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Cardiac arrest emergency department

Felipe Teran, Anthony J Dean, Claire Centeno, Nova L Panebianco, Amy J Zeidan, Wilma Chan, Benjamin S Abella
BACKGROUND: Transesophageal echocardiography (TEE) has been proposed as a modality to assess patients in the setting of cardiac arrest, both during resuscitation care and following return of spontaneous circulation (ROSC). In this study we aimed to assess the feasibility and clinical impact of TEE during the Emergency Department (ED) evaluation during out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS: We conducted a prospective observational study consisting of a convenience sample of adult patients presenting to the ED of an urban university medical center with non-traumatic OHCA...
February 16, 2019: Resuscitation
Steve Balian, David G Buckler, Audrey L Blewer, Abhishek Bhardwaj, Benjamin S Abella
AIM OF THE STUDY: Regionalization of care for out-of-hospital cardiac arrests (OHCA) may improve patient outcomes. We evaluated inter-hospital variations in post-arrest care provision and the relation between hospital case volume and survival in Pennsylvania. METHODS: This retrospective study (2013-2017) used data from adult OHCA cases in Pennsylvania from the Cardiac Arrest Registry to Enhance Survival. Analysis was performed on hospitals reporting greater than 40 cases/5 years with sustained return of spontaneous circulation upon emergency department arrival and survival to hospital admission...
February 13, 2019: Resuscitation
David Pilecky, Mate Vamos, Peter Bogyi, Balazs Muk, Dora Stauder, Hajnalka Racz, Noemi Nyolczas, Gabor Z Duray, Gabor Zacher, Endre Zima
OBJECTIVE: Patients with electrical injury are considered to be at high risk of cardiac arrhythmias. Due to the small number of studies, there is no widely accepted guideline regarding the risk assessment and management of arrhythmic complications after electrical accident (EA). Our retrospective observational study was designed to determine the prevalence of ECG abnormalities and cardiac arrhythmias after EA, to evaluate the predictive value of cardiac biomarkers for this condition and to assess in-hospital and 30-day mortality...
February 15, 2019: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Peter V Bui, Nathan L Haas, Nicholas W C Herrman, Matthew Macias, Victoria Hoch, William Schaeffer, Christopher Wallace
BACKGROUND: Brugada pattern on electrocardiography (ECG) can manifest as type 1 (coved pattern) and type 2 (saddleback pattern). Brugada syndrome represents an ECG with Brugada pattern in a patient with symptoms or clinical factors, including syncope, cardiac arrest, ventricular dysrhythmias, and family history. Brugada syndrome is caused by a genetic channelopathy, but the Brugada pattern may be drug-induced. Epinephrine-induced Brugada pattern has not been reported previously. CASE REPORT: A 63-year-old man developed anaphylaxis secondary to a bee sting, had a transient loss of consciousness, and self-administered intramuscular epinephrine...
February 9, 2019: Journal of Emergency Medicine
Akihiko Inoue, Hiroshi Okamoto, Toru Hifumi, Tadahiro Goto, Yusuke Hagiwara, Hiroko Watase, Kohei Hasegawa
BACKGROUND: Studies in the non-emergency department (ED) settings have reported the relationships of post-intubation hypertension with poor patient outcomes. While ED-based studies have examined post-intubation hypotension and its sequelae, little is known about, post-intubation hypertension and its risk factors in the ED settings. In this context, we aimed to identify the incidence of post-intubation hypertension in the ED, and to test the hypothesis that repeated intubation attempts are associated with an increased risk of post-intubation hypertension...
2019: PloS One
Elizabeth Brigham, Jodi Brady, Robert P Olympia
Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life- and limb-threatening illnesses or injuries may occur, such as sudden cardiac arrest, heat stroke, status asthmaticus, catastrophic brain or cervical spine injuries, hypoglycemia, blunt chest/abdominal injuries, or extremity fractures requiring surgery. It is important for the school nurse to recognize potential life- and limb-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life- and limb-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department via emergency medical services)...
February 9, 2019: NASN School Nurse
Saqer M Althunayyan
Endotracheal intubation is a lifesaving procedure that is performed in various settings within the hospital or even in the pre-hospital field. However, it can result in serious hemodynamic complications, such as post-intubation hypotension (PIH) and cardiac arrest. The most promising predictor of such complications is the shock index (SI), which holds great prognostic value for multiple disorders. On the other hand, most of the studies that have assessed the predictability of the pre-intubation SI have been small and were limited to a particular setting of a single center; thus, the results were not generalizable, and the predictive value vary according to the setting...
January 2019: Bulletin of Emergency and Trauma
Agnieszka Skorko, Andrew Mumford, Matthew Thomas, Anthony E Pickering, Rosemary Greenwood, Elinor Griffiths, Thomas Johnson, Jonathan Benger
AIM: Coagulation and platelet function following out of hospital cardiac arrest (OHCA) at admission to a UK cardiology centre were investigated prospectively in this observational feasibility study, and compared to that of patients receiving percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). METHOD: Blood samples taken immediately at emergency department admission from patients after OHCA of probable cardiac origin were analysed using near-patient thromboelastometry and a platelet function analyser...
February 1, 2019: Resuscitation
Wataru Takayama, Akira Endo, Hazuki Koguchi, Kiyoshi Murata, Yasuhiro Otomo
BACKGROUND: Although patients with out-of-hospital cardiac arrest (OHCA) have a lower survival rate during night-time than during day-time, the cause of this difference remains unclear. We aimed to assess CPR parameters according to time period based on in-hospital cardiopulmonary resuscitation (IHCPR) duration and the frequency of iatrogenic chest injuries among OHCA patients. METHODS: This two-centre observational cohort study evaluated non-traumatic OHCA patients who were transferred between 2013-2016...
January 29, 2019: Resuscitation
Atsuna Fukuda, Takeshi Isoda, Naoya Sakamoto, Keisuke Nakajima, Tetsuya Ohta
BACKGROUND: Finding an abdominal mass or hematuria is the initial step in diagnosing Wilms tumor. As the first manifestation of Wilms tumor, it is exceedingly rare for pulmonary tumor embolism to present with cardiac arrest. A case of a patient whose sudden cardiac arrest due to massive pulmonary tumor embolism of Wilms tumor was not responsive to resuscitation is presented. CASE PRESENTATION: The patient was a five-year-old girl who collapsed suddenly during activity in nursery school and went into cardiac arrest in the ambulance...
January 31, 2019: BMC Pediatrics
Paul R Atkinson, Andrew W Keyes, Kathleen O'Donnell, Nicole Beckett, Ankona Banerjee, Jacqueline Fraser, David Lewis
Introduction Electrocardiographic (ECG) rhythms are used during advanced cardiac life support (ACLS) to guide resuscitation management. Survival to hospital discharge has been reported to be better for patients with pulseless electrical activity (PEA) than asystole in out-of-hospital arrests. Despite this, treatment for these two (non-shockable) rhythms is combined in ACLS guidelines. This study examines if the recorded cardiac rhythm of asystole or PEA during ACLS accurately predicts mechanical cardiac activity as determined by point-of-care ultrasound (PoCUS)...
November 23, 2018: Curēus
Matthew Thomas, Sarah Voss, Jonathan Benger, Kim Kirby, Jerry P Nolan
BACKGROUND: Hyperoxia following out of hospital cardiac arrest (OHCA) is associated with a poor outcome. Animal data suggest the first hour post resuscitation may be the most important. In the UK the first hour usually occurs in the prehospital environment. METHODS: A prospective controlled trial, cluster randomised by paramedic, comparing titrated oxygen with 100% oxygen for the first hour after return of spontaneous circulation (ROSC) following OHCA. The trial was done in a single emergency medical services (EMS) system in the United Kingdom (UK) admitting patients to three emergency departments...
January 25, 2019: BMC Emergency Medicine
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)
Sema Avcı, Ayşe Başaran, Selim Genç, Seda Özkan, Engin Deniz Arslan
OBJECTIVE: Endosulfan is an organochlorine pesticide with high lipophilic features that makes it a well-absorbed agent and penetrates easily to the site of action. Endosulfan toxicities may result in disastrous complications and have high rates of mortality. Several case reports and some researchs discuss the evidence supporting intravenous lipid emulsion (ILE) therapy as a rescue therapy in lipophilic agents' toxicity. CASE REPORT: A 33-years-old healthy woman with  a history of endosulfan ingestion of uncertain quantity in a suicide attempt six hours ago was admitted to our emergency department...
January 15, 2019: Acta Bio-medica: Atenei Parmensis
Raluca Mihaela Tat, Adela Golea, Ştefan Cristian Vesa, Daniela Ionescu
AIM: The aim of our study was to evaluate the potential role of resistin in estimating the 30 days prognosis in patients with hypoxic-ischemic organ injury who survived after a cardiac arrest (CA). MATERIALS AND METHODS: The study included 40 patients resuscitated after a non-traumatic out-of-hospital CA admitted in Emergency Department (ED). All patients were followed for 30 days after CA or until death. Clinical data on admission were recorded. Blood samples were collected on admission in ED (0-time interval), and at 6, 12, 24, 48- and 72-hours following resuscitation...
2019: PloS One
Szu-Hsin Wu, Ryh-Sheng Li, Yuh-Ming Hwu
OBJECTIVE: The aim of this study is to share a valuable experience of perimortem Cesarean delivery (PMCD) when no signs of spontaneous circulation were detected after 4 min of resuscitation. The time interval between maternal cardiac arrest and neonatal delivery was evaluated and reviewed. CASE REPORT: We present the case of an out-of-hospital cardiac arrest (OHCA) in a nulliparous woman who survived a car accident with only seatbelt injuries. The term infant was delivered by PMCD at our emergency department at least 43 min after maternal cardiac arrest...
January 2019: Taiwanese Journal of Obstetrics & Gynecology
Stéphanie Pillet, Pierre-Nicolas Carron, Alexandre Bentvelzen, Nadim Al-Duaij, Laurent Suppan, Christophe Fehlmann, Vincent Darioli
Professionalisation of emergency medicine is currently booming. In order to offer the best care, emergency physician can refer to several new studies : 1) in a cerebral stroke, the 0° head position doesn't offer any benefit ; 2) hyperoxygenation in acute patients could raise mortality ; 3) epinephrine in prehospital cardiac arrest favors return of spontaneous circulation but worsens the neurological prognosis ; 4) systematic cross-checking reduces the risk of adverse events in the emergency department ; 5) ultrasensitive troponins better detect myocardic events, but raises the number of unusefull invasive procedures and 6) combined pre-test probability score and D-dimers potentially allows to rule out aortic dissection...
January 9, 2019: Revue Médicale Suisse
Hui Jai Lee, Jonghwan Shin, Ki Jeong Hong, Jin Hee Jung, Se Jong Lee, Euigi Jung, Kyoung Min You, Tae Han Kim
PURPOSE: We investigated the change in pupil size and pupil light reflex (PLR) using a pupillography capable of continuous measurement both during CPR and immediately following the return-of-spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) comatose patients in an emergency department. METHODS: Pupil size and PLR were continuously measured both during CPR and immediately following ROSC until intensive care unit (ICU) admission. The changes in pupil sizes during CPR were categorized into three groups (no change - N, decreased - D, and increased - I groups)...
December 29, 2018: Resuscitation
Katherine Z Isoardi, Sarah F Ayles, Keith Harris, Clare J Finch, Colin B Page
OBJECTIVE: There is little recent published data characterising methamphetamine intoxication. The present study aims to describe the clinical effects, management, complications and disposition of patients with methamphetamine exposure. METHODS: This is a retrospective review of patients presenting with methamphetamine intoxication to an ED in 2016. All presentations were extracted from a relational database and each medical record reviewed. Demographics, clinical features, complications and disposition were extracted...
December 28, 2018: Emergency Medicine Australasia: EMA
Sola Kim, Ki Ok Ahn, Young Sun Ro, Sang Do Shin
This study aimed to identify factors associated with the decision to transfer resuscitated patients with out-of-hospital cardiac arrest (OHCA) who were initially examined at hospitals with limited targeted temperature management capability (HLTC) in Korea. We included adult patients with OHCA who were initially transported to HLTC from 2012 to 2015. We limited the study population with OHCA who were admitted or transferred. Potential factors associated with the transfer decision were categorized as patient- or hospital-level characteristics...
December 26, 2018: Therapeutic Hypothermia and Temperature Management
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