Archives

Inadequate Sensitivity of Laboratory Risk Indicator to Rule Out Necrotizing Fasciitis in the Emergency Department

Volume 17, Issue 3, May 2016
Elizabeth Burner, MD et al.

Necrotizing fasciitis (NF) is a life-threatening infection with high mortality. Because NF can be misdiagnosed as a less lethal mimic, such as cellulitis and abscess, efforts have been made to identify clinical features that could help clinicians accurately diagnose NF and avoid delays to surgical debridement.1 Prior retrospective studies have shown certain laboratory values, particularly an extremely elevated leukocyte count and a low sodium concentration, are associated with NF.2 These abnormal values might help clinicians distinguish NF from less severe soft-tissue infections. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was developed in a large cohort of admitted patients to identify patients at higher risk for NF.3 Patients are assigned a LRINEC score based on serum sodium, glucose, creatinine, c-reactive protein (CRP), leukocyte count and hemoglobin. Scores range from 0 to 13; a score 6 or greater was associated with a high risk of NF, and a score of 8 or greater with a very high risk.

Read More

Tuberculous Pleural Effusion

Pleural effusions are a common finding in emergency departments, with cytologic analysis traditionally required for definitive diagnosis. This article describes a classic sonographic appearance of tuberculous pleural effusion.

Read More

Necrotizing Fasciitis of the Paraspinous Muscles

Necrotizing fasciitis (NF) is a rare and lethal soft tissue infection that requires urgent surgical intervention. It is most often found in the extremities occurring with precipitating trauma or in immunocompromised states. Signs and symptoms are often vague or missing making early diagnosis very difficult. Our patient presented with flank pain and altered mental status but no known precipitating factors. Computed Tomography showed gas within and around the right paraspinous muscle suspicious for NF. Given NF’s high lethality, early suspicion by emergency physicians of NF in patients with soft tissue infections or with systemic findings of unknown etiology is necessary.

Read More

To identify factors associated with culture-proven serious bacterial infection (SBI) and positive emergency department septic screening (EDSS) tests in children with bronchiolitis and to identify factors associated with the performance of EDSS.

To identify factors associated with culture-proven serious bacterial infection (SBI) and positive emergency department septic screening (EDSS) tests in children with bronchiolitis and to identify factors associated with the performance of EDSS.

Read More

Cecal Diverticulitis

A 56-year-old Hispanic male presented to the emergency department (ED) complaining of right lower quadrant abdominal pain for two days.

Read More

Sporotrichosis

A 25-year-old healthy Hispanic male agricultural laborer presented to the emergency department with six weeks of a painless raised lesion on the proximal thumb with occasional drainage of fluid, without history of injury.

Read More

Infected Thyroglossal Duct Cyst

A 23-year-old female presented to the emergency department (ED) with a five-day history of sore throat, body aches and 24 hours of throat swelling accompanied by globus sensation and hoarseness.

Read More

Incidence of Serious Bacterial Infections in Ex-premature Infants with a Postconceptional Age Less Than 48 Weeks Presenting to a Pediatric Emergency Department

Premature infants are at higher risk of developing serious bacterial infections (SBI). However, the incidence of SBI in ex-premature infants presenting to the emergency department (ED) remains undetermined. The objective of this study is to examine the incidence of SBI in ex-premature infants with a postconceptional age of less than 48 weeks presenting to a pediatric ED.

Read More

Complications of MRSA Treatment: Linezolid-induced Myelosuppression Presenting with Pancytopenia

Methicillin-resistant Staphylococcus aureus (MRSA) infections have grown to epidemic proportions in the United States. With the development of increasing drug resistance of MRSA to traditional antimicrobials, there has been a search for a more effective antibiotic treatment. Linezolid is one of the most effective oral medications used for outpatient treatment of MRSA infections. We present a case of pancytopenia after outpatient treatment with linezolid. Myelosuppression is a rare but serious side effect of linezolid of which emergency physicians need to be aware in order to provide early intervention.

Read More

Herpes Zoster Ophthalmicus

Herpes zoster is a common diagnosis in the emergency department (ED). Caused by the reactivation of the varicellazoster virus (VZV), zoster usually presents as a painful dermatomal rash. In addition to skin or mucosal involvement, VZV reactivation commonly affects the ophthalmic division of the trigeminal nerve and subsequently the eye. This manifestation is termed herpes zoster ophthalmicus (HZO). HZO is considered an ophthalmologic emergency, as sequelae often include severe chronic pain and vision loss. In order to ensure proper follow up and to minimize morbidity, the accurate and timely diagnosis of HZO in the ED is extremely important. While typically an easy diagnosis to make based on history and skin findings, occasionally HZO presents as an isolated ophthalmologic process that is difficult to distinguish from other more benign causes of a red eye.

Read More

A Case of Complicated Urinary Tract Infection: Klebsiella pneumoniae Emphysematous Cystitis Presenting as Abdominal Pain in the Emergency Department

This case report describes an atypical presentation of an atypical disease entity: Emphysematous Cystitis, a rapidly progressive, ascending urinary tract infection, in an emergency department (ED) patient whose chief complaint was abdominal pain and who had a urinalysis not consistent with the diagnosis of cystitis.

Read More

Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
Suite 640
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: editor@westjem.org

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.