Contributor: Aaron Lessen, MD Educational Pearls: UTIs are commonly seen in older women We often see them taking long-term prophylactic antibiotics because of common recurrence. Around 20-30% of older women who develop a UTI have a recurrence due to either diagnostic failure, treatment failure or non-compliance with treatment. UTI signs and symptoms Burning sensation…
Read MoreContributor: Travis Barlock, MD Educational Pearls: Foul-smelling urine and cloudy urine are commonly misinterpreted as indicators of a UTI. However, these findings alone are not diagnostic. Criteria for UTI: Presence of localized urinary symptoms: Suprapubic pain Dysuria Hesitancy Urgency Urinalysis with WBC > 10 Urine culture with > 100,000 CFU/mL Colonization differs from infection – many…
Read MoreEducational Pearls: Most common sexually transmitted disease (STD) in North America: Human Papillomavirus (HPV) From the emergency department patients should be connected to follow-up care and educated on vaccine series Most common non-viral STD in North America: Trichomonas Vaginalis While men may be asymptomatic, they can transmit the disease to women who may experience irritation…
Read MoreEducational Pearls: Recent updates to treatment guidelines increased the 250 mg ceftriaxone IM dose to 500 mg ceftriaxone IM IM dosing can be very painful, so other methods of administration can help decrease pain for patients Using IV ceftriaxone instead of IM has no significant difference in pharmacokinetics or bioavailability, so it can be considered…
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a hidden twist Chief Complaint Abdominal Pain HPI 5-year-old male presents to the emergency department for abdominal pain, which started this morning. Mother reports the pain woke the patient up from sleep. Reports the pain is crampy and patient has been crying since he woke up at 9:00. Mother reports she thinks this happened one…
Read MoreContributor: Jared Scott, MD Educational Pearls: PID (pelvic inflammatory disease) occurs when the infection ascends into the uterus Tubo-ovarian abscess occurs when the infection ascends to the fallopian tubes Fitz-Hugh-Curtis syndrome occurs when the infection enters the peritoneum and causes peritoneal inflammation with peri-hepatic inflammation These conditions require GYN consultation and often more robust antibiotic…
Read MoreContributor: Jared Scott, MD Educational Pearls: Recent study evaluated vaginal self swab testing for STIs to determine if they are equally sensitive to provider-obtained swab 515 patients consented to both tests and 95% agreement was found between the two methods of obtaining samples 75% of participants who preferred this over the pelvic exam, although some…
Read MoreAuthor: Michael Hunt, MD Educational Pearls: Like all tests, urine toxicology (utox) screens can have false positives Prescription medications such as demerol, antipsychotics, ketamine, and tramadol can all produce a false positive utox for PCP Over-the-counter medication such as dextromethorphan also mimic PCP on utox References Doyon S. (January 2014). False Positive Urine…
Read MoreAuthor: Michael Hunt, MD Educational Pearls: As many as 20% of women in assisted living have asymptomatic bacteriuria This can present a diagnostic conundrum when seeing these patients in the emergency department, particularly for altered mental status and deciding whether to treat True diagnosis of UTI in the emergency department is difficult as true diagnoses…
Read MoreAuthor: Jared Scott, MD Educational Pearls: Blood at urethral meatus in trauma can be a sign of bladder/urethral injury Blind placement of a Foley catheter can make an undiagnosed urethral injury worse Urethral injury is evaluated using a retrograde urethrogram (RUG) If urethra is confirmed to be intact, Foley catheter can be placed to allow…
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