collection
https://read.qxmd.com/read/35870366/hyponatremia-in-the-emergency-department
#1
REVIEW
Gregor Lindner, Christoph Schwarz, Michael Haidinger, Svenja Ravioli
Hyponatremia, defined as a serum sodium <135 mmol/L, is frequently encountered in patients presenting to the emergency department. Symptoms are often unspecific and include a recent history of falls, weakness and vertigo. Common causes of hyponatremia include diuretics, heart failure as well as Syndrome of Inappropriate Antidiuresis (SIAD) and correct diagnosis can be challenging. Emergency treatment of hyponatremia should be guided by presence of symptoms and focus on distinguishing between acute and chronic hyponatremia...
October 2022: American Journal of Emergency Medicine
https://read.qxmd.com/read/35882525/non-sterile-gloves-and-dressing-versus-sterile-gloves-dressings-and-drapes-for-suturing-of-traumatic-wounds-in-the-emergency-department-a-non-inferiority-multicentre-randomised-controlled-trial
#2
RANDOMIZED CONTROLLED TRIAL
Juliette J M Zwaans, Wouter Raven, Arthur V Rosendaal, Esther M M Van Lieshout, Geesje Van Woerden, Peter Patka, Juanita A Haagsma, Pleunie P M Rood
BACKGROUND: Patients with traumatic wounds frequently present to the ED. Literature on whether to treat these wounds sterile or non-sterile is sparse. Non-sterile treatment has the advantage of saving resources and costs, and could be of value in health settings where sterile materials are not readily available. Our objective was to compare the rate of wound infection after suturing traumatic lacerations with non-sterile gloves and dressings versus sterile gloves, dressings and drapes in the ED...
September 2022: Emergency Medicine Journal: EMJ
https://read.qxmd.com/read/35852524/diagnosis-and-management-of-hyponatremia-a-review
#3
REVIEW
Horacio J Adrogué, Bryan M Tucker, Nicolaos E Madias
IMPORTANCE: Hyponatremia is the most common electrolyte disorder and it affects approximately 5% of adults and 35% of hospitalized patients. Hyponatremia is defined by a serum sodium level of less than 135 mEq/L and most commonly results from water retention. Even mild hyponatremia is associated with increased hospital stay and mortality. OBSERVATIONS: Symptoms and signs of hyponatremia range from mild and nonspecific (such as weakness or nausea) to severe and life-threatening (such as seizures or coma)...
July 19, 2022: JAMA
https://read.qxmd.com/read/35833768/recommendations-for-the-management-of-hyperkalemia-in-the-emergency-department
#4
JOURNAL ARTICLE
Esther Álvarez-Rodríguez, Alberto Olaizola Mendibil, María de Los Ángeles San Martín Díez, Ainhoa Burzako Sánchez, Alberto Esteban-Fernández, Emilio Sánchez Álvarez
Hyperkalemia, a common electrolyte disorder, is seen often in emergency departments. Patient outcomes are impacted by proper management, which requires consideration of both clinical and laboratory findings in relation to kidney function, hydration, the acid-base balance, and heart involvement. Delicate decisions about the timing of potassium level correction must be tailored in each case. For these reasons the Spanish Society of Emergency Medicine (SEMES), the Spanish Society of Cardiology (SEC), and the Spanish Society of Nephrology (SEN) joined forces to come to a consensus on defining the problem and recommending treatments that improve hospital emergency department management of hyperkalemia...
August 2022: Emergencias: Revista de la Sociedad Española de Medicina de Emergencias
https://read.qxmd.com/read/35713596/delays-in-door-to-diuretic-time-and-1-year-mortality-among-patients-with-heart-failure
#5
JOURNAL ARTICLE
Dillon J Dzikowicz, Sunita Pokhrel Bhattarai, Joyce Ng, Arthur L Zemanek, Mary G Carey
BACKGROUND: Achieving prompt euvolemic state in heart failure (HF) is associated with reduced mortality. Time-sensitive metrics such as door-to-diuretic time , or the time between presentation and administration of intravenous diuretics, may be an important facilitator of achieving a faster euvolemic state and reducing mortality. OBJECTIVE: The aim of this study was to investigate whether reduced door-to-diuretic time was associated with lower odds of death among hospitalized patients with HF...
September 2022: Journal of Cardiovascular Nursing
https://read.qxmd.com/read/35776923/the-lay-public-s-knowledge-of-the-most-common-acute-coronary-syndrome-symptoms-experienced-by-women-and-men
#6
JOURNAL ARTICLE
John R Blakeman, Ann L Eckhardt, MyoungJin Kim
BACKGROUND: Although extensive research and public education for the last 2 decades has focused on symptom differences experienced by men and women, little is known about what acute coronary syndrome symptoms the lay public associates with men, with women, and with both men and women. OBJECTIVE: The aim of this study was to describe what acute coronary syndrome symptoms the lay public associates with men, with women, and with both men and women and to explore whether differences in participant gender affect how these symptoms are associated...
July 1, 2022: Journal of Cardiovascular Nursing
https://read.qxmd.com/read/35752521/intranasal-topical-application-of-tranexamic-acid-in-atraumatic-anterior-epistaxis-a-double-blind-randomized-clinical-trial
#7
JOURNAL ARTICLE
Milad Hosseinialhashemi, Reza Jahangiri, Ali Faramarzi, Naeimehossadat Asmarian, Sarvin Sajedianfard, Maryam Kherad, Amir Soltaniesmaeili, Amirhossein Babaei
STUDY OBJECTIVE: To determine the effectiveness of intranasal topical application of tranexamic acid in reducing the need for anterior nasal packing and determine the number of episodes of rebleeding in adult patients presenting with spontaneous atraumatic anterior epistaxis. METHODS: This study was a double-blind randomized trial conducted from September to November 2021 in the ears, nose, and throat (ENT) emergency department (ED), Khalili Hospital, Shiraz, Iran...
June 22, 2022: Annals of Emergency Medicine
https://read.qxmd.com/read/35633423/prediction-of-fluid-responsiveness-what-s-new
#8
REVIEW
Xavier Monnet, Rui Shi, Jean-Louis Teboul
Although the administration of fluid is the first treatment considered in almost all cases of circulatory failure, this therapeutic option poses two essential problems: the increase in cardiac output induced by a bolus of fluid is inconstant, and the deleterious effects of fluid overload are now clearly demonstrated. This is why many tests and indices have been developed to detect preload dependence and predict fluid responsiveness. In this review, we take stock of the data published in the field over the past three years...
May 28, 2022: Annals of Intensive Care
https://read.qxmd.com/read/35633860/when-should-we-give-up-on-expectant-management-for-patients-with-proximal-ureteral-stones
#9
JOURNAL ARTICLE
Igal Shpunt, Etay Elbaz, Yuval Avda, Jonathan Modai, Dan Leibovici, Brian Berkowitz, Yaniv Shilo
Background: Proximal ureteral stones (PUS) have relatively low rates of spontaneous expulsion. However, some patients do well on expectant management. Our aim was to compare risk factors for surgical intervention in patients with PUS who underwent primary intervention to those subjected to expectant management. Materials and methods: We retrospectively reviewed the medical charts of patients presented to the emergency room with symptoms of renal colic and underwent computerized tomography between August 2016 and August 2017...
March 2022: Current Urology
https://read.qxmd.com/read/35461623/emerging-agents-of-substance-use-misuse
#10
REVIEW
Avery E Michienzi, Heather A Borek
Over the last decade, the use of novel psychoactive substances (NPS) has increased. Some substances are derived from plants but an increasing number are synthetically produced. Examples include synthetic cannabinoids, synthetic cathinones, kratom, phenibut, designer opioids, and benzodiazepines. These substances have a wide variety of effects due to the varied potency with which they bind their targeted receptors. Routine immunoassay urine drug screens do not detect these substances and it is, therefore, important for clinicians to be aware of these substances to make accurate clinical diagnoses...
May 2022: Emergency Medicine Clinics of North America
https://read.qxmd.com/read/34606223/q-15-minutes-vital-sign-documentation-is-a-poor-surrogate-for-assessing-quality-of-care-after-acute-ischemic-stroke
#11
JOURNAL ARTICLE
Suzanne Stone, Huihan Zhao, Daniel Nyancho, Nathan J Schneider, Ty Shang, DaiWai M Olson
OBJECTIVE: Documenting vital signs and National Institutes of Health Stroke Scale (NIHSS) once every 15 minutes after intravenous thrombolytic therapy for acute ischemic stroke is often used as a metric to assess the quality of care. This study explores the association between "once every 15 minutes" documentation and stroke outcomes. METHODS: This is a retrospective study of the first 2 hours of vital signs and NIHSS documentation after thrombolytic stroke therapy...
November 2021: Dimensions of Critical Care Nursing: DCCN
https://read.qxmd.com/read/35489523/the-patient-pathway-for-men-with-chronic-urinary-retention-treatments-complications-and-consequences
#12
JOURNAL ARTICLE
B J Bos, N A M van Merode, M G Steffens, L P W Witte
OBJECTIVE: To explore the treatment options for chronic urinary retention (CUR) in men, including treatment-related complications and consequences. METHODS: This retrospective cohort study included male patients diagnosed with a non-neurogenic, symptomatic and/or high-risk, CUR >150 mL in a large Dutch non-academic teaching hospital. Data for treatments, complications, and consequences (eg, diagnostics, additional treatments, and hospital contact) were recorded and incidence rate ratios (IRRs) were calculated...
September 2022: Urology
https://read.qxmd.com/read/28291095/angioedema
#13
REVIEW
Daniel LoVerde, Daniel Clark Files, Guha Krishnaswamy
OBJECTIVES: Angioedema is a potentially life-threatening occurrence that is encountered by critical care providers. The mechanistic understanding of angioedema syndromes has improved in recent years, and novel medications are available that improve outcomes from these syndromes. This clinically focused review will describe the underlying genetics, pathophysiology, classification and treatment of angioedema syndromes, with an emphasis on the novel pharmacologic agents that have recently become available for acute treatment...
April 2017: Critical Care Medicine
https://read.qxmd.com/read/31171116/wernicke-encephalopathy-clinical-pearls
#14
REVIEW
Shirshendu Sinha, Archish Kataria, Bhanu Prakash Kolla, Nuria Thusius, Larissa L Loukianova
Wernicke encephalopathy (WE) was first described by Carl Wernicke in 1881. WE is caused by thiamine deficiency. Alcoholism is the most common etiologic factor associated with WE in the United States, but it can occur in any patient with a nutritional deficiency state such as hyperemesis gravidarum, intestinal obstruction, and malignancy. WE is a clinical diagnosis. The common findings include mental status changes, ocular dysfunction, and a gait apraxia, present in only 10% of cases. Only a few cases of WE are diagnosed before death...
June 2019: Mayo Clinic Proceedings
https://read.qxmd.com/read/33455623/prehospital-ketamine-use-for-rapid-sequence-intubation-are-higher-doses-associated-with-adverse-events
#15
JOURNAL ARTICLE
William Krebs, Howard Werman, Jeffery Jackson, Karen A Swecker, Heidi Hutchison, Michael Rodgers, Scott Fulton, Christine Celeste Brenna, Julie Stausmire, Nancy Buderer, Alison M Paplaskas
OBJECTIVE: Ketamine for rapid sequence intubation (RSI) is typically dosed at 1 to 2 mg/kg intravenously. The need to ensure dissociation during RSI led some to administer ketamine at doses greater than 2 mg/kg. This study assessed associations between ketamine dose and adverse events. METHODS: This multisite, retrospective study included adult subjects undergoing RSI with intravenous ketamine. Subjects were categorized into 2 groups: a standard ketamine dose (≤ 2 mg/kg intravenously) or a high dose (> 2 mg/kg intravenously)...
January 2021: Air Medical Journal
https://read.qxmd.com/read/33160639/clinical-management-of-hyperkalemia
#16
REVIEW
Biff F Palmer, Juan Jesus Carrero, Deborah J Clegg, Gates B Colbert, Michael Emmett, Steven Fishbane, Debra J Hain, Edgar Lerma, Macaulay Onuigbo, Anjay Rastogi, Simon D Roger, Bruce S Spinowitz, Matthew R Weir
Hyperkalemia is an electrolyte abnormality with potentially life-threatening consequences. Despite various guidelines, no universally accepted consensus exists on best practices for hyperkalemia monitoring, with variations in precise potassium (K+ ) concentration thresholds or for the management of acute or chronic hyperkalemia. Based on the available evidence, this review identifies several critical issues and unmet needs with regard to the management of hyperkalemia. Real-world studies are needed for a better understanding of the prevalence of hyperkalemia outside the clinical trial setting...
November 4, 2020: Mayo Clinic Proceedings
https://read.qxmd.com/read/33257968/intravenous-fluid-management-in-critically-ill-adults-a-review
#17
REVIEW
Ashley Barlow, Brooke Barlow, Nancy Tang, Bhavik M Shah, Amber E King
TOPIC: This article reviews the management of intravenous fluids and the evaluation of volume status in critically ill adults. CLINICAL RELEVANCE: Intravenous fluid administration is one of the most common interventions in the intensive care unit. Critically ill patients have dynamic fluid requirements, making the management of fluid therapy challenging. New literature suggests that balanced salt solutions may be preferred in some patient populations. PURPOSE OF PAPER: The bedside critical care nurse must understand the properties of various intravenous fluids and their corresponding impact on human physiology...
December 1, 2020: Critical Care Nurse
https://read.qxmd.com/read/33257143/evaluation-of-metoprolol-versus-diltiazem-for-rate-control-of-atrial-fibrillation-in-the-emergency-department
#18
JOURNAL ARTICLE
Patrick McGrath, Brian Kersten, Maya R Chilbert, Caroline Rusch, Megan Nadler
OBJECTIVE: The purpose of this study was to compare the effectiveness and safety of the metoprolol and diltiazem administration in the Emergency Department (ED) for rate control of supraventricular tachycardia. METHODS: This was a retrospective cohort study of adult patients who presented to the ED with ventricular rates ≥120 beats per minute (bpm) and who received bolus doses of either intravenous metoprolol or intravenous diltiazem. The primary outcome was achievement of rate control, defined as heart rate < 110 bpm, at two hours after administration of the last bolus dose of metoprolol or diltiazem...
August 2021: American Journal of Emergency Medicine
https://read.qxmd.com/read/33093346/a-contemporary-model-for-undergraduate-nursing-education-a-grounded-theory-study
#19
JOURNAL ARTICLE
Loretta Aller
BACKGROUND: Health care trends including advanced technology, higher patient acuity, and shorter employment orientation have impacted the environment in which new-graduate nurses are entering the workforce. These issues are contributing to new nurses leaving the workforce prematurely. Theoretical foundations for nursing education need to be updated to better prepare graduates for entry into this burdened environment. PURPOSE: The purpose of this study was to explore, from the student perspective, the process of educational development into professional licensure-ready graduates...
July 2021: Nurse Educator
https://read.qxmd.com/read/33000041/managing-sedation-in-the-mechanically-ventilated-emergency-department-patient-a-clinical-review
#20
REVIEW
Clifford L Freeman, Christopher S Evans, Tyler W Barrett
Managing sedation in the ventilated emergency department (ED) patient is increasingly important as critical care unit admissions from EDs increase and hospital crowding results in intubated patients boarding for longer periods. The objectives of this review are 3-fold; (1) describe the historical perspective of how sedation of the ventilated patient has changed, (2) summarize the most commonly used sedation and analgesic agents, and (3) provide a practical approach to sedation and analgesia in mechanically ventilated ED patients...
June 2020: Journal of the American College of Emergency Physicians open
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