Infectious Diseases, “Answers”

Although there are no prospective randomized controlled trials looking specifically at ED patients with UTI symptoms, it is safe to say that a urine culture in healthy adult non-pregnant females with new onset urinary symptoms without concern for pyelonephritis or bacteraemia is unlikely to change management or outcome… SO STOP ORDERING THEM

D-Dimers explained

  • The D-dimer test is a marker of blood clotting activity and is not diagnostic of VTE
  • When used appropriately the D-dimer test helps “rule out” VTE if the test is negative and the chance of the patient having a VTE is relatively low

Orbital Cellulitis

  • Periorbital and Orbital Cellulitis can be difficult to distinguish from initially. Know that both have a good chance of improving with IV antibiotics.
  • Not every child with preseptal/periorbital cellulitis requires a CT in the ED to rule-out orbital involvement.
    • If there is no proptosis and normal eye movement, IV antibiotics may be sufficient.
    • Hospitalization for close reassessments and eye exam can help determine if CT is eventually required.
  • Not every child with CT proven orbital cellulitis requires surgery! So don’t be mad when the ENT doctor recommends that the child is admitted for IV antibiotics to the Pediatric Service.
  • Bilateral is Bad! Think Cavernous Sinus Thrombosis!

Cannabis Intoxication

Cannabis contains two well known components, Delta-9 Tetrahydrocannabinol (Δ-9-THC) and Cannabidiol (CBD). The psychoactive properties of cannabis are typically attributed to Δ-9-THC, which is present in variable concentrations dependent on the strain, and absorbed at variable rates dependent on the mode of ingestion. Acute intoxication is rare from cannabidiol (CBD) products unless given in excess or with high THC:CBD ratio.

Managing Sickle Cell Disease in the ED

  • One of the reasons that managing Sickle Cell pain crises can be challenging is that we often under-dose analgesics in these patients. Use IV opiods for rapid effect. The subcutaneous route is more reliable than the IM route if no IV available. Use NSAIDS sparingly in Sickle Cell Disease! While NSAIDs for acute pain crises have been shown to be effective in reducing pain and decreasing hospital length of stay, many patients with sickle cell disease have progressive chronic renal failure as a result of renal infarcts and their serum creatinine level may appear normal despite this.
  • Boluses of IV fluid should NOT be given un­less patients are overtly hypovolemic (sepsis, diarrheal illness, vomiting). In these situations, resuscitate only to euvolemia and for maintenance fluids use a hypotonic solution such as ½ NS or D5-½ NS.
  • In patients presenting with simple pain without other symptoms who are not being admitted, lab tests are generally NOT necessary. The reticulocyte count is the most useful blood test in those patients who present with complicated pain crises.