Peter Rosen

Cutaneous Abscesses: Anaerobic and Aerobic Bacteriology and Outpatient Management

Specimens from 135 cutaneous abscesses in outpatients were cultured anaerobically and aerobically. Of these, 4% were sterile and 29% yielded pure cultures, predominantly of Staphylococcus aureus. Aerobic species were isolated from all anatomic areas. Anaerobes were found with a frequency comparable to aerobes in all nonperineal areas except the hand. In contrast, abscesses in the perineal region contained a greater variety and frequency of anaerobes. Only two patients were febrile. All abscesses were treated with incision and drainage, and all healed without complication, including those 74% that were treated without adjunctive antibiotics. Primary management of cutaneous abscesses should be incision and drainage. In general, routine culture and antibiotic therapy are not indicated for localized abscesses in patients with presumably normal host defenses.

Life-support system: Emergency medical care for conventions

The life-support system described provides on-site emergency medical care for a designated group of people. It consists of a fixed subunit, a back-up emergency department; a temporary subunit, a life support station, and a mobile subunit, an ambulance and mobile medical personnel. A proposal for a life-support system for indoor conventions is presented with specifications of personnel, communications, supplies, registrant education and life-support team function. Results, critique, and discussion of a life-support station at the 1974 Annual ACEP/EDNA Scientific Assembly are presented.

Pulsus paradoxus as a parameter in treatment of the asthmatic

In 40 patients treated in the Billings Hospital emergency department for acute exacerbations of bronchial asthma, pulsus paradoxus was noted at presentation and at the time of admission to the hospital or discharge. No level of initial pulsus paradoxus predicting eventual admission was found. High initial pulsus paradoxus was more frequent in admitted patients. A correlation between the percent drop of pulsus paradoxus and success or failure of treatment was noted. Treatment failure was the most frequent criterion for admission.

Simple Febrile Convulsions

Simple febrile convulsions occur in otherwise normal children, aged six months to five years, with extracranial infection. Cerebrospinal fluid examination should be done on all children with their first febrile convulsion to rule out an underlying organic disease, especially purulent meningitis. Initial treatment includes antipyretics, tepid sponging and intramuscular phenobarbital. If a seizure recurs, the usual anticonvulsant measures should be carried out and, if prolonged, the patient should receive appropriated doses of diazepam or phenobarbital, intravenously. Patients with suspected epileptic convulsive disorders precipitated by fever, or those with seizures thought to be associated with underlying organic disease, should be hospitalized for further evaluation or treatment or both. Patients with simple febrile convulsions have a benign disorder and can be safely treated as outpatients.

Syphilis and pelvic inflammatory disease

Since screening every patient in the emergency department for venereal disease is impractical, we hypothesized that patients with the clinical diagnosis of pelvic inflammatory disease (PID) might be at higher risk and a group that should be screened. Seventy women with a clinical diagnosis of PID treated in our adult emergency department from July to November 1976 were screened for syphilis using three separate serologic tests: Venereal Disease Research Laboratory, fluorescent treponemal antibody absorption, and treponema pallidum hemagglutination. The incidence of positive serologies in our study group was significantly higher (11.4%) than that of 100 controls (4%). All patients with a clinical diagnosis of PID should be screened for syphilis using both FTA-Abs and TPHA tests, as well as a VDRL.

A method of triage within an emergency department

University of Chicago ED has developed a Triage Scheme composed of three categories: True Emergency, Urgent and non-emergency or ambulatory clinic. Then nurses were utilized but after trying first physicians, then nurses, with indifferent results, a group of ex-military corpsmen were utilized successfully. In 18 months following the programs inception 90,000 patient visits were recorded, of which some 8,000 were admitted. Less than 1% of the patients underwent secondary triage. It is felt that one key element is insistence on taking of vital signs on all persons presenting at the emergency department.

Diabetic emergencies: hypoglycemia and ketoacidosis.

Because hypoglycemia may be rapidly fatal it must be diagnosed and treated early. Ketoacidosis may be difficult to differentiate from hypoglycemia. The diagnosis, treatment and causes of both diabetic emergencies are described. Once rehydration is instituted, further management can be directed using appropriate laboratory and bedside studies that allow stabilization with a high degree of control.

Extratemporal facial nerve injury

Isolated traumatic facial nerve injury, frequently seen in wartime combat, may also be encountered among civilians. The clinical picture occurring as a result of such injury may be confusing because partial, or incomplete, damage to the peripheral nerve may mimic impairment of the central facial motor mechanism. In treating the patient with facial injury, life-threatening aspects of the injury must be assessed and stabilized first. Then, attention may be focused on the injured facial nerve, for which prompt surgical repair is the treatment of choice. Prior to surgery, the assessment of taste and hearing, as well as mastoid and skull x-ray films and electrodiagnostic tests are helpful in localizing the facial nerve injury.