ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Health professionals practicing in emergency department settings must be cognizant of common and life‐threatening infectious diseases that are encountered on a continual basis. The appropriate approach to initial evaluation, clinical diagnosis, and therapy is important in the care of such patients who present with various infectious diseases. The recognition of clinical clues, use of suitable diagnostic studies, decisions to hospitalize, the choice between oral and parenteral antimicrobial therapy, and disease reporting are key aspects of the emergency medicine approach to infectious diseases.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Serious and life‐threatening infections of the central nervous system (CNS) are frequently encountered in emergency departments (ED) and are associated with increased morbidity and mortality. CNS infections such as bacterial meningitis can often be rapidly progressive, resulting in permanent sequelae in a relatively short period of time. Although the availability of a variety of antibiotics has presumably made bacterial meningitis potentially curable, morbidity and mortality from this disease remains unacceptably high. (Quagliarello. VJ, Scheld WM. Treatment of bacterial meningitis.N Eng J Med.2001;336:708‐716). Hence, emergency medicine physicians must maintain a high index of suspicion for possible bacterial meningitis in patients who present to the ED with 1 or more of the following signs and symptoms: fever, headache, meningismus, altered level of consciousness, seizures, and neurological deficits, in order to enable the rapid recognition and prompt initiation of appropriate empiric broad‐spectrum antimicrobial therapy. This article will highlight the epidemiologic trends, discuss the etiology and pathogenesis, clinical manifestations, diagnosis, and practical guidelines for the initiation of appropriate empiric antimicrobial regimens, and address controversial therapeutic adjuncts relating to the treatment of adult patients with bacterial meningitis.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;The anatomy of the head and neck is complex with many contiguous spaces. As a result, infections in one anatomical region may easily spread to involve other anatomical regions, including the pharynx, eye, and brain. This may lead to devastating results, including airway obstruction, blindness, and altered mental status with cranial neuropathies. We present some of the serious infections that affect patients in this confined space with a discussion of etiologies and treatments.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Acute skin and soft tissue infections are commonly encountered in the emergency room setting. The vast majority of patients with simple skin and soft tissue infections such as folliculitis, furunculosis, and carbuncles may generally be managed in the outpatient setting. Some of these patients may occasionally present with fever, chills, or inability to tolerate oral medications and warrant admission to the hospital. Patients with associated diabetes mellitus, acquired immunodeficiency syndrome, malignancies, and other forms of immune compromise are susceptible to severe skin and soft tissue infections. Life‐threatening infections such as infection of deep spaces of the neck and necrotizing fasciitis presenting with minimal warning signs or symptoms are on occasion encountered in the emergency room and necessitate prompt diagnosis and the rapid initiation of surgical and medical therapy. Emergency room physicians should familiarize themselves with the diagnosis and management of such life‐threatening illnesses. This article discusses skin and soft tissue infections commonly seen in emergency room setting.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Infective endocarditis (IE) is a potentially life‐threatening infection with complex pathogenesis and evolving epidemiology. It presents unique diagnostic and therapeutic challenges, requires a high index of suspicion for timely recognition, and causes high morbidity and mortality. The presence of an underlying valvular heart disease, injection drug use, and the prosthetic valves are important predisposing risk factors for IE. Streptococci and staphylococci are the predominant organisms, recovered in ˜80% of patients. Improved echocardiographic techniques, antibiotic treatment regimens, and early surgical intervention have improved the outcome in patients with IE. Aggressive diagnostic and therapeutic approaches are mandatory for a favorable outcome of IE.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Respiratory tract infections are some of the most common illnesses that lead to emergency room visits. In the era of human immunodeficiency virus epidemic, emergency room physicians often encounter patients with pulmonary tuberculosis,Pneumocystis cariniipneumonia, and fungal pneumonia. Familiarity with signs and symptoms of pneumonia, the ability to assess severity of illness, and choice of appropriate antibiotic therapy are skills required in the emergency room setting.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Acute infectious diarrhea is extremely common, but may sometimes pose life‐threatening challenges. Dehydration, especially in the elderly or young patients, may precipitate renal or cerebral damage, and bloody diarrhea treated inappropriately with antimotility agents or certain antimicrobial agents can increase the risk of potentially fatal hemolytic uremic syndrome with Shiga toxin producing enterohemorrhagicEscherichia coli.Hence, it is imperative that the emergency room physician understand syndromes and risks that enable prompt diagnosis in selected cases and appropriate (usually oral) rehydration in all.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Urinary tract infection is a common infection in patients presenting to the emergency department. Appropriate management requires recognition of different presentations, including acute uncomplicated urinary tract infection, acute nonobstructive pyelonephritis, complicated urinary tract infection, and asymptomatic bacteriuria. Antimicrobial selection, duration of therapy, and investigations will differ for different clinical presentations. The severity of clinical presentation will determine whether parenteral or oral therapy is appropriate, and whether hospitalization or short‐term observation is desirable.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Sepsis or septic shock is the fourth leading cause of long‐stay intensive care admissions. Death may occur despite antimicrobial therapy. The incidence of mortality from sepsis has increased over the last one and a half decades, presumably due to an aging population, an increase in the number of invasive procedures performed, and possibly alterations in the infecting microorganisms. In fact mortality has been reported to be as high as 40%. The main challenge is the early identification of one or more possible infectious etiologic agent(s) that will enable prompt institution of appropriate antimicrobial therapy. In the last 2 decades, understanding of the pathways, mediators, feedback loops, and interactions involved in the pathogenesis of sepsis and organ failure has advanced profoundly. Thus the aim of therapeutic intervention for sepsis is to rebalance the complex series of interrelated inflammatory mediators, in which their down‐regulation might benefit the patient. The ultimate aim is to prevent sepsis‐related multiple organ failure, the primary causes of death, and therefore improve both survival rates and quality of life and, incidentally, decrease hospital resource utilization. Toward that effort, this chapter will review terminology associated with sepsis and septic shock, the general diagnostic approach to shock, discuss current treatment options, and offer possible explanations for negative trial results so far.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID