K P Abhilash, H Acharya, J Dua, S Kumar, B Selvaraj, G Priya
Background: Although oxygen is one of the oldest drugs available, it is still one of the most inappropriately administered drugs leading to over utilization of this very expensive resource. Materials and Methods: This prospective observational study was done in a large emergency department (ED) in India. The pattern of oxygen usage was studied before and after the strict implementation of an oxygen treatment algorithm. The algorithm was taught to all doctors and nurses and its implementation was monitored regularly...
June 24, 2020: Journal of Postgraduate Medicine
Diwas Gnyawali, Manish Man Pradhan, Prem Raj Sigdel, Purushottam Parajuli, Sampanna Chudal, Sujeet Poudyal, Suman Chapagain, Bhoj Raj Luitel, Pawan Raj Chalise, Uttam Sharma, Prem Raj Gyawali
Introduction: Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug. Methods: This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching...
2020: Advances in Urology
Bruno Levy, Thomas Klein, Antoine Kimmoun
PURPOSE OF REVIEW: Data and interventional trials on vasopressor use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence regarding their effectiveness in improving outcomes. In the present article, we review the current use of vasopressor therapy during cardiogenic shock. RECENT FINDINGS: Two recent Cochrane analyses concluded that there was insufficient evidence to prove that any one vasopressor was superior to others in terms of mortality...
June 1, 2020: Current Opinion in Critical Care
Eftihia Polyzogopoulou, Angelos Arfaras-Melainis, Vasiliki Bistola, John Parissis
PURPOSE OF REVIEW: Cardiogenic shock is a multifactorial and diverse entity in which inotropes are the cornerstone therapy. Although published clinical trials have focused on pharmacologic treatment of cardiogenic shock, there is lack of an established and widely accepted decision-making algorithm on the use of inotropic agents in cardiogenic shock. RECENT FINDINGS: The current review incorporates cardiogenic shock pathophysiology, inotropes and vasopressors pharmacodynamics...
June 2, 2020: Current Opinion in Critical Care
Marc Pineton de Chambrun, Nicolas Bréchot, Alain Combes
PURPOSE OF REVIEW: Temporary circulatory support (TCS) devices are increasingly used as a salvage therapy for patients with refractory cardiogenic shock. The exact place of the different TCS devices in the management of cardiogenic shock patients remains unclear and intensely debated. This article provides an overview on new cardiogenic shock classification, currently available devices, place of TCS in the management of cardiogenic shock patients, and discusses the results of recent case series and trials in this setting...
June 8, 2020: Current Opinion in Critical Care
Johan Lassus
PURPOSE OF REVIEW: Organ dysfunction is a key feature of cardiogenic shock. Active revascularization and contemporary management in intensive care has improved prognosis in cardiogenic shock, but mortality is still unacceptably high. This review will discuss the prevalence, manifestation, management and clinical impact of kidney and liver dysfunction in cardiogenic shock. RECENT FINDINGS: Patients with cardiogenic shock more frequently have several comorbidities that make them at risk of developing multiorgan failure, including renal and liver dysfunction...
June 8, 2020: Current Opinion in Critical Care
Christopher M Garrison, Frank E Ritter, Benjamin R Bauchwitz, James Niehaus, Peter W Weyhrauch
Educators are challenged to prepare nurses to care for low-frequency, high-stakes problems such as trauma. Computer-based tutors provide a cost-effective teaching strategy without risking patient safety. Evidence for the efficacy of this type of instruction is limited; thus, we tested the learning outcomes of a tutor on trauma care knowledge with senior nursing students. Participants were randomly assigned to either the tutor or a control condition (textbook learning). Instructional design elements incorporated into the tutor included use of multimedia content, emphasis of key points, frequent quizzing with instant feedback, and unfolding case studies to summarize key concepts...
June 19, 2020: Computers, Informatics, Nursing: CIN
Robert Willmore
Cardiac arrest with a degree of concurrent hypothermia is not a rare presentation. This presentation, often in remote areas, poses a challenge for the prehospital physician because the cause of the arrest will significantly alter decision making and prognostication. Survival from cardiac arrest secondary to accidental hypothermia is significantly greater than that of normothermic arrests when appropriate triage and management decisions are made. The complexity of this decision benefits from a specific algorithm to follow in the event of such a casualty presenting...
May 2020: Air Medical Journal
John Conway, Benjamin Friedman
Asthma is a common chronic respiratory disease with acute exacerbations recognized clinically by the signs and symptoms of dyspnea, cough, chest tightness, and wheezing. In the United States approximately 25 million individuals currently have asthma and in 2017, asthma exacerbations accounted for approximately 1.8 million emergency department (ED) visits and 3,500 deaths.
June 23, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Tadahiko Seki, Hidetada Fukushima
Background: There are few reports of chemical proctocolitis induced by transanal administration of alcohol. Case report: The patient was a 21-year-old male with no medical history. He transanally pumped 1.8 L of 35% alcohol, experienced melena and disturbance of consciousness, and was transported by ambulance to our hospital. Abdominal computed tomography and endoscopy findings indicated ischemic colitis. He was administered conservative treatment and discharged after 9 days of hospital stay. Conclusion: Reports on alcohol-induced chemical proctocolitis are rare...
2019: Open Access Emergency Medicine: OAEM
Chelsea Wolf, Ashley Curry, Jacob Nacht, Scott A Simpson
Alcohol withdrawal syndrome (AWS) is a common, heterogenous, and life-threatening complication of alcohol use disorder (AUD). AUD is a leading cause of worldwide mortality, and many patients with AUD will develop AWS during their ED course. This review summarizes the epidemiology, pathology, and management of AWS and AUD in the emergency setting. The time course of AWS and its impact on ED treatment is emphasized. Once AWS is diagnosed, symptom-triggered benzodiazepine administration remains the most commonly provided treatment but may not be appropriate for patients with significant medical or psychiatric comorbidity or pending discharge...
2020: Open Access Emergency Medicine: OAEM
Derwin K C Chan, Chun-Qing Zhang, Karin Weman Josefsson
No abstract text is available yet for this article.
May 15, 2020: Infection Control and Hospital Epidemiology
T M Cook
Personal protective equipment has become an important and emotive subject during the current coronavirus (COVID-19) epidemic. COVID-19 is predominantly caused by contact or droplet transmission attributed to relatively large respiratory particles which are subject to gravitational forces and travel only approximately one metre from the patient. Airborne transmission may occur if patient respiratory activity or medical procedures generate respiratory aerosols. These aerosols contain particles that may travel much longer distances and remain airborne longer, but their infective potential is uncertain...
April 4, 2020: Anaesthesia
Nancy H L Leung, Daniel K W Chu, Eunice Y C Shiu, Kwok-Hung Chan, James J McDevitt, Benien J P Hau, Hui-Ling Yen, Yuguo Li, Dennis K M Ip, J S Malik Peiris, Wing-Hong Seto, Gabriel M Leung, Donald K Milton, Benjamin J Cowling
We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals...
April 3, 2020: Nature Medicine
Brit Long, Alex Koyfman, Michael Gottlieb
BACKGROUND: The spleen performs several important physiologic functions. However, patients can have functional asplenia or have their spleen removed for a number of reasons, which can put them at risk for several dangerous complications. OBJECTIVE: This narrative review provides a focused evaluation of adult asplenic patients and complications in the emergency departing setting. DISCUSSION: The spleen plays integral roles in the immune and reticuloendothelial systems and also modulates the inflammatory and coagulation cascades...
March 26, 2020: American Journal of Emergency Medicine
Brian M Killeen, Allan B Wolfson
Acute cardiogenic pulmonary edema (ACPE) has traditionally been treated pharmacologically, with a combination of nitrates, diuretics, morphine, and inotropes. Since the introduction of non-invasive positive pressure ventilation (NIPPV), a method of providing mechanical ventilation that does not bypass the upper airway, this modality has been widely used as an important addition to the acute care of ACPE.
April 16, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Robert Willmore
Cardiac arrest secondary to accidental hypothermia is rare in the United Kingdom. However, some evidence suggests that it is under-reported; furthermore, recognizing hypothermia as the cause of death is difficult in the postmortem setting. Urban and rural residents are exposed to cold winter conditions both at home and while undertaking recreational activities. Understanding the physiology underpinning hypothermic cardiac arrest is crucial in order to make informed clinical decisions in regard to triage and management by air ambulance services and in prevention of this rare presentation...
March 2020: Air Medical Journal
Patricia A Normandin, Stacey A Benotti, Mark A Mullins
No abstract text is available yet for this article.
January 2020: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Raghad Saadi, Kristin Bohnenberger
No abstract text is available yet for this article.
January 2020: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Maureen Judd
Nurses are responsible for ensuring that short-term enteral feeding tubes are placed correctly before using them for gastric emptying, enteral nutrition, or medication administration. This article reviews evidence-based methods for assessing tube placement and discusses the limitations of each method with a focus on nasogastric tube placement.
April 2020: Nursing
2020-03-22 06:20:46
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