Department's first therapy cat just makes things worse

MORRISTOWN, Mo. — EMTs from Morristown EMS are questioning management's decision to deploy a therapy cat to EMS crews that have a difficult patient encounter just nine weeks into the new Crisis After-action Team protocol. Good Sam, a gray and black striped cat of unknown age, spent the past winter prowling behind a grocery store next to the ambulance garage, killing rats and cultivating an ...

from EMS via xlomafota13 on Inoreader http://ift.tt/2nKVjeV

EM Nerd-The Case of the Bridge to Nowhere

The use of mechanical cardiopulmonary resuscitation (mCPR) has been a polarizing topic almost from its inception. The idea, a simple one. Why not build a machine that is capable of doing perfect chest compressions? A simple, effective way to eliminate the inconsistencies common to manual chest compressions. And yet, despite building a number of devices […]

EMCrit by Rory Spiegel.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2nrMZPv

EM Nerd-The Case of the Bridge to Nowhere

The use of mechanical cardiopulmonary resuscitation (mCPR) has been a polarizing topic almost from its inception. The idea, a simple one. Why not build a machine that is capable of doing perfect chest compressions? A simple, effective way to eliminate the inconsistencies common to manual chest compressions. And yet, despite building a number of devices […]

EMCrit by Rory Spiegel.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2nrMZPv

Validity of the Pediatric Canadian Triage Acuity Scale in a tertiary children's hospital in Israel.

Objective: In 2015, the Israeli Ministry of Health issued national guidelines demanding the use of a five-level triage system in pediatric emergency departments (EDs). The present study aimed to evaluate the validity of the Pediatric Canadian Triage Acuity Scale (PedCTAS) in the ED of a tertiary children's hospital in Israel. Methods: A retrospective cohort study of all patients admitted between January 2011 and December 2015 was carried out. The proportion of hospitalization was the primary outcome measure. The secondary outcomes were proportion of admissions to the ICU, proportions of patients who left without being seen (LWBS), and length of stay (LOS) in the ED. Results: A total of 83 609 patients were included in our analysis. Triage levels 1-5 included 533 (0.6%), 4428 (5.3%), 46 461 (55.6%), 28 510 (34.1%), and 3677 (4.4%) patients, respectively. Hospitalization proportions were 70, 51, 28, 15, and 12% for triage levels 1, 2, 3, 4, and 5, respectively. Admission proportions to ICU were 24.2, 3.05, 0.24, 0.05, and 0.05% for PedCTAS levels 1, 2, 3, 4, and 5, respectively. The proportions of LWBS were 0.001, 0.002, and 0.005% for triage levels 3, 4, and 5, respectively. LOS was shorter as the triage level increased from 2 to 5. Conclusion: Triage level was predictive of hospitalization, admission to the ICU, and proportions of LWBS and LOS in the ED. The findings suggest validity of the PedCTAS in this cohort. This is the first report of the performance of a triage tool in an Israeli ED. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2ole2AJ

The De Winter ECG pattern: morphology and accuracy for diagnosing acute coronary occlusion: systematic review.

The De Winter ECG pattern has been reported to indicate acute left anterior descending coronary artery occlusion and is often considered to be an 'ST elevation myocardial infarction (STEMI) equivalent'. We aimed to investigate the morphology of the 'De Winter ECG pattern' and evaluate the test characteristics of the De Winter pattern for the diagnosis of acute coronary occlusion. We identified papers through the Medline, EMBASE and COCHRANE databases and screened for bias using QUADAS-2. First, measurements were recorded from every ECG reported in the literature and aggregated. Second, diagnostic accuracy data from eligible cohort studies were extracted. The primary outcome was defined as at least 70% angiographic stenosis of a major epicardial vessel. Thirteen papers reported data relevant to question 1 and three papers reported data relevant to question 2. All ECGs showed maximal up-sloping ST depression in lead V3 with a median amplitude of 0.3 mV (interquartile range: 0.2-4 mV). T-wave height peaked in lead V3 with a median amplitude 0.9 mV (interquartile range: 0.8-1.1 mV). The De Winter pattern had positive predictive values of 95.2% (95% confidence interval: 76.2-99.9%), 100% (69.2-100.0%) and 100% (51.7-100%) in the three respective diagnostic studies. There is limited evidence that the De Winter ECG pattern is a 'STEMI equivalent'. The available data suggest that the pattern has high positive predictive value for acute occlusion. Further research is required to evaluate specificity and to determine whether rapid revascularization improves mortality. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2osxFUA

Direct Versus Video Laryngoscopy for Prehospital Intubation: A Systematic Review and Meta-analysis

Abstract

Objectives

The use of video laryngoscopy (VL) for intubation has gained recent popularity. In the prehospital setting, it is unclear if VL increases intubation success rates compared to direct laryngoscopy (DL). We sought to conduct a systematic review and meta-analysis of studies comparing VL to DL in the prehospital setting to determine whether the use of VL increases overall and first-pass endotracheal intubation success rates compared to DL.

Methods

A systematic search was performed of the Pubmed, Embase, and SCOPUS databases through May 2016 to include studies comparing overall and first-pass success for VL vs. DL in patients requiring intubation in the prehospital setting. Data were abstracted by two reviewers. A meta-analysis was performed using a random effects model.

Results

Of a potential 472 articles, eight eligible studies were included. Considerable heterogeneity (I² > 90%) precluded reporting an overall pooled estimate across all studies. When stratified by provider type, the pooled estimate for overall intubation success using VL vs. DL was RR = 0.05 (95% CI 0.01, 0.18) in studies of physicians and RR = 2.28 (95% CI 1.00, 5.20) in non-physicians. For first-pass intubation success the pooled RR estimate for using VL vs. DL was 0.32 (95% CI 0.23, 0.44) and 1.83 (95% CI 1.18, 2.84) among studies using physicians and non-physicians, respectively. There was moderate to significant heterogeneity between studies when stratified by provider.

Conclusions

Among physician intubators with significant DL experience, VL does not increase overall or first-pass success rates and may lead to worsening performance. However, among non-physician intubators with less experience with DL, VL may provide benefit in the prehospital setting.

This article is protected by copyright. All rights reserved.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2osptUc

D-Dimer Interval Likelihood Ratios for Pulmonary Embolism

Abstract

Objective

To estimate D-Dimer interval likelihood ratios (iLRs) for diagnosing pulmonary embolism (PE).

Methods

The authors used pooled patient-level data from five PE diagnostic management studies to estimate iLRs for the eight D-Dimer intervals with boundaries 250, 500, 750, 1000, 1500, 2500, and 5000 ng/mL. Logistic regression was used to fit the data so that an interval increase corresponds to increasing the likelihood ratio by a constant factor.

Results

The iLR for the D-Dimer interval 1000-1499 ng/mL was essentially 1.0 (0.98 with 95% CI 0.82-1.18). In the logistic regression model, the constant between-interval factor was 2.0 (95% CI 1.9 to 2.1). Using these iLR estimates, if the pre-D-Dimer probability of PE is 15%, only a D-Dimer less than 500 ng/mL will result in a post-test probability below 3%; if the pre-test probability is 5%, the threshold for a “negative” D-Dimer is 1000 ng/mL.

Conclusions

A decision strategy based on these approximate iLRs agrees with several published strategies.

This article is protected by copyright. All rights reserved.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2mXOzxj