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https://read.qxmd.com/read/30775936/new-synthetic-opioid-cyclopropylfentanyl-together-with-other-novel-synthetic-opioids-in-respiratory-insufficient-comatose-patients-detected-by-toxicological-analysis
#1
Dieter Müller, Hartmud Neurath, Merja A Neukamm, Maurice Wilde, Caroline Despicht, Sabine Blaschke, Marcel Grapp
INTRODUCTION: Fentanyl derivatives like cyclopropylfentanyl have recently appeared on the recreational drug market. Cyclopropylfentanyl is probably a highly potent opioid, but human toxicological data are not available so far. Similar to other fentanyl derivatives the most serious acute health risk due to the use of cyclopropylfentanyl is likely to be respiratory depression. In case of overdose, this may lead to apnoea, respiratory arrest and death. In this paper, we present three cases of severe intoxication with cyclopropylfentanyl...
February 18, 2019: Clinical Toxicology
https://read.qxmd.com/read/30765037/venoarterial-ecmo-for-adults-jacc-scientific-expert-panel
#2
REVIEW
Maya Guglin, Mark J Zucker, Vanessa M Bazan, Biykem Bozkurt, Aly El Banayosy, Jerry D Estep, John Gurley, Karl Nelson, Rajasekhar Malyala, Gurusher S Panjrath, Joseph B Zwischenberger, Sean P Pinney
Venoarterial extracorporeal membrane oxygenation (ECMO) is a rescue therapy that can stabilize patients with hemodynamic compromise, with or without respiratory failure, for days or weeks. In cardiology, the main indications for ECMO include cardiac arrest, cardiogenic shock, post-cardiotomy shock, refractory ventricular tachycardia, and acute management of complications of invasive procedures. The fundamental premise underlying ECMO is that it is a bridge-to recovery, to a more durable bridge, to definitive treatment, or to decision...
February 19, 2019: Journal of the American College of Cardiology
https://read.qxmd.com/read/30745194/rescue-sedation-when-treating-acute-agitation-in-the-emergency-department-with-intramuscular-antipsychotics
#3
Lauren R Klein, Brian E Driver, Gabriella Horton, Sarah Scharber, Marc L Martel, Jon B Cole
BACKGROUND: Rapid treatment of agitation in the emergency department (ED) is critical to avoid injury to patients and providers. Treatment with intramuscular antipsychotics is often utilized, but there is a paucity of comparative effectiveness evidence available. OBJECTIVE: The purpose of this investigation was to compare the effectiveness of droperidol, olanzapine, and haloperidol for treating agitation in the ED. METHODS: This was a retrospective observational study of adult patients who received intramuscular medication to treat agitation...
February 8, 2019: Journal of Emergency Medicine
https://read.qxmd.com/read/30739090/-cleistanthus-collinus-poisoning-a-case-report-of-intentional-poisoning
#4
Nandakishore Bompelli, Rakesh Reddy C, Santosh Modani, Anirudda Deshpande
We report a case of 50-year-old male patient from tribal area in South Indian state of Telangana, who ingested the liquid extract from crushed leaves of the plant, cleistanthus collinius with the intention of self-harm. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on arterial blood gas (ABG) and was corrected accordingly...
February 9, 2019: BMJ Case Reports
https://read.qxmd.com/read/30739088/rib-fracture-fixation-as-a-tool-for-extubation-in-a-resource-poor-environment
#5
Richard Alexander Dickson-Lowe, Johannes Jacobus Petrus Buitendag, Olamide Oluwafunsho Jolayemi, George Oosthuizen
An elderly female with multiple comorbidities was involved in a pedestrian vehicle accident and sustained blunt chest trauma, arriving at a resource-poor hospital in rural South Africa. She had multiple bilateral rib fractures with a unilateral flail segment that caused her to develop respiratory failure. She was intubated and sent to the intensive care unit (ICU) for ventilation. She developed hospital and ventilator acquired pneumonia. She subsequently had hypoxic arrests on two separate occasions and two failed extubations...
February 9, 2019: BMJ Case Reports
https://read.qxmd.com/read/30737765/derivation-of-a-quick-pitt-bacteremia-score-to-predict-mortality-in-patients-with-gram-negative-bloodstream-infection
#6
Sarah E Battle, Matthew R Augustine, Christopher M Watson, P Brandon Bookstaver, Joseph Kohn, William B Owens, Larry M Baddour, Majdi N Al-Hasan
PURPOSE: This retrospective cohort study derived a "quick" version of the Pitt bacteremia score (qPitt) using binary variables in patients with Gram-negative bloodstream infections (BSI). The qPitt discrimination was then compared to quick sepsis-related organ failure assessment (qSOFA) and systemic inflammatory response syndrome (SIRS). METHODS: Hospitalized adults with Gram-negative BSI at Palmetto Health hospitals in Columbia, SC, USA from 2010 to 2013 were identified...
February 8, 2019: Infection
https://read.qxmd.com/read/30725023/-deterioration-of-vital-signs-as-predictors-of-major-medical-emergencies-in-hospitalized-patients
#7
Esteban Araos-Baeriswyl, Teo Feuerhake, Manuel Mundaca, Bárbara Lara, Francisco Ortega, Nicolás Aeschlimann, Gonzalo Eymin
BACKGROUND: Medical emergencies (ME) in hospitalized patients (cardiac and respiratory arrest, suffocation, asphyxia, seizures, unconsciousness) are associated with high morbidity and mortality. Most of these patients have signs of physiological deterioration prior to the appearance of the emergency. Early detection of warning signs by rapid response teams (RRT) may provide an opportunity for the prevention of major adverse events. AIM: To identify clinical signs predicting death, need for mechanical ventilation, or transfer to a more complex unit during the 72 hours prior to the activation of the ME code...
September 2018: Revista Médica de Chile
https://read.qxmd.com/read/30723893/effect-of-monoamine-reuptake-inhibition-and-%C3%AE-1-blockade-on-respiratory-arrest-and-death-following-electroshock-induced-seizures-in-mice
#8
Stephen W Kruse, Kyle G Dayton, Benton S Purnell, Jared I Rosner, Gordon F Buchanan
OBJECTIVE: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy. Although the mechanisms for SUDEP are incompletely understood, seizure-induced respiratory arrest (S-IRA) has been strongly and consistently implicated. A body of evidence indicates that serotonin (5-HT), a modulator of breathing, plays a critical role in SUDEP. Because the 5-HT and norepinephrine (NE) systems interact in many biologic processes and NE is known to modulate breathing and seizures, we hypothesized that NE may play a role in S-IRA and SUDEP...
February 5, 2019: Epilepsia
https://read.qxmd.com/read/30720392/palliative-care-in-paramedic-practice-a-retrospective-cohort-study
#9
Bill Lord, Emily Andrew, Amanda Henderson, David J Anderson, Karen Smith, Stephen Bernard
BACKGROUND: Paramedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic's role in the care of these patients. AIM: To describe the incidence and nature of cases attended by paramedics and the care provided where the reason for attendance was associated with a history of palliative care. DESIGN: This is a retrospective cohort study. SETTING/PARTICIPANTS: Adult patients (aged >17 years) attended by paramedics in the Australian state of Victoria between 1 July 2015 and 30 June 2016 where terms associated with palliative care or end of life were recorded in the patient care record...
February 5, 2019: Palliative Medicine
https://read.qxmd.com/read/30719703/fenfluramine-a-serotonin-releasing-drug-prevents-seizure-induced-respiratory-arrest-and-is-anticonvulsant-in-the-dba-1-mouse-model-of-sudep
#10
Srinivasan Tupal, Carl L Faingold
OBJECTIVE: Prevention of sudden unexpected death in epilepsy (SUDEP) is a critical goal for epilepsy therapy. The DBA/1 mouse model of SUDEP exhibits an elevated susceptibility to seizure-induced death in response to electroconvulsive shock, hyperthermia, convulsant drug, and acoustic stimulation. The serotonin hypothesis of SUDEP is based on findings that treatments which modify serotonergic function significantly alter susceptibility to seizure-induced sudden death in several epilepsy models, including DBA/1 mice...
February 4, 2019: Epilepsia
https://read.qxmd.com/read/30716427/cost-utility-of-extracorporeal-cardiopulmonary-resuscitation-in-patients-with-cardiac-arrest
#11
Murtaza Bharmal, Joseph M Venturini, Rhys F M Chua, Willard Sharp, David G Beiser, Corey Tabit, Taishi Hirai, Jonathan R Rosenberg, Janet Friant, John E A Blair, Jonathan D Paul, Sandeep Nathan, Atman P Shah
BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is a resource-intensive tool that provides haemodynamic and respiratory support in patients who have suffered cardiac arrest. In this study, we investigated the cost-utility of ECPR (cost/QALY) in cardiac arrest patients treated at our institution. METHODS: We performed a retrospective review of patients who received ECPR following cardiac arrest between 2012 and 2018. All medical care-associated charges with ECPR and subsequent hospital admission were recorded...
February 1, 2019: Resuscitation
https://read.qxmd.com/read/30710595/reasons-for-death-in-patients-successfully-resuscitated-from-out-of-hospital-and-in-hospital-cardiac-arrest
#12
Lise Witten, Ryan Gardner, Mathias J Holmberg, Sebastian Wiberg, Ari Moskowitz, Shivani Mehta, Anne V Grossestreuer, Tuyen Yankama, Michael W Donnino, Katherine M Berg
INTRODUCTION: There is no standard for categorizing reasons for death in those who achieve return of spontaneous circulation (ROSC) after cardiac arrest but die before hospital discharge. Categorization is important for comparing outcomes across studies, assessing benefits of interventions, and developing quality-improvement initiatives. We developed and tested a method for categorizing reasons for death after cardiac arrest in both in-hospital (IHCA) and out-of-hospital (OHCA) arrests...
January 30, 2019: Resuscitation
https://read.qxmd.com/read/30707881/-effect-analysis-of-abdominal-compression-decompression-device-in-patients-with-cardiopulmonary-resuscitation-in-pre-hospital-first-aid
#13
Yonghong Wang, Jie Wang, Guolan Wu, Ronghua Yang, Shouhui Wang, Manguo Zhao, Shijun Zhu, Xusheng Li, Yongsheng Chen
OBJECTIVE: To investigate the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) in patients with pre-hospital respiratory and cardiac arrest. METHODS: Forty-five patients with respiratory and cardiac arrest, and with contraindication of chest compression admitted to Baiyin Central Hospital of Gansu Province from March 2012 to September 2018 were enrolled, and they were divided into two groups according to random number table...
January 2019: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://read.qxmd.com/read/30707863/-review-and-forecast-of-critical-care-medicine-in-2018
#14
Wei Huang, Yongxin Qin
In 2018, a bunch of considerable positive progresses have been presented, including a revised "hour-1 bundle" introduced by international guideline for management of sepsis and septic shock, trans-pulmonary pressure monitoring via esophageal manometry in acute respiratory distress syndrome (ARDS) models, successful trials for new antibiotics, angiotensin II in patients with vasodilatory shock and renal replacement therapy, advanced airway management in out-of-hospital cardiac arrest (OHCA) patients as well cellular immunotherapy for septic shock...
January 2019: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://read.qxmd.com/read/30703160/predicting-in-hospital-mortality-among-non-trauma-patients-based-on-vital-sign-changes-between-prehospital-and-in-hospital-an-observational-cohort-study
#15
Yohei Kamikawa, Hiroyuki Hayashi
OBJECTIVE: To prevent misjudgment of the severity of patients in the emergency department who initially seem non-severe but are in a critical state, methods that differ from the conventional viewpoint are needed. We aimed to determine whether vital sign changes between prehospital and in-hospital could predict in-hospital mortality among non-trauma patients. METHODS: This observational cohort study was conducted in two tertiary care hospitals. Patients were included if they were transported by ambulance for non-trauma-related conditions but were excluded if they experienced prehospital cardiopulmonary arrest, were pregnant, were aged <15 years, had undergone inter-hospital transfer, or had complete missing data regarding prehospital or in-hospital vital signs...
2019: PloS One
https://read.qxmd.com/read/30701823/case-of-iatrogenic-botulism-after-botulinotherapy-in-clinical-practice
#16
R A Ibatullin, R V Magjanov
Injections of botulinum toxin are widely used in different medical fields, namely neurology, urology, stomatology, cosmetology, gastroenterology etc. Preparations of botulinum toxin type A (BTA) prevent the release of acetylcholine at the endings of motor nerves leading to the long-term muscle relaxation. It has been acknowledged that treatment with BTA has very good safety profile and tolerability. Extremely rare but severe complication of botulinotherapy (BT) is a condition, which is associated with generalized muscle Weakness, swallowing difficulty, respiratory arrest, and may lead to the lethal outcomes in the solitary cases...
November 22, 2018: Terapevticheskiĭ Arkhiv
https://read.qxmd.com/read/30701147/rare-cause-of-acute-tetraplegia-and-respiratory-arrest-cervicomedullary-neuroenteric-cyst-in-a-child-case-report
#17
Hakan Ozalp, Vural Hamzaoglu, Derya Karatas, Ahmet Dagtekin, Mehmet Yildız, Emel Avcı
Background: Neuroenteric cysts (NCs) are benign, rare congenital lesions which are most commonly found in the lower cervical and upper thoracic segments. Even though these are benign lesions, it may present with fatal neurologic deterioration particularly in pediatric patients. Case Report: We here report a 16-year-old boy who has unique manifestation with acute tetraplegia and respiratory arrest in emergency room. According to English literature, this is the first case of cervicomedullary intradural neuroenteric cyst which causes acute tetraplegia and respiratory arrest in a child...
January 2019: NMC Case Report Journal
https://read.qxmd.com/read/30696398/acute-respiratory-failure-secondary-to-a-cervical-goitre-in-a-pregnant-woman-a-case-report
#18
Sidi Driss El Jaouhari, Nawfal Doghmi, Hamza Najout, Massine El Hamouni, El Hassane Kabiri, Hicham Bekkali, Jaafar Salim Lalaoui, Mustapha Bensghir
BACKGROUND: Pregnancy constitutes a significant factor in thyroid hypertrophy and can rarely progress to respiratory distress. We describe case of pregnant woman with acute respiratory distress following a tracheal compression due to goiter, quickly resulting in respiratory arrest, requiring emergency orotracheal intubation and thyroidectomy. CASE PRESENTATION: A pregnant woman with a growing goiter was referred to the hospital with a respiratory difficulty. During the examination, we found a large homogeneous goiter...
January 29, 2019: BMC Emergency Medicine
https://read.qxmd.com/read/30694742/therapeutic-direction-versus-adverse-outcomes-in-children-undergoing-lung-biopsy
#19
Justin A Sobrino, Nhatrang Le, Joseph A Sujka, Leo Andrew Benedict, Rebecca M Rentea, Hanna Alemayehu, Shawn D St Peter
BACKGROUND: Lung biopsy is part of the diagnostic workup for multiple diseases. Although the morbidity of the procedure has decreased with the use of thoracoscopy, lung biopsy still holds substantial risk for patients. Therefore, we evaluated the likelihood of lung biopsies impacting treatment compared to complications. MATERIAL AND METHODS: This was a single-institution, retrospective chart review of patients less than aged 18 y undergoing lung biopsy from 2010 to 2016...
December 10, 2018: Journal of Surgical Research
https://read.qxmd.com/read/30681557/impact-of-prehospital-mechanical-ventilation-a-retrospective-matched-cohort-study-of-911-calls-in-the-united-states
#20
Mazen J El Sayed, Hani Tamim, Aurelie Mailhac, N Clay Mann
Prehospital use of ventilators by emergency medical services (EMS) during 911 calls is increasing. This study described the impact of prehospital mechanical ventilation on prehospital time intervals and on mortality.This retrospective matched-cohort study used 4 consecutive public releases of the US National Emergency Medical Services Information System dataset (2011-2014). EMS activations with recorded ventilator use were randomly matched with activations without ventilator use (1 to 1) on age (range ± 2 years), gender, provider's primary impression, urbanicity, and level of service...
January 2019: Medicine (Baltimore)
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