Daniel Runde

Pediatric urinary tract infection: does the evidence support aggressively pursuing the diagnosis?

The epidemiology of pediatric fever has changed considerably during the past 2 decades with the development of vaccines against the most common bacterial pathogens causing bacteremia and meningitis. The decreasing incidence of these 2 conditions among vaccinated children has led to an emphasis on urinary tract infection as a remaining source of potentially hidden infections in febrile children. Emerging literature, however, has led to questions about both the degree and nature of the danger posed by urinary tract infection in nonverbal children, whereas the aggressive pursuit of the diagnosis consumes resources and leads to patient discomfort, medical risks, and potential overdiagnosis. We review both early and emerging literature to examine the utility and efficacy of early identification and treatment of urinary tract infection in children younger than 24 months. We conclude that in well children of this age, it may be reasonable to withhold or delay testing for urinary tract infection if signs of other sources are apparent or if the fever has been present for fewer than 4 to 5 days.

An Inexpensive and Easy Simulation Model of Ocular Ultrasound That Mimics Normal Anatomy as Well as Abnormal Ophthalmologic Conditions

We have constructed a simple and inexpensive simulation model for the educational instruction of health care providers to detect normal and abnormal ocular conditions in the bedside emergency setting. Such a training model serves to increase the comfort level in performing ocular ultrasound examinations and can increase the accuracy of examination interpretation. Ophthalmologic examinations can be difficult in the emergency setting, and ultrasound has become a useful tool in the diagnosis of emergent ocular conditions.

Can Multidetector Computed Tomography Rule Out Left Atrial Thrombus in Patients With Atrial Fibrillation

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Emergency department rectal temperatures in over 10 years: A retrospective observational study

BACKGROUND: Fever in patients can provide an important clue to the etiology of a patients symptoms. Non-invasive temperature sites (oral, axillary, temporal) may be insensitive due to a variety of factors. This has not been well studied in adult emergency department patients. To determine whether emergency department triage temperatures detected fever adequately when compared to a rectal temperature. METHODS: A retrospective chart review was made of 27 130 adult patients in a high volume, urban emergency department over an eight-year period who received first a non-rectal triage temperature and then a subsequent rectal temperature. RESULTS: The mean difference in temperatures between the initial temperature and the rectal temperature was 1.3 °F (P<0.001), with 25.9% of the patients having higher rectal temperatures ≥2 °F, and 5.0% having higher rectal temperatures ≥4 °F. The mean difference among the patients who received oral, axillary, and temporal temperatures was 1.2 °F (P<0.001), 1.8 °F (P<0.001), and 1.2 °F (P<0.001) respectively. About 18.1% of the patients were initially afebrile and found to be febrile by rectal temperature, with an average difference of 2.5 °F (P<0.001). These patients had a higher rate of admission (61.4%, P<0.005), and were more likely to be admitted to the hospital for a higher level of care, such as an intensive care unit, when compared with the full cohort (12.5% vs. 5.8%, P<0.005). CONCLUSIONS: There are significant differences between rectal temperatures and non-invasive triage temperatures in this emergency department cohort. In almost one in five patients, fever was missed by triage temperature.

Short answer question case series: a dangerous cause of dyspnoea

A 52-year-old man with hepatitis C and a remote history of recreational drug abuse presents with several days of shortness of breath, cough and malaise. He was seen at an outside hospital and diagnosed with pneumonia given his cough and shortness of breath. Subsequently, he was seen again and found to have a small abscess of his arm that was drained. On review of systems, he endorses nausea and generalised weakness but denies abdominal pain, chest pain, numbness, fever, headache or dizziness. On physical exam, he is afebrile but tachypnoeic, has decreased breath sounds at the bases, and has an appropriately healing incision site. Neurologically, he had drooping eyelids, decreased ability to adduct his right eye, blurred vision, a normal sensory exam and 4/5 diffuse muscle strength. He may have had worse proximal muscle strength, but this was difficult to distinguish due to poor effort. 1. What is the differential diagnosis for this patient? 2. How should this patient be evaluated? …