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EMERGENCY ECG

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https://www.readbyqxmd.com/read/29149877/key-bottlenecks-to-the-provision-of-safe-obstetric-anaesthesia-in-low-income-countries-a-cross-sectional-survey-of-64-hospitals-in-uganda
#1
Isabella Epiu, Agnes Wabule, Andrew Kambugu, Harriet Mayanja-Kizza, Jossy Verel Bahe Tindimwebwa, Gerald Dubowitz
BACKGROUND: Despite recent advances in surgery and anaesthesia which significantly improve safety, many health facilities in low-and middle-income countries (LMICs) remain chronically under-resourced with inability to cope effectively with serious obstetric complications (Knight et al., PLoS One 8:e63846, 2013). As a result many of these countries still have unacceptably high maternal and neonatal mortality rates. Recent data at the national referral hospitals in East Africa reported that none of the national referral hospitals met the World Federation of Societies of Anesthesiologists (WFSA) international standards required to provide safe obstetric anaesthesia (Epiu I: Challenges of Anesthesia in Low-and Middle-Income Countries...
November 17, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29138794/noninvasive-cardiac-testing-vs-clinical-evaluation-alone-in-acute-chest-pain-a-secondary-analysis-of-the-romicat-ii-randomized-clinical-trial
#2
Samuel W Reinhardt, Chien-Jung Lin, Eric Novak, David L Brown
Importance: The incremental benefit of noninvasive testing in addition to clinical evaluation (history, physical examination, an electrocardiogram [ECG], and biomarker assessment) vs clinical evaluation alone for patients who present to the emergency department (ED) with acute chest pain is unknown. Objective: To examine differences in outcomes with clinical evaluation and noninvasive testing (coronary computed tomographic angiography [CCTA] or stress testing) vs clinical evaluation alone...
November 14, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29138649/-clinical-and-electrocardiographic-aspect-of-pulmonary-embolism-masking-aortic-dissection-revealed-by-thoracic-ct-angiography
#3
Daniella Rakotoniaina Masinarivo, Jenny Larissa Rakotomanana
We here report the case of a 52-year old hypertensive, obese woman (BMI 32,46 kg/m(2)) with a past history of smoking and without evidence-based risk factors of venous thromboembolism, hospitalized for left chest pain radiating to the dorsolumbar region associated with dyspnoea. Clinical examination on hopitalization showed left blood pressure 100/60 mmHg, tachycardia 100/min, oxygen desaturation index at 88% with the patient breathing ambient air, normal cardiopulmonary auscultation, peripheral pulses palpable and no symptoms of phlebitis of the lower limbs...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/29132988/safety-and-immunogenicity-of-a-novel-multiple-antigen-pneumococcal-vaccine-in-adults-a-phase-1-randomised-clinical-trial
#4
Claire Entwisle, Sue Hill, Yin Pang, Michael Joachim, Ann McIlgorm, Camilo Colaco, David Goldblatt, Polly De Gorguette D'Argoeuves, Chris Bailey
BACKGROUND: Pneumococcal vaccines, combining multiple protein antigens, provide an alternative approach to currently marketed vaccines and may provide broader protection against pneumococcal disease. This trial evaluated the safety and immunogenicity of a novel vaccine candidate PnuBioVax in healthy young adults. METHODS: In a Phase 1 double-blind study, 36 subjects (18-40 years) were randomised to receive 3 doses of PnuBioVax, 28 days apart, at one of three dose levels (50, 200, 500 µg) or placebo...
November 10, 2017: Vaccine
https://www.readbyqxmd.com/read/29131477/a-risk-assessment-score-and-initial-high-sensitivity-troponin-combine-to-identify-low-risk-of-acute-myocardial-infarction-in-the-emergency-department
#5
John W Pickering, Dylan Flaws, Stephen W Smith, Jaimi Greenslade, Louise Cullen, William Parsonage, Edward Carlton, A Mark Richards, Richard Troughton, Christopher Pemberton, Peter M George, Martin P Than
OBJECTIVES: Early discharge of patients with presentations triggering assessment for possible acute coronary syndrome is safe when clinical assessment indicates low-risk, biomarkers are negative, and electrocardiograms (ECGs) are non-ischemic. We hypothesized that the Emergency Department Assessment of Chest Pain Score (EDACS) combined with a single measurement of high-sensitivity cardiac troponin (hs-cTn) could allow early discharge of a clinically meaningful proportion of patients. METHODS: We pooled data from 4 patient cohorts from New Zealand and Australia presenting to an ED with symptoms suggestive of ACS...
November 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29127129/heart-failure-in-dilated-cardiomyopathy-mimicking-asthma-triggered-by-pneumonia
#6
Kenichi Tetsuhara, Satoshi Tsuji, Katsutoshi Nakano, Mitsuru Kubota
Heart failure is a rare cause of wheezing and may develop into a critical condition in children. Few cases report patients with heart failure, secondary to dilated cardiomyopathy, with high fever. A 23-month-old girl visited the emergency department with high fever, cough, first wheezing episode, chest retraction and tachycardia. The chest X-ray revealed consolidation on the left lower lung field; the cardiothoracic ratio was 60%. She was diagnosed with bronchial asthma triggered by pneumonia, which remained unchanged during four visits...
November 9, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29119778/correlation-between-concentration-of-air-pollutants-and-occurrence-of-cardiac-arrhythmias-in-a-region-with-humid-continental-climate
#7
Marijana Knezović, Sanja Pintarić, Marko Mornar Jelavić, Višnja Nesek, Goran Krstačić, Mislav Vrsalović, Aljoša Šikić, Ivan Zeljković, Hrvoje Pintarić
In this study, we investigated the correlation of air temperature, pressure and concentration of air pollutants with the rate of admissions for cardiac arrhythmias at two clinical centers in the area with a humid continental climate. This retrospective study included 3749 patients with arrhythmias admitted to emergency department (ED). They were classified into four groups: supraventricular tachycardia (SVT), ventricular tachycardia (VT), atrial fibrillation/undulation (Afib/Aund), and palpitations (with no ECG changes, or with sinus tachycardia and extrasystoles)...
March 2017: Acta Clinica Croatica
https://www.readbyqxmd.com/read/29116311/cardiovascular-emergencies-in-primary-care-an-observational-retrospective-study-of-a-large-scale-telecardiology-service
#8
Milena Soriano Marcolino, Thales Matheus Mendonça Santos, Fernanda Cotrim Stefanelli, João Antonio de Queiroz Oliveira, Maíra Viana Rego Souza E Silva, Diomildo Ferreira Andrade, Grace Kelly Matos E Silva, Antonio Luiz Ribeiro
BACKGROUND: Electrocardiograms (ECGs) are an essential examination for identification and management of cardiovascular emergencies.The aim of this study was to report on the frequency and recognition of cardiovascular emergencies in primary care units. DESIGN AND SETTING: Observational retrospective study assessing consecutive patients whose digital ECGs were sent for analysis to the team of the Telehealth Network of Minas Gerais. METHODS: Data from patients diagnosed with cardiological emergencies in the primary care setting of 750 municipalities in Minas Gerais, Brazil, between March and September 2015, were collected via telephone contact with the healthcare practitioner who performed the ECG...
November 6, 2017: São Paulo Medical Journal, Revista Paulista de Medicina
https://www.readbyqxmd.com/read/29115767/care-delays-in-patients-with-signs-and-symptoms-of-acute-myocardial-infarction
#9
Susan Sanders
AIM: More than six million patients with signs and symptoms suggestive of a heart attack present to emergency departments (EDs) in the US each year. Of those diagnosed with acute myocardial infarction (AMI), one third die in the acute phase. Rapid ED triage can reduce the mortality rate, yet there are still delays in patient care. The aim of this study is to explore the relationship between patient and nurse characteristics, patient presentations, delays in triage, and delays in obtaining electrocardiograms (ECGs) of patients with signs and symptoms of AMI...
October 12, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/29113701/electrocardiographic-patterns-in-biventricular-pacing-delivered-by-second-generation-cardiac-resynchronization-devices
#10
Amirfarjam Fazelifar, Fatemeh Jorfi, Majid Haghjoo
BACKGROUND: With increasing use of cardiac resynchronization therapy (CRT), treating physicians should be familiar with different electrocardiographic (ECG) patterns of left ventricular (LV) lead and biventricular (BiV) pacing. However, there are a few publications on ECG patterns during BiV pacing. PURPOSE: This study was sought to determine different ECG patterns in patients with BiV pacing. METHODS: Twelve-lead ECGs during BiV pacing (right ventricular leads at apex and LV leads in one of the lateral coronary veins) were analyzed in 181 consecutive patients (121 male; mean age, 62...
November 4, 2017: Indian Pacing and Electrophysiology Journal
https://www.readbyqxmd.com/read/29107482/prevalence-and-outcome-of-high-risk-qt-prolongation-recorded-in-the-emergency-department-from-an-institution-wide-qt-alert-system
#11
Heather N Anderson, J Martijn Bos, Kristina H Haugaa, Bruce W Morlan, Robert F Tarrell, Pedro J Caraballo, Michael J Ackerman
BACKGROUND: QT prolongation is an independent risk factor for sudden death, stroke, and all-cause mortality. However, additional studies have shown that in certain settings, QT prolongation may be transient and a result of external factors. OBJECTIVE: In this study, we evaluated the clinical characteristics and outcomes of patients seen in the emergency department (ED) with QT prolongation. METHODS: Between November 2010 and June 2011, 7522 patients had an electrocardiogram (ECG) obtained during their evaluation in the ED...
October 26, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29096909/-assessment-of-mood-disorders-by-passive-data-gathering-the-concept-of-digital-phenotype-versus-psychiatrist-s-professional-culture
#12
A Bourla, F Ferreri, L Ogorzelec, C Guinchard, S Mouchabac
OBJECTIVES: The search for objective clinical signs is a constant practitioners' and researchers' concern in psychiatry. New technologies (embedded sensors, artificial intelligence) give an easier access to untapped information such as passive data (i.e. that do not require patient intervention). The concept of "digital phenotype" is emerging in psychiatry: a psychomotor alteration translated by accelerometer's modifications contrasting with the usual functioning of the subject, or the graphorrhea of patients presenting a manic episode which is replaced by an increase of SMS sent...
October 30, 2017: L'Encéphale
https://www.readbyqxmd.com/read/29077146/study-on-the-effect-of-different-doses-of-rosuvastatin-on-ventricular-remodeling-in-patients-with-acute-coronary-syndrome-after-emergency-percutaneous-coronary-intervention
#13
J Guo, W-Z Zhang, Q Zhao, J-S Wo, S-L Cai
OBJECTIVE: The objective of the present study was to observe the effects of different doses of rosuvastatin on cardiac protection in patients with acute coronary syndrome (ACS) after stent implantation. PATIENTS AND METHODS: A total of 137 patients with ACS were selected from March 2014 to January 2015 and randomly divided into: 1. The conventional treatment group: 45 patients were treated with conventional drugs such as aspirin, clopidogrel, nitrates, and a β-blocker; 2...
October 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29074152/patients-with-type-a-acute-aortic-dissection-presenting-with-an-abnormal-electrocardiogram
#14
Nathaniel I Costin, Amit Korach, Gabriel Loor, Mark D Peterson, Nimesh D Desai, Santi Trimarchi, Carlo de Vincentiis, Takeyoshi Ota, T Brett Reece, Thoralf M Sundt, Himanshu J Patel, Edward P Chen, Dan G Montgomery, Christoph A Nienaber, Eric M Isselbacher, Kim A Eagle, Thomas G Gleason
BACKGROUND: The electrocardiogram (ECG) is often used in the diagnosis of patients presenting with chest pain to emergency departments. Because chest pain is a common manifestation of type A acute aortic dissection (TAAAD), ECGs are obtained in much of this population. We evaluated the effect of particular ECG patterns on the diagnosis and treatment of TAAAD. METHODS: TAAAD patients (N = 2,765) enrolled in the International Registry of Acute Aortic Dissection were stratified based on normal (n = 1,094 [39...
October 24, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29073313/things-we-do-for-no-reason-echocardiogram-in-unselected-patients-with-syncope
#15
Charles L Madeira, Michael J Craig, Andrew Donohoe, John R Stephens
Syncope is a common cause of emergency department visits and hospitalizations. Echocardiogram is frequently used as a diagnostic tool in the evaluation of syncope, performed in 39% to 91% of patients. The diagnostic yield of echocardiogram for detecting clinically important abnormalities in patients with a normal history, physical examination, and electrocardiogram (ECG), however, is extremely low. In contrast, echocardiograms performed on patients with syncope with a positive cardiac history, abnormal examination, and/or ECG identify an abnormality in up to 29% of cases, though these abnormalities are not always defi nitively the cause of symptoms...
October 18, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29067909/atrial-flutter-presenting-as-broad-complex-tachycardia-in-a-patient-with-right-sided-pneumonectomy
#16
Thomas Beiert, Georg Nickenig, Jan Wilko Schrickel, Markus Linhart
A 71-year-old man with no history of coronary artery disease presented with palpitations to the emergency department. The 12-lead ECG showed a regular tachycardia with wide QRS complexes (220 bpm) suggestive of ventricular tachycardia. Instead invasive electrophysiological investigation revealed typical atrial flutter as underlying arrhythmia. The altered QRS morphology resulted from displacement of the heart into the right hemithorax due to right-sided pneumonectomy in combination with bundle branch block.
July 2017: Indian Pacing and Electrophysiology Journal
https://www.readbyqxmd.com/read/29062752/technical-pitfalls-and-tips-for-the-valve-in-valve-procedure
#17
REVIEW
Vinayak Bapat
Transcatheter aortic valve implantation (TAVI) has emerged as a viable treatment modality for patients with severe aortic valve stenosis and multiple co-morbidities. More recent indications include the use of transcatheter heart valves (THV) to treat degenerated bioprosthetic surgical heart valves (SHV), which are failing due to stenosis or regurgitation. Valve-in-valve (VIV) procedures in the aortic position have been performed with a variety of THV devices, although the balloon-expandable SAPIEN valve platform (Edwards Lifesciences Ltd, Irvine, CA, USA) and self-expandable CoreValve platform (Medtronic Inc...
September 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29061617/secondary-analysis-of-frequency-circumstances-and-consequences-of-calculation-errors-of-the-heart-history-ecg-age-risk-factors-and-troponin-score-at-the-emergency-departments-of-nine-hospitals-in-the-netherlands
#18
Marten Ras, Johannes B Reitsma, Arno W Hoes, Alfred Jacob Six, Judith M Poldervaart
OBJECTIVE: The HEART score can accurately stratify the risk of major adverse cardiac events (MACE) in patients with chest pain. We investigated the frequency, circumstances and potential consequences of errors in its calculation. METHODS: We performed a secondary analysis of a stepped wedge trial of patients with chest pain presenting to nine Dutch emergency departments. We recalculated HEART scores for all patients by re-evaluating the elements age (A), risk factors (R) and troponin (T) and compared these new scores with those given by physicians in daily practice...
October 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/29054440/external-validation-of-heart-type-fatty-acid-binding-protein-high-sensitivity-cardiac-troponin-and-electrocardiography-as-rule-out-for-acute-myocardial-infarction
#19
Christopher B Van Hise, Jaimi H Greenslade, William Parsonage, Martin Than, Joanna Young, Louise Cullen
OBJECTIVE: To externally validate a clinical decision rule incorporating heart fatty acid binding protein (h-FABP), high-sensitivity troponin (hs-cTn) and electrocardiogram (ECG) for the detection of acute myocardial infarction (AMI) on presentation to the Emergency Department. We also investigated whether this clinical decision rule improved identification of AMI over algorithms incorporating hs-cTn and ECG only. DESIGN AND METHODS: This study included data from 789 patients from the Brisbane ADAPT cohort and 441 patients from the Christchurch TIMI RCT cohort...
October 18, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/29050844/monitoring-the-corrected-qt-in-the-acute-care-setting-a-comparison-of-the-12%C3%A2-lead-electrocardiogram-and-bedside-monitor
#20
James A Chenoweth, Aaron M Hougham, Daniel K Colby, Jonathan B Ford, Jordan Sandhu, Timothy E Albertson, Mark E Sutter
INTRODUCTION: Prolongation of the QT interval is a well-recognized complication associated with many commonly used medications. Emergency Department monitoring of the corrected QT (QTc) both before and after medication administration is typically performed using the 12‑lead electrocardiogram (ECG). The purpose of this study is to compare the QTc reported on the 12‑lead ECG to that reported by single brand of bedside monitor. METHODS: A convenience sample of emergency department patients over the age of 18 undergoing bedside monitoring and who had an ECG ordered by their treating physician were enrolled...
October 7, 2017: American Journal of Emergency Medicine
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