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By Richard Gough Paramedic tutor, Post Qualification Manager
https://www.readbyqxmd.com/read/26422744/images-in-clinical-medicine-an-acute-dystonic-reaction-after-treatment-with-metoclopramide
#1
Manon Leus, Annenienke van de Ven
A 21-year-old woman with thyroid carcinoma underwent total thyroidectomy and lymph-node dissection. Two days after surgery, she had forced extension of the neck, nonrigid opening of the jaw, and lateral deviation of eyes to the left without a rhythmic component (Video 1). The patient remained able..
October 2015: New England Journal of Medicine
https://www.readbyqxmd.com/read/25502052/caffeine-as-an-analgesic-adjuvant-for-acute-pain-in-adults
#2
REVIEW
Christopher J Derry, Sheena Derry, R Andrew Moore
BACKGROUND: This is an updated version of the original Cochrane review published in Issue 3, 2012. Caffeine has been added to common analgesics such as paracetamol, ibuprofen, and aspirin, in the belief that it enhances analgesic efficacy. Evidence to support this belief is limited and often based on invalid comparisons. OBJECTIVES: To assess the relative efficacy of a single dose of an analgesic plus caffeine against the same dose of the analgesic alone, without restriction on the analgesic used or the pain condition studied...
December 11, 2014: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/25493111/prehospital-use-of-i-m-ketamine-for-sedation-of-violent-and-agitated-patients
#3
MULTICENTER STUDY
Kenneth A Scheppke, Joao Braghiroli, Mostafa Shalaby, Robert Chait
INTRODUCTION: Violent and agitated patients pose a serious challenge for emergency medical services (EMS) personnel. Rapid control of these patients is paramount to successful prehospital evaluation and also for the safety of both the patient and crew. Sedation is often required for these patients, but the ideal choice of medication is not clear. The objective is to demonstrate that ketamine, given as a single intramuscular injection for violent and agitated patients, including those with suspected excited delirium syndrome (ExDS), is both safe and effective during the prehospital phase of care, and allows for the rapid sedation and control of this difficult patient population...
November 2014: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/25402671/when-should-aspirin-be-used-for-prevention-of-cardiovascular-events
#4
EDITORIAL
J Michael Gaziano, Philip Greenland
No abstract text is available yet for this article.
December 17, 2014: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/25207925/anticonvulsant-therapy-for-status-epilepticus
#5
REVIEW
Manya Prasad, Pudukode R Krishnan, Reginald Sequeira, Khaldoon Al-Roomi
BACKGROUND: Status epilepticus is a medical emergency associated with significant mortality and morbidity that requires immediate and effective treatment. OBJECTIVES: (1) To determine whether a particular anticonvulsant is more effective or safer to use in status epilepticus compared to another and compared to placebo.(2) To delineate reasons for disagreement in the literature regarding recommended treatment regimens and to highlight areas for future research. SEARCH METHODS: For the latest update of this review, the following electronic databases were searched on 15/08/2013: the Cochrane Epilepsy Group's Specialized Register, CENTRAL The Cochrane Library July 2013, Issue 7, and MEDLINE (Ovid) 1946 to 15/08/2013...
2014: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/25309942/pre-hospital-glyceryl-trinitrate-potential-for-use-in-intracerebral-hemorrhage
#6
Jason J Chang, Nerses Sanossian
BACKGROUND: Intracerebral hemorrhage is associated with poor clinical outcome and high mortality. Research and treatment modalities have focused on the expansion of the primary hematoma through blood pressure control and activation of coagulation factors. However, clinical trials have failed to show decreased rates of death or disability in intracerebral hemorrhage following hospital initiation of blood pressure control. However, as clinical deterioration often occurs immediately after onset, pre-hospital initiation of blood pressure control may be more ideal...
November 14, 2013: Journal of Neurological Disorders
https://www.readbyqxmd.com/read/25153008/the-potential-threat-of-acetyl-fentanyl-legal-issues-contaminated-heroin-and-acetyl-fentanyl-disguised-as-other-opioids
#7
EDITORIAL
John M Stogner
No abstract text is available yet for this article.
December 2014: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/25089130/statin-therapy-for-primary-prevention-of-atrial-fibrillation-guided-by-chads2-cha2ds2vasc-score
#8
REVIEW
Chen-Ying Hung, Yu-Cheng Hsieh, Jin-Long Huang, Ching-Heng Lin, Tsu-Juey Wu
Atrial fibrillation (AF) is the most common arrhythmia and is associated with increased cardiovascular morbidity and mortality. The anti-arrhythmic effect of statins on AF prevention appears to be highly significant in most clinical studies. However, some discrepancies do exist among different clinical studies. Different clinical settings and types of stains used may explain these differences between trials. The CHADS2 and CHA2DS2VASc scoring systems have been used for stroke risk stratification in AF patients...
July 2014: Korean Circulation Journal
https://www.readbyqxmd.com/read/24972856/an-unusual-postoperative-cerebral-ischemic-stroke
#9
LETTER
Rudin Domi, Aurel Janko, Hektor Sula
No abstract text is available yet for this article.
February 2015: Journal of Anesthesia
https://www.readbyqxmd.com/read/22335736/intramuscular-versus-intravenous-therapy-for-prehospital-status-epilepticus
#10
RANDOMIZED CONTROLLED TRIAL
Robert Silbergleit, Valerie Durkalski, Daniel Lowenstein, Robin Conwit, Arthur Pancioli, Yuko Palesch, William Barsan
BACKGROUND: Early termination of prolonged seizures with intravenous administration of benzodiazepines improves outcomes. For faster and more reliable administration, paramedics increasingly use an intramuscular route. METHODS: This double-blind, randomized, noninferiority trial compared the efficacy of intramuscular midazolam with that of intravenous lorazepam for children and adults in status epilepticus treated by paramedics. Subjects whose convulsions had persisted for more than 5 minutes and who were still convulsing after paramedics arrived were given the study medication by either intramuscular autoinjector or intravenous infusion...
February 16, 2012: New England Journal of Medicine
https://www.readbyqxmd.com/read/23965274/who-does-what-in-prehospital-critical-care-an-analysis-of-competencies-of-paramedics-critical-care-paramedics-and-prehospital-physicians
#11
COMPARATIVE STUDY
Johannes von Vopelius-Feldt, Jonathan Benger
INTRODUCTION: Emergency medical services in the UK are facing the challenge of responding to an increasing number of calls, often for non-emergency care, while also providing critical care to the few severely ill or injured patients. In response, paramedic training in the UK has been extended and there are regional strategies to improve prehospital critical care (PHCC). We describe the clinical competencies of three groups of prehospital providers in the UK with the aim of informing future planning of the delivery of PHCC...
December 2014: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/24954580/statins-in-neurological-disorders-an-overview-and-update
#12
REVIEW
Anna Maria Malfitano, Giuseppe Marasco, Maria Chiara Proto, Chiara Laezza, Patrizia Gazzerro, Maurizio Bifulco
Statins have, at present, the potential to provide a new therapeutic target for various neurological diseases. It is well established that statins reduce cholesterol levels and prevent coronary heart disease. Moreover, evidence suggest that statins have additional properties such as endothelial protection via action on the nitric oxide synthase system as well as antioxidant, anti-inflammatory and anti-platelet effects. These properties might have potential therapeutic implication not only in stroke but also in neurological disorders such as Alzheimer disease, Parkinson's disease, multiple sclerosis and primary brain tumors...
October 2014: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/24876968/the-efficacy-of-nebulized-furosemide-and-salbutamol-compared-with-salbutamol-alone-in-reactive-airway-disease-a-double-blind-randomized-clinical-trial
#13
Kambiz Masoumi, Arash Forouzan, Maryam Haddadzadeh Shoushtari, Samaneh Porozan, Maryam Feli, Mehdi Fallah Bagher Sheidaee, Ali Asgari Darian
We undertook this randomized clinical trial to investigate whether adding furosemide to salbutamol could improve the peak expiratory flow rate (PEFR) and clinical signs of reactive airway disease (RAD) patients. Eligible 18- to 55-year-old patients were randomly divided into intervention and control groups. Patients received 5 mg of nebulized salbutamol and 40 mg of nebulized furosemide in the intervention group and 5 mg of nebulized salbutamol alone in the control group. Patients in both groups received 100 mg of methylprednisolone intravenously stat...
2014: Emergency Medicine International
https://www.readbyqxmd.com/read/24865567/intravenous-magnesium-sulfate-for-treating-adults-with-acute-asthma-in-the-emergency-department
#14
REVIEW
Kayleigh M Kew, Liza Kirtchuk, Clare I Michell
BACKGROUND: Asthma is a chronic respiratory condition characterised by airways inflammation, constriction of airway smooth muscle and structural alteration of the airways that is at least partially reversible. Exacerbations of asthma can be life threatening and place a significant burden on healthcare services. Various guidelines have been published to inform management personnel in the acute setting; several include the use of a single bolus of intravenous magnesium sulfate (IV MgSO4) in cases that do not respond to first-line treatment...
2014: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/24846097/best-evidence-topic-reports-bet-3-topical-intranasal-tranexamic-acid-for-spontaneous-epistaxis
#15
REVIEW
Lee Hilton, Adam Reuben
A short-cut review was carried out to establish whether topical tranexamic acid can be used to treat spontaneous epistaxis. Thirty-three papers were found, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. The clinical bottom line is that there is insufficient evidence to support the use of topical intranasal tranexamic acid in the management of spontaneous epistaxis in haemodynamically stable patients presenting to the emergency department...
May 2014: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/24834399/controversies-in-fluid-therapy-type-dose-and-toxicity
#16
REVIEW
Robert C McDermid, Karthik Raghunathan, Adam Romanovsky, Andrew D Shaw, Sean M Bagshaw
Fluid therapy is perhaps the most common intervention received by acutely ill hospitalized patients; however, a number of critical questions on the efficacy and safety of the type and dose remain. In this review, recent insights derived from randomized trials in terms of fluid type, dose and toxicity are discussed. We contend that the prescription of fluid therapy is context-specific and that any fluid can be harmful if administered inappropriately. When contrasting ''crystalloid vs colloid'', differences in efficacy are modest but differences in safety are significant...
February 4, 2014: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/24782823/magnesium-potential-roles-in-neurovascular-disease
#17
REVIEW
Jason J Chang, William J Mack, Jeffrey L Saver, Nerses Sanossian
OBJECTIVE: Magnesium therapy has been studied extensively in pre-clinical and clinical trials in multiple organ systems. Cerebrovascular diseases may benefit from its neuroprotective properties. This review summarizes current studies of magnesium in a wide range of neurovascular diseases. METHODS: We searched relevant terms in the National Library of Medicine PubMed database and selected research including basic science, translational reports, meta-analyses, and clinical studies...
2014: Frontiers in Neurology
https://www.readbyqxmd.com/read/24705923/prehospital-use-of-furosemide-for-the-treatment-of-heart-failure
#18
MULTICENTER STUDY
Andy Pan, Ian G Stiell, Richard Dionne, Justin Maloney
INTRODUCTION: The diagnosis and management of acute decompensated heart failure (HF) in the prehospital setting can be challenging. The objectives of this study are to evaluate the appropriateness of furosemide use by Emergency Medical Services (EMS) and its association with adverse outcomes. METHODS: This study was a multi-centre health records review of EMS patients who received prehospital furosemide or had an emergency department (ED) diagnosis of HF. We included acutely ill patients ≥50 years of age with shortness of breath transported by land EMS...
January 2015: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/24599652/timing-and-volume-of-fluid-administration-for-patients-with-bleeding
#19
REVIEW
Irene Kwan, Frances Bunn, Paul Chinnock, Ian Roberts
BACKGROUND: Treatment of haemorrhagic shock involves maintaining blood pressure and tissue perfusion until bleeding is controlled. Different resuscitation strategies have been used to maintain the blood pressure in trauma patients until bleeding is controlled. However, while maintaining blood pressure may prevent shock, it may worsen bleeding. OBJECTIVES: To examine the effect on mortality and coagulation times of two intravenous fluid administration strategies in the management of haemorrhagic hypovolaemia, early compared to delayed administration and larger compared to smaller volume of fluid administered...
March 5, 2014: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/24066745/resuscitation-fluids
#20
REVIEW
John A Myburgh, Michael G Mythen
New England Journal of Medicine, Volume 369, Issue 13, Page 1243-1251, September 2013.
September 26, 2013: New England Journal of Medicine
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