Our purpose here is to highlight the areas where evidence is only as strong as the methodological constructs of the research used. This article is a narrative review of the available, limited evidence on which the one-hour bundle was based.
We conducted a retrospective cohort study among patients transported by emergency medical services to compare the use of ETCO2 ≤ 25 mmHg with qSOFA score of ≥ 2 as a predictor of mortality or diagnosis of severe sepsis in prehospital patients with suspected sepsis.
Spinal epidural abscess (SEA), a highly morbid and potentially lethal deep tissue infection of the central nervous system has more than tripled in incidence over the past decade. Early recognition at the point of initial clinical presentation may prevent irreversible neurologic injury or other serious, adverse outcomes. To facilitate early recognition of SEA, we developed a predictive scoring model.
The objective of this study was to determine the frequency of sterile pyuria in women with confirmed STIs, as well as whether the absolute number of leukocytes on microscopy or nitrite on urine dipstick correlated with positive urine cultures in patients with confirmed STIs. We also sought to determine how many patients with STIs were inappropriately prescribed a UTI antibiotic.
Infection with hepatitis A virus (HAV) causes a highly contagious illness that can lead to serious morbidity and occasional mortality. Although the overall incidence of HAV has been declining since the introduction of the HAV vaccine, there have been an increasing number of outbreaks within the United States and elsewhere between 2016 and 2017.
Author Affiliation Jillian Mongelluzzo, MD University of California, San Francisco, San Francisco General Hospital, Department of Emergency Medicine, San Francisco, California Brian Tu, BA University of California, San Francisco, San Francisco General Hospital, Department of Emergency Medicine, San Francisco, California Barbara Grimes, PhD University of California, San Francisco, San Francisco, Department of Epidemiology and Biostatistics, […]
The purpose of this study was to examine community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) carriage and infections and determine risk factors associated specifically with MRSA USA300.
The arboviruses that cause dengue, chikungunya, and Zika illnesses have rapidly expanded across the globe in recent years, with large-scale outbreaks occurring in Western Hemisphere territories in close proximity to the United States (U.S.). In March 2016, the Centers for Disease Control and Protection (CDC) expanded its vector surveillance maps for A. aegypti and A. albopictus, the mosquito vectors for these arboviruses.
Volume 17, Issue 4, July 2016
Lauren K. Whiteside, MD, MS et al.
Emerging infectious diseases often create concern and fear among the public. Ebola virus disease (EVD) and enterovirus (EV-68) are uncommon viral illnesses compared to influenza. The objective of this study was to determine risk for these viral diseases and then determine how public perception of influenza severity and risk of infection relate to more publicized but less common emerging infectious diseases such as EVD and EV-68 among a sample of adults seeking care at an emergency department (ED) in the United States.
Volume 17, Issue 3, May 2016
Kristi L. Koenig, MD et al.
First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2–7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED) personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other arthropod-borne diseases are the only concern, isolation (contact, droplet, airborne) is unnecessary. Zika is a reportable disease and thus appropriate health authorities must be notified. The modified 3I tool will facilitate rapid analysis and triggering of appropriate actions for patients presenting to the ED at risk for Zika.
Volume 16, Issue 7, December 2015.
Warren Wiechmann, MD
As hospitals across the nation were preparing for the
possibility of Ebola or Middle Eastern respiratory syndrome
(MERS-CoV) cases, healthcare workers underwent intricate
training in the use of personal protective equipment (PPE).
An Ebola or MERS-CoV patient requiring intubation places
a healthcare worker at risk for exposure to bodily secretions.
The procedure must be performed only after appropriate
PPE is donned.1
Intubating while wearing PPE is yet another
challenge identified in caring for these patients. Manual
dexterity and free movement decreases when wearing PPE,
and may increase length of time to successful intubation.
Volume 16, Issue 5, September 2015.
Kristi L. Koenig, MD.
Middle East respiratory syndrome (MERS) is a novel infectious disease caused by a coronavirus
(MERS-CoV) first reported in Saudi Arabia in September 2012. MERS later spread to other countries
in the Arabian Peninsula, followed by an outbreak in South Korea in 2015. At least 26 countries
have reported MERS cases, and these numbers may increase over time. Due to international
travel opportunities, all countries are at risk of imported cases of MERS, even if outbreaks do not
spread globally. Therefore, it is essential for emergency department (ED) personnel to be able to
rapidly assess MERS risk and take immediate actions if indicated. The Identify-Isolate-Inform (3I)
tool, originally conceived for initial detection and management of Ebola virus disease patients in the
ED and later adjusted for measles, can be adapted for real-time use for any emerging infectious
disease. This paper reports a modification of the 3I tool for use in initial detection and management
of patients under investigation for MERS. Following an assessment of epidemiologic risk factors,
including travel to countries with current MERS transmission and contact with patients with confirmed
MERS within 14 days, patients are risk stratified by type of exposure coupled with symptoms of fever
and respiratory illness. If criteria are met, patients must be immediately placed into airborne infection
isolation (or a private room until this type of isolation is available) and the emergency practitioner
must alert the hospital infection prevention and control team and the local public health department.
The 3I tool will facilitate rapid categorization and triggering of appropriate time-sensitive actions for
patients presenting to the ED at risk for MERS.
Volume 16, Issue 5, September 2015.
R. James Salway, MD, et al.
Seizures in human immunodeficiency virus (HIV) patients can be caused by a wide variety of
opportunistic infections, and, especially in developing countries, tuberculosis (TB) should be high
on the differential. In India, TB is the most common opportunistic infection in HIV and it can have
several different central nervous system manifestations, including intracranial tuberculomas. In this
case, an HIV patient presenting with new-onset seizure and fever was diagnosed with tuberculous
meningitis and multiple intracranial tuberculomas. The patient received standard TB medications,
steroids, and anticonvulsants in the emergency department and was admitted for further care.
Volume 16, Issue 2, March 2015
Kristi L. Koenig, MD et al.
Measles (rubeola) is a highly contagious airborne disease that was declared eliminated in the U.S. in the year 2000. Only sporadic U.S. cases and minor outbreaks occurred until the larger outbreak beginning in 2014 that has become a public health emergency. The “Identify-Isolate-Inform” tool will assist emergency physicians to be better prepared to detect and manage measles patients presenting to the emergency department. Measles typically presents with a prodrome of high fever, and cough/coryza/conjunctivitis, sometimes accompanied by the pathognomonic Koplik spots. Two to four days later, an erythematous maculopapular rash begins on the face and spreads down the body. Suspect patients must be immediately isolated with airborne precautions while awaiting laboratory confirmation of disease. Emergency physicians must rapidly inform the local public health department and hospital infection control personnel of suspected measles cases.