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https://www.readbyqxmd.com/read/27903001/right-in-front-of-our-eyes-evolution-of-streptococcal-toxic-shock-syndrome-with-ischemic-optic-neuropathy
#1
Salaheldin M Elhamamsy, Mazen O Al-Qadi, Taro Minami, Marguerite Neill
INTRODUCTION: Toxic shock syndrome occurs from dysregulation of host inflammatory responses. Toxin- producing strains of Group A streptococcus cause TSS. Ischemic optic neuropathy rarely complicates septic shock. We present a rare case of streptococcal pharyngitis complicated by septic arthritis and TSS with reversible blindness due to non-arteritic ischemic optic neuropathy. CASE: A 28-year-old man drove to our ED with exudative pharyngitis. A rapid streptococcal test was positive...
December 1, 2016: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/27876327/endotracheal-intubation-with-the-king-laryngeal-tube%C3%A2-in-situ-using-video-laryngoscopy-and-a-bougie-a-retrospective-case-series-and-cadaveric-crossover-study
#2
Kenneth W Dodd, Rebecca L Kornas, Matthew E Prekker, Lauren R Klein, Robert F Reardon, Brian E Driver
BACKGROUND: Removal of a functioning King laryngeal tube (LT) prior to establishing a definitive airway increases the risk of a "can't intubate, can't oxygenate" scenario. We previously described a technique utilizing video laryngoscopy (VL) and a bougie to intubate around a well-seated King LT with the balloons deflated; if necessary, the balloons can be rapidly re-inflated and ventilation resumed. OBJECTIVE: Our objective is to provide preliminary validation of this technique...
November 19, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27850578/940-the-impact-of-an-ed-ventilator-protocol-on-adherence-to-lung-protective-ventilation-in-ards
#3
Brian Fuller, Ian Ferguson, Christopher Palmer, Anne Drewry, Brian Wessman, Enyo Ablordeppey, Nicholas Mohr, Marin Kollef
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27769308/the-modified-save-score-predicting-survival-using-urgent-veno-arterial-extracorporeal-membrane-oxygenation-within-24%C3%A2-hours-of-arrival-at-the-emergency-department
#4
Wei-Cheng Chen, Kuo-Yang Huang, Chih-Wei Yao, Cing-Feng Wu, Shinn-Jye Liang, Chia-Hsiang Li, Chih-Yeh Tu, Hung-Jen Chen
BACKGROUND: Although many risk models have been tested in patients who undergo extracorporeal membrane oxygenation, few have been assessed for patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support in the emergency department (ED). This study aimed to successfully predict outcomes of patients with cardiac or noncardiac failure who received VA-ECMO in the ED within 24 hours of arrival at the ED. METHOD: This retrospective, observational cohort study included 154 patients, who were classified as cardiac (n = 127) and noncardiac (n = 27) patients and received VA-ECMO within 24 hours after arrival at the China Medical University Hospital ED in Taiwan between January 2009 and September 2014...
October 22, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27742520/impact-of-delayed-admission-to-intensive-care-units-on-patients-with-acute-respiratory-failure
#5
Chih-Chia Hsieh, Ching-Chi Lee, Hsiang-Chin Hsu, Hsin-I Shih, Chien-Hsin Lu, Chih-Hao Lin
BACKGROUND/PURPOSE: To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED). METHODS: This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records...
September 30, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27741070/is-serum-bicarbonate-level-associated-with-negative-outcomes-in-pediatric-patients-a-retrospective-cohort-study
#6
Naveen Poonai Prakash Chandra, David Mainprize, Carolyn Travers, Lilian Lee Yan Vivas, Peter Tryphonopoulos, Gurinder Sangha, Ryan Arbeau, Jamie Seabrook, Michael Miller, Amrita Sarpal, Rodrick Lim
OBJECTIVES: Early identification of children at risk for adverse outcomes is important. Serum bicarbonate is easily collected and widely available. We described the relationship between bicarbonate and adverse outcomes in children presenting to the emergency department (ED). METHODS: We conducted a retrospective cohort study of children aged 0 to 17 years from January 1, 2007, to December 31, 2011, who had a serum bicarbonate measured in the ED. Primary outcome was the predictive ability of bicarbonate for the individual components of the composite outcome that included at least one of the following: intensive care unit admission, assisted ventilation, inotropic support, cardiopulmonary resuscitation, or death...
October 6, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27730492/creation-and-validation-of-the-acute-heart-failure-risk-score-ahfrs
#7
Susana Garcia-Gutierrez, José Maria Quintana, Ane Antón-Ladislao, Maria Soledad Gallardo, Esther Pulido, Irene Rilo, Elena Zubillaga, Miren Morillas, José Juan Onaindia, Nekane Murga, Ricardo Palenzuela, José González Ruiz
Our aims were to create and validate a clinical decision rule to assess severity in acute heart failure. We conducted a prospective cohort study of patients with symptoms of acute heart failure who attended the emergency departments (EDs) of three hospitals between April 2011 and April 2013. The following data were collected on arrival to or during the stay in the ED: baseline severity of symptoms; presence of decompensated comorbidities; number of hospital admissions/visits to EDs for acute heart failure during the previous 24 months; triggers of the exacerbation; clinical signs and symptoms; results of ancillary tests requested in the ED; treatments prescribed; and response to the initial treatment in the ED...
October 11, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27692663/decisions-by-default-incomplete-and-contradictory-molst-in-emergency-care
#8
Brian Clemency, Colleen Clemency Cordes, Heather A Lindstrom, Jeanne M Basior, Deborah P Waldrop
OBJECTIVES: What patients intend when they make health care choices and whether they understand the meaning of orders for life-sustaining treatment forms is not well understood. The purpose of this study was to analyze the directives from a sample of emergency department (ED) patients' MOLST forms. PROCEDURES: MOLST forms that accompanied 100 patients who were transported to an ED were collected and their contents analyzed. Data categories included age, gender, if the patient completed the form for themselves, medical orders for life-sustaining treatment including intubation, ventilation, artificial nutrition, artificial fluids or other treatment, and wishes for future hospitalization or transfer...
September 27, 2016: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/27665031/impact-and-feasibility-of-an-emergency-department-based-ventilator-associated-pneumonia-bundle-for-patients-intubated-in-an-academic-emergency-department
#9
Lawrence A DeLuca, Paul Walsh, Donald D Davidson, Lisa R Stoneking, Laurel M Yang, Kristi J H Grall, M Jessica Gonzaga, Wanda J Larson, Uwe Stolz, Dylan M Sabb, Kurt R Denninghoff
BACKGROUND: Ventilator-associated pneumonia (VAP) has been linked to emergency department (ED) intubation and length of stay (LOS). We assessed VAP prevalence in ED intubated patients, feasibility of ED VAP prevention, and effect on VAP rates. METHODS: This was a quality improvement initiative using a pre/post design. Phase 1 (PRE1) comprised patients before intensive care unit (ICU) bundle deployment. Phase 2 (PRE2) occurred after ICU but before ED deployment. Phase 3 (POST) included patients received VAP prevention starting at ED intubation...
September 21, 2016: American Journal of Infection Control
https://www.readbyqxmd.com/read/27613253/optimising-non-invasive-mechanical-ventilation-which-unit-should-care-for-these-patients-a-cohort-study
#10
Marta Raurell-Torredà, E Argilaga-Molero, M Colomer-Plana, A Ródenas-Fransico, M T Ruiz-Garcia, J Uya Muntaña
BACKGROUND: Use of noninvasive ventilation (NIV) has extended beyond intensive care units (ICUs), becoming usual practice in emergency departments (EDs) and general wards. OBJECTIVE: To analyse the relationship between nursing care and NIV outcome in different hospital units. DESIGN AND SETTINGS: Three university hospitals and one community hospital participated in a prospective observational cohort study. PARTICIPANTS: Ten units participated: 4 ICUs (1 surgical, 3 medical-surgical), 3 recovery (1 postsurgical, 2 EDs, 3 general wards)...
September 6, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/27590209/characteristics-and-outcomes-for-acute-heart-failure-in-elderly-patients-presenting-to-the-ed
#11
Pierre-Géraud Claret, Ian G Stiell, Justin W Yan, Catherine M Clement, Brian H Rowe, Lisa A Calder, Jeffrey J Perry
INTRODUCTION: The first aim of this study was to investigate the characteristics for elderly patients with acute heart failure presenting to the emergency department (ED). The second aim was to determine the characteristics of these elderly patients associated with serious adverse events. METHODS: The population was divided into 2 age groups, <80 and ≥80 years. The primary outcome was the occurrence of a serious adverse event, defined as either death from any cause within 30 days of the index ED visit or any of the following events within 14 days of the index ED visit: admission to a monitored unit, intubation, need for noninvasive ventilation, myocardial infarction, major procedure, or, for patients who were discharged after the initial visit, return to the ED resulting in admission to hospital...
August 12, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27495248/carbon-monoxide-poisoning-cases-presenting-with-non-specific-symptoms
#12
Turgut Deniz, Hayati Kandis, Oguz Eroglu, Harun Gunes, Meral Saygun, Ismail Hamdi Kara
Carbon monoxide (CO) is a colourless and odourless gas appearing as a result of incomplete combustion of carbon-containing fuels. Many domestic or occupational poisonings are caused by CO exposure. Malfunctioning heating systems, improperly ventilated motor vehicles, generators, grills, stoves and residential fires may be listed in the common sources of CO exposure. The aim of this study was to emphasize the significance of early diagnosis of CO poisoning with non-invasive measurement of CO levels of the patients with non-specific symptoms using a pulse oximeter device in the triage...
August 4, 2016: Toxicology and Industrial Health
https://www.readbyqxmd.com/read/27487782/clinical-presentation-and-outcomes-associated-with-different-treatment-modalities-for-pediatric-bark-scorpion-envenomation
#13
Vasanth Coorg, Rachel D Levitan, Richard D Gerkin, Jared Muenzer, Anne-Michelle Ruha
INTRODUCTION: Scorpion envenomation is potentially life-threatening and affects children in the Southwestern USA. An FDA-approved antivenom is available, but its high cost has led to use of off-label antivenom dosing or supportive care alone as alternatives to FDA-recommended dosing. This study sought to determine whether treatment approach influences outcomes in envenomated children. METHODS: A retrospective cohort study of children with grade III or IV scorpion envenomation evaluated in Phoenix Children's Hospital ED between September 1, 2011, and March 31, 2014...
August 3, 2016: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/27451461/care-setting-intensity-and-outcomes-after-emergency-department-presentation-among-patients-with-acute-heart-failure
#14
Livia Goldraich, Peter C Austin, Limei Zhou, Jack V Tu, Michael J Schull, Susanna Mak, Heather J Ross, David A Morrow, Douglas S Lee
BACKGROUND: Patients with heart failure (HF) presenting to the emergency department (ED) can be admitted to care settings of different intensity, where the intensive care unit (ICU) is the highest intensity, ward admission is intermediate intensity, and those discharged home are of lowest intensity. Despite the costs associated with higher-intensity care, little is known about disposition decisions and outcomes of HF patients treated in different care settings. METHODS AND RESULTS: We identified predictors of ICU or ward admission and determined whether survival differs in patients admitted to higher-intensity versus lower-intensity care settings (ie, ICU vs ward, or ward vs ED-discharged)...
2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27386925/fatal-ischemic-stroke-following-tityus-serrulatus-scorpion-sting-in-a-patient-with-essential-thrombocythemia
#15
Fábio Bucaretchi, Eduardo M De Capitani, Carla B Fernandes, Thiago M Santos, Igor A G Zamilute, Stephen Hyslop
CONTEXT: Stroke following scorpion stings is rare. We report a fatal envenomation involving multiple, extensive brain infarcts in a patient with a previous diagnosis of essential thrombocythemia (ET) who was stung by Tityus serrulatus (T. serrulatus). CASE DETAILS: A 44-year-old woman with a diagnosis of low-risk ET (platelets <1,000,000/mm(3), age <60 years and no history of thrombosis; positive JAK2V617F mutation) was admitted to a local ED 1 h after being stung by T...
July 8, 2016: Clinical Toxicology
https://www.readbyqxmd.com/read/27283009/correlation-of-venous-blood-gas-and-pulse-oximetry-with-arterial-blood-gas-in-the-undifferentiated-critically-ill-patient
#16
Eli Zeserson, Ben Goodgame, J Daniel Hess, Kristine Schultz, Cynthia Hoon, Keith Lamb, Vinay Maheshwari, Steven Johnson, Mia Papas, James Reed, Michael Breyer
RATIONALE: Blood gas analysis is often used to assess acid-base, ventilation, and oxygenation status in critically ill patients. Although arterial blood gas (ABG) analysis remains the gold standard, venous blood gas (VBG) analysis has been shown to correlate with ABG analysis and has been proposed as a safer less invasive alternative to ABG analysis. OBJECTIVE: The purpose of this study was to evaluate the correlation of VBG analysis plus pulse oximetry (SpO2) with ABG analysis...
June 9, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27251231/diaphragmatic-excursion-measurement-in-emergency-patients-with-acute-dyspnea-toward-a-new-diagnostic-tool
#17
Xavier Bobbia, Aude Clément, Pierre Géraud Claret, Sophie Bastide, Sandrine Alonso, Patricia Wagner, Tristan Tison, Laurent Muller, Jean Emmanuel de La Coussaye
INTRODUCTION: During acute dyspnea (AD), respiratory exhaustion is mainly due to diaphragm fatigue. The primary objective was to validate interobserver reproducibility of diaphragmatic excursion (DE) in emergency department (ED) patients admitted for AD. The secondary objectives were to assess the feasibility of DE measurement and intraobserver reproducibility. Finally, we examined whether the DE value was associated with a need for noninvasive ventilation (NIV). MATERIALS: This was a monocentric, prospective, technical reproducibility study...
August 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27230082/impact-of-hurricane-sandy-on-the-staten-island-university-hospital-emergency-department
#18
Josh Greenstein, Jerel Chacko, Brahim Ardolic, Nicole Berwald
UNLABELLED: Introduction On October 29, 2012, Hurricane Sandy touched down in New York City (NYC; New York USA) causing massive destruction, paralyzing the city, and destroying lives. Research has shown that considerable damage and loss of life can be averted in at-risk areas from advanced preparation in communication procedures, evacuation planning, and resource allocation. However, research is limited in describing how natural disasters of this magnitude affect emergency departments (EDs)...
June 2016: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/27179988/effect-of-aspirin-on-development-of-ards-in-at-risk-patients-presenting-to-the-emergency-department-the-lips-a-randomized-clinical-trial
#19
RANDOMIZED CONTROLLED TRIAL
Daryl J Kor, Rickey E Carter, Pauline K Park, Emir Festic, Valerie M Banner-Goodspeed, Richard Hinds, Daniel Talmor, Ognjen Gajic, Lorraine B Ware, Michelle Ng Gong
IMPORTANCE: Management of acute respiratory distress syndrome (ARDS) remains largely supportive. Whether early intervention can prevent development of ARDS remains unclear. OBJECTIVE: To evaluate the efficacy and safety of early aspirin administration for the prevention of ARDS. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, double-blind, placebo-controlled, randomized clinical trial conducted at 16 US academic hospitals. Between January 2, 2012, and November 17, 2014, 7673 patients at risk for ARDS (Lung Injury Prediction Score ≥4) in the emergency department were screened and 400 were randomized...
June 14, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27177646/ventilation-in-trauma-patients-the-first-24%C3%A2-h-is-different
#20
Timothy Craig Hardcastle, David J J Muckart, Ronald V Maier
INTRODUCTION: Ventilation of major trauma patients is often needed in both the acute (emergency department and early ICU phase) and subsequent phases of trauma care for those who need ICU admission. What is unclear is whether ICU ventilation strategies should be directly extrapolated to the acute phase of treatment. METHODS: This paper reviews the ARDS.net study, highlights recent developments in ventilation strategies, and provides practical ventilation guidance to the trauma surgeon for acute phase (in the ED or ICU) and the subsequent phase of ICU care...
May 13, 2016: World Journal of Surgery
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