PulmCrit- A better approach to Torsade de Pointes

A common approach to TdP is shown above.  The initial episode is controlled with magnesium and perhaps defibrillation.  The patient is sent to ICU for close observation.  Usually the patient will be fine, but sometimes TdP does recur.  Recurrence triggers second-tier therapies, often including overdrive pacing.

EMCrit Project by Josh Farkas.

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PulmCrit- A better approach to Torsade de Pointes

A common approach to TdP is shown above.  The initial episode is controlled with magnesium and perhaps defibrillation.  The patient is sent to ICU for close observation.  Usually the patient will be fine, but sometimes TdP does recur.  Recurrence triggers second-tier therapies, often including overdrive pacing.

EMCrit Project by Josh Farkas.

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Diagnostic Ultrasound and Microbubbles Treatment Improves Outcomes of Coronary No-Reflow in Canine Models by Sonothrombolysis

Objectives: Effective treatment for microvascular thrombosis-induced coronary no-reflow remains an unmet clinical need. This study sought to evaluate whether diagnostic ultrasound and microbubbles treatment could improve outcomes of coronary no-reflow by dissolving platelet- and erythrocyte-rich microthrombi. Design: Randomized controlled laboratory investigation. Setting: Research laboratory. Subjects: Mongrel dogs. Interventions: Coronary no-reflow models induced by platelet- or erythrocyte-rich microthrombi were established and randomly assigned to control, ultrasound, recombinant tissue-type plasminogen activator, ultrasound + microbubbles, or ultrasound + microbubbles + recombinant tissue-type plasminogen activator group. All treatments lasted for 30 minutes. Measurements and Main Results: Percentage of microemboli-obstructed coronary arterioles was lower in ultrasound + microbubbles group than that in control group for platelet- (> 50% obstruction: 10.20% ± 3.56% vs 31.80% ± 3.96%; 50% obstruction: 8.20% ± 3.11% vs 30.60% ± 4.83%;

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Acute Respiratory Failure in Pediatric Hematopoietic Cell Transplantation—A Multicenter Study

Objectives: Acute respiratory failure is common in pediatric hematopoietic cell transplant recipients and has a high mortality. However, respiratory prognostic markers have not been adequately evaluated for this population. Our objectives are to assess respiratory support strategies and indices of oxygenation and ventilation in pediatric allogeneic hematopoietic cell transplant patients receiving invasive mechanical ventilation and investigate how these strategies are associated with mortality. Design: Retrospective, multicenter investigation. Setting: Twelve U.S. pediatric centers. Patients: Pediatric allogeneic hematopoietic cell transplant recipients with respiratory failure. Interventions: None. Measurements and Main Results: Two-hundred twenty-two subjects were identified. PICU mortality was 60.4%. Nonsurvivors had higher peak oxygenation index (38.3 [21.3–57.6] vs 15.0 [7.0–30.7]; p

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Presenting Symptoms Independently Predict Mortality in Septic Shock: Importance of a Previously Unmeasured Confounder

Objectives: Presenting symptoms in patients with sepsis may influence rapidity of diagnosis, time-to-antibiotics, and outcome. We tested the hypothesis that vague presenting symptoms are associated with delayed antibiotics and increased mortality. We further characterized individual presenting symptoms and their association with mortality. Design: Retrospective cohort study. Setting: Emergency department of large, urban, academic U.S. hospital. Patients: All adult patients with septic shock treated in the emergency department between April 2014 and March 2016. Interventions: None. Measurements and Main Results: Of 654 septic shock cases, 245 (37%) presented with vague symptoms. Time-to-antibiotics from first hypotension or elevated lactate was significantly longer for those with vague symptoms versus those with explicit symptoms of infection (1.6 vs 0.8 hr; p

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Factors Associated With Mortality in Children Who Successfully Wean From Extracorporeal Membrane Oxygenation

Objectives: Extracorporeal membrane oxygenation is an established therapy for cardiac and respiratory failure unresponsive to usual care. Extracorporeal membrane oxygenation mortality remains high, with ongoing risk of death even after successful decannulation. We describe occurrence and factors associated with mortality in children weaned from extracorporeal membrane oxygenation. Design: Retrospective cohort study. Setting: Two hundred five extracorporeal membrane oxygenation centers reporting to the Extracorporeal Life Support Organization. Subjects: Eleven thousand ninety-six patients, less than 18 years, supported with extracorporeal membrane oxygenation during 2007–2013, who achieved organ recovery before decannulation. Interventions: None. Measurements and Main Results: Primary outcome was hospital mortality less than or equal to 30 days post extracorporeal membrane oxygenation decannulation. Among 11,096 patients, indication for extracorporeal membrane oxygenation cannulation was respiratory (6,206; 56%), cardiac (3,663; 33%), or cardiac arrest (extracorporeal cardiopulmonary resuscitation, 1,227; 11%); the majority were supported with venoarterial extracorporeal membrane oxygenation at some stage in their course (8,576 patients; 77%). Mortality was 13%. Factors associated with mortality included younger age (all 3 kg; p 43 mm Hg; p

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The organization of Danish emergency departments

Introduction Twenty-one new Danish emergency departments (EDs) were established following a 2007 policy reform that included ED autonomy to self-organize. The aim of this study was to describe the organization of the 21 departments and their organizational challenges. Participants and methods We used a qualitative design based on COREQ guidelines. All 21 EDs participated, and 123 semi-structured interviews with hospital and ED leaders, physicians, nurses, and secretaries were performed between 2013 and 2015. We used the framework matrix method to investigate the ED goals, setting, structure, staff, task coordination, and incentive structure. Results We identified three generic models (virtual, hybrid, and independent). All had goals of high quality of care and high efficiency. The virtual model was staffed by junior physicians and tasks were coordinated by other departments. The hybrid model was staffed by junior physicians and senior physicians according to other departments and the ED. The ED coordinated all activities. The independent model was staffed by junior physicians and senior physicians, and activities were coordinated by the ED. Of the EDs, 19 utilized different organizational models at different times during a 24-h period and on weekdays and weekends. The main challenge of the virtual and hybrid models was high dependency on other departments. The main challenge of the independent model was establishing a high level of quality of emergency medicine. Discussion and conclusion We identified three organizational ED models (virtual, hybrid, and independent). Nineteen EDs used more than one organizational model depending on the time of day or day of the week. Correspondence to Anders Moellekaer, MD, MBA, Research Center for Emergency Medicine, Aarhus University Hospital, Noerrebrogade 44, Bygning 30, 1. sal, DK-8000 Aarhus, Denmark Tel: +45 20 848 304; e-mail: anders.moellekaer@ki.au.dk Received January 7, 2017 Accepted April 13, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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