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Defensive Medicine

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5001. Asthma (Follow-up)

to an inhaled glucocorticoid in the add-on therapy trial. [ ] The results of these two trials suggests that a leukotriene antagonist is equivalent to both comparison drugs with regard to asthma-related quality of life at 2 months, but equivalence was not proven at 2 years. A Cochrane review found that inhaled corticosteroids are superior to anti-leukotrienes when used as monotherapy in adults and children with persistent asthma. The superiority of inhaled corticosteroids is most pronounced in asthma (...) for medication in a 2003 meta-analysis of 75 randomized controlled trials by Abramson et al. [ ] Another study showed improved peak expiratory flow rate (PEFR) and decreased use of medications in a highly selected group of children, but only for the first year of therapy. Patients receiving subcutaneous immunotherapy (SCIT) demonstrated improved medical outcomes and cost savings in one study designed to evaluate the cost-effectiveness of SCIT in addition to symptomatic therapy (ST), compared with ST alone

2014 eMedicine Emergency Medicine

5002. Urinary Tract Infection, Female (Diagnosis)

(Fortaz, Tazicef) 500 mg IV or IM q8-12h for 7-14d Duration of therapy: shorter courses (7d) are reasonable if patient improves rapidly; longer courses (10-14d) are reasonable if patient has a delayed response or is hospitalized. Parenteral therapy can be switched to oral therapy once clinical improvement is observed. Contributor Information and Disclosures Author John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious (...) of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Mark Zwanger, MD, MBA Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University Mark Zwanger, MD, MBA is a member of the following medical societies: , , and Disclosure: Nothing to disclose. What would you like to print? What would you like to print? Sections Urinary Tract Infection (UTI) and Cystitis (Bladder Infection

2014 eMedicine Emergency Medicine

5003. Urinary Tract Infection, Male (Diagnosis)

Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center Richard H Sinert, DO is a member of the following medical societies: and Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference (...) the following: Intravenous (IV) antimicrobial therapy with a third-generation cephalosporin (eg, ceftriaxone, ceftazidime), a fluoroquinolone (eg, ciprofloxacin, levofloxacin, ofloxacin, norfloxacin), or an aminoglycoside (eg, gentamicin, tobramycin) (beware ototoxicity) Antipyretics Analgesics IV fluid resuscitation: To restore appropriate circulatory volume and promote adequate urinary flow Other medications used in the management of male UTIs—or etiologic conditions such as prostatitis; epididymitis

2014 eMedicine Emergency Medicine

5004. Tuberculosis (Diagnosis)

of drug-resistant TB is increasing worldwide. Anteroposterior chest radiograph of a young patient who presented to the emergency department (ED) with cough and malaise. The radiograph shows a classic posterior segment right upper lobe density consistent with active tuberculosis. This woman was admitted to isolation and started empirically on a 4-drug regimen in the ED. Tuberculosis was confirmed on sputum testing. Image courtesy of Remote Medicine (remotemedicine.org). See , a Critical Images (...) therapy consists of the following 4-drug regimens: Isoniazid Rifampin Pyrazinamide Either ethambutol or streptomycin [ ] Special considerations for drug therapy in pregnant women include the following: In the United States, pyrazinamide is reserved for women with suspected MDR-TB Streptomycin should not be used Preventive treatment is recommended during pregnancy Pregnant women are at increased risk for isoniazid-induced hepatotoxicity Breastfeeding can be continued during preventive therapy Special

2014 eMedicine Emergency Medicine

5005. Trichomoniasis (Diagnosis)

, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Reference Salary Employment Robert W Tolan Jr, MD Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine Robert W Tolan Jr, MD is a member of the following medical societies: , , , , , , , and Disclosure: Novartis Honoraria Speaking (...) Emergency Medicine Disclosure: Nothing to disclose. Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Martin Weisse, MD Program Director, Associate Professor, Department of Pediatrics, West Virginia University Martin Weisse, MD is a member of the following medical societies: , , and Disclosure: Nothing to disclose. Jeffrey M Zaks, MD Clinical Associate Professor

2014 eMedicine Emergency Medicine

5006. Transfusion Reactions (Diagnosis)

Medicine, Athens Regional Medical Center Eric M Kardon, MD, FACEP is a member of the following medical societies: , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Jeffrey L Arnold, MD, FACEP Chairman, Department of Emergency Medicine, Santa Clara Valley Medical (...) Reactions in Emergency Medicine Updated: Feb 29, 2016 Author: Eric M Kardon, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP Share Email Print Feedback Close Sections Sections Transfusion Reactions in Emergency Medicine Overview Background Patients with acute blood loss or symptomatic anemia frequently require blood replacement therapy in the emergency department (ED). Although blood replacement therapy is generally safe, it should be understood that certain risks accompany the transfusion

2014 eMedicine Emergency Medicine

5007. Toxoplasmosis (Diagnosis)

, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London Michael Stuart Bronze, MD is a member of the following medical societies: , , , , , , Disclosure: Nothing to disclose. Acknowledgements Joseph U Becker, MD Fellow, Global Health and International Emergency Medicine (...) , Stanford University School of Medicine Joseph U Becker, MD is a member of the following medical societies: , , , and Disclosure: Nothing to disclose. John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance John L Brusch, MD, FACP is a member of the following medical societies: and Disclosure: Nothing to disclose. Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor

2014 eMedicine Emergency Medicine

5008. Grief Support in the ED (Follow-up)

-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Robert Harwood, MD, MPH, FACEP, FAAEM Senior Physcian, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: , , , , , Disclosure: Nothing to disclose. Chief Editor Barry E Brenner, MD, PhD (...) , shock, anger, disbelieving, numbness, crying, or even with violence. [ ] The response of physicians and medical personnel must be adapted to the needs of the situation. Some common reactions that may need to be addressed include the following: [ ] Denial: This common personal defense mechanism allows assimilation of tragic information at a tolerable pace. Early phases of denial should be accepted. If denial persists beyond a few minutes, reiterate the facts. Be direct: use the words "died or dead

2014 eMedicine Emergency Medicine

5009. Tinea (Diagnosis)

Mityanand Ramnarine, MD, FACEP is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Eddy S Lang, MDCM, CCFP(EM), CSPQ Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family (...) . Combination of oral terbinafine and topical ciclopirox compared to oral terbinafine for the treatment of onychomycosis. J Dermatolog Treat . 2005. 16(5-6):327-30. . Bahamdan K, Mahfouz AA, Tallab T, et al. Skin diseases among adolescent boys in Abha, Saudi Arabia. Int J Dermatol . 1996 Jun. 35(6):405-7. . Brodell RT, Elewski BE. Clinical pearl: systemic antifungal drugs and drug interactions. J Am Acad Dermatol . 1995 Aug. 33(2 Pt 1):259-60. . Degreef HJ, DeDoncker PR. Current therapy of dermatophytosis

2014 eMedicine Emergency Medicine

5010. Toxicity, Heavy Metals (Diagnosis)

reactions in the human body, vitamin B-12 has a cobalt atom at its core, and hemoglobin contains iron. Likewise, copper, manganese, selenium, chromium, and molybdenum are all trace elements that are important in the human diet. Another subset of metals includes those used therapeutically in medicine; aluminum, bismuth, gold, gallium, lithium, and silver are all part of the medical armamentarium. Any of these elements may have pernicious effects if taken in quantity or if the usual mechanisms (...) -acetylcysteine. Contributor Information and Disclosures Author Adefris Adal, MD, MS Clinical Assistant Instructor, Resident Physician, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center Disclosure: Nothing to disclose. Coauthor(s) Sage W Wiener, MD Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital

2014 eMedicine Emergency Medicine

5011. Toxicity, Chlorine Gas (Diagnosis)

Medicine, Albert Einstein Medical Center Gerald F O'Malley, DO is a member of the following medical societies: , , , , , Disclosure: Received consulting fee from McNeil Pharmaceuticals for speaking and teaching. Coauthor(s) Robert Bassett, DO, FAAEM Fellow in Medical Toxicology, Department of Emergency Medicine, Einstein Medical Center; Clinical Assistant Professor of Emergency Medicine, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine Robert Bassett, DO, FAAEM is a member (...) . Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital Disclosure: Nothing to disclose. John T VanDeVoort, PharmD Regional Director of Pharmacy

2014 eMedicine Emergency Medicine

5012. Coping With the Death of a Child in the ED (Follow-up)

Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Robert Harwood, MD, MPH, FACEP, FAAEM Senior Physcian, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine Robert Harwood, MD, MPH (...) Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio Wayne Wolfram, MD, MPH is a member of the following medical societies: , , Disclosure: Nothing to disclose. Coauthor(s) Jane E Bradlaw, DO Attending Emergency Medicine Physician, Emergency Department, Porter Memorial Hospital Jane E Bradlaw, DO is a member of the following medical societies: Disclosure: Nothing to disclose. Specialty

2014 eMedicine Emergency Medicine

5013. Conjunctivitis (Follow-up)

Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine Edward Bessman, MD, MBA is a member of the following medical societies: , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Barry E (...) and may speed resolution. As with gonococcal infections, identify and treat patients' sexual partners. Ophthalmic antibiotics Ophthalmic antibiotics are used for infectious conjunctivitis. Therapy must cover all likely pathogens in the context of the clinical setting. However, when prescribing the antibiotic, the care provider must take into account that the incidence of methicillin-resistant Staphylococcus aureus (MRSA) has continued to increase in recent years. The US Food and Drug Administration

2014 eMedicine Emergency Medicine

5014. Diabetes Mellitus, Type 2 (Follow-up)

that medication therapy to reduce the HbA1c level to 7% or less results in reduced mortality or in decreased macrovascular complications, such as heart attack or stroke, compared with a reduction to about 8%. [ , ] However, experts from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) have expressed skepticism about the higher target, noting that the guidance statement does not take into account the cardiovascular disease benefits of newer drugs, which (...) themselves frequently reduce HbA1c levels. In response, a coauthor of the ACP statement observed that other guidelines have also not specifically accounted for these newer medications in their recommended HbA1c levels and that research on such drugs has primarily been in patients either with cardiovascular disease or at high risk of developing it. [ ] Next: Pharmacologic Therapy Early initiation of pharmacologic therapy is associated with improved glycemic control and reduced long-term complications

2014 eMedicine Emergency Medicine

5015. Dysbarism (Follow-up)

to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Eddy S Lang, MDCM, CCFP(EM), CSPQ Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill (...) simple or tension pneumothorax. Try to keep all diving gear with the diver. Previous Next: Medical Care Admission is rarely required for dysbarism issues. Pneumothorax, pneumomediastinum, pneumoperitoneum, or air embolism requires admission. Patients with signs of other dysbaric or decompression injuries require transfer to a facility with HBO capability. For individuals with symptoms that are more than minimal, consult a diving medicine specialist or HBO specialist to determine appropriateness

2014 eMedicine Emergency Medicine

5016. Domestic Violence (Follow-up)

) Jonathan Adler, MD, MS Instructor, Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital Jonathan Adler, MD, MS is a member of the following medical societies: , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Robert Harwood, MD (...) or sedating medications by prescribing them for anxiety, panic symptoms, or chronic pain syndromes that are actually psychiatric or somatic manifestations of abuse. The use or abuse of alcohol and other drugs appears to increase after physical abuse begins; in most people probably as a consequence of abuse rather than a cause. Previous Next: Deterrence/Prevention See the list below: Reportedly, at least 40% of domestic violence victims never contact the police. Of female victims of domestic violence

2014 eMedicine Emergency Medicine

5017. Blast Injuries (Follow-up)

Chairman for Operational Medicine, Department of Emergency Medicine and Hospitalist Services, Georgia Regents University Andre Pennardt, MD, FACEP, FAAEM, FAWM is a member of the following medical societies: , , , , , , , , Disclosure: Nothing to disclose. Coauthor(s) Eric J Lavonas, MD, FACEP Associate Director, Rocky Mountain Poison and Drug Center; Assistant Professor, University of Colorado School of Medicine Eric J Lavonas, MD, FACEP is a member of the following medical societies (...) : , , , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine David B Levy, DO

2014 eMedicine Emergency Medicine

5018. Breast Abscess and Masses (Follow-up)

, MD is a member of the following medical societies: American College of Academic International Medicine, , , , Disclosure: Nothing to disclose. Coauthor(s) Dalal H Alsaggabi, MD Postdoctoral Research Scientist/Fellow, Langone Medical Center, New York University School of Medicine Disclosure: Nothing to disclose. Alexandra R King, PharmD, DABAT Clinical Pharmacist, Emergency Medicine and Toxicology, Vidant Medical Center Alexandra R King, PharmD, DABAT is a member of the following medical societies (...) : , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Barry J Sheridan, DO Chief Warrior in Transition Services, Brooke Army Medical Center Barry J Sheridan, DO is a member of the following medical societies: Disclosure: Nothing to disclose. Chief Editor Jeter (Jay

2014 eMedicine Emergency Medicine

5019. Munchausen Syndrome (Follow-up)

Virginia Medical School; Attending Physician, Division of Emergency Medicine, Children's Hospital of The King's Daughters Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment What would you like to print? What would you like to print? Sections Factitious Disorder Imposed on Self (Munchausen's Syndrome) Find Us On About (...) helpful. Options include the following: Family therapy Cognitive-behavioral therapy Supportive psychotherapy There is little evidence to support the efficacy of any particular pharmacologic intervention in treating factitious disorder; however, the following principles should apply: Pharmacologic therapy may be indicated for concurrent psychiatric diagnoses Drugs may also be considered for treatment of the presenting symptoms Caregivers should routinely copy each other on every progress note

2014 eMedicine Emergency Medicine

5020. Millipede Envenomation (Follow-up)

A Lorber, MD, FAAEM, FACEP is a member of the following medical societies: , Disclosure: Nothing to disclose. Coauthor(s) Preeti Dalawari, MD, MSPH, FAAEM, FACEP Associate Professor, Director of Research, Department of Surgery, Division of Emergency Medicine, St Louis University School of Medicine; Attending Physician in Emergency Medicine, St Louis University Hospital Preeti Dalawari, MD, MSPH, FAAEM, FACEP is a member of the following medical societies: , , , Disclosure: Nothing to disclose (...) . Specialty Editor Board John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals John T VanDeVoort, PharmD is a member of the following medical societies: Disclosure: Nothing to disclose. Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

2014 eMedicine Emergency Medicine

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