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Emergency Management

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https://www.readbyqxmd.com/read/28240620/infection-rates-and-treatment-of-low-velocity-extremity-gunshot-injuries
#1
Mai P Nguyen, Jonathan C Savakus, Jeffrey A O'Donnell, Nicholas F Prayson, Michael S Reich, Joseph F Golob, Amy A McDonald, John J Como, Heather A Vallier
OBJECTIVES: To determine the rates of infection in low-energy gunshot wounds (GSWs) to the extremity. DESIGN: Retrospective review. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Patients (N=140) with at least 90-day follow-up for extremity-only low-energy GSW injuries from 2010-2014 were retrospectively reviewed. Treatment was recorded, including type and duration of antibiotics and details of non-operative and operative management...
February 23, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28240466/liberal-transfusion-strategies-still-the-trend-in-burn-surgery
#2
N L Allorto, M D T Smith, D L Clarke
OBJECTIVE: Blood is a limited resource in middle-income countries such as South Africa. Transfusion is associated with complications and expense. We aimed to understand our transfusion practices in burn surgery as well as ascertain the opinion of a broader group of surgeons and anaesthetists regarding transfusion triggers in order to understand the rationale and bias that drives current transfusion practice in our setting. METHOD: Firstly, we investigated the current blood practices at our regional burn service through an audit of perioperative notes for all patients receiving packed cell transfusions in a 24-month period...
September 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28240433/use-of-three-dimensional-transesophageal-echocardiography-to-evaluate-mitral-valve-morphology-for-risk-stratification-prior-to-mitral-valvuloplasty
#3
Loren Francis, Alan Finley, Walead Hessami
: Mitral stenosis is often managed percutaneously with an interventional procedure such as balloon commissurotomy. Although this often results in an increased mitral valve area and improved clinical symptoms, this procedure is not benign and may have serious complications including the development of hemodynamically significant mitral valve regurgitation. Multiple scoring systems have been developed to attempt to risk stratify these patients prior to their procedure. CASE: A 64-year-old patient underwent an emergent mitral valve replacement after having percutaneous mitral balloon commissurotomy complicated by development of severe mitral regurgitation...
February 2017: Echocardiography
https://www.readbyqxmd.com/read/28240217/quantitative-ultrasound-molecular-imaging-by-modeling-the-binding-kinetics-of-targeted-contrast-agent
#4
Simona Turco, Isabelle Tardy, Peter Frinking, Hessel Wijkstra, Massimo Mischi
Ultrasound molecular imaging (USMI) is an emerging technique to monitor diseases at the molecular level by the use of novel targeted ultrasound contrast agents (tUCA). These consist of microbubbles functionalized with targeting ligands with high-affinity for molecular markers of specific disease processes, such as cancer-related angiogenesis. Among the molecular markers of angiogenesis, the vascular endothelial growth factor receptor 2 (VEGFR2) is recognized to play a major role. In response, the clinical-grade tUCA BR55 was recently developed, consisting of VEGFR2-targeting microbubbles which can flow through the entire circulation and accumulate where VEGFR2 is over-expressed, thus causing selective enhancement in areas of active angiogenesis...
February 27, 2017: Physics in Medicine and Biology
https://www.readbyqxmd.com/read/28239579/neck-trauma-ent-prospects
#5
Kavita Sachdeva, Aparaajita Upadhyay
Neck trauma is a very important surgical emergency faced by ENT surgeons in day to day practice. They are potentially life threatening conditions due to the presence of many vital structures in this area. Timely presentation to the referral centre and proper multidisciplinary approach towards management plays a pivotal role in the healing pattern of the wound and prevention of serious complication like shock, sepsis, laryngeal stenosis or fistula formation. A retrospective study was done in ENT Department, NSCB Medical College, Jabalpur, Madhya Pradesh, India during the period of 2014-2016...
March 2017: Indian Journal of Otolaryngology and Head and Neck Surgery
https://www.readbyqxmd.com/read/28239576/cut-throat-injury-our-experience-in-rural-set-up
#6
Debdulal Chakraborty, Chiranjib Das, Arvind Kumar Verma, Rajesh Hansda
Cut throat injuries are one of the emergency conditions managed by ENT specialists. If not treated in time, they may lead to death. Prevention of these complications depends on immediate resuscitation by securing the airway by tracheostomy or intubation, prompt control of hemorrhage and blood replacement. The present study was conducted to study the sociodemographic profile of patients of cut throat injury, motives behind cut throat injury, site and depth of the injury, treatment given at our hospital and outcome...
March 2017: Indian Journal of Otolaryngology and Head and Neck Surgery
https://www.readbyqxmd.com/read/28239462/thrombocytopenia-in-patients-with-melanoma-receiving-immune-checkpoint-inhibitor-therapy
#7
Eileen Shiuan, Kathryn E Beckermann, Alpaslan Ozgun, Ciara Kelly, Meredith McKean, Jennifer McQuade, Mary Ann Thompson, Igor Puzanov, John P Greer, Suthee Rapisuwon, Michael Postow, Michael A Davies, Zeynep Eroglu, Douglas Johnson
BACKGROUND: Immune checkpoint inhibitors, including antibodies against programmed death 1 (PD-1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4), are being used with increasing frequency for the treatment of cancer. Immune-related adverse events (irAEs) including colitis, dermatitis, and pneumonitis are well described, but less frequent events are now emerging with larger numbers of patients treated. Herein we describe the incidence and spectrum of thrombocytopenia following immune checkpoint inhibitor therapy and two severe cases of idiopathic thrombocytopenic purpura (ITP)...
2017: Journal for Immunotherapy of Cancer
https://www.readbyqxmd.com/read/28239318/maternal-and-fetal-outcomes-in-pregnant-japanese-women-with-inflammatory-bowel-disease-our-experience-with-a-series-of-23-cases
#8
Naoki Minami, Minoru Matsuura, Yorimitsu Koshikawa, Satoshi Yamada, Yusuke Honzawa, Shuji Yamamoto, Hiroshi Nakase
BACKGROUND/AIMS: Our physicians work to expand the possibilities to treat female patients with inflammatory bowel disease (IBD) who wish to become pregnant. Although many drugs, including 5-aminosalicylate (5-ASA), corticosteroids, immunomodulators, and biologics, are used safely during pregnancy, few reports have described the therapeutic regimen throughout pregnancy and the management of patients who relapse during pregnancy precisely. The aim of this study was to assess the management of patients with IBD during pregnancy...
January 2017: Intestinal Research
https://www.readbyqxmd.com/read/28239141/chronic-myeloid-leukemia-associated-hypercalcemia-a-case-report-and-literature-review
#9
David Toro-Tobón, Sarimar Agosto, Sara Ahmadi, Maureen Koops, Jan M Bruder
BACKGROUND Hypercalcemia associated with chronic myeloid leukemia (CML) is an ominous sign. Although rare, several cases have been reported and multiple pathophysiologic mechanisms have been independently proposed. We present a patient case and a literature review of the clinical presentation and mechanisms of CML-associated hypercalcemia. CASE REPORT A 58-year-old male with a past medical history of CML diagnosed six years earlier, presented to the emergency department with one week of acute confusion, disorientation, polyuria, and polydipsia...
February 27, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28238928/endovascular-and-open-repair-of-ruptured-infrarenal-aortic-aneurysms-at-a-tertiary-care-center
#10
Matthew A Schechter, Luigi Pascarella, Steven Thomas, Richard L McCann, Leila Mureebe
OBJECTIVE: The mortality of ruptured infrarenal abdominal aortic aneurysms (rAAA) has been reported as high as 90%. Loss of consciousness and a systolic blood pressure of < 80mmHg on presentation are the most important predictors of mortality after emergent open repair (OR). Endovascular repair of abdominal aortic aneurysm (EVAR) has reduced short-term operative mortality and morbidity for elective abdominal aortic aneurysm repair, and many be advocated for wider application of EVAR for rAAA...
February 23, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28238693/digital-rectal-examination-reduces-hospital-admissions-endoscopies-and-medical-therapy-in-patients-with-acute-gastrointestinal-bleeding
#11
Manish P Shrestha, Mark Borgstrom, Eugene Trowers
BACKGROUND: Although digital rectal examination is an established part of physical examination in patients with acute gastrointestinal bleeding, clinicians are reluctant to perform rectal examination. We intended to assess if rectal examination affects the clinical management decision in these patients. STUDY: We performed a single-center, retrospective, cross-sectional study using data from electronic health record of patients ≥18 years old presenting to emergency with acute gastrointestinal bleeding...
February 23, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28238692/management-of-pruritus-in-primary-biliary-cholangitis-a-narrative-review
#12
REVIEW
Hirsh D Trivedi, Blanca Lizaola, Elliot B Tapper, Alan Bonder
Primary biliary cholangitis is an autoimmune condition characterized by destruction of intrahepatic bile ducts. It causes debilitating symptoms, which dramatically affect the patient's quality of life. Pruritus affects 60% to 70% of individuals with primary biliary cholangitis and leads to sleep disturbances, fatigue, depression and suicidal ideation. A complete search was done with studies from PubMed, EMBASE, Web of Science, Cochrane database, Countway library and CINAHL with specific search terms. This narrative review was prepared after a comprehensive literature review...
February 23, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28238498/legal-social-ethical-and-medical-perspectives-on-the-care-of-the-statutory-rape-adolescent-in-the-emergency-department
#13
Shiu-Lin Tsai, Elvira Acosta, Toni Cardenas, Jeremy K Sigall, Kevin Van Geem
Rapes involving adolescents who present to the emergency department (ED) are fraught with ethical and legal complexities and are often emotionally turbulent for patients, their families, and medical providers. Management requires a thoughtful approach from multiple standpoints, including legal, psychosocial, ethical, and medical ones. However, there is no standardized sexual assault education for emergency medicine residents, and management practices vary widely.(1,2) We present a hypothetical statutory rape case based on real cases that occurred in New York City and bring together the perspectives of an attorney on the legal parameters, two social workers on the psychosocial issues, an ethicist on the moral considerations, and a pediatric emergency physician-who is also a sexual assault forensic examiner-on the medical treatments...
February 23, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28238384/abdominal-pain-in-the-post-menopausal-female-is-ovarian-torsion-in-the-differential
#14
Jason M Rotoli
BACKGROUND: Ovarian torsion is often thought of as a disease process of reproductive-aged women; however, it is also seen in the extremes of age. In post-menopausal women, it can be both a challenge to diagnose and associated with increased morbidity. CASE REPORT: We present a case of a 68-year-old woman with sudden onset of lower abdominal pain 6 h before arrival at the emergency department (ED). She was diagnosed with ovarian torsion, secondary to an ovarian mass, and underwent a full malignancy evaluation...
February 18, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28238017/imaging-findings-of-anterior-hip-dislocations
#15
REVIEW
Kyle Pfeifer, Michael Leslie, Kirsten Menn, Andrew Haims
Anterior hip dislocations are rare orthopedic emergencies resulting from high-energy trauma and have unique imaging characteristics on radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Imaging findings on CT and MRI allow for the prompt recognition and classification of anterior hip dislocations, which guides patient management and reduces complications. The purpose of this article is to review imaging findings of anterior hip dislocations, specifically focusing on CT and MRI.
February 25, 2017: Skeletal Radiology
https://www.readbyqxmd.com/read/28237850/light-at-the-end-of-the-tunnel-new-graduate-nurses-accounts-of-resilience-a-qualitative-study-using-photovoice
#16
Siti Namira Binte Abdul Wahab, Siti Zubaidah Mordiffi, Emily Ang, Violeta Lopez
BACKGROUND: Resilience is the ability to overcome any stressful situation. The ability to bounce back is said to enable a person to emerge stronger, perform better, and become more confident and selfefficient. The new graduate nurses' journey is a stressful experience as they become immersed in the day-to-day work pressures. OBJECTIVE: The study explored the new graduate nurses' accounts of resilience and the facilitating and impeding factors in building their resilience...
February 14, 2017: Nurse Education Today
https://www.readbyqxmd.com/read/28237846/decision-support-for-water-quality-management-of-contaminants-of-emerging-concern
#17
Astrid Fischer, Thomas Ter Laak, Jan Bronders, Nele Desmet, Ekkehard Christoffels, Annemarie van Wezel, Jan Peter van der Hoek
Water authorities and drinking water companies are challenged with the question if, where and how to abate contaminants of emerging concern in the urban water cycle. The most effective strategy under given conditions is often unclear to these stakeholders as it requires insight into several aspects of the contaminants such as sources, properties, and mitigation options. Furthermore the various parties in the urban water cycle are not always aware of each other's requirements and priorities. Processes to set priorities and come to agreements are lacking, hampering the articulation and implementation of possible solutions...
February 23, 2017: Journal of Environmental Management
https://www.readbyqxmd.com/read/28237761/disordered-lives-life-circumstances-and-clinical-characteristics-of-very-frequent-users-of-emergency-departments-for-primary-mental-health-complaints
#18
Xiangfei Meng, Tracy Muggli, Marilyn Baetz, Carl D'Arcy
This study explored the life circumstances and clinical characteristics of very frequent users of emergency departments (EDs) presenting with a primary mental health complaint. Patients with 10 or more EDs visits in 2012 with a primary psychiatric diagnosis in a Canadian regional health authority were identified from electronic administrative files. The hospital charts for these patients were thoroughly reviewed for a three-year period, from 2011 to 2013. A retrospective thematic analysis was undertaken. Very frequent users of EDs were generally young to early middle aged, unemployed, living in transient accommodations, having substance abuse diagnoses, and self-referred to EDs for a variety of psychiatric and health symptoms and/or unmet needs...
February 21, 2017: Psychiatry Research
https://www.readbyqxmd.com/read/28237737/data-from-the-german-chest-pain-unit-registry-the-well-known-gap-between-knowledge-and-practice
#19
EDITORIAL
Daniel Fernández-Bergés
In-hospital mortality of acute myocardial infarction with ST segment elevation remains high and is influenced by many factors, some of which are modifiable such as time to treatment initiation and modality of treatment. It is well established that reperfusion therapy is the gold-standard in the management of ST-elevation acute myocardial infarction. Despite recent developments and clear, comprehensible guidelines recommendations, it remains difficult to disseminate this knowledge to medical practitioners. The German Chest Pain Unit shows that the best door-to-balloon time is reached when patients contact the Emergency Medical Systems (EMS) directly, rather than when referred by the general practitioner (GP), or are transferred from another hospital, or present as a self-referral...
February 13, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28237610/visceral-and-bone-metastases-of-a-who-grade-2-meningioma-a-case-report-and-review-of-the-literature
#20
A Paix, W Waissi, D Antoni, R Adeduntan, G Noël
Meningiomas represent the most common tumours of the central nervous system in adults. Risk factors include ionizing radiation, female hormones exposure, head trauma, cell phone use, breast cancer and family history of meningioma. Despite complete surgical resection, natural history of meningiomas often includes local recurrence but very few metastatic meningiomas have been reported. Here, we report the case of a metastatic meningioma. A 43-year-old woman was firstly treated for a symptomatic parietal meningioma WHO grade II by surgical resection followed by an irradiation of the surgical bed...
February 22, 2017: Cancer Radiothérapie: Journal de la Société Française de Radiothérapie Oncologique
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