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EM@3AM: Stercoral Colitis

EMDocs

Clinical exam: 2, 3, 9 Abdominal distension and tenderness Nausea and vomiting Stool present in the rectal vault Peritonitis may be accompanied by hemodynamic instability in the case of sepsis. 2-4, 6 If there is a concern for perforation or sepsis, surgical consultation, blood cultures, empiric antibiotics, and fluids are recommended.

EMS 98
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REBEL Core Cast 94.0 – SBO

RebelEM

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

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Dacryocystitis 

Don't Forget the Bubbles

Occasionally, lacrimal probing does not work, and an operation is needed. Sepsis: The spread of infection through the bloodstream, known as sepsis, is a critical condition that can lead to organ failure and death if not promptly treated. 2013 Jun 1:E158-62. 2021 Jan 2;40(1):18-23. Isaza G, Arora S. BMC ophthalmology.

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Diagnostics: Inflammatory Markers

Taming the SRU

Similarly, a 2013 meta-analysis of 6 studies with 1,006 patients published in the American Journal of Emergency Medicine showed neither CRP nor PCT are sufficient to rule-in or rule-out infective endocarditis, with PCT having a pooled sensitivity of 64% and specificity of 73% and CRP having a pooled sensitivity of 75% and specificity of 73% [40].

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The PROTECTION Trial – A Randomized Trial of Intravenous Amino Acids for Kidney Protection

RebelEM

Contemp Clin Trials. Epub 2022 Aug 28. PMID: 36038001 Levi TM, et al. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva. PMID: 24553510 Iacone R, et al. Macronutrients in Parenteral Nutrition: Amino Acids.

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Nephrolithiasis: Ultrasonography versus Computed Tomography

Northwestern EM Blog

Follow up CT should depend on the patient and ultrasound operator. Lastly the POCUS operators were ED physicians with training “recommended by ACEP.” were hospitalizations during f/u period; 26.4% vs. In this study, 40.7% of those in the POCUS group and 27% in the formal ultrasound group underwent subsequent CT. References Fwu, C.

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Traumatic Arthrotomy

Northwestern EM Blog

Violation of the joint capsule exposes the sterile intra-articular space to the environment which can result in a deep infection and sepsis. Figure 4: Traumatic arthrotomy on CT scan Source: Konda et al, 2013 Saline Load Test (SLT): Though not strongly backed by the literature, SLT is a standard tool used to assess for traumatic arthrotomy.