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le than MEWS in determining the prognosis of pre-hospitalization sepsis.

Although qSOFA and MEWS are clinical scores used to identify septic patients outside the critical care unit, we believe that patients already diagnosed with sepsis can be assessed with qSOFA and MEWS prior to hospitalization to predict intensive care hospitalization and mortality. qSOFA was found be more valuable than MEWS in determining the prognosis of pre-hospitalization sepsis.

The aim of this study is to investigate the influence of local anesthetic (LA), operator experience level and needle type on patient procedural pain in relation to diagnostic lumbar puncture (LP).

LP was performed with either a 22 gauge traumatic needle (22 TN) or a 22 gauge atraumatic needle (22 ATN). Immediately after LP patients documented a procedural pain score (PPS) on a 10-point Likert scale. Use of LA, needle type, anesthetic time interval (ATI), number of needle insertions and the LP operator experience level were registered. ATI was defined as the time from administration of LA to first needle insertion.

104 patients had the LP procedure performed by 66 physicians (40 novices and 26 experienced physicians). Patients having the procedure performed by novices had a lower PPS of 2.56 if LA was administered compared to a higher PPS of 5.80 if LA was not administered (P = .046). Among experienced physicians there was no difference in PPS regardless of administration of LA. If novices administered LA, patient PPS was equal to patients having the procedure performed by an experienced operator. If novices performed the procedure with a 22 TN PPS decreased with increasing ATI (P = .01). No similar correlation was identified with the 22 ATN.

Our study suggests that LP operator experience level, the needle type used and ATI may influence patient PPS. Further studies are necessary for final conclusions. These studies must consider these factors to avoid fault conclusions.

Our study suggests that LP operator experience level, the needle type used and ATI may influence patient PPS. Further studies are necessary for final conclusions. These studies must consider these factors to avoid fault conclusions.

Clostridioides difficile infection (CDI), characterized primarily by diffuse diarrhea in the setting of recent healthcare and antibiotic exposure, maintains significantly high rates of diagnosis in the U.S., even in the emergency department (ED). Recent updates in the literature concerning CDI should be considered for effective clinical practice in the ED setting.

This narrative review provides an evidence-based summary of current data for the ED-based evaluation and management of CDI.

Substantial literature on the risk factors, diagnostic criteria, and treatment regimens have recently published concerning CDI. These studies include evaluation of risks associated with specific antibiotic classes, demonstrating that even single doses of antibiotics pose significant risk of CDI. Disproportional increases in elderly CDI rates show particular vulnerability in this population. Updated literature reveals presenting symptoms with wide ranges in rates of diarrhea, abdominal pain, fever, and nausea with vomiting. In some patients diarrhea may be altogether absent, clouding clinical suspicion. Classification primarily centers on a non-severe/severe division from the IDSA. Treatment has largely shifted away from metronidazole as a first-line antibiotic, instead focusing on oral vancomycin and fidaxomicin, even for an initial episode of CDI in an uncomplicated patient. Attention to hand hygiene and adherence to contact precautions are key to infection prevention.

CDI cause significant illness throughout the U.S. Successful CDI diagnosis and management in the ED require current knowledge of risk, presentation, diagnosis, and proper antibiotic treatment.

CDI cause significant illness throughout the U.S. Successful CDI diagnosis and management in the ED require current knowledge of risk, presentation, diagnosis, and proper antibiotic treatment.

Although available studies have not demonstrated that antiarrhythmic drugs could increase long-term survival or survival with favorable neurological outcome, some studies have shown that the rate of hospital admission is higher with amiodarone or lidocaine than with placebo. To study the effects of antiarrhythmic drugs during cardiac arrest, a meta-analysis was conducted to assess the efficacy of amiodarone and/or lidocaine.

We searched studies from inception until Jan 21, 2020. The primary endpoint was survival to hospital discharge in cardiac arrest, and the secondary endpoints were survival to hospital admission/24h and favorable neurological outcome.

A total of 9 studies were included. In head-to-head studies, amiodarone (odds ratio [OR] 2.96, 95% credible interval [CrI] 1.02-8.53) and lidocaine (OR 3.12, 95% CrI 1.08-9.98) had superior effects on survival to hospital admission/24h compared to the combination of the two drugs. In terms of survival to hospital discharge, amiodarone (OR 1.18, 95% CrI 1.03-1.35) and lidocaine (OR 1.22, 95% CrI 1.06-1.41) were more effective than placebo. Amiodarone (OR 1.20, 95% CrI 1.02-1.41) was significantly better than placebo in favorable neurological outcome. However, there was no significant difference in other pairwise comparisons. The surface under cumulative ranking curve (SUCRA) revealed that lidocaine was the most effective therapy for survival to hospital admission (84.1%) and discharge (88.4%), while amiodarone was associated with a more favorable neurological outcome (88.2%).

Lidocaine had the best effect on both survival to hospital admission and discharge, while amiodarone was associated with a more favorable neurological outcome.

This study is registered with PROSPERO, number CRD42020171049.

This study is registered with PROSPERO, number CRD42020171049.A 24-year-old male was brought to our emergency with complaints of abdominal pain for two days. There was a history of foreign body ingestion five days earlier, details of which he refused to reveal. After investigation with abdominal X ray and ultrasound, the foreign body was detected to be a mobile phone containing a battery. CP-690550 inhibitor Clinical evaluation revealed no signs of lithium toxicity due to battery leak. The patient underwent endoscopy for removal of the mobile phone. The case shows the importance of thorough investigation and prompt attempt at endoscopic removal in the event of ingestion of foreign bodies containing batteries.