Pediatric emergency medicine trisk 2136 2136
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (146.05 KB, 1 trang )
Clinical Assessment
The emergency physician should focus on identifying patients with relatively
mild illness; the CDC encourages clinicians to err on the side of providing rather
than withholding antibiotic treatment. Additionally, the EM practitioner should
identify women with relatively severe illness, through additional diagnostics,
focusing on the consideration of major competing diagnoses. Many patients with
PID will have negative cultures, which does not exclude the diagnosis, as PID is a
polymicrobial clinical syndrome rather than a specific bacterial infection.
FIGURE 92.3 Strategy for diagnosis of pelvic inflammatory disease (PID). Minimal laboratory
evaluation should include tests for gonococcal and chlamydial cervicitis. Expanded laboratory
investigation may include, in addition to the minimal evaluation, complete blood cell count, Creactive protein or erythrocyte sedimentation rate, and pelvic or transvaginal ultrasonography.
(Adapted from Kahn JG, Walker CK, Washington AE, et al. Diagnosing pelvic inflammatory
disease. A comprehensive analysis and considerations for developing a new model. JAMA
1991;266:2594–2604.)
An important pathophysiologic irony is the observation that tubal occlusion is
associated more often with a relatively unimpressive clinical presentation of PID
(i.e., long duration of symptoms, no signs of peritonitis, normal peripheral
leukocyte count) than with a “hot” clinical disease (i.e., short duration of
symptoms, fever, peritoneal signs, leukocytosis). Similarly, chlamydial PID is
associated with both a longer duration of pain at patient presentation and a higher
risk of infertility than is gonococcal PID. Thus, if the diagnosis of PID is allowed
to depend substantially on patients’ appearance—as either “well” or “sick”—
clinicians may be tempted to reject the diagnosis of PID and to withhold
