UTI Myths

Urine-Infection-in-Dogs-and-Cats

Myth 1: The Urine Is Cloudy and Smells Bad. My Patient Has a UTI

Myth 2: The Urine Has Bacteria Present. My Patient Has a UTI. Also See Myth 8

Myth 3: My Patient’s Urine Sample Has >5 Squamous Epithelial Cells per Low-Power Field and the Culture is Positive. Because the Culture is Positive, I Can Disregard the Epithelial Cell Count and Treat the UTI

Myth 4: The Urine Has Positive Leukocyte Esterase. My Patient Should Have a Urine Culture Performed, Has a UTI, and Needs Antibiotics

Myth 5: My Patient Has Pyuria. They Must Have a UTI

Myth 6: The Urine Has Nitrates Present. My Patient Has a UTI

Myth 7: All Findings of Bacteria in a Catheterized Urine Sample Should Be Diagnosed as a UTI

Myth 8: Patients with Bacteriuria Will Progress to a UTI and Should Therefore Be Treated

Myth 9: Falls and Acute Altered Mental Status Changes in the Elderly Patient Are Usually Caused by UTI

Myth 10: The Presence of Yeast or Candida in the Urine, Especially in Patients with Indwelling Urinary Catheters, Indicates a Candida UTI and Needs to Be Treated

 

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Pancreatitis risk stratification (BISAP)

Bedside Index of Severity in Acute Pancreatitis (BISAP), a simple tool ideal for rapid risk-stratification. The tool is based on a 5-point score, derived from 5 parameters collected within a patient’s first 24 hours in hospital.

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Vasopressors for Septic Shock

  • Epinephrine and norepinephrine are both acceptable, evidence-based approaches to hemodynamic support in septic shock.
  • Individual patient responsiveness to vasopressors is variable and unpredictable.
  • Some patients respond better to epinephrine than norepinephrine.
  • For patients who are not responding well to norepinephrine, it is reasonable to empirically trial a low dose of epinephrine (“epinephrine challenge”).

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Acute Visual Loss in the ED

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  1. History including specific eye involvement, sudden vs. chronic loss, pain, redness and discharge, trauma, other symptoms, and medication use are vital.
  2. Physicians should be comfortable completing an appropriate history and physical examination including general inspection, visual acuity, pupils, EOMs, visual fields, fluorescein, lids, IOP, slit lamp, and US.
  3. Emergent consultation is required for acute angle closure glaucoma, retinal detachment, CRAO, open globe, endophthalmitis, chemical burn, infectious keratitis, and giant cell arteritis.
  4. Urgent referral is needed for uveitis, vitreous hemorrhage, acute maculopathy, CRVO, and optic neuritis.
  5. Keep in mind other etiologies of vision loss including ischemia, stroke, toxin, infection, and functional.

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Adrenaline: It’s just a suggestion

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Epinephrine and other ACLS drugs lead to more patients with ROSC but no increase in the number of patients with good neurologic outcomes after OHCA.

Something that’s very interesting is the actual 2015 ACLS recommendation for epinephrine. It reads, “it is reasonable to consider administering a 1 mg dose of IV/IO epinephrine every 3 to 5 minutes during adult cardiac arrest.” This actually leaves room to not give the medication if the physician thinks it should be withheld.

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TIA

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Cornerstones of treatment for TIA revolve around reducing the risk of future events with blood pressure control, lipid control, and antiplatelet agents. Blood pressure should be maintained at 140/90 with a thiazide diuretic and/or an ACE inhibitor. Statins should be given to keep LDL of under 100mg/dL or 70mg/dL in high risk patients. Niacin or gemfibrozil are recommended to maintain HDL above 40mg/dL. Antiplatelet agents include aspirin with or without dipyridamole, or clopidogrel alone.

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Hand Injuries

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  • When considering when to remove sutures in the hand, leave sutures that are over areas of tension (i.e. over a joint) for longer (at least 12 days) so they heal completely.
  • If controlling bleeding is an issue, do NOT clamp any digital arteries, as the digital nerve is very nearby and hard to visualize. Use pressure, limited tourniquet and elevation to control bleeding safely.
  • Prophylactic antibiotics are indicated for for all animal bites to the hand, and for certain complex injuries (crush wounds, wounds over a joint, or for immune compromised patients).
  • If referring a hand abscess to a clinic, consider swabbing the drained fluid so MRSA status can be determined.
  • Immobilizing the PIP joint in extension can stiffen the collateral ligaments causing permanent disability, so don’t splint PIP joint for greater than 1–2 weeks unless necessary, and if splinting, ensure an early referral time. (within 1–2 weeks).

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