Adam Reuben, Andrew Appelboam, Kara N Stevens, Jane Vickery, Paul Ewings, Wendy Ingram, Alison N Jeffery, Richard Body, Malcolm Hilton, Jason Coppell, Brian Wainman, Andy Barton
STUDY OBJECTIVE: Epistaxis is a common emergency department (ED) presentation and, if simple first aid measures fail, can lead to a need for anterior nasal packing. Tranexamic acid is an agent that contributes to blood clot stability. The aim of this study is to investigate the effectiveness of topical intranasal tranexamic acid in adult patients presenting to the ED with persistent epistaxis, and whether it reduces the need for anterior nasal packing. METHODS: From May 5, 2017, to March 31, 2019, a double-blind, placebo-controlled, multicenter, 1:1, randomized controlled trial was conducted across 26 EDs in the United Kingdom...
June 2021: Annals of Emergency Medicine
Kirsty Challen, Christopher Bond, Lauren Westafer, Corey Heitz, William K Milne
No abstract text is available yet for this article.
July 2021: Academic Emergency Medicine
Catherine Varner, Cameron Thompson, Kerstin de Wit, Bjug Borgundvaag, Reaves Houston, Shelley McLeod
OBJECTIVE: To identify risk factors associated with persistent concussion symptoms in adults presenting to the emergency department (ED) with acute mild traumatic brain injury (TBI). METHODS: This was a secondary analysis of a randomized controlled trial conducted in three Canadian EDs whereby the intervention had no impact on recovery or healthcare utilization outcomes. Adult (18-64 years) patients with a mild TBI sustained within the preceding 48 h were eligible for enrollment...
May 2021: CJEM
Caberry W Yu, Abirami Kirubarajan, Matthew Yau, Dawn Armstrong, Davin E Johnson
OBJECTIVES: Corneal abrasions are common ophthalmic presentations to emergency departments. Among emergency physicians and ophthalmologists, there are highly variable practice patterns with regard to management of resultant pain and discomfort. The goal of this study was to review and analyze the efficacy and safety of topical pain therapies for corneal abrasions, including topical anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), cycloplegics, steroids, pressure patching, and the use of a bandage contact lens (BCL)...
August 2021: Academic Emergency Medicine
Timothy S H Kwok, Victoria Y Y Xu, Shirley L Lake
No abstract text is available yet for this article.
February 1, 2021: Canadian Medical Association Journal: CMAJ
Anna J M Verbeek, Janneke de Valk, Ditmar Schakenraad, Jan F M Verbeek, Anna A Kroon
BACKGROUND: E-bike usage is increasingly popular and concerns about e-bike-related injuries and safety have risen as more injured e-bikers attend the emergency department (ED). Traumatic brain injury (TBI) is the main cause of severe morbidity and mortality in bicycle-related accidents. This study compares the frequency and severity of TBI after an accident with an e-bike or classic bicycle among patients treated in the ED. METHODS: This was a prospective cohort study of patients with bicycle-related injuries attending the ED of a level 1 trauma centre in the Netherlands between June 2016 and May 2017...
April 2021: Emergency Medicine Journal: EMJ
Nie Zhen, Chen De-Sheng, Yan Yan-Jun, Lin Hua
INTRODUCTION: The effect of ketorolac addition for the pain control of renal colic remains controversial. We conduct a systematic review and meta-analysis to explore the analgesic efficacy of ketorolac addition for renal colic. METHODS: We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials (RCTs) assessing the analgesic efficacy of ketorolac addition for renal colic. This meta-analysis is performed using the random-effect model...
May 2021: American Journal of Emergency Medicine
Maria Letizia Petroni, Lucia Brodosi, Elisabetta Bugianesi, Giulio Marchesini
Non-alcoholic fatty liver disease is a very common medical condition, driven by a combination of genetic and lifestyle factors, ultimately producing a severe chronic liver disease and increased cardiovascular risk. Most people are asymptomatic for a long time, and their daily life is unaffected, leading to difficulty in identifying and managing people who slowly progress to non-alcoholic steatohepatitis (NASH), NASH-cirrhosis, and eventually hepatocellular carcinoma. Despite advances in the understanding of pathogenic mechanisms and the identification of liver fibrosis as the strongest factor in predicting disease progression, no specific treatments have been approved by regulatory agencies...
January 18, 2021: BMJ: British Medical Journal
Linda D'Antona, Melida Andrea Jaime Merchan, Anna Vassiliou, Laurence Dale Watkins, Indran Davagnanam, Ahmed Kassem Toma, Manjit Singh Matharu
IMPORTANCE: Spontaneous intracranial hypotension (SIH) is a highly disabling but often misdiagnosed disorder. The best management options for patients with SIH are still uncertain. OBJECTIVE: To provide an objective summary of the available evidence on the clinical presentation, investigations findings, and treatment outcomes for SIH. DATA SOURCES: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline-compliant systematic review and meta-analysis of the literature on SIH...
March 1, 2021: JAMA Neurology
Katie Downie, Aaron Cunningham, Mubeen Jafri
BACKGROUND: The purpose of this study was to provide an evaluation of a performance improvement initiative that operationalized universal concussion screening for all pediatric trauma admissions at a Level I pediatric trauma center. Mild traumatic brain injury may be difficult to identify in injured children. We implemented a screening tool to identify the risk for concussion after traumatic injury and to improve access to cognitive evaluation and intervention in children. Prior to implementation of our screening tool, children admitted without obvious head injury or those younger than 12 years were not being screened for concussion risk...
January 2021: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Jesse P Wray, Rachel E Bridwell, Steven G Schauer, Stacy A Shackelford, Vikhyat S Bebarta, Franklin L Wright, James Bynum, Brit Long
INTRODUCTION: Early recognition and management of hemorrhage, damage control resuscitation, and blood product administration have optimized management of severe trauma. Recent data suggest hypocalcemia exacerbates the ensuing effects of coagulopathy in trauma. OBJECTIVE: This narrative review of available literature describes the physiology and role of calcium in trauma resuscitation. Authors did not perform a systematic review or meta-analysis. DISCUSSION: Calcium is a divalent cation found in various physiologic forms, specifically the bound, inactive state and the unbound, physiologically active state...
March 2021: American Journal of Emergency Medicine
Karadi Hari Sunil Kumar, Jaikirty Rawal, Naoki Nakano, André Sarmento, Vikas Khanduja
PURPOSE: Recent advances in diagnostic imaging techniques and soft tissue endoscopy now allow for precise diagnosis and management of extra-articular hip pathology. The aim of this scoping review is to present an evidence-based update of the relevant literature focussing only on the pathoanatomy, clinical assessment and the diagnosis of pathology in the peritrochanteric space. METHODS: A literature search was performed on PubMed to include articles which reported on the anatomy and diagnosis of greater trochanteric pain syndrome, trochanteric bursitis, gluteus medius tears and external snapping hip syndrome...
August 2021: Knee Surgery, Sports Traumatology, Arthroscopy
Lily Eidinejad, Maryam Bahreini, Ayat Ahmadi, Mahtab Yazdchi, Venkatesh Thiruganasambandamoorthy, Hadi Mirfazaelian
BACKGROUND: Ketorolac tromethamine is a nonsteroidal anti-inflammatory drug (NSAID) that is extensively used for the management of renal colic in the emergency department (ED). It has been proposed that ketorolac is used at doses above its analgesic ceiling with no more advantages and increased risk of adverse effects. In this study, we compared the analgesic effects of three doses of intravenous ketorolac in patients with renal colic. METHODS: This noninferiority, randomized, double-blind clinical trial evaluated the analgesic efficacy of three doses of intravenous ketorolac (10, 20, and 30 mg) in adult patients presenting to the ED with renal colic...
July 2021: Academic Emergency Medicine
Frank De Stefano, Brian Fiani, Tim Mayo
Around 3.8 million traumatic brain injuries (TBI) occur every year from athletic participation. The signs and symptoms of each specific head injury can be difficult to delineate. Further, treatment for each injury varies significantly. While most sports-related head injuries are not life-threatening, prompt recognition of acute head injury with expedited care leads to better outcomes. Current medical education lacks in awareness of common sports-related head injuries and the acute management of these injuries...
November 22, 2020: Curēus
Anne Kathrine Lorentzen, Christopher Davis, Luit Penninga
BACKGROUND: Frostbite is a thermal injury caused when tissue is exposed to sub-zero temperatures (in degrees Celsius) long enough for ice crystals to form in the affected tissue. Depending on the degree of tissue damage, thrombosis, ischaemia, necrosis (tissue death), gangrene and ultimately amputation may occur. Several interventions for frostbite injuries have been proposed, such as hyperbaric oxygen therapy, sympathectomy (nerve block), thrombolytic (blood-thinning) therapy and vasodilating agents such as iloprost, reserpine, pentoxifylline and buflomedil, but the benefits and harms of these interventions are unclear...
December 20, 2020: Cochrane Database of Systematic Reviews
Michelle H Orlowski, William E Soares, Kathleen A Kerrigan, Matthew L Zerden
Although induced abortion is generally a safe outpatient procedure, many patients subsequently present to the emergency department, concerned about a postabortion complication. It is helpful for emergency physicians to understand the medications and procedures used in abortion care in the United States to effectively and efficiently triage and treat women presenting with potential complications from an abortion. Furthermore, because many states are experiencing increased abortion restrictions that limit access to care, emergency medicine physicians may encounter more patients presenting after self-managed abortions, which presents additional challenges...
February 2021: Annals of Emergency Medicine
Theodoros H Tosounidis, Ioannis I Daskalakis, Peter V Giannoudis
Open fractures are considered an orthopaedic emergency due to the severe soft tissue disruption that might potentially lead to devastating complications. On the other hand, closed fractures, and especially those resulting from high-energy mechanisms, are also often accompanied by severe soft tissue trauma. Soft tissue envelope compromise can have a detrimental effect on the final outcome of the patients. Fracture blisters in particular, develop as a sign of significant local tissue trauma and appear in a time period between 6 to 72 hours post-injury...
December 2020: Injury
Jo Ellen Wilson, Matthew F Mart, Colm Cunningham, Yahya Shehabi, Timothy D Girard, Alasdair M J MacLullich, Arjen J C Slooter, E Wesley Ely
Delirium, a syndrome characterized by an acute change in attention, awareness and cognition, is caused by a medical condition that cannot be better explained by a pre-existing neurocognitive disorder. Multiple predisposing factors (for example, pre-existing cognitive impairment) and precipitating factors (for example, urinary tract infection) for delirium have been described, with most patients having both types. Because multiple factors are implicated in the aetiology of delirium, there are likely several neurobiological processes that contribute to delirium pathogenesis, including neuroinflammation, brain vascular dysfunction, altered brain metabolism, neurotransmitter imbalance and impaired neuronal network connectivity...
November 12, 2020: Nature Reviews. Disease Primers
Jasmeet Soar, Katherine M Berg, Lars W Andersen, Bernd W Böttiger, Sofia Cacciola, Clifton W Callaway, Keith Couper, Tobias Cronberg, Sonia D'Arrigo, Charles D Deakin, Michael W Donnino, Ian R Drennan, Asger Granfeldt, Cornelia W E Hoedemaekers, Mathias J Holmberg, Cindy H Hsu, Marlijn Kamps, Szymon Musiol, Kevin J Nation, Robert W Neumar, Tonia Nicholson, Brian J O'Neil, Quentin Otto, Edison Ferreira de Paiva, Michael J A Parr, Joshua C Reynolds, Claudio Sandroni, Barnaby R Scholefield, Markus B Skrifvars, Tzong-Luen Wang, Wolfgang A Wetsch, Joyce Yeung, Peter T Morley, Laurie J Morrison, Michelle Welsford, Mary Fran Hazinski, Jerry P Nolan
This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication...
November 2020: Resuscitation
Noel Chan, Magdalena Sobieraj-Teague, John W Eikelboom
Currently licenced direct oral anticoagulants selectively target thrombin (eg, dabigatran) or coagulation factor Xa (eg, apixaban, betrixaban, edoxaban, and rivaroxaban). Designed to be given in fixed doses without routine monitoring, direct oral anticoagulants have a lower propensity for food and drug interactions than do vitamin K antagonists, and in randomised controlled trials involving around 250 000 patients, they were at least as effective for prevention and treatment of thrombosis and were associated with a lower risk of life-threatening bleeding...
November 28, 2020: Lancet
2020-12-14 15:49:45
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