American Journal of Emergency Medicine最新文献

Acquired palpebral ptosis (also called blepharoptosis, or ptosis) is an abnormally low-positioned upper eyelid and occasionally presents as a chief complaint to the emergency department. Due to the wide range of causes and spectrum of severity, emergency physicians must recognize and initiate appropriate diagnostic and treatment pathways to limit the risk of long-term complications in those affected. We report a case of a 19 year old healthy man who presented with a chief complaint of unilateral eyelid droop in the setting of three days of sinusitis symptoms. Neuroimaging revealed invasive sinusitis with leptomeningeal enhancement and extraconal subperiosteal abscess. He was treated with intravenous antibiotics, admitted to the hospital, and discharged home after 7 days. This uncommon cause of ptosis highlights the need for a broad differential diagnosis for this condition and recognition of uncommon complications of invasive sinusitis.

Introduction: Stercoral colitis is a rare but serious diagnosis which is associated with a high rate of morbidity.

Objective: This review highlights the pearls and pitfalls of stercoral colitis, including presentation, diagnosis, and emergency department (ED) management based on the available evidence.

Discussion: Stercoral colitis is an uncommon inflammatory condition of the distal large bowel and rectum resulting from accumulation of impacted stool and is associated with several complications including bowel ulceration, ischemia, perforation, peritonitis, and sepsis. Though most commonly present with abdominal pain and constipation, many patients present without typical symptoms requiring emergency clinicians to maintain high clinical suspicion, especially in patients at high risk for developing severe constipation. The diagnosis can be secured with cross-sectional radiography, including computed tomography of the abdomen and pelvis. ED management includes fluid resuscitation, initiation of a multimodal bowel regimen, and if indicated, initiation of parenteral antibiotics and consultation with a surgical specialist. Admission to the hospital should be considered for all patients with stercoral colitis.

Conclusions: An understanding of stercoral colitis can assist emergency clinicians in diagnosing and appropriately managing this high risk disease.

Introduction: Sepsis and septic shock are common conditions evaluated and managed in the emergency department (ED), and these conditions are associated with significant morbidity and mortality. There have been several recent updates in the literature, including guidelines, on the evaluation and diagnosis of sepsis and septic shock.

Objective: This is the first paper in a two-part series that provides emergency clinicians with evidence-based updates concerning sepsis and septic shock. This first paper focuses on evaluation and diagnosis of sepsis and septic shock.

Discussion: The evaluation, diagnosis, and management of sepsis have evolved since the first definition in 1991. Current guidelines emphasize rapid diagnosis to improve patient outcomes. However, scoring systems have conflicting data for diagnosis, and sepsis should be considered in any patient with infection and abnormal vital signs, evidence of systemic inflammation (e.g., elevated white blood cell count or C-reactive protein), or evidence of end-organ dysfunction. The clinician should consider septic shock in any patient with infection and hypotension despite volume resuscitation or who require vasopressors to maintain a mean arterial pressure ≥ 65 mmHg. There are a variety of sources of sepsis but the most common include pulmonary, urinary tract, abdomen, and skin/soft tissue. Examples of other less common etiologies include the central nervous system (e.g., meningitis, encephalitis), spine (e.g., spinal epidural abscess, osteomyelitis), cardiac (e.g., endocarditis), and joints (e.g., septic arthritis). Evaluation may include biomarkers such as procalcitonin, C-reactive protein, and lactate, but these should not be used in isolation to exclude sepsis. Imaging is a key component of evaluation and should be based on the suspected source.

Conclusion: There have been several recent updates in the literature including guidelines concerning sepsis and septic shock; an understanding of these updates can assist emergency clinicians and improve the care of these patients.