Melanie Heniff
No abstract text is available yet for this article.
October 2016: Academic Emergency Medicine
Kevin James Tierney, Tiffany Murano, Brenda Natal
BACKGROUND: Local anesthetics are commonly used in the emergency department (ED). Overdoses can lead to disastrous complications including cardiac toxicity and arrest. Recognition of local anesthetic systemic toxicity (LAST) is important; however, prevention is even more critical. Knowledge of proper lidocaine dosage can prevent LAST. LAST may be effectively treated with lipid emulsion therapy. Although the mechanism is not well understood, its use may have a profound impact on morbidity and mortality...
January 2016: Journal of Emergency Medicine
Tomer Avni, Adi Lador, Shaul Lev, Leonard Leibovici, Mical Paul, Alon Grossman
OBJECTIVE: International guidelines recommend dopamine or norepinephrine as first-line vasopressor agents in septic shock. Phenylephrine, epinephrine, vasopressin and terlipressin are considered second-line agents. Our objective was to assess the evidence for the efficiency and safety of all vasopressors in septic shock. METHODS: Systematic review and meta-analysis. We searched electronic database of MEDLINE, CENTRAL, LILACS and conference proceedings up to June 2014...
2015: PloS One
Jeffrey D DellaVolpe, Jason E Moore, Michael R Pinsky
PURPOSE OF REVIEW: Circulatory shock is a complicated problem that carries a high risk of complications and mortality for critically ill patients. The heart rate and blood pressure targets to which a patient in shock should be resuscitated remain a challenge to intensivists. RECENT FINDINGS: While the ideal blood pressure and heart rate in circulatory shock are still not definitive, recent studies have begun to refine these targets. A recent trial comparing a mean arterial pressure target of 80-85 mmHg with a target of 65-70 mmHg showed no difference in mortality, with a decreased need for renal replacement therapy in patients with pre-existing hypertension based on subgroup analysis...
October 2015: Current Opinion in Critical Care
Peter W Macfarlane, Charles Antzelevitch, Michel Haissaguerre, Heikki V Huikuri, Mark Potse, Raphael Rosso, Frederic Sacher, Jani T Tikkanen, Hein Wellens, Gan-Xin Yan
The term early repolarization has been in use for more than 50 years. This electrocardiographic pattern was considered benign until 2008, when it was linked to sudden cardiac arrest due to idiopathic ventricular fibrillation. Much confusion over the definition of early repolarization followed. Thus, the objective of this paper was to prepare an agreed definition to facilitate future research in this area. The different definitions of the early repolarization pattern were reviewed to delineate the electrocardiographic measures to be used when defining this pattern...
July 28, 2015: Journal of the American College of Cardiology
J Michael Brewer, Michael A Puskarich, Alan E Jones
No abstract text is available yet for this article.
December 2015: Annals of Emergency Medicine
Gustavo J Rodrigo, Hugo Neffen
BACKGROUND: Assessment of acute asthma severity in the emergency department (ED) determines the appropriate initial therapy. The aim of this study was to evaluate the usefulness of heart and respiratory rates as determinants of severity of asthma exacerbations. METHODS: It was a pooled analysis of individual patient data from different controlled clinical trials performed over a 9-year period. The sample was characterized by patients with a diagnosis of asthma, age 18 to 50 years, and a forced expiratory volume in the first second (FEV1) or a peak expiratory flow less than or equal to 50% of predicted at ED presentation...
November 2015: American Journal of Emergency Medicine
Michael Doctor, Sebastian D Siadecki, Gabriel Rose, Rachel Berkowitz, Danielle Matilsky, Turandot Saul
INTRODUCTION: The placement of a central venous catheter (CVC) remains an important intervention in the care of critically ill patients in the emergency department, and bedside ultrasound can be used for procedural guidance as well as conformation of placement. Microbubble contrast-enhanced ultrasound may facilitate CVC tip position localization, and the addition of autologous blood can significantly increase its echogenicity. The purpose of this study was to describe the preferences of a group of resident physicians regarding the performance of various concentrations of air-blood-saline sonographic microbubble contrast agents...
October 2015: American Journal of Emergency Medicine
Anne-Maree Kelly, Sharon Klim
BACKGROUND: Guidelines recommend testing for coronary artery disease (CAD) for emergency department (ED) patients with a negative workup for acute coronary syndrome (ACS). The rationale is that, although myocardial infarction has been ruled out, the presentation could still indicate cardiac ischaemia. Evidence supporting this recommendation is weak. METHODS: Planned sub-study of prospective cohort study of ED chest pain patients with a negative ACS workup who were discharged...
January 2016: Heart, Lung & Circulation
Ryoichi Ochiai
Acute respiratory distress syndrome (ARDS) has been intensively and continuously studied in various settings, but its mortality is still as high as 30-40 %. For the last 20 years, lung protective strategy has become a standard care for ARDS, but we still do not know the best way to ventilate patients with ARDS. Tidal volume itself does not seem to have an important role to develop ventilator-induced lung injury (VILI), but the driving pressure, which is inspiratory plateau pressure-PEEP, is the most important to predict and affect the outcome of ARDS, though there is no safe limit for the driving pressure...
2015: Journal of Intensive Care
Haluk Un, Mehmet Dogan, Omer Uz, Zafer Isilak, Mehmet Uzun
Hemodynamically unstable patients with supraventricular tachycardias (SVTs) should be treated with electrical cardioversion. If the patient is stable, acute termination of tachycardia can be achieved by vagal maneuvers or medical therapy. The Valsalva maneuver, carotid massage, and ice to the face are the most common vagal maneuvers. In our experience with patients, we observed that vagal stimulation increases with lying backward. Our suggested maneuver is based on quickly lying backward, from a seated position...
January 2016: American Journal of Emergency Medicine
Roy Nadler, Sami Gendler, Avi Benov, Avi Shina, Erez Baruch, Gilad Twig, Elon Glassberg
BACKGROUND: Intravenous (IV) access has an essential role in the care provided for trauma patients, allowing for transfusion of blood products, fluids, and drugs. Decisions should be made regarding the necessity of IV access while considering cost-benefit of the procedure in terms of delayed evacuation times. METHODS: A retrospective review of all trauma patients in whom at least one attempt at IV access was performed were reviewed. Data were abstracted from the Israeli Defense Force Trauma Registry...
August 2015: Journal of Trauma and Acute Care Surgery
Aaron Brody, Tahsin Rahman, Brian Reed, Scott Millis, Brian Ference, John M Flack, Phillip D Levy
BACKGROUND: Poor blood pressure (BP) control is a primary risk factor for target organ damage in the heart, brain, and kidney. Uncontrolled hypertension is common among emergency department (ED) patients, particularly in underresourced settings, but it is unclear what role ED providers should play in the management of chronic antihypertensive therapy. OBJECTIVES: The objective was to evaluate the safety and efficacy of prescribing antihypertensive therapy from the ED...
May 2015: Academic Emergency Medicine
Andrew D Straznitskas, Sylvia Wong, Nicole Kupchik, David Carlbom
BACKGROUND: Development of ventricular fibrillation or pulseless ventricular tachycardia after an initial rhythm of pulseless electrical activity or asystole is associated with significantly increased cardiac arrest mortality. OBJECTIVE: To examine differences in epinephrine administration during cardiac arrest between patients who had a secondary ventricular fibrillation or ventricular tachycardia develop and patients who did not. METHODS: Data were collected for 2 groups of patients with in-hospital cardiac arrest and an initial rhythm of pulseless electrical activity or asystole: those who had a secondary ventricular fibrillation or ventricular tachycardia develop (cases) and those who did not (controls)...
May 2015: American Journal of Critical Care
Phillip D Levy, James J Mahn, Joseph Miller, Alicia Shelby, Aaron Brody, Russell Davidson, Michael J Burla, Alexander Marinica, Justin Carroll, John Purakal, John M Flack, Robert D Welch
OBJECTIVES: The objective is of the study to evaluate the effect of antihypertensive therapy in emergency department (ED) patients with markedly elevated blood pressure (BP) but no signs/symptoms of acute target organ damage (TOD). METHODS: This is a retrospective cohort study of ED patients age 18 years and older with an initial BP greater than or equal to 180/100 mm Hg and no acute TOD, who were discharged with a primary diagnosis of hypertension. Patients were divided based on receipt of antihypertensive therapy and outcomes (ED revisits and mortality) and were compared...
September 2015: American Journal of Emergency Medicine
Dion Stub, Karen Smith, Stephen Bernard, Janet E Bray, Michael Stephenson, Peter Cameron, Ian Meredith, David M Kaye
BACKGROUND: The role of routine supplemental oxygen for patients with uncomplicated acute myocardial infarction (AMI) has recently been questioned. There is conflicting data on the possible effects of hyperoxia on ischemic myocardium. The few clinical trials examining the role of oxygen in AMI were performed prior to the modern approach of emergent reperfusion and advanced medical management. METHODS: Air Verses Oxygen In myocarDial infarction study (AVOID Study) is a prospective, multi-centre, randomized, controlled trial conducted by Ambulance Victoria and participating metropolitan Melbourne hospitals with primary percutaneous coronary intervention capabilities...
March 2012: American Heart Journal
Frederick D'Aragon, Emilie P Belley-Cote, Maureen O Meade, François Lauzier, Neill K J Adhikari, Matthias Briel, Manoj Lalu, Salmaan Kanji, Pierre Asfar, Alexis F Turgeon, Alison Fox-Robichaud, John C Marshall, François Lamontagne
Physicians often prescribe vasopressors to correct pathological vasodilation and improve tissue perfusion in patients with septic shock, but the evidence to inform practice on vasopressor dosing is weak. We undertook a systematic review of clinical studies evaluating different blood pressure targets for the dosing of vasopressors in septic shock. We searched MEDLINE, EMBASE, CENTRAL (to November 2013), reference lists from included articles, and trial registries for randomized controlled trials (RCTs) and observational and crossover intervention studies comparing different blood pressure targets for vasopressor therapy in septic shock...
June 2015: Shock
Ulrike Holzinger, Richard Brunner, Heidrun Losert, Valentin Fuhrmann, Harald Herkner, Christian Madl, Fritz Sterz, Bruno Schneeweiß
INTRODUCTION: Targeted temperature management improves outcome after cardiopulmonary resuscitation. Reduction of resting energy expenditure might be one mode of action. The aim of this study was to correlate resting energy expenditure and substrate oxidation rates with targeted temperature management at 33°C and outcome in patients after cardiac arrest. METHODS: This prospective, observational cohort study was performed at the department of emergency medicine and a medical intensive care unit of a university hospital...
March 29, 2015: Critical Care: the Official Journal of the Critical Care Forum
Sang Jin Han, Hyoung Soo Kim, Hyun Hee Choi, Gyung Soon Hong, Won Ki Lee, Sun Hee Lee, Dong Geun You, Jae Jun Lee
BACKGROUND: This study aimed to identify the determinant factors for clinical outcomes and survival rates of patients with cardiac arrest (CA) concurrent with acute myocardial infarction (AMI) who underwent extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal membrane oxygenation (ECMO). METHODS: We retrospectively evaluated 37 patients admitted to our emergency department between January 2006 and August 2012 for AMI-induced CA treated with ECPR during ongoing continuous chest compressions...
February 24, 2015: Journal of Cardiothoracic Surgery
Paul R Mouncey, Tiffany M Osborn, G Sarah Power, David A Harrison, M Zia Sadique, Richard D Grieve, Rahi Jahan, Sheila E Harvey, Derek Bell, Julian F Bion, Timothy J Coats, Mervyn Singer, J Duncan Young, Kathryn M Rowan
BACKGROUND: Early, goal-directed therapy (EGDT) is recommended in international guidelines for the resuscitation of patients presenting with early septic shock. However, adoption has been limited, and uncertainty about its effectiveness remains. METHODS: We conducted a pragmatic randomized trial with an integrated cost-effectiveness analysis in 56 hospitals in England. Patients were randomly assigned to receive either EGDT (a 6-hour resuscitation protocol) or usual care...
April 2, 2015: New England Journal of Medicine
2015-04-17 23:14:39
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