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Cardiac emergency medicine

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https://www.readbyqxmd.com/read/30217621/coronary-artery-bypass-graft-surgery-complications-a-review-for-emergency-clinicians
#1
REVIEW
Tim Montrief, Alex Koyfman, Brit Long
INTRODUCTION: Coronary artery bypass graft (CABG) surgery remains a high-risk procedure, and many patients require emergency department (ED) management for complications after surgery. OBJECTIVE: This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post-CABG surgery complications. DISCUSSION: While there has been a recent decline in all cardiac revascularization procedures, there remains over 200,000 CABG surgeries performed in the United States annually, with up to 14% of these patients presenting to the ED within 30 days of discharge with post-operative complications...
September 8, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30208954/ethical-aspects-of-sudden-cardiac-arrest-research-using-observational-data-a-narrative-review
#2
REVIEW
Marieke A R Bak, Marieke T Blom, Hanno L Tan, Dick L Willems
Sudden cardiac arrest (SCA) accounts for half of all cardiac deaths in Europe. In recent years, large-scale SCA registries have been set up to enable observational studies into risk factors and the effect of treatment approaches. The increasing scale and variety of data sources, coupled with the implementation of a new European data protection legal framework, causes researchers to struggle with how to handle these 'big data'. Data protection in the SCA setting is especially complex since patients become at least temporarily incapacitated, and are thus unable to provide prospective informed consent, and because the majority of patients do not survive...
September 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/30197209/advancing-from-a-hemodynamic-model-to-a-mechanistic-disease-modifying-model-of-cardiogenic-shock
#3
EDITORIAL
Patrick R Lawler, Mandeep R Mehra
Emerging clinical evidence has suggested that short-term mechanical augmentation of cardiac output (CO) may not consistently improve mortality in patients with cardiogenic shock (CS), despite improvements in hemodynamics. Such failures could reflect the underlying complexity of the mechanisms that contribute to malperfusion and organ dysfunction in CS. Distinct molecular and physiologic shock endophenotypes likely exist among patients with CS, with hemodynamic aberrations as the inciting insult but not necessarily the primary drivers of clinical outcomes...
July 17, 2018: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/30191187/acute-coronary-syndromes-diagnosis-version-2-0-tomorrow-s-approach-to-diagnosing-acute-coronary-syndromes
#4
REVIEW
Richard Body
Chest pain accounts for approximately 6% of Emergency Department (ED) attendances and is the most common reason for emergency hospital admission. For many years, our approach to diagnosis has required patients to stay in hospital for at least 6-12 h to undergo serial biomarker testing. As less than one fifth of the patients undergoing investigation actually has an acute coronary syndrome (ACS), there is tremendous potential to reduce unnecessary hospital admissions. Recent advances in diagnostic technology have improved the efficiency of care pathways...
September 2018: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30171743/heart-derived-cell-therapy-2-0-paracrine-strategies-to-increase-therapeutic-repair-of-injured-myocardium
#5
REVIEW
Ghazaleh Rafatian, Darryl R Davis
Despite progress in cardiovascular medicine, the incidence of heart failure is rising and represents a growing challenge. To address this, ex vivo proliferated heart-derived cell products have emerged as a promising investigational cell-treatment option. Despite being originally proposed as a straightforward myocyte replacement strategy, emerging evidence has shown that cell-mediated gains in cardiac function are leveraged on paracrine stimulation of endogenous repair and tissue salvage. In this concise review, we focus on the paracrine repertoire of heart-derived cells and outline strategies used to boost cell potency by targeting cytokines, metabolic preconditioning and supportive biomaterials...
September 1, 2018: Stem Cells
https://www.readbyqxmd.com/read/30158256/history-conflict-and-non-formulary-medicine-a-threat-for-anaesthesiologist-in-low-and-middle-income-countries
#6
Muhammad Faisal Khan, Areeba Muzaffar, Faisal Shamim
The practice of complementary and non-formulary medicine has gained tremendous popularity due to their claimed beneficial effects in cardiac, respiratory and chronic diseases, as also other disorders. The most threatening aspect related to these practices pertains to the non-disclosure of its use by patients at the time of their preoperative assessment in elective or emergency setting. We report a case of profound, long-lasting unexplained hypotension during and after anaesthesia in a patient presented for emergency vocal cord surgery (cordectomy)...
August 29, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/30154677/fourth-year-medical-students-do-not-perform-a-focused-physical-examination-during-a-case-based-simulation-scenario
#7
Leslie A Bilello, Nicole M Dubosh, Jason J Lewis, Matthew M Hall, Jonathan Fisher, Edward A Ullman
Background: The art of physical examination is one of the most valuable diagnostic tools bestowed upon new generations of medical students. Despite traditional educational techniques and significant attention on a national level, both trainees and educators have noticed a decrease in physical examination proficiency. Simulation has been identified as a potential way to improve physical examination techniques within undergraduate medical education. We sought to determine the utility of a cardiac case-based simulation scenario to assess physical examination performance of fourth-year medical students during an emergency medicine (EM) clerkship...
2018: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/30149833/adrenaline-in-the-acute-treatment-of-anaphylaxis
#8
Johannes Ring, Ludger Klimek, Margitta Worm
BACKGROUND: Anaphylaxis is the most serious manifestation of an immediate allergic reaction and the most common emergency event in allergology. Adrenaline (epi- nephrine) is the mainstay of acute pharmacotherapy for this complication. Although epinephrine has been in use for more than a century, physicians and patients are often unsure and inadequately informed about its proper administration and dosing in everyday situations. METHODS: This review is based on pertinent publications from the period 1 January 2012 to 30 September 2017 that were retrieved, on the basis of the existing guide- lines of 2007 and 2014, by a PubMed search employing the keywords "anaphylaxis treatment," "allergic shock," "adrenaline," and "epinephrine," as well as on further ar- ticles from the literature...
August 6, 2018: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/30136862/graphene-based-drug-delivery-systems-in-tissue-engineering-and-nanomedicine
#9
Rajesh Lakshmanan, Nilanjana Maulik
The time and dosage form of graphene derivatives have been found to determine therapeutic and toxic windows in several cell lines and preclinical models. The enhanced biological action of graphene derivatives is made possible by altering the chemistry of native materials via surface conjugation, or by changing the oxidation state. The high level of chemical reactivity vested in the planar structure of graphene can be used to load various drugs and biomolecules with maximum radical scavenging effect. The integration of graphene and polymers brings electrical conductivity to scaffolds, making them ideal for cardiac or neuronal tissue engineering...
September 2018: Canadian Journal of Physiology and Pharmacology
https://www.readbyqxmd.com/read/30128729/translating-emerging-molecular-genetic-insights-into-clinical-practice-in-inherited-cardiomyopathies
#10
REVIEW
Babken Asatryan, Argelia Medeiros-Domingo
Cardiomyopathies are primarily genetic disorders of the myocardium associated with higher risk of life-threatening cardiac arrhythmias, heart failure, and sudden cardiac death. The evolving knowledge in genomic medicine during the last decade has reshaped our understanding of cardiomyopathies as diseases of multifactorial nature and complex pathophysiology. Genetic testing in cardiomyopathies has subsequently grown from primarily a research tool into an essential clinical evaluation piece with important clinical implications for patients and their families...
October 2018: Journal of Molecular Medicine: Official Organ of the "Gesellschaft Deutscher Naturforscher und Ärzte"
https://www.readbyqxmd.com/read/30123575/biomaterials-and-heart-recovery-cardiac-repair-regeneration-and-healing-in-the-mcs-era-a-state-of-the-heart
#11
REVIEW
Sveva Di Franco, Cristiano Amarelli, Andrea Montalto, Antonio Loforte, Francesco Musumeci
Regenerative medicine is an emerging interdisciplinary field of scientific research that, supported by tissue engineering is, nowadays, a valuable and reliable solution dealing with the actual organs shortage and the unresolved limits of biological or prosthetic materials used in repair and replacement of diseased or damaged human tissues and organs. Due to the improvements in design and materials, and to the changing of clinical features of patients treated for valvular heart disease the distance between the ideal valve and the available prostheses has been shortened...
July 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/30122458/-emanet-a-regional-network-for-health-services-research-in-emergency-and-acute-medicine
#12
Martina Schmiedhofer, Tobias Inhoff, Verena Krobisch, Liane Schenk, Matthias Rose, Felix Holzinger, Thomas Keil, Ursula Müller-Werdan, Christian Günster, Martin Möckel
The number of patients seeking help in emergency departments is steadily increasing. In part, this is due to patients who have acute symptoms, but do not require emergency care, as well as multimorbid patients needing complex medical care. Emergency departments serve as an interface between primary care and in-patient as well as out-patient care. The ongoing public discussion about the need to readjust emergency care structures in Germany does not adequately address this aspect. The knowledge of characteristics and needs of patients seeking help in emergency departments is insufficient...
September 2018: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/30116529/improvements-in-long-standing-cardiac-pathologies-by-individualized-homeopathic-remedies-a-case-series
#13
Lenka Tenzera, Boris Djindjic, Olivera Mihajlovic-Elez, Bindu John Pulparampil, Seema Mahesh, George Vithoulkas
We present three cases of cardiac arrest at different stages of pathology. Acute myocardial infarction and resulting heart failure is emerging as the leading cause of mortality. In the long run, acute episodes and cardiac remodelling can cause considerable damage and result in heart failure. In these cases, individualized homeopathic therapy was instituted along with the conventional medicines and the results were encouraging. The changes in the laboratory diagnostic parameters (single-photon emission computed tomography, electrocardiograph, echocardiography and ejection fraction as the case may be) are demonstrated over time...
2018: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/30086566/-emergency-medicine-in-remote-settings
#14
REVIEW
Andreas Leischker, Fritz Ge Holst
For many acute diseases and injuries, treatment does not differ between industrialised environment and wilderness setting. However, for some emergencies, treatment needs to be adapted if advanced medical care facilities cannot be reached within 4 hours.In these situations, dislocated joints and fractures should be reduced quickly. Contaminated wounds should be cleaned carefully, with drinking water being sufficient when no sterile solution is available. A patient with a contaminated wound should receive a systemic antibiotic coverage within one hour...
August 2018: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/30078545/-use-of-pocket-sized-ultrasound-in-internal-medicine-hospitalist-practice-feedback-and-perspectives
#15
A Michon, S Jammal, A Passeron, G De Luna, C Bomahou, V Jullien, J Pouchot, J-B Arlet, B Ranque
INTRODUCTION: Point of care ultrasound (POCUS) is routinely used by intensivists and emergency physicians for many years. Its interest is not arguable any more for these specialists, despite the large variety of diseases they care. Hospitalists and internists also should find some interest in POCUS, which convenience and wide range of indications responds well to the variety of their practice. However, it is still not widely used in internal medicine departments. METHODS: We here report our experience of using a pocket-sized ultrasound device in a French internal medicine department...
August 2, 2018: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/30070065/clinical-cellular-therapeutics-accelerate-clot-formation
#16
Mitchell J George, Karthik Prabhakara, Naama E Toledano-Furman, Yao-Wei Wang, Brijesh S Gill, Charles E Wade, Scott D Olson, Charles S Cox
Clinical cellular therapeutics (CCTs) have shown preliminary efficacy in reducing inflammation after trauma, preserving cardiac function after myocardial infarction, and improving functional recovery after stroke. However, most clinically available cell lines express tissue factor (TF) which stimulates coagulation. We sought to define the degree of procoagulant activity of CCTs as related to TF expression. CCT samples from bone marrow, adipose, amniotic fluid, umbilical cord, multi-potent adult progenitor cell donors, and bone marrow mononuclear cells were tested...
August 1, 2018: Stem Cells Translational Medicine
https://www.readbyqxmd.com/read/30064624/oxygen-treatment-in-intensive-care-and-emergency-medicine
#17
Jörn Grensemann, Valentin Fuhrmann, Stefan Kluge
BACKGROUND: Oxygen treatment is often life-saving, but multiple studies in recent years have yielded evidence that the indiscriminate administration of oxygen to patients in the intensive care unit and emergency room can cause hyperoxia and thereby elevate mortality. METHODS: This review is based on prospective, randomized trials concerning the optimum use of oxygen in adult medicine, which were retrieved by a selective search in PubMed, as well as on pertinent retrospective studies and guideline recommendations...
July 9, 2018: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/30050659/therapeutic-potential-of-salviae-miltiorrhizae-radix-et-rhizoma-against-human-diseases-based-on-activation-of-nrf2-mediated-antioxidant-defense-system-bioactive-constituents-and-mechanism-of-action
#18
REVIEW
Guo-Hui Li, Yan-Ru Li, Ping Jiao, Yu Zhao, Hui-Xin Hu, Hong-Xiang Lou, Tao Shen
Oxidative stress plays a central role in the pathogenesis of many human diseases. The nuclear factor erythroid 2-related factor 2 (Nrf2) is a key transcription factor regulating the intracellular antioxidant response and is an emerging target for the prevention and therapy of oxidative stress-related diseases. Salviae Miltiorrhizae Radix et Rhizoma (SMRR) is a traditional Chinese medicine (TCM) and is commonly used for the therapy of cardiac cerebral diseases. Cumulative evidences indicated that the extract of SMRR and its constituents, represented by lipophilic diterpenoid quinones and hydrophilic phenolic acids, were capable of activating Nrf2 and inhibiting oxidative stress...
2018: Oxidative Medicine and Cellular Longevity
https://www.readbyqxmd.com/read/30048261/incidence-of-peri-operative-paediatric-cardiac-arrest-influence-of-a-specialised-paediatric-anaesthesia-team
#19
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
https://www.readbyqxmd.com/read/30017533/2018-guidelines-of-the-taiwan-society-of-cardiology-taiwan-society-of-emergency-medicine-and-taiwan-society-of-cardiovascular-interventions-for-the-management-of-non-st-segment-elevation-acute-coronary-syndrome
#20
Yi-Heng Li, Yu-Chen Wang, Yi-Chih Wang, Ju-Chi Liu, Cheng-Han Lee, Chun-Chi Chen, I-Chang Hsieh, Feng-You Kuo, Wei-Chun Huang, Shih-Hsien Sung, Chiung-Zuan Chiu, Jung-Cheng Hsu, Shu-Long Jen, Juey-Jen Hwang, Jiunn-Lee Lin
In Taiwan, the incidence of non-ST segment elevation acute coronary syndrome (NSTE-ACS) continues to increase in recent years. The purpose of this guideline is to help health care professionals in Taiwan to use adequate tests and treatments for management of NSTE-ACS. For rapid diagnosis, in addition to history and physical examination, 0/3 h rapid diagnosis protocol with high sensitivity cardiac troponin assay is recommended in this guideline. Dual antiplatelet and anticoagulation therapies are important parts in the initial treatment...
September 2018: Journal of the Formosan Medical Association, Taiwan Yi Zhi
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