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Flora Trauma

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145 papers 25 to 100 followers
By Tyrone Richards Working in Emergency Department
https://www.readbyqxmd.com/read/29248334/diagnostic-accuracy-of-a-new-high-sensitivity-troponin-i-assay-and-five-accelerated-diagnostic-pathways-for-ruling-out-acute-myocardial-infarction-and-acute-coronary-syndrome
#1
MULTICENTER STUDY
Jaimi H Greenslade, Edward W Carlton, Christopher Van Hise, Elizabeth Cho, Tracey Hawkins, William A Parsonage, Jillian Tate, Jacobus Ungerer, Louise Cullen
STUDY OBJECTIVE: This diagnostic accuracy study describes the performance of 5 accelerated chest pain pathways, calculated with the new Beckman's Access high-sensitivity troponin I assay. METHODS: High-sensitivity troponin I was measured with presentation and 2-hour blood samples in 1,811 patients who presented to an emergency department (ED) in Australia. Patients were classified as being at low risk according to 5 rules: modified accelerated diagnostic protocol to assess patients with chest pain symptoms using troponin as the only biomarker (m-ADAPT), the Emergency Department Assessment of Chest Pain Score (EDACS) pathway, the History, ECG, Age, Risk Factors, and Troponin (HEART) pathway, the No Objective Testing Rule, and the new Vancouver Chest Pain Rule...
April 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29432369/implementation-of-an-early-discharge-protocol-and-chest-pain-clinic-for-low-risk-chest-pain-in-the-emergency-department
#2
Mohammad Amin Kashef, Jane Garb, Aaron Kugelmass, Amir Lotfi
BACKGROUND: Most of the patients presenting to emergency department with chest pain are at low risk of adverse events. Identifying high-risk patients can be challenging and resource intensive. METHODS: We created a protocol to assist early discharge of low-risk adults with chest pain from emergency department. Also a chest pain clinic (CPC) was started for cardiology follow-up within 72 hours. In a retrospective cohort study, primary outcome of major adverse cardiac events (MACEs) of death, myocardial infarction, or revascularization was compared between CPC patients and those hospitalized for observation...
March 2018: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28602955/etiological-diagnoses-of-out-of-hospital-cardiac-arrest-survivors-admitted-to-the-intensive-care-unit-insights-from-a-french-registry
#3
Guillaume Geri, Olivier Passouant, Florence Dumas, Wulfran Bougouin, Benoit Champigneulle, Michel Arnaout, Jonathan Chelly, Jean-Daniel Chiche, Olivier Varenne, Lucie Guillemet, Frederic Pène, Victor Waldmann, Jean-Paul Mira, Eloi Marijon, Alain Cariou
BACKGROUND: Respective proportions of final etiologies are disparate in cohorts of cardiac arrest patients, depending on examined population and diagnostic algorithms. In particular, prevalence and characteristics of sudden unexplained death syndrome (SUDS) are debated. We aimed at describing etiologies in a large cohort of aborted out-of-hospital cardiac arrest (OHCA) patients, in order to assess prevalence and outcome of SUDS. PATIENTS AND METHODS: We analyzed data from our prospective registry of successfully resuscitated OHCA patients admitted to a cardiac arrest centre between January 2002 and December 2014...
August 2017: Resuscitation
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
#4
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 (ACS) is safe when clinical assessment indicates low risk, biomarkers are negative, and electrocardiograms (ECGs) are nonischemic. 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...
April 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29169886/a-potential-diagnostic-pitfall-in-acute-chest-pain-massive-pulmonary-embolism-mimicking-acute-stemi
#5
Ya-Wen Lu, Yi-Lin Tsai, Chun-Chin Chang, Po-Hsun Huang
BACKGROUND: Pulmonary embolism (PE) represents a clinical challenge for clinicians because of nonspecific presentations, including dyspnea, chest pain, and tachycardia. The immediate 12-lead electrocardiogram (ECG) is commonly used to facilitate differential diagnosis of acute chest pain. Although relative rare, massive pulmonary embolism could induce ST segment elevation and mimic acute myocardial infarction. CASE PRESENTATION: We present a challenging scenario that ECG showed ST segment elevation, nevertheless, urgent coronary angiogram revealed non-obstructive coronary artery disease...
March 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29418039/topical-tranexamic-acid-for-epistaxis-in-patients-on-antiplatelet-drugs-a-new-use-for-an-old-drug
#6
Michael S Runyon
No abstract text is available yet for this article.
March 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29420956/performance-of-coronary-risk-scores-among-patients-with-chest-pain-in-the-emergency-department
#7
Dustin G Mark, Jie Huang, Uli Chettipally, Mamata V Kene, Megan L Anderson, Erik P Hess, Dustin W Ballard, David R Vinson, Mary E Reed
BACKGROUND: Both the modified History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score and the Emergency Department Assessment of Chest pain Score (EDACS) can identify patients with possible acute coronary syndrome (ACS) at low risk (<1%) for major adverse cardiac events (MACE). OBJECTIVES: The authors sought to assess the comparative accuracy of the EDACS (original and simplified) and modified HEART risk scores when using cardiac troponin I (cTnI) cutoffs below the 99th percentile, and obtain precise MACE risk estimates...
February 13, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29397258/propofol-fentanyl-versus-propofol-ketamine-for-procedural-sedation-and-analgesia-in-patients-with-trauma
#8
Hamed Aminiahidashti, Sajad Shafiee, Seyed Mohammad Hosseininejad, Abulfazl Firouzian, Ayyub Barzegarnejad, Alieh Zamani Kiasari, Behzad Feizzadeh Kerigh, Farzad Bozorgi, Misagh Shafizad, Ahmad Geraeeli
OBJECTIVE: Many procedures performed in emergency department are stressful and painful, and creating proper and timely analgesia and early and effective assessment are the challenges in this department. This study has been conducted in order to compare the efficacy of propofol and fentanyl combination with propofol and ketamine combination for procedural sedation and analgesia (PSA) in trauma patients in the emergency department. METHOD: This is a randomized prospective double-blind clinical trial conducted in the emergency department of Imam Khomeini Hospital, a tertiary academic trauma center in northern Iran...
October 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27974285/increased-incidence-of-clinical-hypotension-with-etomidate-compared-to-ketamine-for-intubation-in-septic-patients-a-propensity-matched-analysis
#9
Megan A Van Berkel, Matthew C Exline, Kari M Cape, Lindsay P Ryder, Gary Phillips, Naeem A Ali, Bruce A Doepker
PURPOSE: This study compared the incidence of clinical hypotension between ketamine and etomidate within a 24 hour period following endotracheal intubation. MATERIALS AND METHODS: This single-center, retrospective propensity-matched cohort study included septic patients admitted to our medical intensive care unit who received either etomidate or ketamine for intubation. Clinical hypotension was defined as any one of the following: mean arterial pressure (MAP) decrease >40% compared to baseline and MAP <70 mmHg, MAP <60 mmHg, initiation of a vasopressor, or increase to >30% of the initial vasopressor dose...
April 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28363616/an-end-user-s-guide-to-the-heart-score-and-pathway
#10
REVIEW
Brit Long, Joshua Oliver, Matthew Streitz, Alex Koyfman
BACKGROUND: Chest pain accounts for a significant percentage of emergency department (ED) presentations. The HEART score and pathway have demonstrated an ability to appropriately risk stratify and discharge from the ED a significant proportion of patients. OBJECTIVE: This review evaluates vital components of the HEART score and pathway, while discussing important considerations for current and future use. DISCUSSION: Chest pain is a common ED presentation, and several conditions associated with chest pain result in patient morbidity and mortality...
September 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27681496/reperfusion-treatment-delays-amongst-patients-with-painless-st-segment-elevation-myocardial-infarction
#11
Pin Pin Pek, En Yun Loy, Win Wah, Andrew Fu Wah Ho, Huili Zheng, Stephanie Man Chung Fook-Chong, Terrance Siang Jin Chua, Tian Hai Koh, Khuan Yew Chow, Nan Liu, Marcus Eng Hock Ong
OBJECTIVE: Early reperfusion therapy in the treatment of ST segment elevation myocardial infarction (STEMI) patients can improve outcomes. Silent myocardial infarction is associated with poor prognosis, but little is known about its effect on treatment delays. We aimed to characterize STEMI patients presenting without complaints of pain to the emergency departments (EDs) in Singapore. METHODS: Retrospective data were requested from the Singapore Myocardial Infarction Registry (SMIR), a national level registry in Singapore...
September 2017: CJEM
https://www.readbyqxmd.com/read/27692651/best-clinical-practice-current-controversies-in-the-evaluation-of-low-risk-chest-pain-with-risk-stratification-aids-part-2
#12
Brit Long, Alex Koyfman
BACKGROUND: Chest pain accounts for 10% of emergency department (ED) visits annually, and many of these patients are admitted because of potentially life-threatening conditions. A substantial percentage of patients with chest pain are at low risk for a major cardiac adverse event (MACE). OBJECTIVE: We investigated controversies in the evaluation of patients with low-risk chest pain, including clinical scores, decision pathways, and shared decision-making. DISCUSSION: ED patients with chest pain who have negative biomarker results and nonischemic electrocardiograms are at low risk for MACE...
January 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/26802433/external-validation-of-the-manchester-acute-coronary-syndromes-decision-rule
#13
Edward Carlton, Richard Body, Kim Greaves
OBJECTIVES: The Manchester Acute Coronary Syndromes (MACS) decision rule has been shown to be a powerful diagnostic tool in emergency department (ED) patients with suspected acute coronary syndromes (ACS). It has the potential to improve system efficiency by identifying patients suitable for discharge after a single blood draw for high-sensitivity troponin and heart-type fatty acid-binding protein (h-FABP) analysis at presentation to the ED. The objective was to externally validate the MACS decision rule and establish its diagnostic accuracy as a discharge tool in a new set of prospectively recruited ED patients...
February 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27765481/cost-analysis-of-the-history-ecg-age-risk-factors-and-initial-troponin-heart-pathway-randomized-control-trial
#14
Robert F Riley, Chadwick D Miller, Gregory B Russell, Erin N Harper, Brian C Hiestand, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Simon A Mahler
INTRODUCTION: The HEART Pathway is a diagnostic protocol designed to identify low-risk patients presenting to the emergency department with chest pain that are safe for early discharge. This protocol has been shown to significantly decrease health care resource utilization compared with usual care. However, the impact of the HEART Pathway on the cost of care has yet to be reported. METHODS AND RESULTS: We performed a cost analysis of patients enrolled in the HEART Pathway trial, which randomized participants to either usual care or the HEART Pathway protocol...
January 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27717937/peculiarities-of-heart-rate-in-the-patients-with-unstable-angina-and-non-st-elevation-myocardial-infarction-and-concomitant-diabetes-mellitus-type-2
#15
Kyyak Hryhoriy
INTRODUCTION: type 2 diabetes mellitus is one of the most important medical and social problems in the world. Patients with diabetes are prone to coronary artery disease, in particular acute coronary syndrome, with atypical clinical signs and susceptibility to tachycardia. Elevated heart rate is an important factor of premature mortality in all patients with acute coronary syndrome. The aim of the investigation was to reveal the heart rate peculiarities in unstable angina and non-ST elevation myocardial infarction patients suffering from diabetes mellitus type 2 for more effective treatment of these patients...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/27677387/prognostic-value-of-the-thrombolysis-in-myocardial-infarction-risk-score-in-st-elevation-myocardial-infarction-patients-with-left-ventricular-dysfunction-from-the-ephesus-trial
#16
RANDOMIZED CONTROLLED TRIAL
Batric Popovic, Nicolas Girerd, Patrick Rossignol, Nelly Agrinier, Edoardo Camenzind, Renaud Fay, Bertram Pitt, Faiez Zannad
The Thrombolysis in Myocardial Infarction (TIMI) risk score remains a robust prediction tool for short-term and midterm outcome in the patients with ST-elevation myocardial infarction (STEMI). However, the validity of this risk score in patients with STEMI with reduced left ventricular ejection fraction (LVEF) remains unclear. A total of 2,854 patients with STEMI with early coronary revascularization participating in the randomized EPHESUS (Epleronone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) trial were analyzed...
November 15, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27769754/long-term-prognostic-value-of-a-negative-work-up-for-acute-coronary-disease-in-emergency-department-chest-pain-patients-without-known-coronary-artery-disease-a-cohort-study
#17
Anne-Maree Kelly, Sharon Klim
BACKGROUND: To determine the rate of all cause and cardiac death, new myocardial infarction (MI) or coronary revascularisation at over three years from index visit in emergency department chest pain patients without known coronary artery disease (CAD) at index presentation who had a negative electrocardiogram (ECG) and biomarker workup for acute coronary syndrome (ACS). METHODS: An unplanned sub-study of a prospective observational study of consecutive adult patients presenting to the ED with atraumatic chest pain (or equivalents)...
April 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/27765299/prognostic-value-of-coronary-artery-calcium-score-in-acute-chest-pain-patients-without-known-coronary-artery-disease-systematic-review-and-meta-analysis
#18
REVIEW
Kongkiat Chaikriangkrai, Ghanshyam Palamaner Subash Shantha, Hye Yeon Jhun, Patompong Ungprasert, Gardar Sigurdsson, Faisal Nabi, John J Mahmarian, Su Min Chang
STUDY OBJECTIVE: Coronary artery calcium score (CACS) is a well-established test for risk stratifying asymptomatic patients. Recent studies also indicate that CACS may accurately risk stratify stable patients presenting to the emergency department (ED) with acute chest pain; however, many were underpowered. The purpose of this systematic review and meta-analysis is to evaluate the prognostic value and accuracy of a zero (normal) CACS for identifying patients at acceptable low risk for future cardiovascular events who might be safely discharged home from the ED...
December 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/26542793/st-depression-in-lead-avl-differentiates-inferior-st-elevation-myocardial-infarction-from-pericarditis
#19
Johanna E Bischof, Christine Worrall, Peter Thompson, David Marti, Stephen W Smith
BACKGROUND: ST-segment elevation (STE) due to inferior STE myocardial infarction (STEMI) may be misdiagnosed as pericarditis. Conversely, this less life-threatening etiology of ST elevation may be confused for inferior STEMI. We sought to determine if the presence of any ST-segment depression in lead aVL would differentiate inferior STEMI from pericarditis. METHODS: Retrospective study of 3 populations. Cohort 1 included patients coded as inferior STEMI, cohort 2 included patients with a discharge diagnosis of pericarditis who presented with chest pain and at least 0...
February 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27220653/efficiency-and-safety-of-coronary-ct-angiography-compared-to-standard-care-in-the-evaluation-of-patients-with-acute-chest-pain-a-canadian-study
#20
Elena Peña, Fraser Rubens, Ian Stiell, Rebecca Peterson, Joao Inacio, Carole Dennie
The optimal assessment of patients with chest pain and possible acute coronary syndrome (ACS) remains a diagnostic dilemma for emergency physicians. Cardiac computed tomographic angiography (CCTA) may identify patients who can be safely discharged home from the emergency department (ED). The objective of the study was to compare the efficiency and safety of CCTA to standard care in patients presenting to the ED with low- to intermediate-risk chest pain. This was a single-center before-after study enrolling ED patients with chest pain and low to intermediate risk of ACS, before and after implementing a cardiac CT-based management protocol...
August 2016: Emergency Radiology
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