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https://www.readbyqxmd.com/read/29781051/prehospital-prediction-of-large-vessel-occlusion-in-suspected-stroke-patients
#1
REVIEW
Kevin J Keenan, Charles Kircher, Jason T McMullan
PURPOSE OF REVIEW: Recent advances in endovascular thrombectomy have made acute ischemic stroke due to a large vessel occlusion more treatable than ever. Rapid access to treatment remains paramount and multiple large vessel occlusion prediction scales have been created to enhance prehospital identification and triage of these patients. This review summarizes the current state of large vessel occlusion prediction scales, proposes a set of ideal scale features, and discusses the future of these scales and prehospital neurological emergency response systems...
May 21, 2018: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/29779831/interleukin-6-significantly-improves-predictive-value-of-systemic-inflammatory-response-syndrome-for-predicting-severe-acute-pancreatitis
#2
Saransh Jain, Shallu Midha, Soumya Jagannath Mahapatra, Swatantra Gupta, Manish Kumar Sharma, Baibaswata Nayak, Tony George Jacob, Shalimar, Pramod Kumar Garg
BACKGROUND: Predicting severe acute pancreatitis (AP) is important for triage, prognosis, and designing therapeutic trials. Persistent systemic inflammatory response syndrome (SIRS) predicts severe AP but its diagnostic accuracy is suboptimal. Our objective was to study if cytokine levels could improve the predictive value of clinical variables for the development of severe AP. METHODS: Consecutive patients with AP were included in a prospective cohort study at a tertiary care center...
May 14, 2018: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/29768477/faster-clinical-response-to-the-onset-of-adverse-events-a-wearable-metacognitive-attention-aid-for-nurse-triage-of-clinical-alarms
#3
Daniel C McFarlane, Alexa K Doig, James A Agutter, Lara M Brewer, Noah D Syroid, Ranjeev Mittu
OBJECTIVE: This study evaluates the potential for improving patient safety by introducing a metacognitive attention aid that enables clinicians to more easily access and use existing alarm/alert information. It is hypothesized that this introduction will enable clinicians to easily triage alarm/alert events and quickly recognize emergent opportunities to adapt care delivery. The resulting faster response to clinically important alarms/alerts has the potential to prevent adverse events and reduce healthcare costs...
2018: PloS One
https://www.readbyqxmd.com/read/29767322/management-of-cardiogenic-shock-complicating-myocardial-infarction
#4
REVIEW
Alexandre Mebazaa, Alain Combes, Sean van Diepen, Alexa Hollinger, Jaon N Katz, Giovanni Landoni, Ludhmila Abrahao Hajjar, Johan Lassus, Guillaume Lebreton, Gilles Montalescot, Jin Joo Park, Susanna Price, Alessandro Sionis, Demetris Yannopolos, Veli-Pekka Harjola, Bruno Levy, Holger Thiele
Up to 10% of acute coronary syndromes are complicated by cardiogenic shock (CS) with contemporary mortality rates of 40-50%. The extent of ischemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis in this patient population. Individualized patient risk assessment plays an important role in determining appropriate revascularization, drug treatment with inotropes and vasopressors, mechanical circulatory support, intensive care support of other organ systems, hospital level of care triage, and allocation of clinical resources...
May 16, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29766138/risk-stratification-tools-in-emergency-general-surgery
#5
REVIEW
Joaquim Michael Havens, Alexandra B Columbus, Anupamaa J Seshadri, Carlos V R Brown, Gail T Tominaga, Nathan T Mowery, Marie Crandall
The use of risk stratification tools (RST) aids in clinical triage, decision making and quality assessment in a wide variety of medical fields. Although emergency general surgery (EGS) is characterized by a comorbid, physiologically acute patient population with disparately high rates of perioperative morbidity and mortality, few RST have been explicitly examined in this setting. We examined the available RST with the intent of identifying a tool that comprehensively reflects an EGS patients perioperative risk for death or complication...
2018: Trauma surgery & acute care open
https://www.readbyqxmd.com/read/29765393/support-of-new-triage-protocol-among-acute-stroke-care-providers
#6
Haitham M Hussein, David C Anderson
Objective: We conducted an online survey to gauge the acceptance of sending acute stroke patients with suspected large vessel occlusion (LVO) directly to an endovascular-capable hospital (ECH) even if that means bypassing a closer alteplase-capable hospital (ACH) without endovascular capability. Methods: The survey was composed of two cases of acute stroke, one with cortical symptoms suggestive of LVO and the other without. In each case, responders were asked to choose between triaging to a closer ACH or an ECH that is further away and to provide an opinion regarding the maximum extra travel time they would tolerate if they chose the ECH...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29749756/sensitivity-and-specificity-of-the-manchester-triage-system-in-risk-prioritization-of-patients-with-acute-myocardial-infarction-who-present-with-chest-pain
#7
Fernanda A Nishi, Catarina Polak, Diná de Almeida Lopes Monteiro da Cruz
BACKGROUND: The purpose of the Manchester Triage System is to clinically prioritize each patient seeking care in an emergency department. Patients with suspected acute myocardial infarction who have typical symptoms including chest pain should be classified in the highest priority groups, requiring immediate medical assistance or care within 10 min. As such, the Manchester Triage System should present adequate sensitivity and specificity. AIMS: This study estimated the sensitivity and specificity of the Manchester Triage System in the triage of patients with chest pain related to the diagnosis of acute myocardial infarction, and the associations between the performance of the Manchester Triage System and selected variables...
May 1, 2018: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29729811/a-multicenter-program-to-implement-the-canadian-c-spine-rule-by-emergency-department-triage-nurses
#8
Ian G Stiell, Catherine M Clement, Maureen Lowe, Connor Sheehan, Jacqueline Miller, Sherry Armstrong, Brenda Bailey, Kerry Posselwhite, Jannick Langlais, Karin Ruddy, Susan Thorne, Alison Armstrong, Catherine Dain, Jeffrey J Perry, Christian Vaillancourt
STUDY OBJECTIVE: The Canadian C-Spine Rule has been widely applied by emergency physicians to safely reduce use of cervical spine imaging. Our objective is to evaluate the clinical effect and safety of real-time Canadian C-Spine Rule implementation by emergency department (ED) triage nurses to remove cervical spine immobilization. METHODS: We conducted this multicenter, 2-phase, prospective cohort program at 9 hospital EDs and included alert trauma patients presenting with neck pain or with cervical spine immobilization...
May 2, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29719875/using-an-original-triage-and-on-call-management-tool-aids-identification-and-assessment-of-the-acutely-unwell-surgical-patient
#9
Stacie Hodge, Sebastian Helliar, Hamish Ian Macdonald, Paul Mackey
Until now, there have been no published surgical triage tools. We have developed the first such tool with a tiered escalation policy, aiming to improve identification and management of critically unwell patients. The existing sheet which is used to track new referrals and admissions to the surgical assessment unit was reviewed. The sheet was updated and a traffic light triage tool generated using National Early Warning Scores (NEWS), sepsis criteria and user discretion. A tiered escalation policy to guide urgency of assessment was introduced and education sessions for all staff undertaken, to ensure understanding and compliance...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29716787/management-of-acute-retinal-ischemia-follow-the-guidelines
#10
REVIEW
Valérie Biousse, Fadi Nahab, Nancy J Newman
Acute retinal arterial ischemia, including vascular transient monocular vision loss (TMVL) and branch (BRAO) and central retinal arterial occlusions (CRAO), are ocular and systemic emergencies requiring immediate diagnosis and treatment. Guidelines recommend the combination of urgent brain magnetic resonance imaging with diffusion-weighted imaging, vascular imaging, and clinical assessment to identify TMVL, BRAO, and CRAO patients at highest risk for recurrent stroke, facilitating early preventive treatments to reduce the risk of subsequent stroke and cardiovascular events...
April 28, 2018: Ophthalmology
https://www.readbyqxmd.com/read/29716576/protocol-a-multi-level-intervention-program-to-reduce-stress-in-9-1-1-telecommunicators
#11
Hendrika Meischke, Michelle Lilly, Randal Beaton, Rebecca Calhoun, Ann Tu, Scott Stangenes, Ian Painter, Debra Revere, Janet Baseman
BACKGROUND: Nationwide, emergency response systems depend on 9-1-1 telecommunicators to prioritize, triage, and dispatch assistance to those in distress. 9-1-1 call center telecommunicators (TCs) are challenged by acute and chronic workplace stressors: tense interactions with citizen callers in crisis; overtime; shift-work; ever-changing technologies; and negative work culture, including co-worker conflict. This workforce is also subject to routine exposures to secondary traumatization while handling calls involving emergency situations and while making time urgent, high stake decisions over the phone...
May 2, 2018: BMC Public Health
https://www.readbyqxmd.com/read/29698506/external-validation-of-the-noblads-score-a-risk-scoring-system-for-severe-acute-lower-gastrointestinal-bleeding
#12
Tomonori Aoki, Atsuo Yamada, Naoyoshi Nagata, Ryota Niikura, Yoshihiro Hirata, Kazuhiko Koike
BACKGROUND: We aimed to evaluate the generalizability of NOBLADS, a severe lower gastrointestinal bleeding (LGIB) prediction model which we had previously derived when working at a different institution, using an external validation cohort. NOBLADS comprises the following factors: non-steroidal anti-inflammatory drug use, no diarrhea, no abdominal tenderness, blood pressure ≤ 100 mmHg, antiplatelet drug use, albumin < 3.0 g/dL, disease score ≥ 2, and syncope. METHODS: We retrospectively analyzed 511 patients emergently hospitalized for acute LGIB at the University of Tokyo Hospital, from January 2009 to August 2016...
2018: PloS One
https://www.readbyqxmd.com/read/29692931/the-reliability-of-the-use-of-serum-neutrophil-gelatinase-associated-lipocalin-levels-in-the-assessment-of-renal-functions-after-coronary-artery-bypass-grafting
#13
Ozan Onur Balkanay, Deniz Göksedef, Suat Nail Ömeroğlu, Gökhan İpek
Objective: Evaluation of perioperative renal function is very important for early diagnosis and treatment of acute kidney injury after coronary artery bypass grafting. Serum creatinine levels, creatinine clearance, and estimated glomerular filtration rates used in determination of postoperative kidney injury can lead to late detection. Therefore, it is necessary to make a diagnosis earlier in clinical practice and to search for a reliable method. The reliability of the use of serum neutrophil gelatinase-associated lipocalin levels in close follow-up of renal function was evaluated in patients with coronary artery bypass grafting under cardiopulmonary bypass in our study...
2018: Cardiology Research and Practice
https://www.readbyqxmd.com/read/29674417/value-of-quantitative-collateral-scoring-on-ct-angiography-in-patients-with-acute-ischemic-stroke
#14
A M M Boers, R Sales Barros, I G H Jansen, O A Berkhemer, L F M Beenen, B K Menon, D W J Dippel, A van der Lugt, W H van Zwam, Y B W E M Roos, R J van Oostenbrugge, C H Slump, C B L M Majoie, H A Marquering
BACKGROUND AND PURPOSE: Many studies have emphasized the relevance of collateral flow in patients presenting with acute ischemic stroke. Our aim was to evaluate the relationship of the quantitative collateral score on baseline CTA with the outcome of patients with acute ischemic stroke and test whether the timing of the CTA acquisition influences this relationship. MATERIALS AND METHODS: From the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) data base, all baseline thin-slice CTA images of patients with acute ischemic stroke with intracranial large-vessel occlusion were retrospectively collected...
April 19, 2018: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29668596/predictors-of-in-hospital-mortality-in-a-cohort-of-elderly-egyptian-patients-with-acute-upper-gastrointestinal-bleeding
#15
Mohamed A Elsebaey, Heba Elashry, Tamer A Elbedewy, Ahmed A Elhadidy, Noha E Esheba, Sherif Ezat, Manal Saad Negm, Yousry Esam-Eldin Abo-Amer, Mohamed El Abgeegy, Heba Fadl Elsergany, Loai Mansour, Sherief Abd-Elsalam
Acute upper gastrointestinal bleeding (UGIB) affects large number of elderly with high rates of morbidity and mortality. Early identification and management of the factors predicting in-hospital mortality might decrease mortality. This study was conducted to identify the causes of acute UGIB and the predictors of in-hospital mortality in elderly Egyptian patients.286 elderly patients with acute UGIB were divided into: bleeding variceal group (161 patients) and bleeding nonvariceal group (125 patients). Patients' monitoring was done during hospitalization to identify the risk factors that might predict in-hospital mortality in elderly...
April 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29667789/updates-and-controversies-in-the-management-of-acute-optic-neuritis
#16
Ethan Meltzer, Sashank Prasad
Optic neuritis remains a common diagnosis with controversial management. Although typical optic neuritis is often associated with "good" recovery of visual acuity, patients are often left with persistent impairments of contrast sensitivity, color vision, and visual field. These permanent visual deficits correlate with structural injury to the anterior visual pathway and are closely linked to visual quality of life. High dose corticosteroids are commonly used for patients with acute optic neuritis...
April 18, 2018: Asia-Pacific Journal of Ophthalmology
https://www.readbyqxmd.com/read/29661625/unusual-presentation-of-middle-east-respiratory-syndrome-coronavirus-leading-to-a-large-outbreak-in-riyadh-during-2017
#17
Hala Amer, Abdulrahman S Alqahtani, Hind Alzoman, Nawfal Aljerian, Ziad A Memish
BACKGROUND: The hallmark of Middle East respiratory syndrome coronavirus (MERS-CoV) disease is the ability to cause major health care-associated nosocomial outbreaks with superspreading events leading to massive numbers of cases and excessive morbidity and mortality. In this report, we describe a patient who presented with acute renal failure requiring hemodialysis and became a MERS-CoV superspreader, igniting a recent multihospital outbreak in Riyadh. MATERIAL AND RESULTS: Between May 31 and June 15, 2017, 44 cases of MERS-CoV infection were reported from 3 simultaneous clusters from 3 health care facilities in Riyadh, Saudi Arabia, including 11 fatal cases...
April 13, 2018: American Journal of Infection Control
https://www.readbyqxmd.com/read/29652166/ambulance-use-distance-and-outcomes-in-patients-with-suspected-cardiovascular-disease-a-registry-based-geographic-information-system-study
#18
Nariman Sepehrvand, Wendimagegn Alemayehu, Padma Kaul, Rick Pelletier, Aminu K Bello, Robert C Welsh, Paul W Armstrong, Justin A Ezekowitz
BACKGROUND: Despite guideline recommendations, the majority of patients with symptoms suggestive of acute coronary syndrome do not use emergency medical services to reach the emergency department (ED). The aim of this study was to investigate the factors associated with EMS utilisation and subsequent patient outcomes. METHODS: Using administrative data, all patients who presented to an ED in the metropolitan areas of Edmonton and Calgary in the years of 2007-2013 with main ED diagnosis of acute coronary syndrome, stable angina or chest pain were included...
April 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29652165/exploring-the-predictors-of-emergency-department-triage-acuity-assignment-in-patients-with-sepsis
#19
Leon Petruniak, Maher El-Masri, Susan Fox-Wasylyshyn
Background and purpose Evidence suggests that septic patients, who require prompt medical attention, may be undertriaged, resulting in delayed treatment. The purpose of this study was to examine patient and contextual variables that contribute to high- versus low-acuity triage classification of patients with sepsis. Methods Data were abstracted from the medical records of 154 adult patients with sepsis admitted to hospital through a Canadian Emergency Department. Logistic regression was used to explore the predictors of triage classification...
June 2018: Canadian Journal of Nursing Research, Revue Canadienne de Recherche en Sciences Infirmières
https://www.readbyqxmd.com/read/29651626/current-topics-in-the-management-of-acute-traumatic-spinal-cord-injury
#20
Christopher D Shank, Beverly C Walters, Mark N Hadley
Acute traumatic spinal cord injury (SCI) affects more than 250,000 people in the USA, with approximately 17,000 new cases each year. It continues to be one of the most significant causes of trauma-related morbidity and mortality. Despite the introduction of primary injury prevention education and vehicle safety devices, such as airbags and passive restraint systems, traumatic SCI continues to have a substantial impact on the healthcare system. Over the last three decades, there have been considerable advancements in the management of patients with traumatic SCI...
April 12, 2018: Neurocritical Care
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