May Introduction - Hematuria and AAA

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Nurses Edition Commentary

Mizuho Morrison, DO, Kathy Garvin, RN, and Lisa Chavez, RN
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Jim B. -

Dear EM Rappers,

Having just received the sales pitch from the PCT sales person, are there any good studies speaking to its ED utility or lack thereof ? Have serious studies actually verified its mystical ability to differentiate viral and bacterial infections and guide the treatment of sepsis ?
Thanks

Rob O -

Hi Jim,
In the below post, there is a link to the article "Procalcitonin algorithm in critically ill adults with undifferentiated infection or suspected sepsis. A randomized controlled trial"
We will have a segment in the near future addressing your specific question.

If you want the punchline/conclusion of the study... In critically ill adults with undifferentiated infections, a PCT algorithm including 0.1 ng/ml cut-off did not achieve 25% reduction in duration of antibiotic treatment

Bilgehan O. -

http://www.ncbi.nlm.nih.gov/pubmed/?term=25295709

Bilgehan O. -

i also like this http://emcrit.org/emnerd/the-valley-of-fear/

Jim B. -

Thanks for the synopsis and the suggestion of the two articles, both edifying.

Kevin K. -

Hey EM Rap(pers),

So, I listened to the discussion of abdominal seatbelt signs with great interest. Fascinating stuff. Decided to do a lit search. Seems that seat belt sign on the chest also connotes a higher risk of internal injury.

However, here is my question, one that I have not been able to find an answer:

What EXACTLY constitutes a seatbelt sign?

Now, I'm not talking about the large, deep contusion across the lower abdomen. That is clearly a seatbelt sign. However, my residents are constantly pointing to little, tiny abrasions over bony prominences (most notably the pelvic ASIS and clavicle) and calling it a seatbelt sign in an otherwise normal patient. I'm a pretty strong believer in NOT whole-body CT scanning everyone who has trauma. However, this discussion on seatbelt signs has given me some pause... do I need to increase my scanning? *GASP*

Thanks!

Kevin

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