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Sage P Whitmore, Kyle J Gunnerson, Jonathan W Haft, William R Lynch, Tyler VanDyck, Christopher Hebert, John Waldvogel, Renee Havey, Allison Weinberg, James A Cranford, Deborah M Rooney, Robert W Neumar
BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a viable rescue strategy for refractory out-of-hospital cardiac arrest. In the U.S., limited training of emergency medicine providers is a barrier to widespread implementation. AIMS: Test the hypothesis that emergency medicine physicians and nurses can acquire and retain the skills to rapidly and safely initiate ECPR using high-fidelity simulation. STUDY DESIGN: Prospective interventional study...
March 9, 2019: Resuscitation
Nathan L Haas, Roma Y Gianchandani, Kyle J Gunnerson, Benjamin S Bassin, Arun Ganti, Christopher Hapner, Caryn Boyd, James A Cranford, Sage P Whitmore
BACKGROUND: The "two-bag method" of management of diabetic ketoacidosis (DKA) allows for titration of dextrose delivery by adjusting the infusions of two i.v. fluid bags of varying dextrose concentrations while keeping fluid, electrolyte, and insulin infusion rates constant. OBJECTIVE: We aimed to evaluate the feasibility and potential benefits of this strategy in adult emergency department (ED) patients with DKA. METHODS: This is a before-and-after comparison of a protocol using the two-bag method operationalized in our adult ED in 2015...
May 2018: Journal of Emergency Medicine
Lena M Napolitano, Venkatakrishna Rajajee, Kyle J Gunnerson, Michael D Maile, Michael Quasney, Robert C Hyzy
Critical care fellowship training in the United States differs based on specific specialty and includes medicine, surgery, anesthesiology, pediatrics, emergency medicine, and neurocritical care training pathways. We provide an update regarding the number and growth of US critical care fellowship training programs, on-duty residents and certified diplomates, and review the different critical care physician training pathways available to residents interested in pursuing a fellowship in critical care. Data were obtained from the Accreditation Council for Graduate Medical Education and specialty boards (American Board of Internal Medicine, American Board of Surgery, American Board of Anesthesiology, American Board of Pediatrics American Board of Emergency Medicine) and the United Council for Neurologic Subspecialties for the last 16 years (2001-2017)...
June 2018: Journal of Trauma and Acute Care Surgery
Kyle J Gunnerson
No abstract text is available yet for this article.
October 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Joseph E Tonna, Nicholas J Johnson, John Greenwood, David F Gaieski, Zachary Shinar, Joseph M Bellezo, Lance Becker, Atman P Shah, Scott T Youngquist, Michael P Mallin, James Franklin Fair, Kyle J Gunnerson, Cindy Weng, Stephen McKellar
PURPOSE: To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department. METHODS: We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO)...
October 2016: Resuscitation
Rebecca A Hess, Kyle Gunnerson, John Kahler
Herpes zoster, commonly called shingles, is a disease that results from the reactivation of varicella zoster virus. Local trauma has been reported as a precipitant for reactivation, but this condition is rarely seen localized to a fresh surgical incision. We present the case of a patient who developed shingles overlying the incision site of a recently buried central venous access port, illustrating the need to consider this diagnosis as a unique imposter of localized infection or reaction at sites of recent procedural trauma...
January 2017: CJEM
Amir Rezk, A Clark Gunnerson, Michael Komar
No abstract text is available yet for this article.
May 2016: Gastroenterology
Kyle J Gunnerson, Andrew D Shaw, Lakhmir S Chawla, Azra Bihorac, Ali Al-Khafaji, Kianoush Kashani, Matthew Lissauer, Jing Shi, Michael G Walker, John A Kellum
BACKGROUND: Acute kidney injury (AKI) is an important complication in surgical patients. Existing biomarkers and clinical prediction models underestimate the risk for developing AKI. We recently reported data from two trials of 728 and 408 critically ill adult patients in whom urinary TIMP2•IGFBP7 (NephroCheck, Astute Medical) was used to identify patients at risk of developing AKI. Here we report a preplanned analysis of surgical patients from both trials to assess whether urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) accurately identify surgical patients at risk of developing AKI...
February 2016: Journal of Trauma and Acute Care Surgery
Jarrod M Mosier, Melissa Kelsey, Yuval Raz, Kyle J Gunnerson, Robyn Meyer, Cameron D Hypes, Josh Malo, Sage P Whitmore, Daniel W Spaite
Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient. ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy. While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and cardiogenic shock and the potential indications for ECMO continue to increase...
December 17, 2015: Critical Care: the Official Journal of the Critical Care Forum
Adit A Ginde, Patrick J Blatchford, Stephen Trzeciak, Judd E Hollander, Robert Birkhahn, Ronny Otero, Tiffany M Osborn, Eugene Moretti, H Bryant Nguyen, Kyle J Gunnerson, David Milzman, David F Gaieski, Munish Goyal, Charles B Cairns, Emanuel P Rivers, Nathan I Shapiro
The authors aimed to evaluate age-related differences in inflammation biomarkers during the first 72 h of hospitalization for sepsis. This was a secondary analysis of a prospective observational cohort of adult patients (n = 855) from 10 urban academic emergency departments with confirmed infection and two or more systemic inflammatory response syndrome criteria. Six inflammation-related biomarkers were analyzed-chemokine (CC-motif) ligand-23, C-reactive protein, interleukin-1 receptor antagonist, neutrophil gelatinase-associated lipocalin (NGAL), peptidoglycan recognition protein, and tumor necrosis factor receptor-1a (TNFR-1a)-measured at presentation and 3, 6, 12, 24, 48, or 72 h later...
August 2014: Shock
Azra Bihorac, Lakhmir S Chawla, Andrew D Shaw, Ali Al-Khafaji, Danielle L Davison, George E Demuth, Robert Fitzgerald, Michelle Ng Gong, Derrel D Graham, Kyle Gunnerson, Michael Heung, Saeed Jortani, Eric Kleerup, Jay L Koyner, Kenneth Krell, Jennifer Letourneau, Matthew Lissauer, James Miner, H Bryant Nguyen, Luis M Ortega, Wesley H Self, Richard Sellman, Jing Shi, Joely Straseski, James E Szalados, Scott T Wilber, Michael G Walker, Jason Wilson, Richard Wunderink, Janice Zimmerman, John A Kellum
RATIONALE: We recently reported two novel biomarkers for acute kidney injury (AKI), tissue inhibitor of metalloproteinases (TIMP)-2 and insulin-like growth factor binding protein 7 (IGFBP7), both related to G1 cell cycle arrest. OBJECTIVES: We now validate a clinical test for urinary [TIMP-2]·[IGFBP7] at a high-sensitivity cutoff greater than 0.3 for AKI risk stratification in a diverse population of critically ill patients. METHODS: We conducted a prospective multicenter study of 420 critically ill patients...
April 15, 2014: American Journal of Respiratory and Critical Care Medicine
Kianoush Kashani, Ali Al-Khafaji, Thomas Ardiles, Antonio Artigas, Sean M Bagshaw, Max Bell, Azra Bihorac, Robert Birkhahn, Cynthia M Cely, Lakhmir S Chawla, Danielle L Davison, Thorsten Feldkamp, Lui G Forni, Michelle Ng Gong, Kyle J Gunnerson, Michael Haase, James Hackett, Patrick M Honore, Eric A J Hoste, Olivier Joannes-Boyau, Michael Joannidis, Patrick Kim, Jay L Koyner, Daniel T Laskowitz, Matthew E Lissauer, Gernot Marx, Peter A McCullough, Scott Mullaney, Marlies Ostermann, Thomas Rimmelé, Nathan I Shapiro, Andrew D Shaw, Jing Shi, Amy M Sprague, Jean-Louis Vincent, Christophe Vinsonneau, Ludwig Wagner, Michael G Walker, R Gentry Wilkerson, Kai Zacharowski, John A Kellum
INTRODUCTION: Acute kidney injury (AKI) can evolve quickly and clinical measures of function often fail to detect AKI at a time when interventions are likely to provide benefit. Identifying early markers of kidney damage has been difficult due to the complex nature of human AKI, in which multiple etiologies exist. The objective of this study was to identify and validate novel biomarkers of AKI. METHODS: We performed two multicenter observational studies in critically ill patients at risk for AKI - discovery and validation...
February 6, 2013: Critical Care: the Official Journal of the Critical Care Forum
A Clark Gunnerson, David L Diehl, Viet-Nhan H Nguyen, Matthew J Shellenberger, Joseph Blansfield
No abstract text is available yet for this article.
October 2012: Gastrointestinal Endoscopy
Kyle J Gunnerson
No abstract text is available yet for this article.
September 2012: Resuscitation
Sarah M Perman, Anna Marie Chang, Judd E Hollander, David F Gaieski, Stephen Trzeciak, Robert Birkhahn, Ronny Otero, Tiffany M Osborn, Eugene Moretti, H Bryant Nguyen, Kyle J Gunnerson, David Milzman, Munish Goyal, Charles B Cairns, Long Ngo, Emanuel P Rivers, Nathan I Shapiro
OBJECTIVES: Myocardial dysfunction is an important aspect of sepsis pathophysiology. B-type natriuretic peptide (BNP) is a neurohormone released from the ventricles in response to myocardial stretch and volume overload. The authors hypothesized that an elevated BNP in patients presenting to the emergency department (ED) with suspected sepsis are at increased risk for development of adverse events. METHODS: This was a prospective, observational, multicenter cohort study in 10 EDs...
February 2011: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Teresa Camp-Rogers, Geoff Murphy, Anne Dean, Kyle Gunnerson, Darrin Rossler, Michael C Kurz
No abstract text is available yet for this article.
February 2012: American Journal of Emergency Medicine
Christopher R Ensor, William D Cahoon, Michael A Crouch, Gundars J Katlaps, Michael L Hess, Richard H Cooke, Kyle J Gunnerson, Vigneshwar Kasirajan
The CardioWest temporary total artificial heart serves as a viable bridge to orthotopic heart transplantation in patients who are experiencing end-stage refractory biventricular heart failure. This device is associated with a low, albeit still substantial, risk of thrombosis. Platelet interactions with artificial surfaces are complex and result in continuous activation of contact proteins despite therapeutic anticoagulation. We searched the medical literature (publication dates, January 1962-October 2009) in order to evaluate means of mitigating adverse events that have occurred after implantation of the CardioWest temporary total artificial heart...
2010: Texas Heart Institute Journal
Julie A Mayglothling, Kyle J Gunnerson, David T Huang
OBJECTIVES: Critical care medicine (CCM) is of growing interest among emergency physicians (EPs), but the number of CCM-trained EPs and their postfellowship practice is unknown. This study's purpose was to conduct a descriptive census survey of EPs who have completed or are currently in a CCM fellowship. METHODS: The authors created a Web-based survey, and requests to participate were sent to EPs who have completed or are currently in a CCM fellowship. Responses were collected over a 12-month period...
March 2010: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Nathan I Shapiro, Stephen Trzeciak, Judd E Hollander, Robert Birkhahn, Ronny Otero, Tiffany M Osborn, Eugene Moretti, H Bryant Nguyen, Kyle Gunnerson, David Milzman, David F Gaieski, Munish Goyal, Charles B Cairns, Kenneth Kupfer, Seok-Won Lee, Emanuel P Rivers
STUDY OBJECTIVE: We assess the diagnostic accuracy of plasma neutrophil gelatinase-associated lipocalin (NGAL) to predict acute kidney injury in emergency department (ED) patients with suspected sepsis. METHODS: We conducted a secondary analysis of a prospective observational study of a convenience sample of patients from 10 academic medical center EDs. Inclusion criteria were adult patients aged 18 years or older, with suspected infection or a serum lactate level greater than 2...
July 2010: Annals of Emergency Medicine
Kyle J Gunnerson, Nattachai Srisawat, John A Kellum
PURPOSE: Abnormalities of strong ion gap (SIG) are common in critically ill intensive care unit (ICU) patients in conjunction with a high incidence of acid-base abnormalities. However, it is unknown whether abnormalities in SIG are also seen in ICU patients without active acid-base abnormalities. Thus, we conducted this pilot study to examine differences in quantitative acid-base variables between healthy adult volunteers and stable ICU patients with no suspected acid-base abnormalities...
September 2010: Journal of Critical Care
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