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medical emergency

Chittaranjan Andrade
Patients with schizophrenia have increased prevalence rates for many cardiometabolic risk factors; the prevalence and severity of these risks increase after the institution of antipsychotic medication. Nearly 2 dozen different pharmacologic interventions have been trialed to prevent or attenuate antipsychotic-related cardiometabolic changes. Metformin (usually 1,000-1,500 mg/d) has emerged as the best-studied intervention; in short- and intermediate-duration randomized controlled trials, it has been shown to bring about improvements in weight and other anthropometric indices, in fasting sugar and other glycemic control indices, and in total cholesterol and other lipid metabolism indices...
September 2016: Journal of Clinical Psychiatry
Megan Johnson, Kenji Inaba, Saskya Byerly, Erika Falsgraf, Lydia Lam, Elizabeth Benjamin, Aaron Strumwasser, Jean-Stephane David, Demetrios Demetriades
Intraosseous (IO) needle placement is an alternative for patients with difficult venous access. The purpose of this retrospective study was to examine indications and outcomes associated with IO use at a Level 1 trauma center (January 2008-May 2015). Data points included demographics, time to insertion, intravenous (IV) access points, indications, infusions, hospital and intensive care unit length of stay, and mortality. Of 68 patients with IO insertion analyzed (63.2% blunt trauma, 29.4% penetrating trauma, and 7...
October 2016: American Surgeon
Ara Ko, Megan Y Harada, Eric J T Smith, Michael Scheipe, Rodrigo F Alban, Nicolas Melo, Daniel R Margulies, Eric J Ley
Elderly trauma patients may be at increased risk for underassessment and inadequate pain control in the emergency department (ED). We sought to characterize risk factors for oligoanalgesia in the ED in elderly trauma patients and determine whether it impacts outcomes in elderly trauma patients. We included elderly patients (age ≥55 years) with Glasgow Coma Scale scores 13 to 15 and Injury Severity Score (ISS) ≥9 admitted through the ED at a Level I trauma center. Patient characteristics and outcomes were compared between those who reported pain and received analgesics medication in the ED (MED) and those who did not (NO MED)...
October 2016: American Surgeon
Monica Chahal-Kummen, Trond-Eirik Strand, Jan Ove Owe, Eigil Gulliksen, Anthony S Wagstaff
BACKGROUND: A candidate with paraplegia contacted the Institute of Aviation Medicine, Oslo, requesting a medical examination and medical certification for flying back seat on an F-16 Fighting Falcon. Thorough aeromedical examinations, including specialist evaluations, were initiated for the final decision to be made. CASE REPORT: Almost 13 yr earlier the candidate had acquired spinal cord damage at neurological level L1 after falling 4 m (13 ft) from out of a window...
2016: Aerospace Medicine and Human Performance
Alejandro Garbino, Derek M Nusbaum, Daniel M Buckland, Anil S Menon, Jonathan B Clark, Erik L Antonsen
The Stratex Project is a high altitude balloon flight that culminated in a freefall from 41,422 m (135,890 ft), breaking the record for the highest freefall to date. Crew recovery operations required an innovative approach due to the unique nature of the event as well as the equipment involved. The parachutist donned a custom space suit similar to a NASA Extravehicular Mobility Unit (EMU), with life support system mounted to the front and a parachute on the back. This space suit had a metal structure around the torso, which, in conjunction with the parachute and life support assembly, created a significant barrier to extraction from the suit in the event of a medical emergency...
2016: Aerospace Medicine and Human Performance
Emily E Whitgob, Rebecca L Blankenburg, Alyssa L Bogetz
PURPOSE: Trainee mistreatment remains an important and serious medical education issue. Mistreatment toward trainees by the medical team has been described; mistreatment by patients and families has not. Motivated by discrimination towards a resident by a family in their emergency department, the authors sought to identify strategies for trainees and physicians to respond effectively to mistreatment by patients and families. METHOD: A purposeful sample of pediatric faculty educational leaders was recruited from April-June 2014 at Stanford University...
November 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Anatoly Margolis, Paola Rosca, Rena Kurs, Sharon R Sznitman, Alexander Grinshpoon
OBJECTIVE: This study investigates the proportion of drug users among patients with mental disorders that attended the emergency department of one major psychiatric hospital in Northern Israel, the most frequent psychiatric diagnoses associated with drug use and the impact of confirmed drug use on hospital admission. We hypothesized that the proportion of individuals with positive urine drug test results presenting at the psychiatric emergency department during the study period would be 20-30%...
October 25, 2016: Journal of Dual Diagnosis
A Honig, D Sierink, B Verwey
Care provided by consultation-liaison (CL) psychiatry and general hospital (GH) psychiatry varies widely. This means that certain services are almost unrecognisable and therefore less readily available to patients. <br/> AIM: To describe the core tasks of current CL- and GH-psychiatry care and to suggest how these tasks can best be performed and developed in the future.<br/> METHOD: We conducted a selective review of relevant CL- and GH-related literature and combined the information we obtained with the results of a consultation with CL-psychiatrists about how CL- and GL psychiatry should function in the future...
2016: Tijdschrift Voor Psychiatrie
Sung Phil Chung, Je Sung You
We are pleased that Zeng et al. have taken an interest in our paper. As Zeng et al. pointed out, the mean platelet volume (MPV) is a crucial parameter that reflects platelet size and activation [1]. Recently, MPV has also been highlighted as a critical inflammatory marker in infectious, cardiovascular, and immunological diseases [2-5]. We also recognize that changes in MPV may be influenced by disease conditions, current medications, and environments. Although we retrospectively analyzed the Cardiac Arrest Registry in our emergency department, which prospectively collects critical data of patients with out-of-hospital cardiac arrest (OHCA), our registry was simply composed of traditional Utstein style data and frequently used information in the OHCA study because the registry is not intended for providing evidence of the usefulness of MPV as a marker of clinical outcomes after OHCA [1]...
October 25, 2016: Journal of Thrombosis and Haemostasis: JTH
Nandini Venkateswaran, Rachel A F Wozniak, Holly B Hindman
Purpose. To describe a unique case of O. anthropi keratitis associated with a rare manifestation of Descemet's membrane detachment and intracorneal hypopyon and to discuss challenges in diagnosis and management. Methods. Best-corrected visual acuity was measured with Snellen letters. Corneal scrapings were performed and aerobic, viral, herpetic, acid-fast bacilli, Acanthamoeba, and fungal stains and cultures were obtained. Following evisceration, tissue was evaluated for histologic features and again stained for bacteria, mycobacteria, Acanthamoeba, fungi, and viral particles...
2016: Case Reports in Ophthalmological Medicine
Ali Taghizadieh, Mahboub Pouraghaei, Payman Moharamzadeh, Alireza Ala, Farzad Rahmani, Karim Basiri Sofiani
Introduction: The routine and gold standard method to diagnose of acid - base disturbance is arterial blood gas (ABG) sampling. Capnography could be used to measure the end-tidal carbon dioxide (ETCO2) levels and ETco2 has a close correlation with the PaCo2. The aim of this study was comparison the ETco2 and arterial blood bicarbonate levels in patients with metabolic acidosis. Methods: In a descriptive-analytical study that performed in Emergency Department of Emam Reza Medical Research and Training Hospital of Tabriz on patients with metabolic acidosis, ETco2 level and blood bicarbonate levels in 262 patients were evaluated...
2016: Journal of Cardiovascular and Thoracic Research
Francis L Counselman, Terry Kowalenko, Catherine A Marco, Kevin B Joldersma, Robert C Korte, Earl J Reisdorff
BACKGROUND : In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted requirements that limited the number of hours residents could spend on duty, and in 2011, it revised these requirements. OBJECTIVE : This study explored whether the implementation of the 2003 and 2011 duty hour limits was associated with a change in emergency medicine residents' performance on the American Board of Emergency Medicine (ABEM) Qualifying Examination (QE)...
October 2016: Journal of Graduate Medical Education
Marek L Kowalski, Ignacio Ansotegui, Werner Aberer, Mona Al-Ahmad, Mubeccel Akdis, Barbara K Ballmer-Weber, Kirsten Beyer, Miguel Blanca, Simon Brown, Chaweewan Bunnag, Arnaldo Capriles Hulett, Mariana Castells, Hiok Hee Chng, Frederic De Blay, Motohiro Ebisawa, Stanley Fineman, David B K Golden, Tari Haahtela, Michael Kaliner, Connie Katelaris, Bee Wah Lee, Joanna Makowska, Ulrich Muller, Joaquim Mullol, John Oppenheimer, Hae-Sim Park, James Parkerson, Giovanni Passalacqua, Ruby Pawankar, Harald Renz, Franziska Rueff, Mario Sanchez-Borges, Joaquin Sastre, Glenis Scadding, Scott Sicherer, Pongsakorn Tantilipikorn, James Tracy, Vera van Kempen, Barbara Bohle, G Walter Canonica, Luis Caraballo, Maximiliano Gomez, Komei Ito, Erika Jensen-Jarolim, Mark Larche, Giovanni Melioli, Lars K Poulsen, Rudolf Valenta, Torsten Zuberbier
One of the major concerns in the practice of allergy is related to the safety of procedures for the diagnosis and treatment of allergic disease. Management (diagnosis and treatment) of hypersensitivity disorders involves often intentional exposure to potentially allergenic substances (during skin testing), deliberate induction in the office of allergic symptoms to offending compounds (provocation tests) or intentional application of potentially dangerous substances (allergy vaccine) to sensitized patients. These situations may be associated with a significant risk of unwanted, excessive or even dangerous reactions, which in many instances cannot be completely avoided...
2016: World Allergy Organization Journal
Chien Chuang, Wen-Chien Fan, Yi-Tsung Lin, Fu-Der Wang
BACKGROUND: Klebsiella pneumoniae is the most common pathogen of community-acquired pyogenic liver abscess in East Asia. Diabetes mellitus (DM) is a well-established risk factor for K. pneumoniae liver abscess (KPLA). However, reports regarding the emergence of KPLA in non-diabetic patients are limited. RESULTS: A total 230 patients with KPLA from a medical center in Taiwan were identified retrospectively. The rate of DM in patients with KPLA was 44.4 % in 2011, 57...
2016: Gut Pathogens
K A Hollowed, T E Travis, M H Jordan, J W Shupp
Education of first responders and referring medical professionals is considered vital to high-quality burn care. Prior to 1999, the community education program at The Burn Center of MedStar Washington Hospital Center (MWHC) was staffed by ICU nurses who volunteered their time. As the program became more popular in the mid-1990s, the requests for lectures exceeded the capacity of a volunteer program. A request to hospital administration for a full-time education coordinator position was rejected in the climate of budget cut-backs and declining reimbursement...
December 31, 2015: Annals of Burns and Fire Disasters
Sameer Arora, Amol A Bahekar
The management of concomitant obstructive coronary artery disease and severe aortic stenosis in poor surgical candidates is an evolving topic. Although the typical current practice is to perform percutaneous revascularization before transcatheter aortic valve replacement (TAVR), some data have emerged regarding revascularization after performing TAVR. We present the case of a 90-year-old man with multivessel coronary artery disease who was at prohibitive risk for surgical aortic valve replacement. We first performed TAVR with use of hemodynamic support, then Impella-assisted multivessel percutaneous coronary intervention on the patient's unprotected left main coronary artery...
October 2016: Texas Heart Institute Journal
J Czamanski-Cohen, K L Weihs
This paper introduces the Bodymind model of Art Therapy and delineates the processes through which it has salutary effects on individuals coping with a variety of health related challenges. The goal of this model is to articulate how activation, reorganization, growth and reintegration of the self can emerge from bodymind processes activated by art therapy. It provides a framework for the conduct of research that will test the key theoretical mechanisms through which art therapy benefits clients. We expect this model to be a spring board for discussion, debate and development of the profession of art therapy...
September 2016: Arts in Psychotherapy
Takeshi Nishimura, Keisuke Kohama, Takaaki Osako, Taihei Yamada, Hiroyuki Tanaka, Atsunori Nakao, Joji Kotani
Advances in critical care medicine have made it possible to sustain vital organ systems in brain-dead patients. One clinical scenario besides donor organ retrieval in which a benefit may be gained from continuing life support is pregnancy. A pregnant woman in her late 30's at 23 weeks gestation exhibiting worsening depression was referred to the Department of Psychiatry. One day after admission she attempted suicide by hanging and suffered a cardiopulmonary arrest. A fetal heart beat and fetal motion was confirmed immediately after resuscitation...
October 2016: Acta Medica Okayama
Kate Brameld, Katrina Spilsbury, Lorna Rosenwax, Kevin Murray, James Semmens
BACKGROUND: Studies aiming to identify palliative care populations have used data from death certificates and in some cases hospital records. The size and characteristics of the identified populations can show considerable variation depending on the data sources used. It is important that service planners and researchers are aware of this. AIM: To illustrate the differences in the size and characteristics of a potential palliative care population depending on the differential use of linked hospital records and death certificate data...
October 24, 2016: Palliative Medicine
Laura Housden, Sabrina T Wong, Annette J Browne, Martin Dawes
In Canada, increasing numbers of people with chronic conditions have prompted calls for innovative approaches to delivering primary care. These approaches may include group medical visits (GMVs) and the introduction of nurse practitioners (NPs). We examined why NPs in the province of British Columbia were not using GMVs. This case study is part of a larger research project that examined the impact of GMVs with NPs for patients with chronic conditions. We completed open-ended interviews with seven NPs working in primary care...
October 24, 2016: Policy, Politics & Nursing Practice
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