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
Barb Nickel
TOPIC: This article presents an overview of the burden of peripheral intravenous catheter infections and current evidence-based recommendations for prevention. CLINICAL RELEVANCE: Peripheral intravenous catheters are ubiquitous in most health care settings, fostering an acceptance of the peripheral intravenous catheter as benign and inevitable. This device, however, is far from benign, with reported failure rates as high as 90% from complications such as infection and phlebitis...
October 1, 2020: Critical Care Nurse
Jaimee Warren, Blake Cooper, Anton Jermakoff, Jonathan C Knott
This was a double-blind, randomized clinical trial comparing three different solutions for the treatment of adults with epigastric pain or dyspepsia presenting to the emergency department (ED). It was conducted in the Royal Melbourne Hospital, a tertiary, adult-only, inner-city center in Melbourne with 75,000 annual ED visits. Data were collected over three months, from June to August 2019, between 0800 and 2300, seven days a week.
June 29, 2020: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Joan Somes
No abstract text is available yet for this article.
July 2020: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Wiphawadee Potisopha, Karen M Vuckovic, Holli A DeVon, Chang G Park, Patricia E Hershberger
BACKGROUND: In 2009, the window from symptom onset to administration of tissue plasminogen activator for acute ischemic stroke was extended from 3 to 4.5 hours. Yet no systematic review has addressed prehospital delay by sex for stroke symptoms since this change. PURPOSE: We aimed to (1) compare prehospital delay times-the time from symptom onset to hospital arrival-between women and men with acute stroke or transient ischemic attack and (2) summarize factors influencing prehospital delay by sex...
November 2020: Journal of Cardiovascular Nursing
Stephanie Meyer
No abstract text is available yet for this article.
June 1, 2020: Critical Care Nurse
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...
August 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
No abstract text is available yet for this article.
October 2020: 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 disease 2019 epidemic. Coronavirus disease 2019 is predominantly caused by contact or droplet transmission attributed to relatively large respiratory particles which are subject to gravitational forces and travel only approximately 1 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...
July 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
2020-05-18 00:03:26
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