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Pediatric patients are a unique subset of emergency patients, making up about one-quarter of all emergency department visits. Textbooks regarding the care of pediatric patients are almost universally organized by organ system, which does not facilitate an efficient diagnosis. Taking a case-based approach, Pediatric Emergency Medicine: Chief Complaints and Differential Diagnosis is arranged by chief complaint, using real patient scenarios to help the reader work through the inductive and deductive reasoning needed to assess, evaluate, treat, and disposition pediatric patients with urgent complaints. Cases are structured in the way in which they are presented during medical care, allowing practitioners to become comfortable with the general structure of case presentations: chief complaint, HPI, PMH, ROS, exam, and ancillary studies. This volume also discusses disease processes and their differentiations, providing in-depth knowledge regarding current standards of diagnosis and care.
Lactate levels are increasingly used to guide resuscitation efforts. Some surgical literature suggests that tourniquet use during phlebotomy falsely elevates results, although studies in healthy volunteers have not demonstrated this. The purpose of this study was to determine in clinical practice whether tourniquet use during the drawing of a lactate results in significantly altered levels compared to the result of a level drawn without a tourniquet.
A prospective cohort study was carried out on emergency department patients whose clinical presentation led a physician to order a lactate level. Written informed consent was obtained from patients or their proxies. Study lactates were obtained using a tourniquet during the draw sequence of other laboratory studies. Lactate levels for clinical use were drawn per hospital protocol with no tourniquet. The time of lactate measurements and patient demographic information were recorded. Lactate levels for each patient were compared with the Wilcoxon Rank-Sum Test.
40 patients were consented and enrolled. The median clinical lactate level was 1.9 (interquartile range 1.5-2.6), and the median study lactate level was 1.9 (interquartile range 1.4-2.7). There was no difference between paired lactate values (p=0.95).
Tourniquet use appears to have no impact on measured lactate levels. Our findings suggest that current practices at many institutions regarding lactate collection are likely too stringent and should be changed.