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EM Labs

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27 papers 25 to 100 followers Use of labs in the ED
By Merlin Curry MD, EMT-P
François Dépret, W Frank Peacock, Kathleen D Liu, Zubaid Rafique, Patrick Rossignol, Matthieu Legrand
PURPOSE: To review the mechanisms of action, expected efficacy and side effects of strategies to control hyperkalemia in acutely ill patients. METHODS: We searched MEDLINE and EMBASE for relevant papers published in English between Jan 1, 1938, and July 1, 2018, in accordance with the PRISMA Statement using the following terms: "hyperkalemia," "intensive care," "acute kidney injury," "acute kidney failure," "hyperkalemia treatment," "renal replacement therapy," "dialysis," "sodium bicarbonate," "emergency," "acute...
February 28, 2019: Annals of Intensive Care
Thomas A Gibson, Robert E Weiss, Benjamin C Sun
Introduction: We performed a systematic review and meta-analysis to identify predictors of serious clinical outcomes after an acute-care evaluation for syncope. Methods: We identified studies that assessed for predictors of short-term (≤30 days) serious clinical events after an emergency department (ED) visit for syncope. We performed a MEDLINE search (January 1, 1990 - July 1, 2017) and reviewed reference lists of retrieved articles. The primary outcome was the occurrence of a serious clinical event (composite of mortality, arrhythmia, ischemic or structural heart disease, major bleed, or neurovascular event) within 30 days...
May 2018: Western Journal of Emergency Medicine
Ignacio Portales Castillo, Toltaku Thomas, Ankur Shah
No abstract text is available yet for this article.
December 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Julie Contenti, Celine Occelli, Fabien Lemoel, Patricia Ferrari, Jacques Levraut
We evaluate in this retrospective cohort, the clinical situations leading emergency physicians to take a blood lactate sample, the prevalence of hyperlactatemia and its impact on short-term adverse outcome. ED patients requiring a blood lactate measurement (BLM) during a two-year period were included. Early patients' outcomes were extracted and discharge diagnoses were classified into 12 diagnostic categories. A total of 118,737 patients were analyzed. A BLM was carried out in 13,089 of them. Surprisingly, the proportion of patients having a BLM was higher in those admitted for seizure (31...
March 2019: American Journal of Emergency Medicine
Kenrick Berend
New England Journal of Medicine, Volume 378, Issue 15, Page 1419-1428, April 2018.
April 12, 2018: New England Journal of Medicine
Stephen J Wolf, Sigrid A Hahn, Lauren M Nentwich, Ali S Raja, Scott M Silvers, Michael D Brown
No abstract text is available yet for this article.
May 2018: Annals of Emergency Medicine
Sarah J Schrauben, Dan Negoianu, Cristiana Costa, Raphael M Cohen, Stanley Goldfarb, Barry D Fuchs, Jeffrey S Berns
BACKGROUND: Acid-base disturbances are frequent in critically ill patients. Arterial blood gas (ABG) is the gold standard in the diagnosis of these disturbances, but it is invasive with potential hazards. For patients with a central venous catheter, venous blood gas (VBG) sampling may be an alternative, less-invasive diagnostic tool. However, the accuracy of a central VBG-based acid-base disorder diagnosis compared to an ABG is unknown. The primary objective of this study was to assess the accuracy of a central VBG-based acid-base disorder diagnosis compared to the "gold standard" ABG in critically ill patients...
2018: Nephron
Ryan D Aycock, Lauren M Westafer, Jennifer L Boxen, Nima Majlesi, Elizabeth M Schoenfeld, Raveendhara R Bannuru
STUDY OBJECTIVE: Computed tomography (CT) is an important imaging modality used in the diagnosis of a variety of disorders. Imaging quality may be improved if intravenous contrast is added, but there is a concern for potential renal injury. Our goal is to perform a meta-analysis to compare the risk of acute kidney injury, need for renal replacement, and total mortality after contrast-enhanced CT versus noncontrast CT. METHODS: We searched MEDLINE (PubMed), the Cochrane Library, CINAHL, Web of Science, ProQuest, and Academic Search Premier for relevant articles...
January 2018: Annals of Emergency Medicine
Jaehun Oh, Soo Hyun Kim, Kyu Nam Park, Sang Hoon Oh, Young Min Kim, Han Joon Kim, Chun Song Youn
OBJECTIVE: The objective of this study was to test the hypothesis that an elevated high-sensitivity C-reactive protein (hs-CRP)/albumin ratio at admission increases the risk of mortality in older patients admitted to the hospital via the emergency department (ED). METHODS: We performed a retrospective analysis of patients admitted to the ED with any medical problem between May 2013 and October 2013 who were older than 65 years. The hs-CRP and albumin levels were measured at the time of admission to the ED...
March 2017: Clinical and Experimental Emergency Medicine
Ramon Sager, Alexander Kutz, Beat Mueller, Philipp Schuetz
Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy. Most research has focused on lower respiratory tract infections and critically ill sepsis patients. A clinical utility for PCT has also been found for patients with urinary tract infections, postoperative infections, meningitis, and patients with acute heart failure with possible superinfection (i...
January 24, 2017: BMC Medicine
Jansen Seheult, Gerard Fitzpatrick, Gerard Boran
Lactate is one of the most crucial intermediates in carbohydrate and nonessential amino acid metabolism. The complexity of cellular interactions and metabolism means that lactate can be considered a waste product for one cell but a useful substrate for another. The presence of elevated lactate levels in critically ill patients has important implications for morbidity and mortality. In this review, we provide a brief outline of the metabolism of lactate, the pathophysiology of lactic acidosis, the clinical significance of D-lactate, the role of lactate measurement in acutely ill patients, the methods used to measure lactate in blood or plasma and some of the methodological issues related to interferences in these assays, especially in the case of ethylene glycol poisoning...
March 1, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
Prashant Mahajan, Mary Grzybowski, Xinguang Chen, Nirupama Kannikeswaran, Rachel Stanley, Bonita Singal, John Hoyle, Dominic Borgialli, Elizabeth Duffy, Nathan Kuppermann
OBJECTIVES: There is no perfectly sensitive or specific test for identifying young, febrile infants and children with occult serious bacterial infections (SBIs). Studies of procalcitonin (PCT), a 116-amino-acid precursor of the hormone calcitonin, have demonstrated its potential as an acute-phase biomarker for SBI. The objective of this study was to compare performance of serum PCT with traditional screening tests for detecting SBIs in young febrile infants and children. METHODS: This was a prospective, multicenter study on a convenience sample from May 2004 to December 2005...
February 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Karen Milcent, Sabine Faesch, Christèle Gras-Le Guen, François Dubos, Claire Poulalhon, Isabelle Badier, Elisabeth Marc, Christine Laguille, Loïc de Pontual, Alexis Mosca, Gisèle Nissack, Sandra Biscardi, Hélène Le Hors, Ferielle Louillet, Andreea Madalina Dumitrescu, Philippe Babe, Christelle Vauloup-Fellous, Jean Bouyer, Vincent Gajdos
IMPORTANCE: The procalcitonin (PCT) assay is an accurate screening test for identifying invasive bacterial infection (IBI); however, data on the PCT assay in very young infants are insufficient. OBJECTIVE: To assess the diagnostic characteristics of the PCT assay for detecting serious bacterial infection (SBI) and IBI in febrile infants aged 7 to 91 days. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study that included infants aged 7 to 91 days admitted for fever to 15 French pediatric emergency departments was conducted for a period of 30 months (October 1, 2008, through March 31, 2011)...
January 2016: JAMA Pediatrics
Nils A Sörensen, Anoop Sv Shah, Francisco M Ojeda, Philipp Peitsmeyer, Tanja Zeller, Till Keller, Silke S Johannsen, Karl J Lackner, Megan Griffiths, Thomas Münzel, Nicholas L Mills, Stefan Blankenberg, Renate B Schnabel
AIMS: To evaluate the diagnostic performance of high-sensitivity troponin I (hsTnI) and other novel biomarkers for diagnosing non-ST-segment elevation myocardial infarction (NSTEMI) in patients with atrial fibrillation. METHODS: In an acute chest pain cohort (N=1673), mean age 61.4±13.6 (34% female), we measured hsTnI and 13 established and novel biomarkers reflecting ischaemia, necrosis, inflammation, myocardial stress, angiogenesis on admission and after three hours in order to investigate their diagnostic accuracy for NSTEMI...
October 2016: European Heart Journal. Acute Cardiovascular Care
Jason Chertoff, Michael Chisum, Bryan Garcia, Jorge Lascano
Over the last two decades, there have been vast improvements in sepsis-related outcomes, largely resulting from the widespread adoption of aggressive fluid resuscitation and infection control. With increased understanding of the pathophysiology of sepsis, novel diagnostics and resuscitative interventions are being discovered. In recent years, few diagnostic tests like lactate have engendered more attention and research in the sepsis arena. Studies highlighting lactate's prognostic potential for mortality and other outcomes are ubiquitous and largely focus on the early stage of sepsis management, defined as the initial 6 h and widely referred to as the "golden hours...
2015: Journal of Intensive Care
Michael Emmett
When anion gap calculation generates a very small or negative number, an explanation must be sought. Sporadic (nonreproducible) measurement errors and systematic (reproducible) laboratory errors must be considered. If an error is ruled out, 2 general possibilities exist. A true anion gap reduction can be generated by either reduced concentrations of unmeasured anions such as albumin or increased concentrations of unmeasured cations such as magnesium, calcium, or lithium. This teaching case describes a patient with aspirin (salicylate) poisoning whose anion gap was markedly reduced (-47 mEq/L)...
January 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Dan A Henry
No abstract text is available yet for this article.
August 4, 2015: Annals of Internal Medicine
Borja Gomez, Silvia Bressan, Santiago Mintegi, Liviana Da Dalt, Daniel Blazquez, Izaskun Olaciregui, Mercedes de la Torre, Miriam Palacios, Paola Berlese, Aitor Ruano
BACKGROUND AND OBJECTIVE: Procalcitonin (PCT) has been introduced in many European protocols for the management of febrile children. Its value among young, well-appearing infants, however, is not completely defined. Our objective was to assess its performance in diagnosing serious bacterial infections and specifically invasive bacterial infections (IBIs) in well-appearing infants aged <3 months with fever without source (FWS). METHODS: Well-appearing infants aged <3 months with FWS admitted to 7 European pediatric emergency departments were retrospectively included...
November 2012: Pediatrics
Nathalie Layios, Bernard Lambermont, Jean-Luc Canivet, Philippe Morimont, Jean-Charles Preiser, Christophe Garweg, Didier Ledoux, Frédéric Frippiat, Sonia Piret, Jean-Baptiste Giot, Patricia Wiesen, Christelle Meuris, Paul Massion, Philippe Leonard, Monique Nys, Patrizio Lancellotti, Jean-Paul Chapelle, Pierre Damas
OBJECTIVES: To test the usefulness of procalcitonin serum level for the reduction of antibiotic consumption in intensive care unit patients. DESIGN: Single-center, prospective, randomized controlled study. SETTING: Five intensive care units from a tertiary teaching hospital. PATIENTS: All consecutive adult patients hospitalized for >48 hrs in the intensive care unit during a 9-month period. INTERVENTIONS: Procalcitonin serum level was obtained for all consecutive patients suspected of developing infection either on admission or during intensive care unit stay...
August 2012: Critical Care Medicine
Mathilde Pedersen, Vibeke Schnack Brandt, Jon Gitz Holler, Annmarie Touborg Lassen
BACKGROUND: Increased lactate is associated with high mortality among patients with suspected infection or trauma in the emergency department (ED), but the association with patients with other aetiologies is less well described. The aim of this study was to describe the relation between lactate, aetiology and 7-day mortality in adult ED patients. METHODS: A retrospective cohort study of all adult patients who had a lactate measured within 4 h after arrival to the ED at Odense University Hospital between June 2012 and May 2013...
September 2015: Emergency Medicine Journal: EMJ
2015-03-20 05:09:43
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