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out od hospital

Frank X Scheuermeyer, Christopher DeWitt, Jim Christenson, Brian Grunau, Andrew Kestler, Eric Grafstein, Jane Buxton, David Barbic, Stefan Milanovic, Reza Torkjari, Indy Sahota, Grant Innes
STUDY OBJECTIVE: Fentanyl overdoses are increasing and few data guide emergency department (ED) management. We evaluate the safety of an ED protocol for patients with presumed fentanyl overdose. METHODS: At an urban ED, we used administrative data and explicit chart review to identify and describe consecutive patients with uncomplicated presumed fentanyl overdose (no concurrent acute medical issues) from September to December 2016. We linked regional ED and provincial vital statistics databases to ascertain admissions, revisits, and mortality...
March 9, 2018: Annals of Emergency Medicine
Aaron B Klassen, S Brent Core, Christine M Lohse, Matthew D Sztajnkrycer
Study Objectives Law enforcement is increasingly viewed as a key component in the out-of-hospital chain of survival, with expanded roles in cardiac arrest, narcotic overdose, and traumatic bleeding. Little is known about the nature of care provided by law enforcement prior to the arrival of Emergency Medical Services (EMS) assets. The purpose of the current study was to perform a descriptive analysis of events reported to a national EMS database. METHODS: This study was a descriptive analysis of the 2014 National Emergency Medical Services Information System (NEMSIS) public release research data set, containing EMS emergency response data from 41 states...
March 13, 2018: Prehospital and Disaster Medicine
Déborah Jaeger, Florence Dumas, Josephine Escutnaire, Sonia Sadoune, Adrien Lauvray, Carlos Elkhoury, Adrien Bassand, Nicolas Girerd, Pierre Yves Gueugniaud, Karim Tazarourte, Hervé Hubert, Alain Cariou, Tahar Chouihed
BACKGROUND: The survival rate of out-of-hospital cardiac arrest (OHCA) remains extremely low, generally under 10%. Post-resuscitation care, and particularly early coronary reperfusion, may improve this outcome. The main objective of the present study was to determine whether patients with immediate coronary angiography at hospital admission (CAA) had a better outcome than patients without immediate CAA. METHODS: This cohort analysis study was based on data extracted from the French National Cardiac Arrest registry (RéAC)...
March 5, 2018: Resuscitation
A Cetinkaya, D Avci, A Erden, O Akca, O Ozer, U Kalan, A I Gunal
Introduction: This study has been performed for the purpose of researching the complications occurred at patients who took metformin overdose in an attempt to suicide. None of the patients has the diagnosis of diabetes mellitus and never used metformin. Materials and Methods: This retrospective cross-sectional study was carried out with 21 patients who has neither diagnosed diabetes mellitus nor taken metformin for suicide before. Results: It was observed that there is a moderate, negative (r = -0...
February 2018: Nigerian Journal of Clinical Practice
Z L Xing, W L Yu, M Xu, C Y Yu
Objective: To investigate the infertility rate and influencing factors of female workers in China's nine industries. Methods: Using multi-stage sampling method, from January to November in 2016. A cross-sectional survey was conducted on the infertility of 33 685 female workers in the nine industries including medical and health, petrochemical, metallurgy, railway, machinery manufacturing and electronics,a questionnaire survey. First, three provincial capitals were randomly selected in seven regions. And then we consulted and communicated with the hospital of the provincial city's occupational disease prevention and treatment, marking and coding the target enterprise within its jurisdiction, In these enterprises, we randomly selected five companies...
February 6, 2018: Zhonghua Yu Fang Yi Xue za Zhi [Chinese Journal of Preventive Medicine]
Osman Perez, Kairavee Dave, Aimee Almanzar, Tajul Prodhan, Livasky Concepion
Neuropsychiatric systemic lupus erythematosus (NPSLE) has a wide variety of neurologic and psychiatric features. NPSLE symptoms and the psychotic features of primary psychiatric disorders often overlap with each other. These psychotic features often mask and delay the diagnosis of NPSLE. We present the case of a 59-year-old female previously diagnosed with bipolar disorder and generalized anxiety disorder presenting with altered mental status (AMS), subsequently diagnosed with neuropsychiatric lupus. Initially, medication overdose was suspected as an empty bottle of trazodone was found beside her...
October 23, 2017: Curēus
M V Verschueren, F G A Jansman, D J Touw, C Kramers
- A new guideline: 'Intoxication: initial approach in the hospital' will be published this year. This guideline sets out the latest insights on gastrointestinal decontamination in intoxication; the advice is summarized in a flowchart.- The advice is to generally administer activated charcoal, unless there are indications that the toxin will not bind to activated charcoal or that the amount of toxin that the patient has ingested is too great; in these cases gastric lavage can be considered.- Activated charcoal can be administered up to 2 hours after the ingestion of a toxic substance, unless there are contra-indications...
2018: Nederlands Tijdschrift Voor Geneeskunde
Rachael Rzasa Lynn, J L Galinkin
Opioid-related mortality is a growing problem in the United States, and in 2015 there were over 33,000 opioid-related deaths. To combat this mortality trend, naloxone is increasingly being utilized in a pre-hospital setting by emergency personnel and prescribed to laypersons for out-of-hospital administration. With increased utilization of naloxone there has been a subsequent reduction in mortality following an opioid overdose. Reversal of opioid toxicity may precipitate an opioid-withdrawal syndrome. At the same time, there is a risk of inadequate response or re-narcotization after the administration of a single dose of naloxone in patients who have taken large doses or long-acting opioid formulations, as the duration of effect of naloxone is shorter than that of many opioid agonists...
January 2018: Therapeutic Advances in Drug Safety
Sachiko Nishina, Satoshi Katagiri, Atsuko Nakazawa, Chikako Kiyotani, Tadashi Yokoi, Noriyuki Azuma
Purpose: To report the clinical and histopathological findings of atypical intravitreal growth of a retinoblastoma with a multi-branching configuration. Observations: A 7-month-old boy was referred to our hospital due to leukocoria in the right eye. Ophthalmic examinations identified multi-branching vessels surrounded by diaphanous tissue behind the lens in the right eye. Imaging modalities showed microphthalmos, band-shaped calcification, and cystic lesions in that eye...
September 2017: American Journal of Ophthalmology Case Reports
Roger Chou, P Todd Korthuis, Dennis McCarty, Phillip O Coffin, Jessica C Griffin, Cynthia Davis-O'Reilly, Sara Grusing, Mohamud Daya
Background: Naloxone is effective for reversing opioid overdose, but optimal strategies for out-of-hospital use are uncertain. Purpose: To synthesize evidence on 1) the effects of naloxone route of administration and dosing for suspected opioid overdose in out-of-hospital settings on mortality, reversal of overdose, and harms, and 2) the need for transport to a health care facility after reversal of overdose with naloxone. Data Sources: Ovid MEDLINE (1946 through September 2017), PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, U...
December 19, 2017: Annals of Internal Medicine
Arthur Yin Fan, David W Miller, Bonnie Bolash, Matthew Bauer, John McDonald, Sarah Faggert, Hongjian He, Yong Ming Li, Amy Matecki, Lindy Camardella, Mel Hopper Koppelman, Jennifer A M Stone, Lindsay Meade, John Pang
The United States (U.S.) is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public's opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives...
November 2017: Journal of Integrative Medicine
Kiran Jakhar, Ram Pratap Beniwal, Triptish Bhatia, Smita N Deshpande
BACKGROUND: The risk of suicide among persons with schizophrenia (SZ) is higher than in general population, with multiple contributory factors. We assessed the prevalence of risk of deliberate self-harm and suicide attempts, along with associated socio-demographic and clinical factors in a group of SZ outpatients (n=61) as part of a larger study on overall schizophrenia-associated risks. AIMS: To investigate factors associated with risk of deliberate self-harm and suicide among persons with schizophrenia...
December 2017: Asian Journal of Psychiatry
Ziad Nehme, Emily Andrew, Resmi Nair, Stephen Bernard, Karen Smith
BACKGROUND: Little is known about the burden of recurrent out-of-hospital cardiac arrest (OHCA) episodes in initial survivors of OHCA. We sought to investigate the frequency of recurrent OHCA, describe time-to-event trends, and establish baseline predictors of occurrence. METHODS: Between January 2000 and June 2015, we included consecutive OHCA survivors to hospital discharge from the Victorian Ambulance Cardiac Arrest Registry. Patient identifiers were used to match index and recurrent episodes of OHCA, and death records from a government database...
December 2017: Resuscitation
Matt Hansen, Carl Eriksson, Barbara Skarica, Garth Meckler, Jeanne-Marie Guise
OBJECTIVE: The objective of this study was to explore the types of patient safety events that take place during pediatric out-of-hospital cardiac arrest resuscitation. METHODS: Retrospective medical record review from a single large urban EMS system of EMS-treated pediatric (<18years of age) out-of-hospital cardiac arrests (OHCA) occurring between 2008 and 2011. A chart review tool was developed for this project and each chart was reviewed by a multidisciplinary review panel...
August 14, 2017: American Journal of Emergency Medicine
Maxime Gosselin, Yann Dazé, Pascal Mireault, Marie Crahes
We report the case of an 18-year-old woman with personality disorders who was hospitalized a few hours after suicidal ingestion of acetaminophen, quetiapine, acetylsalicylic acid, and ethanol. Twelve hours after admission, severe liver damage was evident, but the patient was stable and awaiting hepatic transplantation. Electrolytes were successfully controlled. The condition of the liver stabilized. Cardiac biomarkers then deteriorated unexpectedly. Localized ST-segment elevations were noted on electrocardiogram, but angiography ruled out myocardial infarction...
December 2017: American Journal of Forensic Medicine and Pathology
Jennifer R Beavers, Joanna L Stollings, Todd W Rice
PURPOSE: A case of symptomatic hyponatremia induced by hyperinsulinemia-euglycemia (HIE) therapy is reported. SUMMARY: A 59-year-old, 81.65-kg woman with hypertension, major depressive disorder, and anxiety arrived at a tertiary medical center 1.5 hours after an intentional overdose of oral amlodipine 200 mg, metoprolol tartrate 2,000 mg, and isosorbide mononitrate 1,200 mg. Upon arrival, her pulse was 63 beats/min and blood pressure was 106/56 mm Hg. The patient's blood pressure was refractory to fluids, calcium gluconate, and norepinephrine, resulting in initiation of HIE therapy...
July 15, 2017: American Journal of Health-system Pharmacy: AJHP
Pieter Francsois Fouche, Paul Andrew Jennings, Karen Smith, Malcolm Boyle, Gabriel Blecher, Jonathan Knott, Mani Raji, Pamela Rosengarten, Michael Roberto Augello, Stephen Bernard
INTRODUCTION: Rapid sequence intubation (RSI) is not only used in traumatic brain injuries in the out-of-hospital setting, but also for non-traumatic brain pathologies (NTBP) such as brain tumors, meningitis, encephalitis, hypoxic/anoxic brain injury, stroke, arteriovenous malformations, tumors, aneurysms, brain hemorrhage, as well as brain injury due to diabetes, seizures and toxicity, metabolic conditions, and alcohol and drug overdose. Previous research suggests that RSI is common in non-traumatic coma, but with an unknown prevalence of NTBP in those that receive RSI...
November 2017: Prehospital Emergency Care
Amina Godinjak, Amer Iglica, Adis Kukuljac, Ira Tančica, Selma Jusufović, Anes Ajanović, Šejla Rožajac
OBJECTIVE: We present the use of targeted temperature management in a tertiary-level intensive care unit, in three patients who experienced an out-of-hospital cardiac arrest. CASE REPORT: Three young patients experienced an out-of-hospital non-coronary cardiac arrest. The causes of the cardiac arrest were: Wolf-Parkinson-White syndrome, drug overdose and long-QT syndrome. All patients were resuscitated according to the advanced cardiac life support guidelines, and treated with targeted temperature management, with a target temperature of 33°C for 24 hours...
May 2017: Acta Medica Academica
Katherine S Allan, Laurie J Morrison, Arnold Pinter, Jack V Tu, Paul Dorian
AIM: To use a novel methodology to assess the incidence and specific causes of Out-of-Hospital Cardiac Arrest (OHCA) within a young urban cohort. METHODS: All EMS attended OHCA patients in a large urban area, between 2009 and 2012, aged 2-45 years, treated or untreated, who died or survived, and that were designated as "no obvious cause" etiology by trained data abstractors were included. Using multisource (medical and coroner) records, an expert panel adjudicated the causes of the OHCAs as: confirmed cardiac causes, confirmed non- cardiac causes, and other causes...
June 7, 2017: Resuscitation
Johan N Siebert, Frederic Ehrler, Alain Gervaix, Kevin Haddad, Laurence Lacroix, Philippe Schrurs, Ayhan Sahin, Christian Lovis, Sergio Manzano
BACKGROUND: The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) are nowadays recognized as the world's most authoritative resuscitation guidelines. Adherence to these guidelines optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite their availability, suboptimal quality of CPR is still common. Currently, the median hospital survival rate after pediatric in-hospital cardiac arrest is 36%, whereas it falls below 10% for out-of-hospital cardiac arrest...
May 29, 2017: Journal of Medical Internet Research
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