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Resuscitation documentation

David Picker, Maria Dans, Kevin Heard, Thomas Bailey, Yixin Chen, Chenyang Lu, Marin H Kollef
OBJECTIVE: To determine whether an Early Warning System could identify patients wishing to focus on palliative care measures. DESIGN: Prospective, randomized, pilot study. SETTING: Barnes-Jewish Hospital, Saint Louis, MO (January 15, 2015, to December 12, 2015). PATIENTS: A total of 206 patients; 89 intervention (43.2%) and 117 controls (56.8%). INTERVENTIONS: Palliative care in high-risk patients targeted by an Early Warning System...
October 20, 2016: Critical Care Medicine
Alan M Batt, Ahmed S Al-Hajeri, Fergal H Cummins
To report the characteristics of out-of-hospital cardiac arrest patients and their outcomes in the emirates of Sharjah, Ras-al-Khaimah, Umm Al-Quwain, Fujairah, and Ajman in the United Arab Emirates (collectively known as the Northern Emirates). Methods: This is a prospective descriptive cohort study of out-of-hospital cardiac arrest incidents transported by the national ambulance crews between February 2014 and March 2015 in the Northern Emirates. Results: A total of 384 patients were enrolled in this study...
November 2016: Saudi Medical Journal
Amber Mills, Anne Walker, Michele Levinson, Alison M Hutchinson, Gemma Stephenson, Anthea Gellie, George Heriot, Harvey Newnham, Megan Robertson
OBJECTIVE: To determine the prevalence of resuscitation orders and Advance Care Plans, and the relationship with Medical Emergency Team (MET) calls. METHOD: A point prevalence review of patient records at five Victorian hospital services. RESULTS: One thousand nine hundred and thirty-four patient records were reviewed, and 230 resuscitation orders and 15 Advance Care Plans found. Significantly, more resuscitation orders were found at public hospitals...
October 19, 2016: Australasian Journal on Ageing
Lori A Stolz, Uwe Stolz, J Matthew Fields, Turandot Saul, Michael Secko, Matthew J Flannigan, Johnathan M Sheele, Robert P Rifenburg, Anthony J Weekes, Elaine B Josephson, John Bedolla, Dana M Resop, Jonathan Dela Cruz, Megan Boysen-Osborn, Terrell Caffery, Charlotte Derr, Rimon Bengiamin, Gerardo Chiricolo, Brandon Backlund, Jagdipak Heer, Robert J Hyde, Srikar Adhikari
OBJECTIVES: Emergency ultrasound (EUS) has been recognized as integral to the training and practice of emergency medicine (EM). The Council of Emergency Medicine Residency-Academy of Emergency Ultrasound (CORD-AEUS) consensus document provides guidelines for resident assessment and progression. The Accredited Council for Graduate Medical Education (ACGME) has adopted the EM Milestones for assessment of residents' progress during their residency training which includes demonstration of procedural competency in bedside ultrasound...
October 14, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Akwugo A Eziefule, Solafa Elshatanoufy, Mili Thakur, Frederico G Rocha
Background Propofol is a widely known, commonly used drug. Complications can occur with the use of this drug, including propofol-related infusion syndrome (PRIS). PRIS, in the obstetric population, has not been documented; however, we report a case of a patient who developed PRIS after an emergent cesarean delivery of a preterm infant. Case Study A 35-year-old multigravida woman presented complaining of leakage of fluid and decreased fetal movement. Her pregnancy was complicated by methadone maintenance therapy due to a history of opioid abuse...
October 2016: American Journal of Perinatology Reports
Kaisa Rajala, Juho T Lehto, M Saarinen, E Sutinen, T Saarto, M Myllärniemi
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with median survival from 2 to 7 years. Palliative care is an important part of patients´ care as lung transplantation is not an option for the majority of patients. The aim of this study was to describe treatment practices, decision-making and symptoms during end-of-life care of IPF patients. METHODS: We identified 59 deceased patients from a national prospective IPF cohort study (FinnishIPF) and analyzed retrospectively their health care documentation during the 6 months that preceded death...
October 12, 2016: BMC Palliative Care
Julie C McDonald, Jeanne M du Manoir, Nanor Kevork, Lisa W Le, Camilla Zimmermann
PURPOSE: The purposes of the study were to assess awareness and prevalence of advance directives (ADs) among patients with advanced cancer undergoing active outpatient care and to determine factors associated with AD completion before and after the diagnosis of cancer. METHODS: Patients with advanced solid tumor malignancy receiving treatment at the Chemotherapy Day Unit were approached for recruitment. They completed an onsite questionnaire about completion and timing of ADs, demographic information, and perceived health; a review of their medical records was conducted to document their cancer care and co-morbidities...
October 7, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Nicholas Waldron, Claire E Johnson, Peter Saul, Heidi Waldron, Jeffrey C Chong, Anne-Marie Hill, Barbara Hayes
BACKGROUND: Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. METHODS: Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature...
October 6, 2016: BMC Health Services Research
Kaci Osenga, Andrea Postier, Jill Dreyfus, Laurie Foster, Wrenda Teeple, Stefan J Friedrichsdorf
CONTEXT: Specialized pediatric palliative care (PPC) services have become more common in urban pediatric hospital settings, though little is known about palliative care specialist involvement. OBJECTIVES: The objective of this study was to compare circumstances prior to death in children who spent their last days of life in an inpatient pediatric hospital setting, with or without PPC provider involvement during their inpatient stay. METHODS: Retrospective chart review of medical records of children for the last inpatient stay that resulted in death at a children's hospital setting between January 2012 through June 2013...
September 29, 2016: Journal of Pain and Symptom Management
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
Dara L Gottlieb, Jennifer Prittie, Yekaterina Buriko, Kenneth E Lamb
OBJECTIVE: To evaluate the presence of acute traumatic coagulopathy (ATC) in dogs and cats following blunt trauma and to relate coagulation variables with injury severity and admission variables. DESIGN: Prospective, single center, observational study from 2013 to 2014. SETTING: Urban private referral hospital. ANIMALS: Eighteen and 19 client-owned dogs and cats, respectively, sustaining blunt trauma within 8 hours of presentation without prior resuscitation; 17 healthy staff and client-owned control cats METHODS: Blood samples were collected upon presentation for measurement of blood gas, lactate, blood glucose, ionized calcium, PCV, total plasma protein, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, platelet count, and thromboelastography...
September 30, 2016: Journal of Veterinary Emergency and Critical Care
Anne E Sales, Mary Ersek, Orna K Intrator, Cari Levy, Joan G Carpenter, Robert Hogikyan, Helen C Kales, Zach Landis-Lewis, Tobie Olsan, Susan C Miller, Marcos Montagnini, Vyjeyanthi S Periyakoil, Sheri Reder
BACKGROUND: The program "Implementing Goals of Care Conversations with Veterans in VA LTC Settings" is proposed in partnership with the US Veterans Health Administration (VA) National Center for Ethics in Health Care and the Geriatrics and Extended Care Program Offices, together with the VA Office of Nursing Services. The three projects in this program are designed to support a new system-wide mandate requiring providers to conduct and systematically record conversations with veterans about their preferences for care, particularly life-sustaining treatments...
September 29, 2016: Implementation Science: IS
Richa Gangwar, Sarita Chaudhary
BACKGROUND: The main documented indication of intrapartum caesarean section is foetal distress (MacKenzie and Cooke in BMJ 323(7318):930, 2001). Foetal distress indicates foetal hypoxia and acidosis during intrauterine life. PURPOSE: To correlate the diagnosis of foetal distress and perinatal outcome. METHODS: This was a prospective observational study of women who underwent caesarean section for foetal distress as detected by cardiotocography and not responding to intrauterine resuscitation...
October 2016: Journal of Obstetrics and Gynaecology of India
L Lagunes, A Rey-Pérez, M T Martín-Gómez, A Vena, V de Egea, P Muñoz, E Bouza, A Díaz-Martín, I Palacios-García, J Garnacho-Montero, M Campins, M Bassetti, J Rello
Early empiric therapy and adequate resuscitation have been identified as main predictors of outcome in patients with candidemia or bacteremia. Moreover, source control is a major determinant in infectious sites when feasible, as a main technique to reduce microbiological burden. A retrospective, multicenter, cohort study was performed at surgical wards and intensive care units (ICU) of three University Hospitals in Spain between 2010 and 2014, with the aim of improving understanding of the interaction between source control, early antifungal therapy, and use of vasoactives in patients with intra-abdominal candidiasis (IAC)...
September 21, 2016: European Journal of Clinical Microbiology & Infectious Diseases
Ayan Sen, Christopher M Keener, Florentina E Sileanu, Emily Foldes, Gilles Clermont, Raghavan Murugan, John A Kellum
OBJECTIVE: We sought to investigate if the chloride content of fluids used in resuscitation was associated with short- and long-term outcomes. DESIGN: We identified patients who received large-volume fluid resuscitation, defined as greater than 60 mL/kg over a 24-hour period. Chloride load was determined for each patient based on the chloride ion concentration of the fluids they received during large-volume fluid resuscitation multiplied by the volume of fluids...
September 15, 2016: Critical Care Medicine
Sebastien Tanaka, Etienne Escudier, Sophie Hamada, Anatole Harrois, Pierre Etienne Leblanc, Eric Vicaut, Jacques Duranteau
OBJECTIVES: The effects of RBC transfusion on microvascular perfusion are not well documented. We investigated the effect of RBC transfusion on sublingual microcirculation in hemorrhagic shock patients. DESIGN: Prospective, preliminary observational study. SETTINGS: A 28-bed, surgical ICU in a university hospital. PATIENTS: Fifteen hemorrhagic shock patients requiring RBC transfusion. INTERVENTION: Transfusion of one unit of RBCs...
September 15, 2016: Critical Care Medicine
Peter Paal, Les Gordon, Giacomo Strapazzon, Monika Brodmann Maeder, Gabriel Putzer, Beat Walpoth, Michael Wanscher, Doug Brown, Michael Holzer, Gregor Broessner, Hermann Brugger
BACKGROUND: This paper provides an up-to-date review of the management and outcome of accidental hypothermia patients with and without cardiac arrest. METHODS: The authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review. RESULTS: The hospital use of minimally-invasive rewarming for non-arrested, otherwise healthy, patients with primary hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients...
September 15, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Timothy F Platts-Mills, Natalie L Richmond, Eric M LeFebvre, Sowmya A Mangipudi, Allison G Hollowell, Debbie Travers, Kevin Biese, Laura C Hanson, Angelo E Volandes
INTRODUCTION: Increasing advance care planning (ACP) among older adults is a national priority. Documentation of ACP in the electronic health record (EHR) is particularly important during emergency care. OBJECTIVE: We sought to characterize completion and availability of ACP among a subset of older patients at an academic emergency department (ED) with an integrated EHR. METHODS: In this cross-sectional study, patients were eligible if aged ≥80 years or aged 65-79 with ≥1 indicator of high risk for short-term mortality...
September 13, 2016: Journal of Palliative Medicine
Bobby Daly, Andrew Hantel, Kristen Wroblewski, Jay S Balachandran, Selina Chow, Rebecca DeBoer, Gini F Fleming, Olwen M Hahn, Justin Kline, Hongtao Liu, Bhakti K Patel, Anshu Verma, Leah J Witt, Mayumi Fukui, Aditi Kumar, Michael D Howell, Blase N Polite
PURPOSE: Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs. METHODS: This was a retrospective case series of patients cared for in an academic medical center's ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient's electronic health record from 3 months preceding terminal hospitalization until death...
September 6, 2016: Journal of Oncology Practice
Charles D Deakin, Jie Yang, Robert Nguyen, Jiawen Zhu, Stephen J Brett, Jerry P Nolan, Gavin D Perkins, David G Pogson, Sam Parnia
BACKGROUND: Epinephrine has been presumed to improve cerebral oxygen delivery during cardiopulmonary resuscitation (CPR), but animal and registry studies suggest that epinephrine-induced capillary vasoconstriction may decrease cerebral capillary blood flow and worsen neurological outcome. The effect of epinephrine on cerebral oxygenation (rSO2) during CPR has not been documented in the clinical setting. METHODS: rSO2 was measured continuously using cerebral oximetry in patients with in-hospital cardiac arrest...
August 31, 2016: Resuscitation
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