited, and require only supportive care; nonetheless, patients at high risk due to extremes of age or immunosuppression often require specific therapy to ensure resolution of symptoms. With this common ED presentation, there are many potential decisions related to resource utilization and management. This review provides a best-evidence approach to diagnosis and management supported by recent guidelines from the American College of Gastroenterology and the Infectious Diseases Society of America.
Excerpt From This Issue
You are working in the ED on a busy morning when you meet an otherwise healthy 42-year-old man reporting 2 days with 5 to 10 watery, nonbloody, unformed stools and persistent nausea, anorexia, and 1 to 2 episodes of nonbloody emesis each day. He is mildly tachycardic, but afebrile, and is normotensive. He is alert and conversant but appears mildly uncomfortable. He has dry mucous membranes and diffuse abdominal pain, with minimal tenderness on exam. He denies any recent hospitalizations, antibiotic use, foreign travel, or sick contacts. The patient requests that you “check blood work” and provide him with IV fluids and antibiotics for his infection. You wonder how best to educate him about the best use of his time and healthcare resources for his condition…
Your next patient is a 68-year-old woman with nonÐinsulin-dependent diabetes, hypothyroidism, and previous cholecystectomy, who resides in an assisted-living facility. She describes 1 day of diarrhea, with a fever of 38.9°C (102°F) this morning. She is tachycardic and febrile, but normotensive. She reports some generalized abdominal cramping and has a soft abdomen. She denies any recent hospitalizations, antibiotic use, or foreign travel. She tells you that she heard that one of the kitchen staff had to leave early yesterday because “he looked sick and kept vomiting.” You wonder if there is a connection between this history and the current presentation, as you ask the clerk to call the assisted-living facility…