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Cardiac arrest emergency department

Julie E Sinclair, Mike Austin, Mark Froats, Shannon Leduc, Justin Maloney, Richard Dionne, Andy Reed, Christian Vaillancourt
BACKGROUND: In Ontario, Canada, there currently are no prehospital treat-and-release protocols and the safety of this practice remains unclear. We sought to describe the characteristics, management, and outcomes of patients with hypoglycemia treated by paramedics, and to determine the predictors of repeat access to prehospital or emergency department (ED) care within 72 hours of initial paramedic assessment. METHODS: We performed a health record review of paramedic call reports and ED records over a 12-month period...
August 15, 2018: Prehospital Emergency Care
Lauren Scalercio, Jillian Vitter, Clint E Elliott
A patient with a history of Prinzmetal angina, refractory ventricular fibrillation, cardiac arrest with an implantable cardioverter-defibrillator, and obesity presented to the emergency department at 17 weeks gestational age with a chief complaint of angina and multiple episodes of defibrillation. A T3/4 thoracic epidural was placed to assess the effectiveness of a partial chemical sympathectomy in alleviating symptoms of angina as well as decreasing the amount of defibrillation episodes. Once this proved to be beneficial in accomplishing both of these goals, a more specific approach was designed...
August 10, 2018: A&A practice
Nina Buchtele, Christian Schörgenhofer, Alexander O Spiel, Bernd Jilma, Michael Schwameis
OBJECTIVES: Recent data suggest that early increased fibrinolysis may be associated with unfavorable prognosis in cardiac arrest. The current study aimed to assess whether there is an optimal fibrinolysis cutoff value as determined by thrombelastometry at hospital admission to predict poor outcome in a cohort of adult patients with out-of-hospital cardiac arrest. DESIGN: Prospective observational cohort study. SETTING: Emergency department of a 2...
August 9, 2018: Critical Care Medicine
Tiffany Patterson, Alexander Perkins, Gavin D Perkins, Tim Clayton, Richard Evans, Hanna Nguyen, Karen Wilson, Mark Whitbread, Johanna Hughes, Rachael T Fothergill, Joanne Nevett, Iris Mosweu, Paul McCrone, Miles Dalby, Roby Rakhit, Philip MacCarthy, Divaka Perera, Jerry P Nolan, Simon R Redwood
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a global public health issue. There is wide variation in both regional and inter-hospital survival rates from OHCA and overall survival remains poor at 7%. Regionalization of care into cardiac arrest centers (CAC) improves outcomes following cardiac arrest from ST elevation myocardial infarction (STEMI) through concentration of services and greater provider experience. The International Liaison Committee on Resuscitation (ILCOR) recommends delivery of all post-arrest patients to a CAC, but that randomized controlled trials are necessary in patients without ST elevation (STE)...
August 6, 2018: American Heart Journal
Anandhi D, Vinay R Pandit, Tamilarasu Kadhiravan, Soundaravally R, K N J Prakash Raju
BACKGROUND: Consumption of yellow oleander (Cascabela thevetia) is a popular method of intentional self-harm in South India. OBJECTIVES: The objectives of this study were to identify the cardiac arrhythmias and electrolyte abnormalities in yellow oleander poisoning and to identify the association between electrolyte abnormalities, cardiac glycoside concentrations at admission and the severity of cardiotoxicity. This study was also designed to identify clinical and biochemical parameters at presentation which predict serious arrhythmias and determinants of mortality...
August 3, 2018: Clinical Toxicology
Dino F Druda, Santosh Gone, Andis Graudins
INTRODUCTION: Pentobarbital (PB) is a euthanasia drug in doses of 2 to 10 grams, causing death within 15-30 minutes. We report a case of recovery from lethal pentobarbital deliberate self-poisoning with confirmatory serum drug concentrations. CASE REPORT: A 45-year-old male purchased 20 grams of PB powder over the Internet. He ingested this powder and then alerted his mother 10 minutes later. She found him unresponsive and commenced cardiopulmonary resuscitation (CPR)...
August 2, 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Luis M García-Núñez, Irving I Morales-Pogoda, Edgar F Hernández-García, Juan A Rodríguez-Inurrigarro, Raúl García-Ramírez, Fernando F Arcaute-Velázquez
Instituida bajo recomendaciones objetivas, la toracotomía en el departamento de urgencias (TDU) se ha descrito como una maniobra quirúrgica salvatoria de la vida en pacientes traumatizados in extremis. Sin embargo, hay pocos reportes acerca de la experiencia con su empleo en la actividad eléctrica sin pulso no traumática. Describimos el caso de una paciente obstétrica exanguinada por sangrado masivo transoperatorio, en la que se realizó una TDU con un resultado óptimo para la vida y la función neurológica...
2018: Cirugia y Cirujanos
Pei-Fang Lai, Ping-An Wu
The best first-aid treatment for cardiac arrest patients is advanced cardiac life support (ACLS) in terms both of saving lives and of reducing the incidence of sequelae. The American Heart Association (AHA) published updated ACLS guidelines for care in 2015. These updated guidelines emphasized the importance of teamwork in resuscitation, noting that, in addition to standard procedures, team members should be familiar with their distinct roles and should cooperate together during emergent situations. Implementing ACLS is not easy due to stress and unfamiliarity with the process and thus often achieves less-than-optimal results in practice...
August 2018: Hu Li za Zhi the Journal of Nursing
Young Sun Ro, Sang Do Shin, Seung Chul Lee, Kyoung Jun Song, Joo Jeong, Dae Han Wi, Sungwoo Moon
OBJECTIVES: We aimed to evaluate the associations between the centralization of dispatch centers and dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) for out-of-hospital cardiac arrest (OHCA) patients. METHODS: All emergency medical services (EMS)-treated adults in Gyeonggi province (34 fire departments covering 43 counties, with a population of 12.6 million) with OHCAs of cardiac etiology were enrolled between 2013 and 2016, excluding cases witnessed by EMS providers...
July 29, 2018: Resuscitation
Mirosław Tarasiuk, Bogdan Kalicki, Adam Leoniuk, Weronika Krysztopowicz, Piotr Gałkin, Marzena Wojewódzka-Żelezniakowicz
The pulmonary embolism is caused by the sudden occlusion or narrowing of the pulmonary artery or its branches through the emboli and it is the third cause of death due to cardiovascular diseases. This disease is characterized by multiple complications, among others, the sudden cardiac arrest or stroke. The success in treatment of pulmonary embolism depends on the early disease diagnosis and a valid therapeutic procedure. The aim of this paper is to discuss the diagnostic and therapeutic procedure in pulmonary embolism, based on the case report of 65-year-old patient with high risk pulmonary embolism complicated with sudden cardiac arrest and stroke...
June 27, 2018: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
Chen Ji, Tom Quinn, Lucia Gavalova, Ranjit Lall, Charlotte Scomparin, Jessica Horton, Charles D Deakin, Helen Pocock, Michael A Smyth, Nigel Rees, Samantha J Brace-McDonnell, Simon Gates, Gavin D Perkins
OBJECTIVES: There is considerable interest in reducing the cost of clinical trials. Linkage of trial data to administrative datasets and disease-specific registries may improve trial efficiency, but it has not been reported in resuscitation trials conducted in the UK. To assess the feasibility of using national administrative and clinical datasets to follow up patients transported to hospital following attempted resuscitation in a cluster randomised trial of a mechanical chest compression device in out-of-hospital cardiac arrest...
July 28, 2018: BMJ Open
Andreas Hohn, Uwe Trieschmann, Jeremy Franklin, Jan-Nicolas Machatschek, Jost Kaufmann, Holger Herff, Jochen Hinkelbein, Thorsten Annecke, Bernd W Böttiger, Stephan A Padosch
BACKGROUND: Peri-operative critical events are still a major problem in paediatric anaesthesia care. Access to more experienced healthcare teams might reduce the adverse event rate and improve outcomes. OBJECTIVE: The current study analysed incidences of peri-operative paediatric cardiac arrest before and after implementation of a specialised paediatric anaesthesia team and training programme. DESIGN: Retrospective cohort study with before-and-after analysis...
July 25, 2018: European Journal of Anaesthesiology
Nan Zhang, Hong Zhang, Zheng Ni, Shaohong Shang, Gang Chen, Liying Zhang, Xiang Li, Jingwei Zhu, Zheng Cao, Suxia Ma
OBJECTIVE: To explore the difference in ultrasonic monitoring in carotid blood flow, resuscitation effects and prognosis between interposed abdominal pulling-pressing cardiopulmonary resuscitation (IAPP-CPR) and standard cardiopulmonary resuscitation (STD-CPR). METHODS: Seventy-five cardiac arrest (CA) patients admitted to emergency department of Shijingshan Teaching Hospital of Capital Medical University from June 2015 to December 2017 were enrolled. The patients were divided into STD-CPR group and IAPP-CPR group according to the treatment orders of them and the desire of relatives...
July 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Mateusz Puślecki, Marcin Ligowski, Marek Dąbrowski, Sebastian Stefaniak, Małgorzata Ładzińska, Piotr Ładziński, Aleksander Pawlak, Marcin Zieliński, Agata Dąbrowska, Aniela Artyńska, Mariusz Gezela, Paweł Sobczyński, Łukasz Szarpak, Bartłomiej Perek, Marek Jemielity
BACKGROUND: The implemented "ECMO for Greater Poland" program takes full advantage of the ECMO (extracorporeal membrane oxygenation) perfusion therapy to promote health for 3.5 million inhabitants in the region (Greater Poland). The predominant subjects of implementation are patients with hypothermia, with severe reversible respiratory failure (RRF) and treatment of other critical states leading to heart failure such as sudden cardiac arrest, cardiogenic shock or acute intoxication...
July 25, 2018: Artificial Organs
Yi-Chuan Chen, Kai-Hsiang Wu, Kuang-Yu Hsiao, Ming-Szu Hung, Yi-Chen Lai, Yuan-Shun Chen, Chih-Yao Chang
BACKGROUND: Prognostic factors for the outcomes in traumatic cardiac arrest (TCA) patients transported to hospitals without prehospital return of spontaneous circulation (ROSC) remain uncertain. The aim of this study is to investigate factors associated with outcomes in TCA patients without prehospital ROSC. METHODS: We conducted a retrospective cohort study using a multi-institutional, 5-year database. Only TCA patients without prehospital ROSC were included. The primary outcome was ROSC in the emergency department (ED), and the secondary outcome was 30-day survival...
July 17, 2018: Injury
Michael Saul Lundin, Subash Bastakoti, Daniel Havlichek, Heather Laird-Fick
An 18-year-old woman presented to clinic with acute pharyngitis with 4/4 Centor criteria. Rapid streptococcal antigen test was negative. The patient, who was allergic to penicillin, was prescribed azithromycin. Ultimately, after 5 days and without any corticosteroids, she presented to the emergency department with 10/10 chest pain and was admitted to the intensive care unit. CT showed nodular lung disease and blood cultures on admission grew Fusobacterium, likely Fusobacterium nucleatum. She sustained two cardiac arrests, three tube thoracostomies, acute kidney injury requiring dialysis and ventilatory failure requiring tracheostomy...
July 19, 2018: BMJ Case Reports
Morten Langfeldt Friberg, Leif Rognås
OBJECTIVES: The primary objective was to estimate the incidence of patients in the Central Denmark Region triaged to bypass the local emergency department without being part of a predefined fast-track protocol. The secondary objective was to describe these triage decisions in more detail with regard to the most common diagnoses, incidence of direct referral sorted by the prehospital critical care team (PHCCT) and the destination hospital. DESIGN: Retrospective descriptive study...
July 18, 2018: BMJ Open
Elisabeth Day, Jason R Hort
OBJECTIVE: In paediatric cardiopulmonary arrest, International Liaison Committee on Resuscitation (ILCOR) states, 'there are no simple guidelines to determine when resuscitative efforts become futile'. Considerations to assist this decision-making include cause of arrest, pre-existing medical conditions, age, site of arrest, duration of untreated cardiopulmonary arrest, witnessed arrest and presence of shockable rhythm. Outcomes are poor in out-of-hospital cardiac arrests (OHCA), particularly for infants...
July 18, 2018: Emergency Medicine Australasia: EMA
Robyn McDannold, Bentley J Bobrow, Vatsal Chikani, Annemarie Silver, Daniel W Spaite, Tyler Vadeboncoeur
BACKGROUND: Clinical investigations have shown improved outcomes with primary compression cardiopulmonary resuscitation strategies. It is unclear whether this is a result of passive ventilation via chest compressions, a low requirement for any ventilation during the early aspect of resuscitation or avoidance of inadvertent over-ventilation. OBJECTIVES: To quantify whether chest compressions with guideline-compliant depth (>2 in) produce measurable and substantial ventilation volumes during emergency department resuscitation of out-of-hospital cardiac arrest...
June 30, 2018: American Journal of Emergency Medicine
Batur Gonenc Kanar, Kursat Tigen, Halil Atas, Altug Cincin, Beste Ozben
A prosthetic valve thrombosis (PVT), which is a potentially fatal complication, refers to the presence of non-infective thrombotic material on a prosthetic valve apparatus, interfering with its function. Possible complications of a PVT include transient neurologic embolic events, cardiac arrest due to a stuck valve prosthesis, and cardio-embolic myocardial infarction (MI). The choice of treatments, including a redo surgery, a percutaneous coronary intervention (PCI), and a fibrinolysis with PVT or MI dosages, depends on the patient's clinical and hemodynamic status and thrombotic burden involving the prosthetic valve and surrounding tissues...
June 19, 2018: American Journal of Emergency Medicine
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