keyword
https://read.qxmd.com/read/38533294/a-review-and-discussion-of-full-time-equivalency-and-appropriate-compensation-models-for-an-adult-intensivist-in-the-united-states-across-various-base-specialties
#1
JOURNAL ARTICLE
Michael Nurok, Brigid C Flynn, Marc Pineton de Chambrun, Mina Kazemian, Joel Geiderman, Mark E Nunnally
OBJECTIVES: Physicians with training in anesthesiology, emergency medicine, internal medicine, neurology, and surgery may gain board certification in critical care medicine upon completion of fellowship training. These clinicians often only spend a portion of their work effort in the ICU. Other work efforts that benefit an ICU infrastructure, but do not provide billing opportunities, include education, research, and administrative duties. For employed or contracted physicians, there is no singular definition of what constitutes an intensive care full-time equivalent (FTE)...
April 2024: Critical care explorations
https://read.qxmd.com/read/38350971/transforming-research-to-improve-therapies-for-trauma-in-the-twenty-first-century
#2
REVIEW
Nicole P Juffermans, Tarik Gözden, Karim Brohi, Ross Davenport, Jason P Acker, Michael C Reade, Marc Maegele, Matthew D Neal, Philip C Spinella
Improvements have been made in optimizing initial care of trauma patients, both in prehospital systems as well as in the emergency department, and these have also favorably affected longer term outcomes. However, as specific treatments for bleeding are largely lacking, many patients continue to die from hemorrhage. Also, major knowledge gaps remain on the impact of tissue injury on the host immune and coagulation response, which hampers the development of interventions to treat or prevent organ failure, thrombosis, infections or other complications of trauma...
February 13, 2024: Critical Care: the Official Journal of the Critical Care Forum
https://read.qxmd.com/read/38323952/implementation-of-extracorporeal-cpr-programs-for-out-of-hospital-cardiac-arrest-another-tale-of-two-county-hospitals
#3
JOURNAL ARTICLE
Anna Condella, Nicholas S Simpson, Kyle S Bilodeau, Barclay Stewart, Samuel Mandell, Mark Taylor, Beth Heather, Eileen Bulger, Nicholas J Johnson, Matthew E Prekker
Extracorporeal cardiopulmonary resuscitation (ECPR) is a form of intensive life support that has seen increasing use globally to improve outcomes for patients who experience out-of-hospital cardiac arrest (OHCA). Hospitals with advanced critical care capabilities may be interested in launching an ECPR program to offer this support to the patients they serve; however, to do so, they must first consider the significant investment of resources necessary to start and sustain the program. The existing literature describes many single-center ECPR programs and often focuses on inpatient care and patient outcomes in hospitals with cardiac surgery capabilities...
February 5, 2024: Annals of Emergency Medicine
https://read.qxmd.com/read/38135288/diagnosis-and-treatment-of-right-ventricular-failure-secondary-to-acutely-increased-right-ventricular-afterload-acute-cor-pulmonale-a-clinical-consensus-statement-of-the-association-for-acute-cardiovascular-care-acvc-of-the-esc
#4
JOURNAL ARTICLE
Mattia Arrigo, Susanna Price, Veli-Pekka Harjola, Lars C Huber, Hannah A I Schaubroeck, Antoine Vieillard-Baron, Josep Masip, Alexandre Mebazaa
Acute right ventricular failure secondary to acutely increased right ventricular afterload (acute cor pulmonale) is a life-threatening condition that may arise in different clinical settings. Patients at risk of developing or with manifest acute cor pulmonale usually present with an acute pulmonary disease (e.g., pulmonary embolism, pneumonia, ARDS) and are managed initially in emergency departments and later in intensive care units. According to the clinical setting, other specialties are involved (cardiology, pneumology, internal medicine)...
December 22, 2023: European Heart Journal. Acute Cardiovascular Care
https://read.qxmd.com/read/37313688/the-maryland-usa-critical-care-coordination-center-c4-from-pandemic-to-permanence
#5
JOURNAL ARTICLE
Melissa A Kelly, Luis M Pinet-Peralta, Tara M Roque, Thomas M Scalea, Theodore R Delbridge, Samuel M Galvagno
INTRODUCTION: The 2019 coronavirus disease (COVID-19) pandemic created overwhelming demand for critical care services within Maryland's (USA) hospital systems. As intensive care units (ICUs) became full, critically ill patients were boarded in hospital emergency departments (EDs), a practice associated with increased mortality and costs. Allocation of critical care resources during the pandemic requires thoughtful and proactive management strategies. While various methodologies exist for addressing the issue of ED overcrowding, few systems have implemented a state-wide response using a public safety-based platform...
June 2023: Prehospital and Disaster Medicine
https://read.qxmd.com/read/37010317/association-of-an-emergency-critical-care-program-with-survival-and-early-downgrade-among-critically-ill-medical-patients-in-the-emergency-department
#6
JOURNAL ARTICLE
Tsuyoshi Mitarai, Alexandra June Gordon, Matthew J R Nudelman, Alfredo E Urdaneta, Jason Lawrence Nesbitt, Kian Niknam, Anna Graber-Naidich, Jennifer G Wilson, Michael A Kohn
OBJECTIVES: To determine whether implementation of an Emergency Critical Care Program (ECCP) is associated with improved survival and early downgrade of critically ill medical patients in the emergency department (ED). DESIGN: Single-center, retrospective cohort study using ED-visit data between 2015 and 2019. SETTING: Tertiary academic medical center. PATIENTS: Adult medical patients presenting to the ED with a critical care admission order within 12 hours of arrival...
June 1, 2023: Critical Care Medicine
https://read.qxmd.com/read/36877802/effects-of-covid-19-acute-respiratory-distress-syndrome-icu-survivor-telemedicine-clinic-on-patient-readmission-pain-perception-and-self-assessed-health-scores-a-randomized-prospective-single-center-exploratory-study
#7
JOURNAL ARTICLE
Bathmapriya Balakrishnan, Lucas Hamrick, Ariful Alam, Jesse Thompson
BACKGROUND: Post-intensive care syndrome (PICS) affects up to 50% of intensive care unit (ICU) survivors leading to long-term neurocognitive, psychosocial, and physical impairments. Approximately 80% of COVID-19 pneumonia patients who require ICU level care are at elevated risk for developing acute respiratory distress syndrome (ARDS). Survivors of COVID-19 ARDS are at high-risk for unanticipated healthcare utilization post discharge. Common to this group of patients are increased readmission rates, long term decreased mobility, and overall poorer outcomes...
February 28, 2023: JMIR Formative Research
https://read.qxmd.com/read/36769833/ultrasound-in-sepsis-and-septic-shock-from-diagnosis-to-treatment
#8
REVIEW
Gianluca Tullo, Marcello Candelli, Irene Gasparrini, Sara Micci, Francesco Franceschi
UNLABELLED: Sepsis and septic shock are among the leading causes of in-hospital mortality worldwide, causing a considerable burden for healthcare. The early identification of sepsis as well as the individuation of the septic focus is pivotal, followed by the prompt initiation of antibiotic therapy, appropriate source control as well as adequate hemodynamic resuscitation. For years now, both emergency department (ED) doctors and intensivists have used ultrasound as an adjunctive tool for the correct diagnosis and treatment of these patients...
February 2, 2023: Journal of Clinical Medicine
https://read.qxmd.com/read/36686138/an-uncontrollable-aggressive-patient-at-a-free-standing-emergency-department
#9
Joel Crane, Brittney E Aguiar, Jeffrey A Nielson
We present the case of an aggressive male patient who was unable to be successfully sedated with conventional medications in the ED and ultimately required intubation to ensure the safety of the patient himself and the staff. After admission to the ICU, he was found to have atrophy of the frontal and bilateral lobes secondary to a traumatic brain injury (TBI) 19 years prior. Managing the patient required collaboration with the intensivist, hospitalist, and psychiatry and neurology teams for 10 months, and he was refused admission to multiple psychiatric facilities due to safety concerns because of his high level of aggression and unpredictability...
December 2022: Curēus
https://read.qxmd.com/read/36660015/emerging-concepts-in-heart-failure-management-and-treatment-focus-on-point-of-care-ultrasound-in-cardiogenic-shock
#10
REVIEW
Mariela Ruben, María Sol Molinas, Hugo Paladini, Wissam Khalife, Alejandro Barbagelata, Sergio Perrone, Edgardo Kaplinsky
Point-of-care ultrasound (POCUS) plays a strategic role in the diagnostic and therapeutic evaluation of critically ill patients and, especially, in those who are haemodynamically unstable. In this context, POCUS allows a more precise identification of the cause, its differential diagnosis, the eventual coexistence with another entity and, finally, guiding of the therapeutic approach. It implies a portable use of ultrasound in acute settings covering different specified protocols, such as echocardiography, vascular, lung or abdominal ultrasound...
2023: Drugs in Context
https://read.qxmd.com/read/36582622/prudence-in-end-of-life-decision-making-a-virtue-based-analysis-of-physician-communication-with-patients-and-surrogates
#11
JOURNAL ARTICLE
Alan C Murphy, Kevan C Schultz, ShaSha Gao, Andre M Morales, Amber E Barnato, Joseph B Fanning, Daniel E Hall
Despite significant improvements in end-of-life care over several decades, belated hospice referrals and hospital staffing patterns make challenging end-of-life conversations between strangers unsurprising, especially when the interaction is time-sensitive. Understanding how physicians perform under these circumstances is relevant to patient quality and medical education. This study is a secondary analysis of transcripts from a simulation that placed 88 intensivists, hospitalists, and ED physicians in the setting of responding to a nurse's call to evaluate a floor patient for impending respiratory collapse...
December 2022: SSM Qual Res Health
https://read.qxmd.com/read/36435755/clinical-impact-of-physician-staffing-transition-in-intensive-care-units-a-retrospective-observational-study
#12
JOURNAL ARTICLE
Yosuke Fujii, Kiichi Hirota, Kentaro Muranishi, Yumiko Mori, Kei Kambara, Yoshitaka Nishikawa, Mitsuko Hashiguchi
BACKGROUND: Intensivists play an essential role in improving the outcomes of critically ill patients in intensive care units (ICUs). The transition of ICU physician staffing from low-intensity ICUs (elective intensivist or no intensivist consultation) to high-intensity ICUs (mandatory intensivist consultation or a closed ICU) improves clinical outcomes. However, whether a transition from high-intensity to low-intensity ICU staffing affects ICU outcomes and quality of care remains unknown...
November 26, 2022: BMC Anesthesiology
https://read.qxmd.com/read/36194993/decision-support-system-and-outcome-prediction-in-a-cohort-of-patients-with-necrotizing-soft-tissue-infections
#13
JOURNAL ARTICLE
Sonja Katz, Jaco Suijker, Christopher Hardt, Martin Bruun Madsen, Annebeth Meij-de Vries, Anouk Pijpe, Steinar Skrede, Ole Hyldegaard, Erik Solligård, Anna Norrby-Teglund, Edoardo Saccenti, Vitor A P Martins Dos Santos
INTRODUCTION: Necrotizing Soft Tissue Infections (NSTI) are severe infections with high mortality affecting a heterogeneous patient population. There is a need for a clinical decision support system which predicts outcomes and provides treatment recommendations early in the disease course. METHODS: To identify relevant clinical needs, interviews with eight medical professionals (surgeons, intensivists, general practitioner, emergency department physician) were conducted...
September 24, 2022: International Journal of Medical Informatics
https://read.qxmd.com/read/35946660/ketamine-use-in-critically-ill-patients-a-narrative-review
#14
REVIEW
Thais Dias Midega, Renato Carneiro de Freitas Chaves, Carolina Ashihara, Roger Monteiro Alencar, Verônica Neves Fialho Queiroz, Giovana Roberta Zelezoglo, Luiz Carlos da Silva Vilanova, Guilherme Benfatti Olivato, Ricardo Luiz Cordioli, Bruno de Arruda Bravim, Thiago Domingos Corrêa
Ketamine is unique among anesthetics and analgesics. The drug is a rapid-acting general anesthetic that produces an anesthetic state characterized by profound analgesia, preserved pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. Research has demonstrated the efficacy of its use on anesthesia, pain, palliative care, and intensive care. Recently, it has been used for postoperative and chronic pain, as an adjunct in psychotherapy, as a treatment for depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and/or neurologic clinical conditions...
2022: Revista Brasileira de Terapia Intensiva
https://read.qxmd.com/read/35874585/gastric-point-of-care-ultrasound-in-acutely-and-critically-ill-children-pocus-ped-a-scoping-review
#15
REVIEW
Frederic V Valla, Lyvonne N Tume, Corinne Jotterand Chaparro, Philip Arnold, Walid Alrayashi, Claire Morice, Tomasz Nabialek, Aymeric Rouchaud, Eloise Cercueil, Lionel Bouvet
INTRODUCTION: Point-of-care ultrasound (POCUS) use is increasing in pediatric clinical settings. However, gastric POCUS is rarely used, despite its potential value in optimizing the diagnosis and management in several clinical scenarios (i.e., assessing gastric emptying and gastric volume/content, gastric foreign bodies, confirming nasogastric tube placement, and hypertrophic pyloric stenosis). This review aimed to assess how gastric POCUS may be used in acute and critically ill children...
2022: Frontiers in Pediatrics
https://read.qxmd.com/read/35766666/reduced-physical-functional-performance-before-hospitalization-predicts-life-support-limitations-and-mortality-in-nonsurgical-intensive-care-unit-patients
#16
JOURNAL ARTICLE
Jamile Caroline Garbuglio Araujo da Silva, Tiago Giraldi, Carolina Matida Gontijo Coutinho, Marco Antonio Carvalho Filho, Dario Cecílio Fernandes, Thiago Martins Santos
OBJECTIVE: To assess whether scales of physical functional performance and the surprise question ("Would I be surprised if this patient died in 6 months?") predict life support limitations and mortality in critically ill nonsurgical patients. METHODS: We included 114 patients admitted from the Emergency Department to an intensive care unit in this prospective cohort. Physical functional performance was assessed by the Palliative Prognostic Score, Karnofsky Performance Status, and the Katz Activities of Daily Living scale...
January 2022: Revista Brasileira de Terapia Intensiva
https://read.qxmd.com/read/35766660/a-nationwide-survey-on-health-resources-and-clinical-practices-during-the-early-covid-19-pandemic-in-brazil
#17
MULTICENTER STUDY
Pedro Paulo Zanella do Amaral Campos, Guilherme Martins de Souza, Thais Midega, Hélio Penna Guimarães, Thiago Domingos Corrêa, Ricardo Luiz Cordioli
OBJECTIVE: To evaluate clinical practices and hospital resource organization during the early COVID-19 pandemic in Brazil. METHODS: This was a multicenter, cross-sectional survey. An electronic questionnaire was provided to emergency department and intensive care unit physicians attending COVID-19 patients. The survey comprised four domains: characteristics of the participants, clinical practices, COVID-19 treatment protocols and hospital resource organization. RESULTS: Between May and June 2020, 284 participants [median (interquartile ranges) age 39 (33 - 47) years, 56...
January 2022: Revista Brasileira de Terapia Intensiva
https://read.qxmd.com/read/35602521/a-quality-improvement-project-to-improve-the-pathway-and-outcomes-for-patients-with-necrotising-fasciitis
#18
JOURNAL ARTICLE
Mehul Thakkar, Timothy Schrire, Bartlomiej Bednarz, Thomas Wright
Background: Necrotising fasciitis (NF) is a life-threatening illness that requires a multidisciplinary approach between surgeons in multiple specialties, intensivists, and microbiologists. Serial debridements and change of dressings are required prior to reconstruction. The aim of this study was to review the workload and streamline services in a tertiary centre for regional and internal referrals by formalizing an NF pathway agreed upon by all multidisciplinary team stakeholders and securing adequate resources for these complex patients...
2022: Eplasty
https://read.qxmd.com/read/35530897/refeeding-syndrome-in-emergency-department-boarders-how-covid-19-can-reshape-patient-care-in-the-emergency-department
#19
Patrick Meloy, Lauren Howell, Emily Armstrong, Elaine Bromberek
Emergency departments (EDs) in the United States are the primary drivers of hospital admissions. As the nation continues to experience unrestrained spread of the severe acute respiratory syndrome coronavirus 2, causing coronavirus disease 2019 (COVID-19), EDs, hospitals, and testing centers are overwhelmed with patients. The consequence of "boarding" admitted patients in EDs leads not only to longer ED wait times for all patients but also delays the medical practice of intensivists and internists while patients await an inpatient bed...
April 2022: Curēus
https://read.qxmd.com/read/35431486/end-of-life-communication-in-the-emergency-department-the-emergency-physicians-perspectives
#20
JOURNAL ARTICLE
Yuan Helen Zhang, Muthuwadura Waruni Subashini De Silva, John Carson Allen, Fatimah Lateef, Eunizar Binte Omar
Introduction: End-of-life (EOL) conditions are commonly encountered by emergency physicians (EP). We aim to explore EPs' experience and perspectives toward EOL discussions in acute settings. Methods: A qualitative survey was conducted among EPs in three tertiary institutions. Data on demographics, EOL knowledge, conflict management strategies, comfort level, and perceived barriers to EOL discussions were collected. Data analysis was performed using SPSS and SAS...
January 2022: Journal of Emergencies, Trauma, and Shock
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