Children with knee monoarthritis from Lyme disease and septic arthritis can have similar presentations. The early disseminated stage of Lyme disease, when knee monoarthritis would typically present, occurs 3-5 weeks post tick bite and a history of tick bite may not be present. In addition, synovial fluid cell counts do not distinguish between septic and Lyme arthritis and bacterial cultures and Lyme disease serology may take several days to result.
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Pregnant women have a higher risk of venous thromboembolism (VTE) and an increasing D-Dimer over the course of pregnancy. The majority of clinical guidelines recommend the D-dimer should not be used to assess the risk of VTE in pregnant women. However, CTPE presents a radiation risk to both the mother and fetus. Unfortunately, most VTE studies exclude pregnant women.
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Acute acidemia is common in critically ill adult patients. Use of sodium bicarbonate infusion for the treatment of severe metabolic acidemia is controversial and understudied.
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A strategy of high-sensitivity cardiac troponins over short time intervals for the diagnosis of acute myocardial infarction has been recommended in European cardiology guidelines. It is unclear if the European strategy is generalizable to the US population. A strategy that identifies low risk patients early can lead to limited further diagnostic testing, ED length of stay,
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Pulmonary complications after opioid overdose include: non-cardiogenic pulmonary edema, aspiration pneumonia/pneumonitis and acute respiratory distress syndrome. Multiple mechanisms have been proposed for these complications. These complications have been described in opioid overdose both with and without Naloxone administration. The purpose of the study was to determine if higher doses of Naloxone are associated with an increased risk of pulmonary complications after opioid overdose.
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Lacerations are a common cause of visits to the pediatric emergency department. Laceration repair can be a traumatizing experience. The use of topical anesthetics may obviate the need for infiltrative anesthetics. This could result in less patient pain, may improve the rate of successful laceration repair and decrease the need for procedural sedation.
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Recommendations that “rest is best” for concussions are based on animal research and consensus opinion. Recent evidence suggests that strict limitation of activity may not be beneficial. A small clinical trial (n=88) of pediatric patients with acute concussion randomized patients to “strict rest” for 5 days and “usual care” defined as 1-2 days of rest and then a gradual return to activities.
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Head trauma is a leading cause of trauma related morbidity and mortality worldwide. Tranexamic acid (TXA) inhibits fibrinolysis and can decrease ongoing hemorrhage. In the CRASH-2 Trial, TXA given within 3 hours of injury was shown to decrease mortality from major extracranial injury (CRASH 2 Investigators, Lancet. 2010. PMID: 20554319). A subgroup analysis of the CRASH 2 study that included 270 patients who met criteria for trauma with concern for hemorrhage and a GCS <
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