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Clinical and Experimental Emergency Medicine

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https://www.readbyqxmd.com/read/29706060/variability-of-extracorporeal-cardiopulmonary-resuscitation-utilization-for-refractory-adult-out-of-hospital-cardiac-arrest-an-international-survey-study
#1
Patrick J Coppler, Benjamin S Abella, Clifton W Callaway, Minjung Kathy Chae, Seung Pill Choi, Jonathan Elmer, Won Young Kim, Young-Min Kim, Michael Kurz, Joo Suk Oh, Joshua C Reynolds, Jon C Rittenberger, Kelly N Sawyer, Chun Song Youn, Byung Kook Lee, David F Gaieski
Objective: A growing interest in extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue strategy for refractory adult out-of-hospital cardiac arrest (OHCA) currently exists. This study aims to determine current standards of care and practice variation for ECPR patients in the USA and Korea. Methods: In December 2015, we surveyed centers from the Korean Hypothermia Network (KORHN) Investigators and the US National Post-Arrest Research Consortium (NPARC) on current targeted temperature management and ECPR practices...
April 30, 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29706057/monomorphic-ventricular-tachycardia-due-to-protease-inhibitor-intoxication-by-atazanavir
#2
Byunghyun Kim, Kyung Su Kim
Atazanavir is a protease inhibitor approved for use in combination with other antiretroviral drugs for the treatment of human immunodeficiency virus infection. Atazanavir and other protease inhibitors can sometimes induce corrected QT prolongation and ventricular arrhythmia. A 40-year-old man with no comorbidities, except human immunodeficiency virus 1 infection, presented with palpitations 3 days after an overdose of 150 caps of atazanavir, with suicidal intent. His initial electrocardiogram showed monomorphic ventricular tachycardia, and hyperbilirubinemia was observed in his initial blood test...
April 30, 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29706056/changes-in-medical-care-due-to-the-absence-of-internal-medicine-physicians-in-emergency-departments
#3
Kyoung Ho Kim, Jang Young Lee, Won Suk Lee, Won Young Sung, Sang Won Seo
Objective: Especially in emergency departments (EDs), a lack of internal medicine (IM) residents in charge causes difficulties in medical care and ED overcrowding. Thus, protocols without IM residents in EDs is needed. This study aimed to investigate changes in medical care when emergency medicine residents replaced the roles of IM residents. Methods: This study was conducted at a single-site ED of a university medical center. The study group contained patients admitted to the IM department between September and December 2015, during which IM residents were absent in the ED...
April 30, 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29706055/hemoglobin-concentration-is-associated-with-neurologic-outcome-after-cardiac-arrest-in-patients-treated-with-targeted-temperature-management
#4
Daesung Kim, Soo Hyun Kim, Kyu Nam Park, Sang Hoon Oh, Young Min Kim, Chun Song Youn
Objective: The objective of this study was to test the hypothesis that hemoglobin concentration after return of spontaneous circulation (ROSC) is associated with neurologic outcome after cardiac arrest in patients treated with targeted temperature management. Methods: We studied consecutive adult patients with out-of-hospital cardiac arrest treated with targeted temperature management between January 2009 and December 2015. We quantified the association between post ROSC hemoglobin concentrations and good neurologic outcome (defined as Cerebral Performance Category of 1 and 2) at hospital discharge using multivariate logistic regression analysis...
April 30, 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29706054/heparin-free-extracorporeal-membrane-oxygenation-in-a-patient-with-severe-pulmonary-contusions-and-bronchial-disruption
#5
Kyoung Min Ryu, Sung Wook Chang
Pulmonary contusion complicated with endobronchial hemorrhage is potentially life-threatening, particularly in patients with tracheobronchial tree disruption and severe airway bleeding after blunt trauma, and pose a high mortality risk. In such cases, extracorporeal membrane oxygenation (ECMO) can be used as a salvage treatment modality. However, the use of ECMO for moribund trauma patients with respiratory failure may be limited for several reasons, such as intractable bleeding. In this case report, we describe a patient with severe bilateral pulmonary contusions with tracheobronchial tree disruption that was successfully treated using heparin-free venovenous ECMO...
April 30, 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29706053/night-shift-preparation-performance-and-perception-are-there-differences-between-emergency-medicine-nurses-residents-and-faculty
#6
John R Richards, Taylor L Stayton, Jason A Wells, Aman K Parikh, Erik G Laurin
Objective: Determine differences between faculty, residents, and nurses regarding night shift preparation, performance, recovery, and perception of emotional and physical health effects. Methods: Survey study performed at an urban university medical center emergency department with an accredited residency program in emergency medicine. Results: Forty-seven faculty, 37 residents, and 90 nurses completed the survey. There was no difference in use of physical sleep aids between groups, except nurses utilized blackout curtains more (69%) than residents (60%) and faculty (45%)...
April 30, 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29618195/inter-rater-variability-in-the-interpretation-of-the-head-impulse-test-results
#7
Alexander Cuculiza Henriksen, Peter Hallas
No abstract text is available yet for this article.
March 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29618194/quality-improvement-activity-for-improving-pain-management-in-acute-extremity-injuries-in-the-emergency-department
#8
Hyung Lan Chang, Jin Hee Jung, Young Ho Kwak, Do Kyun Kim, Jin Hee Lee, Jae Yun Jung, Hyuksool Kwon, So Hyun Paek, Joong Wan Park, Jonghwan Shin
OBJECTIVE: The aim of this study was to investigate the effectiveness of a quality improvement activity for pain management in patients with extremity injury in the emergency department (ED). METHODS: This was a retrospective interventional study. The patient group consisted of those at least 19 years of age who visited the ED and were diagnosed with International Classification of Diseases codes S40-S99 (extremity injuries). The quality improvement activity consisted of three measures: a survey regarding activities, education, and the triage nurse's pain assessment, including change of pain documentation on electronic medical records...
March 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29618193/a-novel-method-to-cease-traumatic-urethral-bleeding
#9
Hamed Akhavizadegan
Urethral bleeding due to trauma is a well-studied and often self-limiting condition. However, existing evidence regarding effective management of massive hemorrhage is limited. Intermittent penile compression and continuous perineal pressure are methods commonly used to control urethral bleeding. Nevertheless, these methods are not mentioned in the literature as specific treatment for this condition, and are rather learned by physicians via word of mouth. Sometimes these methods are ineffective and difficult for the patient to tolerate...
March 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29618192/incidence-and-characteristics-of-major-bleeding-among-rivaroxaban-users-with-renal-disease-and-nonvalvular-atrial-fibrillation
#10
Manesh R Patel, W Frank Peacock, Sally Tamayo, Nicholas Sicignano, Kathleen P Hopf, Zhong Yuan
OBJECTIVE: Patients with nonvalvular atrial fibrillation (AF) and renal disease (RD) who receive anticoagulation therapy appear to be at greater risk of major bleeding (MB) than AF patients without RD. As observed in past studies, anticoagulants are frequently withheld from AF patients with RD due to concerns regarding bleeding. The objective of this study was to evaluate the incidence and pattern of MB in those with RD, as compared to those without RD, in a population of rivaroxaban users with nonvalvular AF...
March 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29618191/delayed-massive-hemothorax-requiring-surgery-after-blunt-thoracic-trauma-over-a-5-year-period-complicating-rib-fracture-with-sharp-edge-associated-with-diaphragm-injury
#11
Sung Wook Chang, Kyoung Min Ryu, Jae-Wook Ryu
Delayed massive hemothorax requiring surgery is relatively uncommon and can potentially be life-threatening. Here, we aimed to describe the nature and cause of delayed massive hemothorax requiring immediate surgery. Over 5 years, 1,278 consecutive patients were admitted after blunt trauma. Delayed hemothorax is defined as presenting with a follow-up chest radiograph and computed tomography showing blunting or effusion. A massive hemothorax is defined as blood drainage >1,500 mL after closed thoracostomy and continuous bleeding at 200 mL/hr for at least four hours...
March 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29618190/pre-hospital-i-gel-blind-intubation-for-trauma-a-simulation-study
#12
Jae Guk Kim, Wonhee Kim, Gu Hyun Kang, Yong Soo Jang, Hyun Young Choi, Hyeongtae Kim, Minji Kim
OBJECTIVE: This study aimed to evaluate the efficacy of i-gel blind intubation (IGI) as a rescue device for definitive airway management in ground intubation for pre-hospital trauma patients. METHODS: A prospective randomized crossover study was conducted with 18 paramedics to examine intubation performance of two blind intubation techniques through a supraglottic airway devices (IGI and laryngeal mask airway Fastrach), compared with use of a Macintosh laryngoscope (MCL)...
March 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29618189/cervical-collar-makes-difficult-airway-a-simulation-study-using-the-lemon-criteria
#13
Moonsu Yuk, Woonhyung Yeo, Kangeui Lee, Jungin Ko, Taejin Park
OBJECTIVE: Endotracheal intubation is extremely difficult to perform in patients wearing a cervical collar for a head and neck injury. Therefore, we analyzed actual measurements using the look externally, evaluate 3-3-2, Mallampati score, obstruction, and neck mobility (LEMON) criteria before and after cervical collar application to investigate the causes of a difficult airway. METHODS: This simulation study was performed in 76 healthy volunteers. We measured the mouth opening, modified Mallampati classification, and neck extension before and after cervical collar application...
March 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29618188/is-it-possible-to-reduce-intra-hospital-transport-time-for-computed-tomography-evaluation-in-critically-ill-cases-using-the-easy-tube-arrange-device
#14
Kyung Hyeok Song, Sung Uk Cho, Jin Woong Lee, Yong Chul Cho, Won Joon Jeong, Yeon Ho You, Seung Ryu, Seung Whan Kim, In Sool Yoo, Ki Hyuk Joo
OBJECTIVE: Patients are often transported within the hospital, especially in cases of critical illness for which computed tomography (CT) is performed. Since increased transport time increases the risks of complications, reducing transport time is important for patient safety. This study aimed to evaluate the ability of our newly invented device, the Easy Tube Arrange Device (ETAD), to reduce transport time for CT evaluation in cases of critical illness. METHODS: This prospective randomized control study included 60 volunteers...
March 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29618187/effect-of-alcohol-use-on-emergency-department-length-of-stay-among-minimally-injured-patients-based-on-mechanism-of-injury-multicenter-observational-study
#15
Jeong Ho Park, Ju Ok Park, Young Sun Ro, Sang Do Shin
OBJECTIVE: This study aimed to evaluate the effect of alcohol use on emergency department (ED) length of stay (LOS) among minimally injured patients by mechanism of injury. METHODS: This was a retrospective study of injury surveillance data for injured patients (except poisoning), aged over 18 years, discharged home from the ED, and treated at seven academic EDs in Korea during 2008 to 2012. Patients were divided into alcohol-related and alcohol-unrelated groups based on self-report...
March 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29618186/predictors-of-abnormal-brain-computed-tomography-findings-in-patients-with-acute-altered-mental-status-in-the-emergency-department
#16
Somi Shin, Hui Jai Lee, Jongwhan Shin, Sejong Lee
OBJECTIVE: Brain computed tomography (CT) is commonly performed to diagnose acute altered mental status (AMS), a critically important symptom in many serious diseases. However, negative CT results are common, which result in unnecessary CT use. Therefore, this study aimed to determine the clinical factors associated with positive CT findings. METHODS: Patients with acute AMS selected from an emergency department-based registry were retrospectively evaluated. Patients with non-traumatic and noncommunicable diseases on initial presentation and with Glasgow Comal Scale scores of <15 were included in the study...
March 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29381908/long-term-changes-in-computed-tomography-and-ultrasound-utilization-in-a-pediatric-emergency-department
#17
Ikwan Chang, Jae Yun Jung, Young Ho Kwak, Do Kyun Kim, Jin Hee Lee, Jin Hee Jung, Hyuksool Kwon, So Hyun Paek, Joong Wan Park
OBJECTIVE: Many studies have proposed reducing unnecessary use of computed tomography (CT), and ongoing studies in pediatric populations are aiming to decrease radiation dosages whenever possible. We aimed to evaluate the long-term changes in the utilization patterns of CT and ultrasound (US) in pediatric emergency departments (PEDs). METHODS: This retrospective study reviewed the electronic medical data of patients who underwent CT and/or US in the PED of a tertiary referral hospital from 2000 to 2014...
March 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29381909/metoprolol-treatment-of-dual-cocaine-and-bupropion-cardiovascular-and-central-nervous-system-toxicity
#18
John R Richards, Jessica B Gould, Erik G Laurin, Timothy E Albertson
Cardiovascular and central nervous system (CNS) toxicity, including tachydysrhythmia, agitation, and seizures, may arise from cocaine or bupropion use. We report acute toxicity from the concomitant use of cocaine and bupropion in a 25-year-old female. She arrived agitated and uncooperative, with a history of possible antecedent cocaine use. Her electrocardiogram demonstrated tachycardia at 130 beats/min, with a corrected QT interval of 579 ms. Two doses of 5 mg intravenous metoprolol were administered, which resolved the agitation, tachydysrhythmia, and corrected QT interval prolongation...
January 31, 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29306269/sealone-safety-and-efficacy-of-coronary-computed-tomography-angiography-with-low-dose-in-patients-visiting-emergency-room-trial-study-protocol-for-a-randomized-controlled-trial
#19
Joonghee Kim, Joon-Won Kang, Kyuseok Kim, Sang Il Choi, Eun Ju Chun, Yeo Goon Kim, Won Young Kim, Dong Woo Seo, Jonghwan Shin, Huijai Lee, Kwang-Nam Jin, Soyeon Ahn, Seung Sik Hwang, Kwang Pyo Kim, Ru-Bi Jeong, Sang Ook Ha, Byungho Choi, Chang-Hwan Yoon, Jung-Won Suh, Hack-Lyoung Kim, Ju Kyoung Kim, Sujin Jang, Ji Seon Seo
OBJECTIVE: Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain...
December 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29306268/addressing-overuse-in-emergency-medicine-evidence-of-a-role-for-greater-patient-engagement
#20
REVIEW
Erika H Newton
Overuse of health care refers to tests, treatments, and even health care settings when used in circumstances where they are unlikely to help. Overuse is not only wasteful, it threatens patient safety by exposing patients to a greater chance of harm than benefit. It is a widespread problem and has proved resistant to change. Overuse of diagnostic testing is a particular problem in emergency medicine. Emergency physicians cite fear of missing a diagnosis, fear of law suits, and perceived patient expectations as key contributors...
December 2017: Clinical and Experimental Emergency Medicine
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