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EMRA Landmark Articles

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112 papers 25 to 100 followers
By Vidya Eswaran EM Resident at Northwestern University
Scott D Weingart, N Seth Trueger, Nelson Wong, Joseph Scofi, Neil Singh, Soren S Rudolph
STUDY OBJECTIVE: We investigate a new technique for the emergency airway management of patients with altered mental status preventing adequate preoxygenation. METHODS: This was a prospective, observational, multicenter study of patients whose medical condition led them to impede optimal preintubation preparation because of delirium. A convenience sample of emergency department and ICU patients was enrolled. Patients received a dissociative dose of ketamine, allowing preoxygenation with high-flow nonrebreather mask or noninvasive positive pressure ventilation (NIPPV)...
April 2015: Annals of Emergency Medicine
Arun D Nagdev, Roland C Merchant, Alfredo Tirado-Gonzalez, Craig A Sisson, Michael C Murphy
STUDY OBJECTIVE: Among adult emergency department (ED) patients undergoing central venous catheterization, we determine whether a greater than or equal to 50% decrease in inferior vena cava diameter is associated with a central venous pressure of less than 8 mm Hg. METHODS: Adult patients undergoing central venous catheterization were enrolled in a prospective, observational study. Inferior vena cava inspiratory and expiratory diameters were measured by 2-dimensional bedside ultrasonography...
March 2010: Annals of Emergency Medicine
S W Branney, R E Wolfe, E E Moore, N P Albert, M Heinig, M Mestek, J Eule
The minimum volume of intraperitoneal fluid that is detectable in Morison's pouch with ultrasound in the trauma setting is not well defined. To evaluate this question, we used diagnostic peritoneal lavage (DPL) as a model for intraperitoneal hemorrhage and undertook a blinded prospective study of the sensitivity of ultrasound in detecting intraperitoneal fluid. Participants included attending physicians and residents in emergency medicine, radiology, and surgery. During the infusion of the DPL fluid, participants continuously scanned Morison's pouch until they detected fluid...
August 1995: Journal of Trauma
Ellen J MacKenzie, Frederick P Rivara, Gregory J Jurkovich, Avery B Nathens, Katherine P Frey, Brian L Egleston, David S Salkever, Daniel O Scharfstein
BACKGROUND: Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers and hospitals without a trauma center (non-trauma centers). METHODS: Mortality outcomes were compared among patients treated in 18 hospitals with a level 1 trauma center and 51 hospitals non-trauma centers located in 14 states. Patients 18 to 84 years old with a moderate-to-severe injury were eligible...
January 26, 2006: New England Journal of Medicine
Satoshi Tsutsumi, Takayoshi Ueta, Keiichiro Shiba, Shunsaku Yamamoto, Kenji Takagishi
STUDY DESIGN: Retrospective single-center study. OBJECTIVE: To evaluate the recovery of motor function and the early complications in patients with acute cervical spinal cord injury after receiving a high dose of methylprednisolone sodium succinate (MPSS) within 8 hours of injury. SUMMARY OF BACKGROUND DATA: High-dose MPSS therapy has been demonstrated to improve the neurologic recovery in patients with acute spinal cord injury. However, it remains a controversial treatment...
December 15, 2006: Spine
S W Branney, E E Moore, K M Feldhaus, R E Wolfe
BACKGROUND: Despite numerous studies, no clear consensus exists for the optimal use of emergency department thoracotomy (EDT). As such, we have continued to critically review our experience with EDT during the last 23 years to clarify indications for EDT and evaluate its cost-effectiveness. METHODS: This was a retrospective review of 950 EDTs performed at our regional Level I trauma center during the last 23 years. Cost-benefit ratios were calculated using standardized models...
July 1998: Journal of Trauma
Haleema Shakur, Ian Roberts, Raúl Bautista, José Caballero, Tim Coats, Yashbir Dewan, Hesham El-Sayed, Tamar Gogichaishvili, Sanjay Gupta, Jorge Herrera, Beverley Hunt, Pius Iribhogbe, Mario Izurieta, Hussein Khamis, Edward Komolafe, María-Acelia Marrero, Jorge Mejía-Mantilla, Jaime Miranda, Carlos Morales, Oluwole Olaomi, Fatos Olldashi, Pablo Perel, Richard Peto, P V Ramana, R R Ravi, Surakrant Yutthakasemsunt
BACKGROUND: Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients. METHODS: This randomised controlled trial was undertaken in 274 hospitals in 40 countries. 20 211 adult trauma patients with, or at risk of, significant bleeding were randomly assigned within 8 h of injury to either tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo...
July 3, 2010: Lancet
M J Haydel, C A Preston, T J Mills, S Luber, E Blaudeau, P M DeBlieux
BACKGROUND: Computed tomography (CT) is widely used as a screening test in patients with minor head injury, although the results are often normal. We performed a study to develop and validate a set of clinical criteria that could be used to identify patients with minor head injury who do not need to undergo CT. METHODS: In the first phase of the study, we recorded clinical findings in 520 consecutive patients with minor head injury who had a normal score on the Glasgow Coma Scale and normal findings on a brief neurologic examination; the patients then underwent CT...
July 13, 2000: New England Journal of Medicine
John H Chi, M Margaret Knudson, Mary J Vassar, Mary C McCarthy, Michael B Shapiro, Susan Mallet, John J Holcroft, Hugh Moncrief, Jennifer Noble, David Wisner, Krista L Kaups, Lynn D Bennick, Geoffrey T Manley
BACKGROUND: The goals of this study were to determine the incidence and duration of hypotension and hypoxia in the prehospital setting in patients with potentially survivable brain injuries, and to prospectively examine the association of these secondary insults with mortality and disability at hospital discharge. METHODS: Trauma patients with suspected brain injuries underwent continuous blood pressure and pulse oximetry monitoring during helicopter transport. Postadmission inclusion criteria were (1) diagnosis of acute traumatic brain injury (TBI) confirmed by computed tomography (CT) scan, operative findings, or autopsy findings; and (2) Head Abbreviated Injury Scale (AIS) score of > or = 3 or Glasgow Coma Scale (GCS) score of < or = 12 within the first 24 hours of admission...
November 2006: Journal of Trauma
I G Stiell, H Lesiuk, G A Wells, R D McKnight, R Brison, C Clement, M A Eisenhauer, G H Greenberg, I MacPhail, M Reardon, J Worthington, R Verbeek, B Rowe, D Cass, J Dreyer, B Holroyd, L Morrison, M Schull, A Laupacis
Head injuries are among the most common types of trauma seen in North American emergency departments, with an estimated 1 million cases seen annually. "Minor" head injury (sometimes known as "mild") is defined by a history of loss of consciousness, amnesia, or disorientation in a patient who is conscious and talking, that is, with a Glasgow Coma Scale score of 13 to 15. Although most patients with minor head injury can be discharged without sequelae after a period of observation, in a small proportion, their neurologic condition deteriorates and requires neurosurgical intervention for intracranial hematoma...
August 2001: Annals of Emergency Medicine
W H Bickell, M J Wall, P E Pepe, R R Martin, V F Ginger, M K Allen, K L Mattox
BACKGROUND: Fluid resuscitation may be detrimental when given before bleeding is controlled in patients with trauma. The purpose of this study was to determine the effects of delaying fluid resuscitation until the time of operative intervention in hypotensive patients with penetrating injuries to the torso. METHODS: We conducted a prospective trial comparing immediate and delayed fluid resuscitation in 598 adults with penetrating torso injuries who presented with a pre-hospital systolic blood pressure of < or = 90 mm Hg...
October 27, 1994: New England Journal of Medicine
J R Hoffman, A B Wolfson, K Todd, W R Mower
Fear of failure to identify cervical spine injury has led to extremely liberal use of radiography in patients with blunt trauma and remotely possible neck injury. A number of previous retrospective and small prospective studies have tried to address the question of whether any clinical criteria can identify patients, from among this group, at sufficiently low risk that cervical spine radiography is unnecessary. The National Emergency X-Radiography Utilization Study (NEXUS) is a very large, federally supported, multicenter, prospective study designed to define the sensitivity, for detecting significant cervical spine injury, of criteria previously shown to have high negative predictive value...
October 1998: Annals of Emergency Medicine
E Rivers, B Nguyen, S Havstad, J Ressler, A Muzzin, B Knoblich, E Peterson, M Tomlanovich
BACKGROUND: Goal-directed therapy has been used for severe sepsis and septic shock in the intensive care unit. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand. The purpose of this study was to evaluate the efficacy of early goal-directed therapy before admission to the intensive care unit. METHODS: We randomly assigned patients who arrived at an urban emergency department with severe sepsis or septic shock to receive either six hours of early goal-directed therapy or standard therapy (as a control) before admission to the intensive care unit...
November 8, 2001: New England Journal of Medicine
R Phillip Dellinger, Mitchell M Levy, Jean M Carlet, Julian Bion, Margaret M Parker, Roman Jaeschke, Konrad Reinhart, Derek C Angus, Christian Brun-Buisson, Richard Beale, Thierry Calandra, Jean-Francois Dhainaut, Herwig Gerlach, Maurene Harvey, John J Marini, John Marshall, Marco Ranieri, Graham Ramsay, Jonathan Sevransky, B Taylor Thompson, Sean Townsend, Jeffrey S Vender, Janice L Zimmerman, Jean-Louis Vincent
OBJECTIVE: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," published in 2004. DESIGN: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee...
January 2008: Critical Care Medicine
Jonathan S Luchs, Douglas S Katz, Michael J Lane, Brett C Mellinger, Jeffrey H Lumerman, Charles A Stillman, Evan M Meiner, Steven Perlmutter
OBJECTIVES: To determine the utility of hematuria testing in a large series of patients with suspected renal colic using unenhanced helical computed tomography (CT) as the reference standard. METHODS: A retrospective review of the CT reports of all patients who underwent unenhanced helical CT for suspected renal colic at one institution during a 3.5-year period and who also underwent a formal microscopic urinalysis within 24 hours of the CT study was conducted. The sensitivity, specificity, positive predictive value, and negative predictive value of the presence of any blood on the urinalysis for renal colic were calculated...
June 2002: Urology
Deirdre M Coll, Michael J Varanelli, Robert C Smith
OBJECTIVE: Prior studies using radiography have examined the relationship of ureteral stone size and location to the probability of spontaneous passage. Given the improved accuracy and new role of unenhanced CT in the diagnosis of acute ureterolithiasis, we studied the relationship of stone size and location as determined by unenhanced CT to the rate of spontaneous passage. MATERIALS AND METHODS: Over a 29-month period, 850 patients with acute flank pain were evaluated with unenhanced CT...
January 2002: AJR. American Journal of Roentgenology
A T Berg, S Shinnar, W A Hauser, M Alemany, E D Shapiro, M E Salomon, E F Crain
BACKGROUND: Febrile seizures occur in about 2 to 4 percent of all children, approximately one third of whom will have recurrent febrile seizures. Little is known about predictors of recurrence. METHODS: In this prospective study, we identified 347 children (1 month to 10 years of age) who presented with a first febrile seizure at one of four pediatric emergency departments. Information about these children was collected from medical records and interviews with the parents, and the children were followed for a median of 20 months to ascertain whether febrile seizures recurred...
October 15, 1992: New England Journal of Medicine
Saleh Altamimi, Glenn Robertson, Wasil Jastaniah, Allyson Davey, Navid Dehghani, Ruth Chen, Karen Leung, Margaret Colbourne
OBJECTIVE: To compare the efficacy of a single dose of oral dexamethasone (Dex) versus 5 days of twice-daily prednisolone (Pred) in the management of mild to moderate asthma exacerbations in children. STUDY DESIGN: A prospective, randomized, double-blinded trial of children 2 to 16 years of age who presented to the emergency department (ED) with acute mild to moderate asthma exacerbations. Subjects received single-dose oral Dex (0.6 mg/kg to a maximum of 18 mg) or oral Pred (1 mg/kg per dose to a maximum of 30 mg) twice daily for 5 days...
December 2006: Pediatric Emergency Care
James F Holmes, Amy Mao, Smita Awasthi, John P McGahan, David H Wisner, Nathan Kuppermann
STUDY OBJECTIVE: We validate the accuracy of a previously derived clinical prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma. METHODS: We conducted a prospective observational study of children with blunt torso trauma who were evaluated for intra-abdominal injury with abdominal computed tomography (CT), diagnostic laparoscopy, or laparotomy at a Level I trauma center during a 3-year period to validate a previously derived prediction rule...
October 2009: Annals of Emergency Medicine
L B Morgenstern, H Luna-Gonzales, J C Huber, S S Wong, M O Uthman, J H Gurian, P R Castillo, S G Shaw, R F Frankowski, J C Grotta
STUDY OBJECTIVE: This study investigated the hypothesis that modern computed tomographic (CT) imaging is sufficient to exclude subarachnoid hemorrhage (SAH) in patients with severe headache. METHODS: All 38,730 adult patients who presented to Hermann Hospital in Houston, Texas, during a 16-month period were prospectively screened to detect those with "the worst headache of my life." Two neuroradiologists blinded to the study hypothesis interpreted the CT scans. Patients with negative scans underwent comprehensive cerebrospinal fluid (CSF) analysis including cell count in first and last tubes, visual and spectrophotometric detection of xanthochromia, and CSF D-dimer assay...
September 1998: Annals of Emergency Medicine
2015-02-22 16:55:51
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