Does the applied polytrauma definition notably influence outcome and patient population? – a retrospective analysis

Although the term “polytrauma” has been in use for decades, no generally accepted definition exists. The aim of this study was to demonstrate that different polytrauma definitions applied to a specific patient...

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Psychiatric Emergencies for Clinicians: Emergency Department Management of Cocaine-Related Presentations

Publication date: Available online 31 August 2017
Source:The Journal of Emergency Medicine
Author(s): Jagoda Pasic, Paul Zarkowski, Kimberly Nordstrom, Michael P. Wilson




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EMS Artwork: London Ambulance Service Incident Response Unit personnel

See all of Daniel Sundahl's photos.

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Paramedic - Superior Ambulance

Superior Air-Ground Ambulance Service, Inc. is the largest independent, locally owned and operated Emergency Medical Service provider in Michigan, Northern Illinois, Northwest Indiana and Ohio. We provide wheelchair transportation, Basic Life Support, Advanced Life Support and Critical Care Ground Transportation; as well as Critical Care Rotary Air Transportation. Much of our proven success is attributable ...

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Paramedic Firefighter - Metro Paramedic Services, Inc.

Metro Paramedic Services, Inc., a subsidiary of Superior Air-Ground Ambulance, Inc., contracts with municipalities to provide emergency medical services and/or fire services. We are currently seeking a Part-time Firefighter II/Medic at our Roselle IL location. Qualifications include: IL Paramedic license in good standing, in the CDH EMS System or able to test in before beginning work OSFM Firefighter ...

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Inside EMS Podcast: Why did you become a caregiver?

<!--cke_bookmark_116S--><!--cke_bookmark_116E--> Download this podcast on iTunes, SoundCloud or via RSS feed ​​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson discuss their funniest calls they have encountered, as well as the one call that caused them to be better caregivers. Learn more about the EMS1 Academy and schedule a free demo.

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Paramedics, Full Time, Part Time, PRN - Second Alarmers Rescue Squad

Working in EMS but looking to make more money" We are going to assume you just said YES! Second Alarmers Rescue Squad is pleased to announce new stipends for PRN and permanant part tim...e career members. All hours worked by PRN staff receive a $3.00 stipend and all hours worked by PPT staff receive a $1.50 stipend. Dont forget we still have a $4 per hour stipend for any shift that is opened within ...

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EMT, Full Time, Part Time, and PRN - Second Alarmers Rescue Squad

Working in EMS but looking to make more money" We are going to assume you just said YES! Second Alarmers Rescue Squad is pleased to announce new stipends for PRN and permanant part time career members. All hours worked by PRN staff receive a $3.00 stipend and all hours worked by PPT staff receive a $1.50 stipend. Dont forget we still have a $4 per hour stipend for any shift that is opened within 48 ...

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Yuneec International announces availability of Yuneec H520 Commercial UAV

The H520 Incorporates Multiple Interchangeable Payload Options, DataPilot™ Mission Planning Software and All-New YES! Commercial Service Program

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HeartRescue expands effort to reduce sudden cardiac arrest deaths

By EMS1 Staff MINNEAPOLIS — Three more states joined a project dedicated to increasing sudden cardiac arrest survival rates. The HeartRescue Project is a collaborative forum that lets partners share strategies to improve survival rates for sudden cardiac arrest victims. Recently, Maine, New Hampshire and Vermont joined the organization, bringing the total number of states to 15. “While every ...

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Harvey victims use social media when 911 fails

"We called 911 and it rang and rang and rang and rang," a Houston resident said

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Risk factors for acute kidney injury in patients with burn injury: A meta-analysis and systematic review

Journal of Burn Care & Research

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Comparison of fetomaternal outcome between 47 deliveries following successful external cephalic version for breech presentation and 7456 deliveries following spontaneous cephalic presentation

Gynecologic and Obstetric Investigation

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Report reveals high level of drug use in athletics

Reuters Health News

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The effect of peer support groups on family adaptation from the perspective of wives of war veterans with posttraumatic stress disorder

Public Health Nursing

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New ransomware strain targeting healthcare

Healthcare Finance News

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Feasibility and safety of intact cord resuscitation in newborn infants with congenital diaphragmatic hernia (CDH)

Resuscitation

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Impact of age on extracorporeal membrane oxygenation survival of patients with cardiac failure

Clinical Interventions in Aging

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Early versus late canalicular laceration repair outcomes

American Journal of Ophthalmology

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The use of aortic balloon occlusion in traumatic shock: First report from the ABO trauma registry

European Journal of Trauma and Emergency Surgery

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Might statin use lower the risk of death from prostate cancer?

Reuters Health News

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Emergency department provider perspectives on benzodiazepine-opioid co-prescribing: A qualitative study

Academic Emergency Medicine

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The management of small area burns and unexpected illness after burn in children under five years of age - A costing study in the English healthcare setting

Burns

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Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use

JAMA Internal Medicine

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The neurobiology of brain recovery from traumatic stress: A Longitudinal DTI Study

Journal of Affective Disorders

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Bacterial and fungal infections in acute-on-chronic liver failure: Prevalence, characteristics and impact on prognosis

Gut

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Impact of systemic inflammatory response syndrome and surgical Apgar score on post-operative acute kidney injury

Acta Anaesthesiologica Scandinavica

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Childhood bruising distribution observed from eight mechanisms of unintentional injury

Archives of Diseases in Childhood

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Treatment of unstable thoracolumbar fractures: Does fracture level fixation accelerate the bone healing?

World Neurosurgery

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Asian dust exposure triggers acute myocardial infarction

European Heart Journal

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Exploring the relationship between general practice characteristics and attendance at Walk-in Centres, Minor Injuries Units and Emergency Departments in England 2009/10–2012/2013: a longitudinal study

BMC Health Services Research

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Patient physiological status during emergency care and rapid response team or cardiac arrest team activation during early hospital admission

Objectives: The objective of this study was to examine the relationship between rapid response team (RRT) or cardiac arrest team (CAT) activation within 72 h of emergency admission and (i) physiological status in the emergency department (ED) and (ii) risk for ICU admission and in-hospital mortality. Methods: A retrospective matched cohort study was conducted in three hospitals in Melbourne, Australia. The exposed cohort (n=660) included randomly selected adults admitted to the medical or surgical ward through the ED who had RRT or CAT activation within 72 h of admission. Unexposed matched controls (n=1320) did not have RRT or CAT activation. Results: The exposed cohort was more likely to have physiological abnormalities fulfilling hospital RRT activation criteria during ED care (36.7 vs. 23.8%, P

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Diagnosis and treatment of upper airway oedema caused by acute angio-oedema in the emergency department: a French consensus statement

Angio-oedema is a transitory, localized, noninflammatory oedema of subcutaneous tissue or mucous. When the oedema affects the mouth, lips, tongue or larynx, it can result in fatal asphyxiation in the absence of specific treatment. Oedema secondary to plasma extravasation is usually mediated by either histamine or bradykinin. As laboratory tests are not available in an emergency setting, the implicated mediator cannot be readily determined. The challenge for the emergency physician is to determine the aetiological type, evaluate severity and initiate adapted treatment by means of a structured approach. A team of experts from the French Reference Centre for Angio-oedema reached a consensus for recommendations for the diagnostic and therapeutic strategy to be adopted by emergency departments faced with angio-oedema of the upper airways in adults. The experts defined 11 important questions. Responses were rated using a two-round Delphi methodology. The 11 recommendations were related to triage on admission, a step-by-step diagnostic protocol, definition of attack severity, discouragement of instrumental examination, prioritization of treatment for severe attacks according to clinical signs and anticipation of access to specific treatments by the hospital. Angio-oedema of the upper airways can be fatal and requires anticipation by the emergency department. A search for the aetiology, an evaluation of clinical symptoms and the availability of the treatments are challenges justifying these recommendations.

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Disaster preparedness and response improvement: comparison of the 2010 Haiti earthquake-related diagnoses with baseline medical data

Objectives: Disaster medicine research generally lacks control groups. This study aims to describe categories of diagnoses encountered by the Belgian First Aid and Support Team after the 2010 Haiti earthquake and extract earthquake-related changes from comparison with comparable baseline data. The hypothesis is that besides earthquake-related trauma, medical problems emerge soon, questioning an appropriate composition of Foreign Medical Teams and Interagency Emergency Health Kits. Methods: Using a descriptive cohort study design, diagnoses of patients presenting to the Belgian field hospital were prospectively registered during 4 weeks after the earthquake and compared with those recorded similarly by Médecins Sans Frontières in the same area and time span in previous and later years. Results: Of 7000 triaged postearthquake patients, 3500 were admitted, of whom 2795 were included and analysed. In the fortnight after the earthquake, 90% suffered from injury. In the following fortnight, medical diseases emerged, particularly respiratory (23%) and digestive (14%). More than 53% developed infections within 3 weeks after the event. Médecins Sans Frontières registered 6407 patients in 2009; 6033 in 2011; and 7300 in 2012. A comparison indicates that postearthquake patients suffered significantly less from violence, but more from wounds, respiratory, digestive and ophthalmological diseases. Conclusion: This is the first comparison of postearthquake diagnoses with baseline data. Within 2 weeks after the acute phase of an earthquake, respiratory, digestive and ophthalmological problems will emerge to the prejudice of trauma. This fact should be anticipated when composing Foreign Medical Teams and Interagency Emergency Health Kits to be sent to the disaster site.

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OBESICA study: relationship between BMI and acute heart failure outcome

Objective: The objective of this study was to investigate the relationship between BMI and outcome of acute heart failure (AHF). Methods: We carried out a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency department Registry (prospective, multicenter registry following a cohort of AHF patients from 34 Spanish emergency departments). Follow-up was at 3 months and 1 year after enrolment over the telephone and included medical history review. We analyzed revisits to the emergency department and death in relation to BMI. Significant differences were analyzed using proportional risk models including data on demographic variables, basal status, the acute episode, and patient outcome. Results: We included 1562 patients: low weight 1.3%, normal weight 26.1%, overweight 45.3%, obese 24.3%, and morbidly obese 3.1%. BMI was inversely associated with mortality (P

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TIER competency-based training course for the first receivers of CBRN casualties: a European perspective

Introduction: Education and training are key elements of health system preparedness vis-à-vis chemical, biological, radiological and nuclear (CBRN) emergencies. Medical respondents need sufficient knowledge and skills to manage the human impact of CBRN events. Objective: The current study was designed to determine which competencies are needed by hospital staff when responding to CBRN emergencies, define educational needs to develop these competencies, and implement a suitable delivery method. Methods: This study was carried out from September 2014 to February 2015, using a three-step modified Delphi method. On the basis of international experiences, publications, and experts’ consensus, core competencies for hospital staff – as CBRN casualty receivers – were determined, and training curricula and delivery methods were defined. Results: The course consists of 10 domains. These are as follows: threat identification; health effects of CBRN agents; planning; hospital incident command system; information management; safety, personal protective equipment and decontamination; medical management; essential resources; psychological support; and ethical considerations. Expected competencies for each domain were defined. A blended approach was chosen. Conclusion: By identifying a set of core competencies, this study aimed to provide the specific knowledge and skills required by medical staff to respond to CRBN emergencies. A blended approach may be a suitable delivery method, allowing medical staff to attend the same training sessions despite different time zones and locations. The study output provides a CBRN training scheme that may be adapted and used at the European Union level.

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Drug safety at admission to emergency department: an innovative model for PRIOritizing patients for MEdication Reconciliation (PRIOMER)

Objective: This study aimed to develop an innovative prioritizing model for conducting medication reconciliation (MR) at a fast-paced workflow emergency department (ED) and to implement an efficient working model for MR. Patients and methods: A total of 276 patients were included at the ED, Diakonhjemmet Hospital, Norway, and medication discrepancies (MDs) between hospital admission records and information on prehospital medication use were recorded. Clinically relevant medication discrepancies (crMDs) were assessed by a multidisciplinary panel. Binary logistic regression was used to construct the prioritizing model from patient characteristics correlated to crMDs, and patient characteristics included in the model should be easily available in the acute situation. A survey among the physicians made up the basis for the working model for conducting MR. Results: In total, 62% of the patients had one or more crMD. The following turned out to be risk factors for having a crMD suitable for inclusion in the model: sex (woman), age (≥60), one or more admission to hospital in the last 12 months and admission causes: surgical, malfunction, cancer. The prioritizing model correctly classified 76.1% of the patients as high-risk patients for having a crMD. In the new working model, in which clinical pharmacists/trained nurses perform MR before the physician did the medication history, was perceived to be more time efficient and also clarified questions related to the medication history early in the admission process. Conclusion: This innovative prioritizing model is designed to be practical in the fast-paced workflow at the ED and can identify what patients are at increased risk of having crMDs. The multidisciplinary working model was proven time efficient and could contribute towards increased patient safety.

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Further developments

No abstract available

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Prognosis of overt disseminated intravascular coagulation in patients admitted to a medical emergency department

Objective: To assess the prevalence, characteristics and prognosis of overt disseminated intravascular coagulation (DIC) in adult emergency department (ED) patients and identify markers of poor outcome. Materials and methods: In a chart review study, we analysed the occurrence of overt DIC in all patients (n=1 001 727) attending the University’s ED from 2003 to 2014 applying the ISTH DIC score. The primary outcome measure was 30-day mortality. Logistic regression analysis was used to determine predictors of mortality. Results: The initial inter-rater reliability in the diagnosis of DIC was 0.85 [κ; 95% confidence interval (CI), 0.77–0.92]. The main DIC precipitators were malignancy (47%), cardiovascular diseases (CVD, 27%) and sepsis (16%). Hyperfibrinolytic DIC occurred in 27% of patients and was over-represented in those with cardiac arrest (68%). Thirty-day mortality (52%) was inversely associated with fibrinogen levels on admission [adjusted odds ratio, 0.49; 95% CI: 0.30–0.82; P=0.006]. Afibrinogenaemia implied an even 10-fold increased risk of dying (crude odds ratio, 10.0; 95% CI: 3.2–31.4; P

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Hospital preparedness and response in CBRN emergencies: TIER assessment tool

Introduction: Chemical, biological, radiological, and nuclear (CBRN) emergencies need particular hospital preparedness and resources availability. Also, specific skills and capabilities are required for efficient response to these types of events. The aim of this study was to develop an assessment tool to evaluate hospital preparedness and response performance with respect to CBRN emergencies. Methods: An evaluation tool was developed using the Delphi technique. A panel of experts from 10 countries, both European and non-European, with more than 5 years of experience in research or practice in CBRN emergency management was involved in this study. The study was run online, and the experts were asked to evaluate a list of items on hospital preparedness and response in CBRN emergencies. A threshold of 85% agreement level was defined as the consensus of experts in this study. Results: The first-round questionnaire was answered by 13 experts. Consensus on the preparedness section was reached for all 29 items during the first round and one item was also added by the experts. Consensus on the response performance indicators were reached in 51 out of the 59 items, during the first round, and eight items were modified and then approved in the second round by the experts. Conclusion: Hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. The assessment tool, developed through experts’ consensus in this study, provides a standardized method for the evaluation of hospital preparedness and response performance with respect to CBRN emergencies. The feasibility and reliability of this assessment tool could be evaluated before and during simulated exercises in a standardized manner.

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Anticoagulation therapy among patients presenting to the emergency department with symptomatic atrial fibrillation – the FinFib2 study

Objectives: Atrial fibrillation (AF) causes numerous visits to emergency departments (EDs). We evaluated the thromboembolic and bleeding risk profile and use of oral anticoagulation (OAC) therapy among patients presenting with symptomatic AF to ED. Methods: Within a 2-week period, all patients whose primary reason for the ED visit was AF were enrolled into this prospective study in 35 EDs around Finland. The risk of thromboembolic and bleeding events was assessed by the CHA2DS2VASc and the HAS-BLED score, respectively. Thereafter, we evaluated whether OAC was used according to the contemporary management guidelines. Results: The study population included 1013 patients (mean age 70±13 years, 52.4% men) with newly or previously diagnosed symptomatic AF. The mean CHA2DS2VASc and HAS-BLED score was 3.1±2.1 and 1.9±1.2, respectively. At admission, 76.3% of the patients with previously diagnosed AF and CHA2DS2VASc score of at least 2 were using OAC (warfarin 92.3%). However, the international normalized ratio was not at the therapeutic level in 41.9% of them. At discharge, 84.1% of the high-risk patients (85.5% of previously diagnosed and 79.6% of newly diagnosed) and 57.0 and 37.0% of the moderate-risk and low-risk patients were on OAC, respectively. Of the high-risk patients, 5.4% were treated with aspirin. Conclusion: These data showed that OAC was prescribed frequently to patients with symptomatic AF and risk factors for stroke. However, in patients using warfarin, international normalized ratio was not at the therapeutic level in a large proportion of the patients with previously diagnosed AF.

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Usefulness of a multiplying factor in predicting the final number of victims during a mass casualty incident

Objective: Whenever a mass casualty incident (MCI) occurs, it is essential to anticipate the final number of victims to dispatch the adequate number of ambulances. In France, the custom is to multiply the initial number of prehospital victims by 2–4 to predict the final number. However, no one has yet validated this multiplying factor (MF) as a predictive tool. We aimed to build a statistical model to predict the final number of victims from their initial count. Methods: We observed retrospectively over 30 years of MCIs triggered in a large urban area. We considered three types of events: explosions, fires, and road traffic accidents. We collected the initial and final numbers of victims, with distinction between deaths, critical victims (T1), and delayed or minimal victims (T2–T3). The MF was calculated for each category of victims according to each type of event. Using a Poisson multivariate regression, we calculated the incidence risk ratio (IRR) of the final number of T1 as a function of the initial deaths and the initial T2–T3 counts, while controlling for potential confounding variables. Results: Sixty-eight MCIs were included. The final number of T1 increased with the initial incidence of deaths [IRR: 1.8 (1.4–2.2)], the initial number of T2–T3 being greater than 12 [IRR: 1.6 (1.3–2.1)], and the presence of one or more explosion [IRR: 1.4 (1.1–1.8)]. Conclusion: The MF seems to be an appealing decision-making tool to anticipate the need for ambulance resources. In explosive MCIs, we recommend multiplying T1 by 1.4 to estimate final count and the need for supplementary advanced life support teams.

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Large arterial occlusive strokes as a medical emergency: need to accurately predict clot location

Background: Endovascular treatment for acute ischemic stroke with a large intracranial occlusion was recently shown to be effective. Timely knowledge of the presence, site, and extent of arterial occlusions in the ischemic territory has the potential to influence patient selection for endovascular treatment. We aimed to find predictors of large vessel occlusive strokes, on the basis of available demographic, clinical, radiological, and laboratory data in the emergency setting. Methods: Patients enrolled in ASTRAL registry with acute ischemic stroke and computed tomography (CT)-angiography within 12 h of stroke onset were selected and categorized according to occlusion site. Easily accessible variables were used in a multivariate analysis. Results: Of 1645 patients enrolled, a significant proportion (46.2%) had a large vessel occlusion in the ischemic territory. The main clinical predictors of any arterial occlusion were in-hospital stroke [odd ratios (OR) 2.1, 95% confidence interval 1.4–3.1], higher initial National Institute of Health Stroke Scale (OR 1.1, 1.1–1.2), presence of visual field defects (OR 1.9, 1.3–2.6), dysarthria (OR 1.4, 1.0–1.9), or hemineglect (OR 2.0, 1.4–2.8) at admission and atrial fibrillation (OR 1.7, 1.2–2.3). Further, the following radiological predictors were identified: time-to-imaging (OR 0.9, 0.9–1.0), early ischemic changes (OR 2.3, 1.7–3.2), and silent lesions on CT (OR 0.7, 0.5–1.0). The area under curve for this analysis was 0.85. Looking at different occlusion sites, National Institute of Health Stroke Scale and early ischemic changes on CT were independent predictors in all subgroups. Conclusion: Neurological deficits, stroke risk factors, and CT findings accurately identify acute ischemic stroke patients at risk of symptomatic vessel occlusion. Predicting the presence of these occlusions may impact emergency stroke care in regions with limited access to noninvasive vascular imaging.

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Interactive videoconferencing versus audio telephone calls for dispatcher-assisted cardiopulmonary resuscitation using the ALERT algorithm: A randomized trial: Erratum

No abstract available

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Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock.

Objectives: To review temporary percutaneous mechanical circulatory support devices for the treatment of cardiogenic shock, including current evidence, contraindications, complications, and future directions. Data Sources: A MEDLINE search was conducted with MeSH terms: cardiogenic shock, percutaneous mechanical circulatory support, extracorporeal membrane oxygenation, Impella, and TandemHeart. Study Selection: Selected publications included randomized controlled trial data and observational studies describing experience with percutaneous mechanical circulatory support in cardiogenic shock. Data Extraction: Studies were chosen based on strength of association with and relevance to cardiogenic shock. Data Synthesis: Until recently, there were few options if cardiogenic shock was refractory to vasopressors or intra-aortic balloon pump counterpulsation. Now, several percutaneous mechanical circulatory support devices, including Impella (Abiomed, Danvers, MA), TandemHeart (CardiacAssist, Pittsburgh, PA), and extracorporeal membrane oxygenation, are more accessible. Compared with intra-aortic balloon pump, Impella provides greater hemodynamic support but no reduction in mortality. Similarly, TandemHeart improves hemodynamic variables but not survival. Comparative studies have been underpowered for mortality because of small sample size. Veno-arterial extracorporeal membrane oxygenation offers the advantage of biventricular circulatory support and oxygenation, but there are significant vascular complications. Comparative studies with extracorporeal membrane oxygenation have not been completed. Despite lack of randomized controlled data, there has been a substantial increase in use of -percutaneous mechanical circulatory support. Several ongoing prospective studies with larger sample sizes may provide answers, and newer devices may become smaller, easier to insert, and more effective. Conclusions: Mortality from cardiogenic shock remains unacceptably high despite early coronary revascularization or other therapies. Although evidence is lacking and complications rates are high, improvements and experience with percutaneous mechanical circulatory support may offer the prospect of better outcomes. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Interventions to Improve Hand Hygiene Compliance in the ICU: A Systematic Review.

Objectives: To synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described. Data Sources: Systematic searches were conducted in November 2016 using five electronic databases: Medline, CINAHL, PsycInfo, Embase, and Web of Science. Additionally, the reference lists of included studies and existing review papers were screened. Study Selection: English language, peer-reviewed studies that evaluated an intervention to improve hand hygiene in an adult ICU setting, and reported hand hygiene compliance rates collected via observation, were included. Data Extraction: Data were extracted on the setting, participant characteristics, experimental design, hand hygiene measurement, intervention characteristics, and outcomes. Interventional components were categorized using the Behavior Change Wheel. Methodological quality was examined using the Downs and Black Checklist. Data Synthesis: Thirty-eight studies were included. The methodological quality of studies was poor, with studies scoring a mean of 8.6 of 24 (SD = 2.7). Over 90% of studies implemented a bundled intervention. The most frequently employed interventional strategies were education (78.9%), enablement (71.1%), training (68.4%), environmental restructuring (65.8%), and persuasion (65.8%). Intervention outcomes were variable, with a mean relative percentage change of 94.7% (SD = 195.7; range, 4.3-1155.4%) from pre to post intervention. Conclusions: This review demonstrates that best practice for improving hand hygiene in ICUs remains unestablished. Future research employing rigorous experimental designs, careful statistical analysis, and clearly described interventions is important. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Antifungal Prevention of Systemic Candidiasis in Immunocompetent ICU Adults: Systematic Review and Meta-Analysis of Clinical Trials.

Objectives: The aim of this study was to identify the impact of antifungal prevention in critically ill immunocompetent adult patients on mortality and subsequent infection. Data Sources: A systematic review and meta-analysis of randomized controlled trials comparing any antifungal use versus placebo to prevent candidiasis in ICU patients were performed. Study Selection: Searches were performed on PubMed, Embase, Scopus, main conference proceedings, and ClinicalTrials.gov, as well as reference lists. Data Extraction: The primary outcomes were mortality and invasive candidiasis. The secondary outcome was the rate of Candida albicans and nonalbicans strains after treatment. A random effect model was used, and sensitivity analysis was performed for both outcomes. Results are expressed as risk ratios and their 95% CIs. Data Synthesis: Nineteen trials (10 with fluconazole, four with ketoconazole, one with itraconazole, three with micafungin, and one with caspofungin) including 2,792 patients were identified. No individual trial showed a decreased mortality rate. Combined analysis showed that preventive antifungal did not decrease mortality (risk ratio, 0.88; 95% CI, 0.74-1.04; p = 0.14) but significantly decreased secondary fungal infections by 50% (risk ratio, 0.49; 95% CI, 0.35-0.68; p = 0.0001). No shift across nonalbicans strains was observed during treatment (risk ratio, 0.62; 95% CI, 0.19-1.97; p = 0.42). However, publication biases preclude any definite conclusions for prevention of infection. Conclusions: Antifungal prevention of systemic candidiasis in immunocompetent critically ill adults did not reduce mortality and may have decreased secondary fungal infection rates. However, significant publication bias was present. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Effects of High-Flow Nasal Cannula on the Work of Breathing in Patients Recovering From Acute Respiratory Failure.

Objectives: High-flow nasal cannula is increasingly used in the management of respiratory failure. However, little is known about its impact on respiratory effort, which could explain part of the benefits in terms of comfort and efficiency. This study was designed to assess the effects of high-flow nasal cannula on indexes of respiratory effort (i.e., esophageal pressure variations, esophageal pressure-time product/min, and work of breathing/min) in adults. Design: A randomized controlled crossover study was conducted in 12 patients with moderate respiratory distress (i.e., after partial recovery from an acute episode, allowing physiologic measurements). Setting: Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada. Subjects: Twelve adult patients with respiratory distress symptoms were enrolled in this study. Interventions: Four experimental conditions were evaluated: baseline with conventional oxygen therapy and high-flow nasal cannula at 20, 40, and 60 L/min. The primary outcomes were the indexes of respiratory effort (i.e., esophageal pressure variations, esophageal pressure-time product/min, and work of breathing/min). Secondary outcomes included tidal volume, respiratory rate, minute volume, dynamic lung compliance, inspiratory resistance, and blood gases. Measurements and Main Results: Esophageal pressure variations decreased from 9.8 (5.8-14.6) cm H2O at baseline to 4.9 (2.1-9.1) cm H2O at 60 L/min (p = 0.035). Esophageal pressure-time product/min decreased from 165 (126-179) to 72 (54-137) cm H2O * s/min, respectively (p = 0.033). Work of breathing/min decreased from 4.3 (3.5-6.3) to 2.1 (1.5-5.0) J/min, respectively (p = 0.031). Respiratory pattern variables and capillary blood gases were not significantly modified between experimental conditions. Dynamic lung compliance increased from 38 (24-64) mL/cm H2O at baseline to 59 (43-175) mL/cm H2O at 60 L/min (p = 0.007), and inspiratory resistance decreased from 9.6 (5.5-13.4) to 5.0 (1.0-9.1) cm H2O/L/s, respectively (p = 0.07). Conclusions: High-flow nasal cannula, when set at 60 L/min, significantly reduces the indexes of respiratory effort in adult patients recovering from acute respiratory failure. This effect is associated with an improvement in respiratory mechanics. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Valproic Acid Combined With Postcardiac Arrest Hypothermic-Targeted Temperature Management Prevents Delayed Seizures and Improves Survival in a Rat Cardiac Arrest Model.

Objectives: High-dose valproic acid in combination with hypothermic-targeted temperature management has been reported to synergistically improve neurologic outcomes after cardiac arrest. This study investigated the potential synergistic mechanisms. Design: Prospective, randomized, experimental study. Setting: University research institution. Subjects: Male Long Evans rats. Intervention: Rats resuscitated from asphyxial cardiac arrest were randomized to one of the three groups: normothermic-targeted temperature management (37[degrees]C +/- 1[degrees]C), hypothermic-targeted temperature management (33[degrees] +/- 1[degrees] x 24 hr + placebo infusion), hypothermic-targeted temperature management plus high-dose valproic acid (300 mg/kg IV x 1 initiated 5 min post return of spontaneous circulation and infused over 20 min) (hypothermic-targeted temperature management + valproic acid). Measurements and Main Results: Seventy-two-hour survival was significantly greater with hypothermic-targeted temperature management + valproic acid, compared to hypothermic-targeted temperature management and normothermic-targeted temperature management (p

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Heparin-Free Prolonged Intermittent Hemodialysis Using Calcium-Free Citrate Dialysate in Critically Ill Patients.

Objectives: Critically ill patients who have a high risk of bleeding but require prolonged intermittent dialysis need a heparin-free easy-to-use alternative type of anticoagulation within the dialysis circuit. We assessed the safety and efficiency of heparin-free regional citrate anticoagulation of the dialysis circuit using a calcium-free citrate-containing dialysate, with calcium reinjected according to ionic dialysance. Design: Prospective cohort study. Setting: Critical care units. Patients: Critically ill patients who required renal replacement therapy. Interventions: None. Measurements and Main Results: A total of 101 dialysis sessions were performed in 35 patients (mechanical ventilation n = 78; norepinephrine n = 13). Median duration of dialysis was 294 minutes (interquartile range, 240-300), and median ultrafiltration volume was 2.3 L (1-2.8). Urea and [beta]2-microglobulin reduction rates were 64.5% +/- 0.4% and 48% +/- 0.13%, respectively. Postfilter ionized calcium was 0.35 +/- 0.17 and 0.38 +/- 0.14 mmol/L at 1 and 3 hours, respectively, within the extracorporeal circuit. A major clotting event that led to premature termination of the session occurred in only three of 101 sessions. In these three cases, major catheter dysfunction occurred before clotting within the circuit. Prefilter ionized calcium remained within narrow ranges (before/after change +0.07 +/- 0.006 mmol/L), and total-to-ionized calcium ratio, a surrogate marker for citratemia, was unchanged. Conclusions: Dialysis anticoagulation with calcium-free citrate-containing dialysate and calcium reinjection according to ionic dialysance is an easy-to-use, efficient, and inexpensive form of heparin-free regional anticoagulation. It allows prolonged hemodialysis sessions in critically ill patients without the need to systemically monitor ionized calcium. Furthermore, sessions can be safely extended according to the hemodynamic tolerance to ensure an adequate dose of dialysis and a negative water balance, a major point in patients with severe acute kidney disease. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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"It Was the Only Thing I Could Hold Onto, But[horizontal ellipsis]": Receiving a Letter of Condolence After Loss of a Loved One in the ICU: A Qualitative Study of Bereaved Relatives' Experience.

Objectives: Family members of patients who die in the ICU often remain with unanswered questions and suffer from lack of closure. A letter of condolence may help bereaved relatives, but little is known about their experience of receiving such a letter. The objective of the study was to understand bereaved family members' experience of receiving a letter of condolence. Design: Qualitative study using interviews with bereaved family members who received a letter of condolence and letters written by these family members to the ICU team. This study was designed to provide insight into the results of a larger randomized, controlled, multicenter study. Setting: Twenty-two ICUs in France. Subjects: Family members who lost a loved one in the ICU and who received a letter of condolence. Measurements and Main Results: Thematic analysis was used and was based on 52 interviews and 26 letters. Six themes emerged: 1) a feeling of support, 2) humanization of the medical system, 3) an opportunity for reflection, 4) an opportunity to describe their loved one, 5) continuity and closure, and 6) doubts and ambivalence. Possible difficulties emerged, notably the re-experience of the trauma, highlighting the absence of further support. Conclusions: This study describes the benefits of receiving a letter of condolence; mainly, it humanizes the medical institution (feeling of support, confirmation of the role played by the relative, supplemental information). However, this study also shows a common ambivalence about the letter of condolence's benefit. Healthcare workers must strive to adapt bereavement follow-up to each individual situation. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Nebulized Versus IV Amikacin as Adjunctive Antibiotic for Hospital and Ventilator-Acquired Pneumonia Postcardiac Surgeries: A Randomized Controlled Trial.

Objective: Nebulized antibiotics offer high efficacy due to significant local concentrations and safety with minimal blood levels. This study evaluates the efficacy and nephrotoxicity of nebulized versus IV amikacin in postcardiothoracic surgical patients with nosocomial pneumonia caused by multidrug-resistant Gram--negative bacilli. Design: Prospective, randomized, controlled study on surgical patients divided into two groups. Setting: Postcardiac surgery ICU. Interventions: The first gtroup was administered IV amikacin 20 mg/kg once daily. The second group was prescribed amikacin nebulizer 400 mg twice daily. Both groups were co-administered IV piperacillin/tazobactam empirically. Patients: Recruited patients were diagnosed by either hospital-acquired pneumonia or ventilator-associated pneumonia where 56 (42.1%) patients were diagnosed with hospital-acquired pneumonia, 51 (38.34%) patients were diagnosed with early ventilator-associated pneumonia, and 26 (19.54%) patients with late ventilator-associated pneumonia. Measurements and Main Results: Clinical cure in both groups assessed on day 7 of treatment was the primary outcome. Efficacy was additionally evaluated through assessing the length of hospital stay, ICU stay, days on amikacin, days on mechanical ventilator, mechanical ventilator-free days, days to reach clinical cure, and mortality rate. Lower nephrotoxicity in the nebulized group was observed through significant preservation of kidney function (p

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Daily volume of cases in emergency call centers: construction and validation of a predictive model

Variations in the activity of emergency dispatch centers are an obstacle to the rationalization of resource allocation. Many explanatory factors are well known, available in advance and could predict the volum...

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Rate-control with beta-blockers versus calcium-channel blockers in the emergency setting: predictors of medication class choice and associated hospitalization

Abstract

Objectives

Rate-control is an important component of the management of patients with atrial fibrillation (AF). Previous studies of emergency department (ED) rate-control have been limited by relatively small sample sizes. We examined the use of beta-blockers (BB) versus non-dihydropyridine calcium channel blockers (CCB) in ED patients from 24 sites, and the associated hospital admission rates.

Methods

In this pre-planned sub-study, we examined chart data on AF patients who visited one of 24 hospital EDs in Ontario, Canada, between April 2008 and March 2009. We describe the proportion of patients who received either a BB or a CCB, had a heart rate < 110 beats/minute 2 hours later, and any complications. We used hierarchical logistic regression modeling to determine the predictors of BB versus CCB use, and to assess the between-hospital variation in use of BB versus CCB. Solely in patients who had no rhythm control attempts, we examined the difference in the probability of hospital admission after propensity score matching patients by medication class.

Results

Of the 1639 patients who received either a BB (n=429) or a CCB (n=1210), 70.9% of the patients who received a BB had successful rate-control, versus 66.1% for a CCB. Complications were rare (2.4%), and the large majority were hypotension (2.0%). In adjusted analyses, predictors of receiving a BB (compared to a CCB) included already being on a BB, being sent in from a doctor's office, or being seen at a teaching hospital. In contrast, patients with evidence of heart failure, prior use of a CCB, a higher presenting heart rate, a successful pharmacological cardioversion (versus no attempt), or who were seen at the highest AF volume EDs were significantly less likely to receive a BB, compared to a CCB. Systematic between-hospital differences accounted for 8% of the variation in BB versus CCB use. Hospital characteristics accounted for the large majority of that variation: after accounting for patient characteristics the between-hospital variation decreased by a relative 2.8%. By further adjusting for hospital characteristics, it decreased by a relative 74.7%. Among propensity-score matched patients with no rhythm-control attempts, more CCB patients were admitted (51.6%) compared to BB patients (40.0%) (difference of 11.6%; 95% CI, 7.9-16.2).

Conclusions

In this study of 24 EDs, CCBs were used more frequently for rate-control than BBs, and complications were rare and easily managed using both agents. Variation between hospitals in BB versus CCB use was predominantly due to hospital characteristics such as teaching status and AF volumes, rather than different case-mix. Among patients who did not receive attempts at rhythm control, use of a BB for rate control was associated with a lower rate of hospitalization.

This article is protected by copyright. All rights reserved.

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The 2017 Academic Emergency Medicine Consensus Conference: Catalyzing System Change through Healthcare Simulation: Systems, Competency, and Outcomes

Abstract

Over the past decade, emergency medicine took a lead role in healthcare simulation in part due to its demands for successful interprofessional and multidisciplinary collaboration, along with educational needs in a diverse array of cognitive and procedural skills. Simulation-based methodologies have the capacity to support training and research platforms that model micro-, meso- and macro- systems of healthcare. To fully capitalize on the potential of simulation-based research to improve emergency healthcare delivery will require the application of rigorous methods from engineering, social science, and basic science disciplines. The Academic Emergency Medicine (AEM) Consensus Conference, “Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcome” was conceived to foster discussion among experts in emergency medicine, engineering, and social sciences, focusing on key barriers and opportunities in simulation-based research. This executive summary describes the overall rationale for the conference, conference planning, consensus-building approaches, and outlines the focus of the eight breakout sessions. The consensus outcomes from each breakout session are summarized in Proceedings papers published in this issue of Academic Emergency Medicine. Each paper provides an overview of methodological and knowledge gaps in simulation research and identifies future research targets aimed at improving the safety and quality of healthcare.

This article is protected by copyright. All rights reserved.

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Innovation Zone - Mercury Medical Small Adult CPR2 Bag

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Innovation Zone - Mercury Medical Small Adult CPR2 Bag

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Innovation Zone - Mercury Medical Small Adult CPR2 Bag

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EMCrit Wee – Central Line MicroSkills – Dilation

The next in the microskill series

EMCrit by Scott Weingart.

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How to remove the most common uniform stains

Despite your best efforts, blood stains, food grease and the not-so-fun vomit tinge happen from time to time

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Innovation Zone - Mercury Medical Small Adult CPR2 Bag

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EMCrit Wee – Central Line MicroSkills – Dilation

The next in the microskill series

EMCrit by Scott Weingart.

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Golfers, staff save man in cardiac arrest

When the golfer dropped, players immediately called 911, started performing CPR and contacted the course clubhouse

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EM Nerd-The Case of the Liberated Radicals

A recent publication in the NEJM by Hofmann et al (1) serves as a nice reminder that so many of our therapeutic staples while based on sound physiological reasoning fail to translate into clinically important realities when empirically tested. This mammoth undertaking, entitled the DETO2X trial, randomized 6629 adult patients (>30 years old) presenting to […]

EMCrit by Rory Spiegel.

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EM Nerd-The Case of the Liberated Radicals

A recent publication in the NEJM by Hofmann et al (1) serves as a nice reminder that so many of our therapeutic staples while based on sound physiological reasoning fail to translate into clinically important realities when empirically tested. This mammoth undertaking, entitled the DETO2X trial, randomized 6629 adult patients (>30 years old) presenting to […]

EMCrit by Rory Spiegel.

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NHTSA to host webinar on patient, EMS provider safety

By EMS1 Staff WASHINGTON — The National Highway Traffic Safety Administration will host a webinar discussing lights and siren use and fatigue in EMS providers. Two recent projects reviewed evidence in order to develop recommendations for improving the safety of EMS patients as well as EMS providers. The lead investigators on the projects will share the data in the webinar and how you can incorporate ...

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Prognostic value of admission red blood cell distribution width in acute pancreatitis: A systematic review

Annals of Translational Medicine

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Gilead to buy Kite for promising cancer therapies in $12 billion deal

Reuters Health News

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Medical treatment may prevent, alleviate mitral valve damage after a heart attack

Massachusetts General Hospital News

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Providers still largely in the dark about MACRA as reporting deadline nears

Healthcare Finance News

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Unsuspected critical illness among emergency department patients presenting for acute alcohol intoxication

Annals of Emergency Medicine

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Early Detection of brain death using the Bispectral Index (BIS) in patients treated by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest

Resuscitation

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The efficacy of mini-c-arm fluoroscopy for the closed reduction of distal radius fractures in adults: A randomized controlled trial

The Journal of Hand Surgery

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Time trends and predictors of acute gastroenteritis in the United States: results from National Health and Nutrition Examination Survey 2005-2014

Journal of Clinical Gastroenterology

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King-Devick test identifies real-time concussion and asymptomatic concussion in youth athletes

Neurology® Clinical Practice

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Dehydroepiandrosterone sulfate and dehydroepiandrosterone sulfate/cortisol ratio in cirrhotic patients with septic shock: Another sign of hepatoadrenal syndrome?

Critical Care

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Burns in a major burns center in East China from 2005 to 2014: Incidence and outcome

Burns

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Impact of rapid response car system on extracorporeal life support in out-of-hospital cardiac arrest: A retrospective cohort study

The American Journal of Emergency Medicine

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US FDA steps up scrutiny of stem-cell therapies

Reuters Health News

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Traumatic lower extremity and lumbosacral peripheral nerve injuries in adults: Electrodiagnostic studies and patients symptoms

Journal of Forensic and Legal Medicine

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Using external lumbar CSF drainage to treat communicating external hydrocephalus in adult patients after acute traumatic or non-traumatic brain injury

Acta Neurochirurgica

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Small intestinal angioectasia: Characterization, risk factors, and rebleeding

Journal of Clinical Gastroenterology

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Differences and similarities in risk factors for post-operative acute kidney injury between younger and older adults undergoing cardiac surgery

The Journal of Thoracic and Cardiovascular Surgery

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N-acetylcysteine and prednisolone treatment improved serum biochemistries in suspected flupirtine cases of severe idiosyncratic liver injury

Liver International

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Trauma mechanisms and injury patterns in pediatric burn patients

Burns

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Risk stratification for return emergency department visits among high-risk patients

The American Journal of Managed Care

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Bringing a 'Yes, and' mindset to EMS

By Eric Chase, EMS1 Contributor It was late in December and I was grinding through the holiday season. I was often assessing failures from the last call that didn't end well, compounded with my own feelings of inadequacy. I’d go over the decision points and questions from Monday morning quarterbacks, saying ,"they just don't know what we do anyhow." I wonder why people complain ...

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Basil A. Pruitt Jr. MD and the US Army Institute for Surgical Research: Five Decades of Science, Clinical Care, Mentorship, and Leadership.

Over the past half century Dr. Basil A. Pruitt, Jr., a great citizen, surgeon, innovator, mentor and leader, transformed our world through his dogged commitment to science and service to humanity. Dr. Pruitt's contribution lives on in the work of the US Army Institute of Surgical Research and the surgeons, physicians and scientists he shaped and inspired. (C) 2017 Lippincott Williams & Wilkins, Inc.

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Lead Paramedic (Full Time) - Constellis, LLC

Constellis was established in 2010 by a group of operators and investors who sought to combine best-in-class brands, assets and people within the complex risk management industry. Today, the leading provider of risk management and operational support services worldwide, Constellis combines the legacy capabilities and experience of ACADEMI, Triple Canopy, Olive Group, Centerra, Edinburgh International ...

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Paramedic (Part Time) - Constellis, LLC

Constellis was established in 2010 by a group of operators and investors who sought to combine best-in-class brands, assets and people within the complex risk management industry. Today, the leading provider of risk management and operational support services worldwide, Constellis combines the legacy capabilities and experience of ACADEMI, Triple Canopy, Olive Group, Centerra, Edinburgh International ...

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Training: How to use the 2016 Emergency Response Guidebook

Learn the basics on how to use the Emergency Response Guidebook (ERG).

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Training: How to use the 2016 Emergency Response Guidebook

Learn the basics on how to use the Emergency Response Guidebook (ERG).

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Training: How to use the 2016 Emergency Response Guidebook

Learn the basics on how to use the Emergency Response Guidebook (ERG).

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Searching for mortality predictors in trauma patients: a challenging task

Abstract

Background

We aimed to study the value of new physiological variables compared with ISS and GCS as predictors for trauma mortality in a high-income developing country having a young population.

Methods

Data of 1008 consecutive trauma patients who were included in Al-Ain City Road Traffic Collision Registry were analyzed. Demography of patients, systolic blood pressure, heart rate, shock index, shock index age (SIA), blood pressure age index (BPAI), Glasgow Coma Scale (GCS), injury severity score (ISS), and in-hospital mortality were analyzed. Univariate analysis was used to compare those who died with those who survived. Significant factors were then entered into a backward logistic regression model to define factors predicting mortality.

Results

80.3% of the patients were males. The median (range) age of patients was 26 (1–78) years. Significant factors that predicted mortality were GCS (p < 0.0001), SIA (p = 0.003), ISS (p = 0.007), and BPAI (p = 0.022).

Conclusions

The physiological variables including GCS and shock index age were better predictors for trauma mortality comparted with ISS in our young population. A large global multi-centric study could possibly define an accurate global formula that uses both anatomical and physiological variables for predicting trauma mortality.

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Training: How to use the 2016 Emergency Response Guidebook

Learn the basics on how to use the Emergency Response Guidebook (ERG).

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Top EMS Game Changers – #8: Specialty centers

Hospitals with enhanced capabilities to treat trauma, cardiac care, pediatrics, burns and more are providing specialized care and changing transport algorithms

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Top EMS Game Changers – #8: Specialty centers

Specialty centers – hospitals with enhanced capabilities to treat specific presenting problems – are far more numerous today than when I transported my first patient on Long Island, New York in 1992. Back then, there were only a few types of emergent patients that we didn’t automatically bring to the closest hospital: Major trauma Behavioral disorders dangerous to patients or others ...

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Mannequin-based telesimulation: Increasing access to simulation-based education

The 2017 Academic Emergency Medicine Consensus Conference, “Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes,” highlights how simulation can improve the delivery of health care across larger systems; however, how can systems change when valuable educational interventions reach only limited populations? Studies have demonstrated the benefit of simulation education^1,2 but have questioned the use of simulation in a system with limited financial resources.³ Most academic medical centers have mannequin-based simulation technology;⁴ yet, it is unclear from the literature how many community hospitals, especially in rural areas, have a simulation center or mannequins.

This article is protected by copyright. All rights reserved.

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“What do people do if they don't have insurance?”: ED to ED Referrals

Abstract

Objective

Up to 20% of patients seen in public emergency departments (EDs) have already been seen for the same complaint at another ED, but little is known about the origin or impact of these duplicate ED visits. The goals of this investigation were to explore (1) whether patients making a repeat ED visit are self-referred or indirectly referred from the other ED; and (2) gather the perspective of affected patients on the health, social, and financial consequences of these duplicate ED visits.

Methods

This mixed-methods study conducted over a 10-week period during 2016 in a large public hospital ED in Texas prospectively surveyed patients seen in another ED for the same chief complaint. Selected patients presenting with fractures were then enrolled for semi-structured qualitative interviews, which were audiotaped, transcribed, and independently coded by two team members until thematic saturation was reached.

Results

143 patients were identified as being recently seen at another local ED for the same chief complaint prior to presenting to the public hospital; 94% were uninsured and 61% presented with fractures. 27% required admission at the public ED and 95% of those discharged required further outpatient follow-up. 51 patients completed a survey and qualitative interviews were conducted with 23 fracture patients. 53% of patients reported that staff at the first hospital told them to go the public hospital ED, and 23% reported referral from a follow-up physician associated with the first hospital. 73% reported receiving the same tests at both EDs. Interview themes identified multiple healthcare visits for the same injury, concern about complications, disrespectful treatment at the first ED, delayed care, problems accessing needed follow-up care without insurance, loss of work, and financial strain.

Conclusions

The majority of patients presenting to a public hospital ED after treatment for the same complaint in another local ED were indirectly referred to the public ED without transferring paperwork or records, incurring duplicate testing and patient anxiety.

This article is protected by copyright. All rights reserved.

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PulmCrit- Brain death, mimics, and flow scans

As with many uncommon situations that are unique to critical illness, we cannot always rely on specialist consultation.  Critical care practitioners must develop a firm grasp of this diagnosis.  This post will explore some diagnostic conundrums in brain death diagnosis.  The radionuclide flow scan is emphasized because it is the most commonly used tool to sort out difficult cases.

EMCrit by Josh Farkas.

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PulmCrit- Brain death, mimics, and flow scans

As with many uncommon situations that are unique to critical illness, we cannot always rely on specialist consultation.  Critical care practitioners must develop a firm grasp of this diagnosis.  This post will explore some diagnostic conundrums in brain death diagnosis.  The radionuclide flow scan is emphasized because it is the most commonly used tool to sort out difficult cases.

EMCrit by Josh Farkas.

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Mechanisms, treatment, and patient outcome of iatrogenic injury to the brachial plexus – A retrospective single-center study

World Neurosurgery

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MGMA: Medical practices focused on customer service, revenue cycle training

Healthcare Finance News

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Adequate interval for the monitoring of vital signs during endotracheal intubation

BMC Anesthesiology

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Aetna violated HIPAA when envelope windows exposed HIV medication use, attorneys say

Healthcare Finance News

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Hip osteoarthritis as a predictor of the fracture pattern in proximal femur fractures

Injury

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Ambulatory hemodynamic monitoring strategy for heart failure management reduces utilization of emergency room services

Journal of Cardiac Failure

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Markers of acute kidney injury in patients with sepsis: The role of soluble thrombomodulin

Critical Care

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Enteral nutrition as stress ulcer prophylaxis in critically ill patients: A randomized controlled exploratory study

Journal of Critical Care

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Association between strained capacity and mortality among patients admitted to intensive care: A path-analysis modeling strategy

Journal of Critical Care

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Safety threats during the care of infants with hypoglycemic seizures in the emergency department: A multicenter, simulation-based prospective cohort study

The Journal of Emergency Medicine

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Improving trend in ventricular fibrillation/pulseless ventricular tachycardia out-of-hospital cardiac arrest in Rochester Minnesota: A 26-year observational study from 1991 to 2016

Resuscitation

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Effectiveness of endoscopic treatments for colonic diverticular bleeding

Gastrointestinal Endoscopy

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FDA clears Novo Nordisk's diabetes drug to treat heart diseases

Reuters Health News

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Patients discharged from the intensive care unit on a dopamine infusion: A retrospective, observational study

Journal of Cardiothoracic and Vascular Anesthesia

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Heart rate variability associated with posttraumatic stress disorder in victims’ families of sewol ferry disaster

Psychiatry Research

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Non-medical use of psychoactive prescription drugs is associated with fatal poisoning

Addiction

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Brain ischemia: CT and MRI techniques in acute ischemic stroke

European Journal of Radiology

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The pediatric submersion score predicts children at low risk for injury following submersions

Academic Emergency Medicine

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RCR audit of compliance with UK guidelines for the prevention and detection of acute kidney injury in adult patients undergoing iodinated contrast media injections for CT

Clinical Radiology

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Inferior vena cava filters in stable patients with acute pulmonary embolism who receive thrombolytic therapy

American Journal of Medicine

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Clinical Care Specialist (Paramedic/EMT-CC) - Call9

Tap Into The Revolution: As a Call9 team member you will operate at the nexus of clinical excellence, engineering innovation and progressive enterprise amongst a culture that fosters ingenuity and education.Tapping into the unique profession of the Call9 Clinical Care Specialist you will be the face of the service, the hands of the physician, and the voice of the patient. On a daily basis you will ...

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Laceration Management

Publication date: Available online 25 August 2017
Source:The Journal of Emergency Medicine
Author(s): Scott L. Mankowitz
BackgroundTraumatic lacerations to the skin represent a fairly common reason for seeking emergency department care. Although the incidence of lacerations has decreased over the past decades, traumatic cutaneous lacerations remain a common reason for patients to seek emergency department care.ObjectiveInnovations in laceration management have the potential to improve patient experience with this common presentation.DiscussionStudies have confirmed that delays in wound closure rarely confer increased rates of infection, although comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered. Antibiotics should be reserved for high-risk wounds, such as those with comorbidities, gross contamination, involvement of deeper structures, stellate wounds, and selected bite wounds. Topical anesthetics, which are painless to apply, have a role in select populations. In most studies, absorbable sutures perform similarly to nonabsorbable sutures and do not require revisit for removal. Novel atraumatic closure devices and expanded use of tissue adhesives for wounds under tension further erode the primacy of regular sutures in wound closure. Maintaining a moist wound environment with occlusive dressings is more important than previously thought. Most topical wound agents are of limited benefit.ConclusionsRecent innovations in wound closure are allowing emergency physicians to shift toward painless, atraumatic, and rapid closure of lacerations.



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Extracorporeal Circulatory Support in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis.

Objectives: Extracorporeal circulatory support is a life-saving technique, and its use is increasing in acute coronary syndromes. A meta-analysis on pooled event rate of short-term mortality and complications of acute coronary syndrome patients treated with extracorporeal circulatory support was performed. Data Sources: Articles were searched in MEDLINE, Cochrane Library, Google Scholar, and Biomed Central. Study Selection: Inclusion criteria were observational studies on acute coronary syndrome patients treated with extracorporeal circulatory support. Primary outcome was short-term mortality. Secondary outcomes were extracorporeal circulatory support-related complications, causes of death, long-term mortality, and bridge therapy. Data Extraction: Sixteen articles were selected. Data about clinical characteristics, acute coronary syndrome diagnosis and treatment, extracorporeal circulatory support setting, outcome definitions, and event rate were retrieved from the articles. Random effect meta-analytic pooling was performed reporting results as a summary point estimate and 95% CI. Data Synthesis: A total of 739 patients were included (mean age, 59.8 +/- 2.9). The event rate of short-term mortality was 58% (95% CI, 51-64%), 6-month mortality was affecting 24% (95% CI, 5-63%) of 1-month survivors, and 1-year mortality 17% (95% CI, 6-40%) of 6-month survivors. The event rates of extracorporeal circulatory support-related complications were acute renal failure 41%, bleeding 25%, neurologic damage in survivors 21%, sepsis/infections 21%, and leg ischemia 12%. Between causes of death, multiple organ failure and brain death affected respectively 40% and 27% of patients. Bridge to ventricular assistance device was offered to 14% of patients, and 7% received a transplant. Conclusions: There is still a high rate of short-term mortality and complications in acute coronary syndrome patients treated with extracorporeal circulatory support . New studies are needed to optimize and standardize extracorporeal circulatory support. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Delirium and Catatonia in Critically Ill Patients: The Delirium and Catatonia Prospective Cohort Investigation.

Objectives: Catatonia, a condition characterized by motor, behavioral, and emotional changes, can occur during critical illness and appear as clinically similar to delirium, yet its management differs from delirium. Traditional criteria for medical catatonia preclude its diagnosis in delirium. Our objective in this investigation was to understand the overlap and relationship between delirium and catatonia in ICU patients and determine diagnostic thresholds for catatonia. Design: Convenience cohort, nested within two ongoing randomized trials. Setting: Single academic medical center in Nashville, TN. Patients: We enrolled 136 critically ill patients on mechanical ventilation and/or vasopressors, randomized to two usual care sedation regimens. Measurements and Main Results: Patients were assessed for delirium and catatonia by independent and masked personnel using Confusion Assessment Method for the ICU and the Bush Francis Catatonia Rating Scale mapped to Diagnostic Statistical Manual-5 criterion A for catatonia. Of 136 patients, 58 patients (43%) had only delirium, four (3%) had only catatonia, 42 (31%) had both, and 32 (24%) had neither. In a logistic regression model, more catatonia signs were associated with greater odds of having delirium. For example, patient assessments with greater than or equal to three Diagnostic Statistical Manual-5 symptoms (75th percentile) had, on average, 27.8 times the odds (interquartile range, 12.7-60.6) of having delirium compared with patient assessments with zero Diagnostic Statistical Manual-5 criteria (25th percentile) present (p

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Early post-traumatic seizures are associated with valproic acid plasma concentrations and UGT1A6/CYP2C9 genetic polymorphisms in patients with severe traumatic brain injury

Seizure is a common complication for severe traumatic brain injury (TBI). Valproic acid (VPA) is a first-line antiepileptic drug, though its metabolism is affected by genetic polymorphisms and varies between i...

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The Cause of the Aimless Convoy

  Never has a biomarker with so much evidence demonstrating its disutility, enjoyed such a long reign of prosperity as BNP and its natriuretic analogs. And while evidence discrediting BNP’s use for the diagnosis and inpatient management of acute exacerbations of heart failure (HF) is well documented, its utility to guide outpatient therapy in patients […]

EMCrit by Rory Spiegel.

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The Cause of the Aimless Convoy

  Never has a biomarker with so much evidence demonstrating its disutility, enjoyed such a long reign of prosperity as BNP and its natriuretic analogs. And while evidence discrediting BNP’s use for the diagnosis and inpatient management of acute exacerbations of heart failure (HF) is well documented, its utility to guide outpatient therapy in patients […]

EMCrit by Rory Spiegel.

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Paramedics roll child down sidewalk to ER after ambulance breaks down

The paramedics pushed the child with cardiac problems on a gurney for two blocks to the hospital

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Paramedic Fulltime - City of Croswell EMS

Fulltime Paramedic needed for low volume municipal ALS/BLS service.

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Commissioners order audit of Pa. 911 center

Dispatchers were unable to page fire and EMS for more than a week after a malfunction caused the county's software to revert back to 1997

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The accuracy of acuity scoring tools to predict 24-hour mortality in traumatic brain injury patients: A guide to triage criteria

International Emergency Nursing

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Elders may face hearing challenges at doctor's offices

Reuters Health News

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Violent behavior by emergency department patients with an involuntary hold status

The American Journal of Emergency Medicine

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Last 'bare county' in US gets insurer

Reuters Health News

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Potential drug–drug interactions among critically ill pediatric patients in a tertiary pulmonary center

The Journal of Clinical Pharmacology

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Improving discharge care: The potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study

BMJ Open

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Endocrinopathies and renal outcomes in lithium therapy: Impact of lithium toxicity

QJM: An International Journal of Medicine

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Dual antiplatelet therapy and the severity risk of lower intestinal bleeding

Journal of Emergencies, Trauma and Shock

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Performance of serum creatinine and kidney injury biomarkers for diagnosing histologic acute tubular injury

American Journal of Kidney Diseases

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The value of arterial blood gas parameters for prediction of mortality in survivors of out-of-hospital cardiac arrest

Journal of Emergencies, Trauma and Shock

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Controlled trial to improve resident sign-out in a medical intensive care unit

BMJ Quality & Safety

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Long-term outcomes after acute myocardial infarction in countries with different socioeconomic environments: An international prospective cohort study

BMJ Open

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Novartis picks retail expert for new role of digital chief

Reuters Health News

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Economic implications of unintentional carbon monoxide poisoning in the United States and the cost and benefit of CO detectors

The American Journal of Emergency Medicine

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Cerebral oximetry versus end tidal CO2 in predicting ROSC after cardiac arrest

The American Journal of Emergency Medicine

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Effectiveness and safety of polygeline in patients with hypovolemia due to trauma

Journal of Emergencies, Trauma and Shock

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Evaluation of negative pressure wound therapy to closed laparotomy incisions in acute care surgery

The American Journal of Surgery

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Aspiration pneumonia in patients with carbon monoxide poisoning who had loss of consciousness: Prevalence, outcomes, and risk factors

American Journal of Medicine

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Collaborative care from the emergency department for injured patients with prescription drug misuse: An open feasibility study

Journal of Substance Abuse Treatment

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Massive transfusion practice in non-trauma related hemorrhagic shock

Journal of Critical Care

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Human Neutrophil Elastase Mediates Fibrinolysis Shutdown Through Competitive Degradation of Plasminogen and Generation of Angiostatin.

Background: A subset of trauma patients undergo fibrinolysis shutdown rather than pathologic hyperfibrinolysis, contributing to organ failure. The molecular basis for fibrinolysis shutdown in trauma is incompletely understood. Elastase released from primed/activated human neutrophils (HNE) has historically been described as fibrin(ogen)olytic. However, HNE can also degrade plasminogen (PLG) to angiostatin (ANG), retaining the Kringle domains but not the proteolytic function, and could thereby compete for generation of active plasmin by tPA. We hypothesized that HNE can drive fibrinolysis shutdown rather than fibrinolysis. Methods: Turbidometry was performed using light scatter ([lambda]=620nm) in a purified fibrinogen + PLG system and in healthy citrate plasma clotted with Ca2+/thrombin -/+tPA, -/+HNE, and -/+ANG to evaluate HNE effects on fibrinolysis, quantified by time to transition midpoint (Tm). [DELTA]Tm from control is reported as percent of control +/-95%CI. Purified HNE coincubated with PLG or tPA was analysed by western blot to identify cleavage products. Exogenous HNE was mixed ex-vivo with healthy volunteer blood (n=7) and used in TEG -/+tPA to evaluate effects on fibrinolysis. Results: HNE did not cause measurable fibrinolysis on fibrin clots, clotted plasma, or whole blood as assessed by turbidometry or TEG in the absence of tPA. Upon tPA treatment, all 3 methods of evaluating fibrinolysis showed delays and decreases in fibrinolysis due to HNE relative to control: fibrin clot turbidometry [DELTA]Tm =110.7% (CI 105.0%-116.5%), clotted citrate plasma (n=6 healthy volunteers) [DELTA]Tm =126.1% (CI 110.4%-141.8%), and whole blood native TEG (n=7 healthy volunteers) with [DELTA]LY30=28% (p=0.043). Western blot analysis of HNE-PLG co-incubation confirmed that HNE generates angiostatin K1-3, and plasma turbidity assays treated with angiostatin K1-3 delayed fibrinolysis. Conclusions: HNE degrades PLG and generates angiostatin K1-3, which predominates over HNE cleavage of fibrin(ogen). These findings suggest that neutrophil release of elastase may underlie trauma-induced fibrinolytic shutdown. (C) 2017 Lippincott Williams & Wilkins, Inc.

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Developing a risk calculator for mortality following emergency general surgery.

No abstract available

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Multi-institutional analysis of neutrophil to lymphocyte ratio (NLR) in patients with severe hemorrhage: A new mortality predictor value.

Background: The neutrophil/lymphocyte ratio (NLR) has been associated as a predictor for increased mortality in critically ill patients. We sought to determine the relationship between NLR and outcomes in adult trauma patients with severe hemorrhage requiring the initiation of massive transfusion protocol (MTP). We hypothesized that the NLR would be a prognostic indicator of mortality in this population. Methods: This was a multi-institutional retrospective cohort study of adult trauma patients (>=18 years) with severe hemorrhage who received MTP between November 2014 - November 2015. Differentiated blood cell counts obtained at days 3 and 10 were used to obtain NLR. Receiver operating characteristic (ROC) curve analysis assessed the predictive capacity of NLR on mortality. To identify the effect of NLR on survival, Kaplan-Meier (KM) survival analysis and Cox regression models were used. Results: A total of 285 patients with severe hemorrhage managed with MTP were analyzed from 6 participating institutions. Most (80%) were male, 57.2% suffered blunt trauma. Median (IQR) age, Injury Severity Score, and Glasgow Coma Scale were 35 (25-47), 25 (16-36), 9 (3-15), respectively. Using ROC curve analysis, optimal NLR cutoff values of 8.81 at day 3 and 13.68 at day 10 were calculated by maximizing the Youden index. KM curves at day 3 (p = 0.05) and day 10 (p = 0.02) revealed an NLR greater than or equal to these cutoff values as a marker for increased in-hospital mortality. Cox regression models failed to demonstrate an NLR over 8.81 as predictive of in-hospital mortality at day 3 (p = 0.056) but was predictive for mortality if NLR was greater than 13.68 at day 10 (p=0.036). Conclusions: NLR is strongly associated with early mortality in patients with severe hemorrhage managed with MTP. Further research is needed to focus on factors that can ameliorate NLR in this patient population. Level of evidence: Prognostic study, Level III (C) 2017 Lippincott Williams & Wilkins, Inc.

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Characterization of hypoalbuminemia following temporary abdominal closure.

Background: The purpose of this study was to characterize associations among serum proteins, negative pressure wound therapy (NPWT) fluid loss, and primary fascial closure (PFC) following emergent laparotomy and temporary abdominal closure (TAC). We hypothesized that high levels of C-reactive protein (CRP) and NPWT output would be associated with hypoalbuminemia and failure to achieve PFC. Methods: We performed a retrospective analysis of 233 patients managed with NPWT TAC. Serum proteins and resuscitation indices were assessed on admission, initial laparotomy, and then at 48h, 96h, 7d, and discharge. Correlations were assessed by Pearson's coefficient. Multivariable regression was performed to identify predictors of PFC with cutoff values for continuous variables determined by Youden's index. Results: Patients who failed to achieve PFC (n =55) had significantly higher CRP at admission (249 vs. 148 mg/L, p =0.003), initial laparotomy (237 vs. 154, p =0.002), and discharge (124 vs. 72, p =0.003), as well as significantly lower serum albumin at 7d (2.3 vs. 2.5 g/dL, p =0.028) and discharge (2.5 vs. 2.8, p =0.004). Prealbumin (mg/dL) was similar between groups at each time point. There was an inverse correlation between nadir serum albumin and total mL NPWT output (r =-0.33, p 40 kg/m2, and CRP >250 mg/L. Conclusions: Early and persistent systemic inflammation and high NPWT output were associated with hypoalbuminemia, which was an independent predictor of failure to achieve primary fascial closure. The utility of exogenous albumin following TAC requires further study. Level of Evidence: Prognostic study, level III (C) 2017 Lippincott Williams & Wilkins, Inc.

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Severe Burnout Is Common Among Critical Care Physician Assistants.

Objectives: To determine the prevalence of and risk factors for burnout among critical care medicine physician assistants. Design: Online survey. Settings: U.S. ICUs. Subjects: Critical care medicine physician assistant members of the Society of Critical Care Medicine coupled with personal contacts. Interventions: None. Measurements and Main Results: We used SurveyMonkey to query critical care medicine physician assistants on demographics and the full 22-question Maslach Burnout Inventory, a validated tool comprised of three subscales-emotional exhaustion, depersonalization, and achievement. Multivariate regression was performed to identify factors independently associated with severe burnout on at least one subscale and higher burnout scores on each subscale and the total inventory. From 431 critical care medicine physician assistants invited, 135 (31.3%) responded to the survey. Severe burnout was seen on at least one subscale in 55.6%-10% showed evidence of severe burnout on the "exhaustion" subscale, 44% on the "depersonalization" subscale, and 26% on the "achievement" subscale. After multivariable adjustment, caring for fewer patients per shift (odds ratio [95% CI]: 0.17 [0.05-0.57] for 1-5 vs 6-10 patients; p = 0.004) and rarely providing futile care (0.26 [0.07-0.95] vs providing futile care often; p = 0.041) were independently associated with having less severe burnout on at least one subscale. Those caring for 1-5 patients per shift and those providing futile care rarely also had a lower depersonalization scores; job satisfaction was independently associated with having less exhaustion, less depersonalization, a greater sense of personal achievement, and a lower overall burnout score. Conclusions: Severe burnout is common in critical care medicine physician assistants. Higher patient-to-critical care medicine physician assistant ratios and provision of futile care are risk factors for severe burnout. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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The Epidemiology of Chronic Critical Illness After Severe Traumatic Injury at Two-Level One Trauma Centers.

Objective: To determine the incidence and risk factors of chronic critical illness after severe blunt trauma. Design: Prospective observational cohort study (NCT01810328). Setting: Two-level one trauma centers in the United States. Patients: One hundred thirty-five adult blunt trauma patients with hemorrhagic shock who survived beyond 48 hours after injury. Interventions: None. Measurements and Main Results: Chronic critical illness was defined as an ICU stay lasting 14 days or more with evidence of persistent organ dysfunction. Three subjects (2%) died within the first 7 days, 107 (79%) exhibited rapid recovery and 25 (19%) progressed to chronic critical illness. Patients who developed chronic critical illness were older (55 vs 44-year-old; p = 0.01), had more severe shock (base deficit, -9.2 vs -5.5; p = 0.005), greater organ failure severity (Denver multiple organ failure score, 3.5 +/- 2.4 vs 0.8 +/- 1.1; p

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Monotherapy Is Adequate for Septic Shock Due to Gram-Negative Organisms.

No abstract available

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Inside EMS Podcast: Giving volunteer EMTs meaningful incentives

Download this podcast on iTunes, SoundCloud or via RSS feed ​​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson discuss two recent news articles. The first is out of Pennsylvania, where they are looking to give a tax credit to volunteers to increase recruitment and retention. The second is out of Florida, where an ambulance service was forced to write off $11.8 million ...

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App boosts communications for emergency medical services

Responders can transmit information more efficiently while en route to hospital, crucial when a person’s life could be on the line

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ESO announces addition of SafetyPAD to its product portfolio

Leading Healthcare Software and Data Company for EMS, Fire, and Hospitals Expands Through Transaction to Acquire Assets of oPEN Inc.

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Uncomplicated

Publication date: Available online 23 August 2017
Source:The Journal of Emergency Medicine
Author(s): Meghan G. Liroff




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Safety Threats During the Care of Infants with Hypoglycemic Seizures in the Emergency Department: A Multicenter, Simulation-Based Prospective Cohort Study

Publication date: Available online 24 August 2017
Source:The Journal of Emergency Medicine
Author(s): Barbara M. Walsh, Sandeep Gangadharan, Travis Whitfill, Marcie Gawel, David Kessler, Robert A. Dudas, Jessica Katznelson, Megan Lavoie, Khoon-Yen Tay, Melinda Hamilton, Linda L. Brown, Vinay Nadkarni, Marc Auerbach
BackgroundErrors in the timely diagnosis and treatment of infants with hypoglycemic seizures can lead to significant patient harm. It is challenging to precisely measure medical errors that occur during high-stakes/low-frequency events. Simulation can be used to assess risk and identify errors.ObjectiveWe hypothesized that general emergency departments (GEDs) would have higher rates of deviations from best practices (errors) compared to pediatric emergency departments (PEDs) when managing an infant with hypoglycemic seizures.MethodsThis multicenter simulation-based prospective cohort study was conducted in GEDs and PEDs. In situ simulation was used to measure deviations from best practices during management of an infant with hypoglycemic seizures by inter-professional teams. Seven variables were measured: five nonpharmacologic (i.e., delays in airway assessment, checking dextrose, starting infusion, verbalizing disposition) and two pharmacologic (incorrect dextrose dose and incorrect dextrose concentration). The primary aim was to describe and compare the frequency and types of errors between GEDs and PEDs.ResultsFifty-eight teams from 30 hospitals (22 GEDs, 8 PEDs) were enrolled. Pharmacologic errors occurred more often in GEDs compared to PEDs (p = 0.043), while nonpharmacologic errors were uncommon in both groups. Errors more frequent in GEDs related to incorrect dextrose concentration (60% vs. 88%; p = 0.025), incorrect dose (20% vs. 56%; p = 0.033), and failure to start maintenance dextrose (33% vs. 65%; p = 0.040).ConclusionsDuring the simulated care of an infant with hypoglycemic seizures, errors were more frequent in GEDs compared to PEDs. Decreasing annual pediatric patient volume was the best predictor of errors on regression analysis.



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Tanzania to use drone network to deliver critical medicines

In 2018, they will begin using drones to make up to 2,000 deliveries per day to more than 1,000 health facilities

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6-year-old pulls drowning toddler twin cousins from pool

The twins' father, a first responder, said they were limp and "blue as a pair of blue jeans" when he began CPR

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Acute unilateral hip pain in fibrodysplasia ossificans progressiva (FOP)

Bone

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After solar eclipse, Americans' eyes seem mostly none the worse

Reuters Health News

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Epidemiology from tweets: Estimating misuse of prescription opioids in the USA from social media

Journal of Medical Toxicology

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CMS targets providers that have high error rates in new claims processing, fraud reviews

Healthcare Finance News

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Pulmonary CTA in sickle cell patients: Quantitative assessment of enhancement quality

Emergency Radiology

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A walking program plus high intensity breathing exercise may enhance quality of life in individuals with heart failure - A preliminary report

Journal of Cardiac Failure

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Knowledge and practice for pressure injury prevention among care managers in a home care setting: A cross-sectional study

Chronic Wound Care Management and Research

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Thoracic epidural anesthesia reversed myocardial fibrosis in patients with heart failure caused by dilated cardiomyopathy

Journal of Cardiothoracic and Vascular Anesthesia

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Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study

Burns

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Risk factors for the occurrence of epistaxis: Prospective study

Auris Nasus Larynx

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Correlation of venous lactate and time of death in emergency department patients with noncritical lactate levels and mortality from trauma

Journal of Emergencies, Trauma and Shock

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Hyperlactatemia, lactate kinetics and prediction of citrate accumulation in critically ill patients undergoing continuous renal replacement therapy with regional citrate anticoagulation

Critical Care Medicine

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Using unproven methods to tackle cancer could be deadly

Reuters Health News

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Patient navigation for patients frequently visiting the emergency department: a randomized, controlled trial

Academic Emergency Medicine

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Anterior cruciate ligament injury/reinjury in alpine ski racing: A narrative review

Open Access Journal of Sports Medicine

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Critical care polyneuropathy in burn injuries: an integrative review

Burns

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Early surgical intervention for acute ulcerative colitis is associated with improved postoperative outcomes

Journal of Gastrointestinal Surgery

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Identifying emergency department patients at low risk for a variceal source of upper gastrointestinal hemorrhage

Academic Emergency Medicine

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The time-sensitive challenge of diagnosing spinal epidural abscess in the emergency department

Internal and Emergency Medicine

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The association between intensive care unit-acquired hypernatraemia and mortality in critically ill patients with cerebrovascular diseases: A single-centre cohort study in Japan

BMJ Open

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Maintaining immobilisation devices on trauma patients during CT: a feasibility study

To reduce the possibility of secondary deterioration of spinal injuries, it is desirable to maintain the spinal immobilisation that is applied in the prehospital setting throughout computed tomography (CT) sca...

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Identifying pre-hospital factors associated with outcome for major trauma patients in a regional trauma network: an exploratory study

Major trauma is often life threatening and the leading cause of death in the United Kingdom (UK) for adults aged less than 45 years old. This study aimed to identify pre-hospital factors associated with patien...

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Acute Limb Ischemia

Acute limb ischemia is a medical emergency with significant morbidity and mortality. Rapid diagnosis is required because it is a time-sensitive condition. Timely treatment is necessary to restore blood flow to the extremity and prevent complications. The differential diagnosis of acute limb ischemia is broad. Classification of severity of acute limb ischemia is based on clinical variables. A suspicion of acute ischemia based on history and physical examination warrants heparin administration and vascular surgery consultation. The decision for endovascular thrombolysis or standard surgery depends on etiology, duration, and location of vascular occlusion. This review evaluates the diagnostic approach and management for acute limb ischemia.

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Penetrating Vascular Injury

Penetrating vascular injury is becoming increasingly common in the United States and abroad. Much of the current research and treatment is derived from wartime and translation to the civilian sector has been lacking. Penetrating vascular injury can be classified as extremity, junctional, or noncompressible. Diagnosis can be obvious but at other times subtle and difficult to diagnose. Although there are numerous modalities, computed tomography angiography is the diagnostic study of choice. It is hoped that care will be improved by using an algorithmic approach integrating experience from military and civilian research.

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Cerebral Venous Thrombosis

Headache is a common emergency department chief complaint. Although most are benign, emergency physicians must rapidly identify and manage the uncommon, sometimes subtle, presentation of headache from a life-threatening cause. Cerebral venous thrombosis imparts significant morbidity and mortality, and can be a challenging diagnosis. It most commonly occurs in those under 50 years of age with thrombosis of the cerebral veins/sinuses. Diagnosis is frequently delayed. The disease can present with 1 or more clinical syndromes, including intracranial hypertension with headaches, focal neurologic deficits, seizures, and encephalopathy. Diagnosis requires imaging. Treatment includes stabilization, management of complications, and anticoagulation.

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Extracranial Cervical Artery Dissections

Cervical artery dissections (CeAD) include both internal carotid and vertebral artery dissections. They are rare but important causes of stroke, especially in younger patients. CeAD should be considered in patients with strokelike symptoms, a new-onset headache and/or neck pain, and/or other risk factors. Early imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is key to making the diagnosis. Treatment may vary depending on the extent of the dissection, timing of the dissection, and other comorbidities. The overall prognosis is good, but does depend on the initial severity of symptoms.

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Subarachnoid Hemorrhage

Subarachnoid hemorrhage (SAH) is a neurologic emergency due to bleeding into the subarachnoid space. Mortality can reach 50%. The clinical presentation is most often in the form of headache, classically defined as maximal at onset and worst of life. The most common cause is traumatic; approximately 80% of nontraumatic SAH are due to aneurysmal rupture, with the remainder from idiopathic peri-mesencephalic hemorrhage or other less common causes. Noncontrast brain computed tomography (CT) performed within 6 hours of symptom onset has sensitivity approaching 100%. Lumbar puncture may be considered after this period for definitive diagnosis if initial CT is normal.

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Vascular Access Complications

Millions of central venous and arterial catheters are placed across the United States annually as mechanisms of obtaining advanced hemodynamic monitoring and facilitating acute resuscitation. Although presumably life saving or sustaining in many circumstances, current literature identifies the preprocedural and postprocedural complications of infection, thrombosis, embolism, and iatrogenic injury as resulting in patient morbidity and mortality. Today, through the application of aseptic technique, performance of operator training, and the utilization of ultrasound, emergency physicians may limit vascular access complications and improve patient outcomes.

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Deep Venous Thrombosis

Deep venous thrombosis (DVT) is a frequently encountered condition that is often diagnosed and treated in the outpatient setting. Risk stratification is helpful and recommended in the evaluation of DVT. An evidence-based diagnostic approach is discussed here. Once diagnosed, the mainstay of DVT treatment is anticoagulation. The specific type and duration of anticoagulation depend upon the suspected etiology of the venous thromboembolism, as well as risks of bleeding and other patient comorbidities. Both specific details and a standardized approach to this vast treatment landscape are presented.

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Pulsara releases version 6.2, debuting 'Flexible Teams' feature

BOZEMAN, Mont. — Pulsara announced today the release of software version 6.2. The highlight of the release is the Flexible Teams feature, which allows hospital admins to create, assign and alert unlimited CUSTOM teams. In addition, users can now go on call for custom teams, with the option of being assigned for MULTIPLE hospitals at the same time. "This feature is a big step in our efforts ...

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Registered Nurse - Falck Northern California

Position Summary The primary responsibility of the Registered Nurse (RN) is to provide or assist in providing an ongoing plan to care for patients through established pre-hospital processes, the environment, instrumentation, other health care team members, and interacting agencies. The primary objective of the Registered Nurse (RN) is to provide safe and expedient response and transport as dispatched ...

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Paramedic - Falck Northern California

Position Summary: The primary responsibility of the Paramedic is to emergency medical care to the sick and injured in accordance with all applicable laws, regulations, and Company policies. Essential Functions: The Paramedic may be assigned one or more duties. These duties may include, but are not limited to, the following: Presents himself/herself in a professional manner and displays a good public ...

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Top EMS Game Changers – #9: ePCRs

Electronic PCRs, now used by roughly three quarters of U.S. EMS agencies, were pretty far from commonplace in 1995 when I started my first two paramedic jobs. One of those positions was administrative; I was responsible for keeping manual records of day-to-day patient encounters by ALS providers in our county. Creating, sorting and sometimes tabulating paper reports was no fun. I’d gotten into ...

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A New Rule for Terminating Resuscitation of Out-of-Hospital Cardiac Arrest Patients in Japan: A Prospective Study

Publication date: Available online 23 August 2017
Source:The Journal of Emergency Medicine
Author(s): SOS–KANTO 2012 Study GroupSadakiInokuchiMDYoshihiroMasuiMDKunihisaMiuraMDHaruhikoTsutsumiMDKiyotsuguTakumaMDIshiharaAtsushiMDMinoruNakanoMDHiroshiTanakaMDKeiichiIkegamiMDTakaoAraiMDArinoYaguchiMDNobuyaKitamuraMDShigetoOdaMDKenjiKobayashiMDTakayukiSudaMDKazuyukiOnoMDNaotoMorimuraMDRyosukeFuruyaMDYuichiKoidoMDFumiakiIwaseMDKenNagaoMDShigeruKanesakaMDYasuseiOkadaMDKyokoUnemotoMDTomohitoSadahiroMDMasayukiIyanagaMDAsakiMuraokaMDMunehiroHayashiMDShinichiIshimatsuMDYasufumiMiyakeMDHideoYokokawaMDYasuakiKoyamaMDAsukaTsuchiyaMDTetsuyaKashiyamaMDMunetakaHayashiMDKiyohiroOshimaMDKazuyaKiyotaMDYuichiHamabeMDHiroyukiYokotaMDShingoHoriMDShinInabaMDTetsuyaSakamotoMDNaoshigeHaradaMDAkioKimuraMDMasayukiKanaiMDYasuhiroOtomoMDManabuSugitaMDKosakuKinoshitaMDTakatoshiSakuraiMDMitsuhideKitanoMDKiyoshiMatsudaMDKotaroTanakaMDKatsunoriYoshiharaMDKikuoYohMDJunichiSuzukiMDHiroshiToyodaMDKunihiroMashikoMDNaokiShimizuMDTakashiMugurumaMDTadanagaShimadaMDYoshiroKobeMDTomohisaShokoMDKazuyaNakanishiMDTakashiShigaMDTakefumiYamamotoMDKazuhikoSekineMDShinichiIzukaMD
BackgroundThe American Heart Association and European Resuscitation Council guidelines for cardiopulmonary resuscitation present rules for termination of resuscitation (TOR) in cases of out-of-hospital cardiac arrest (OHCA). In Japan, only doctors are legally allowed TOR in OHCA cases.ObjectiveThis study aimed to develop a new TOR rule that suits the actual situations of the Japanese emergency medical services system.MethodsFive different combinations of the TOR rule criteria were compared regarding specificity and positive predictive value (PPV) for 1-month survival with unfavorable neurologic outcomes. The criteria were unwitnessed by emergency medical service personnel, unwitnessed by bystanders, initial unshockable rhythm in the field, initial asystole in the field, no shock delivered, no prehospital return of spontaneous circulation, unshockable rhythm at hospital arrival, and asystole at hospital arrival.ResultsA total of 13,291 cases were included. The following combination provided the highest specificity and PPV for predicting 1-month unfavorable neurologic outcomes and death: unwitnessed by bystanders, initial asystole in the field, and asystole at hospital arrival. The specificity and PPV for the combination of the three criteria for predicting 1-month unfavorable neurologic outcomes were 0.992 and 0.999, and for predicting death at 1 month after OHCA were 0.986 and 0.998, respectively.ConclusionsOHCA patients fulfilling the criteria unwitnessed by bystanders and asystole in the field and at hospital arrival had universally poor outcomes. Termination of resuscitation after hospital arrival for these patients may decrease unwarranted treatments.



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