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Flora Trauma

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135 papers 25 to 100 followers
By Tyrone Richards Working in Emergency Department
https://www.readbyqxmd.com/read/27681496/reperfusion-treatment-delays-amongst-patients-with-painless-st-segment-elevation-myocardial-infarction
#1
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 29, 2016: CJEM
https://www.readbyqxmd.com/read/27692651/best-clinical-practice-current-controversies-in-the-evaluation-of%C3%A2-low-risk-chest-pain-with-risk-stratification-aids-part-2
#2
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...
September 27, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/26802433/external-validation-of-the-manchester-acute-coronary-syndromes-decision-rule
#3
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
#4
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...
October 5, 2016: 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
#5
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
#6
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...
August 22, 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
#7
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)...
September 13, 2016: 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
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/27707527/chemical-agents-for-the-sedation-of-agitated-patients-in-the-ed-a-systematic-review
#11
Viola Korczak, Adrienne Kirby, Naren Gunja
OBJECTIVE: Chemical agents commonly used to sedate agitated patients in the emergency department include benzodiazepines, antipsychotics, or a combination of the 2 classes. Our objective was to determine if a class or combination therapy is (1) more effective, as measured by the proportion sedated at 15-20 minutes and the need for repeat sedation, and (2) safer, as measured by the proportion of reported adverse events. METHODS: Systematic literature review and meta-analysis of studies comparing 2 or more chemical agents for sedation of agitated patients in the emergency department were carried out in PubMed, PsycINFO, Embase, and the Cochrane database...
September 16, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27693075/best-clinical-practice-current-controversies-in-evaluation-of-low-risk-chest-pain-part-1
#12
Brit Long, Alex Koyfman
BACKGROUND: Chest pain is a common presentation to the emergency department (ED), though the majority of patients are not diagnosed with acute coronary syndrome (ACS). Many patients are admitted to the hospital due to fear of ACS. OBJECTIVE: Our aim was to investigate controversies in low-risk chest pain evaluation, including risk of missed ACS, stress test, and coronary computed tomography angiography (CCTA). DISCUSSION: Chest pain accounts for 10 million ED visits in the United States annually...
December 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27724978/the-copenhagen-triage-algorithm-a-randomized-controlled-trial
#13
Rasmus Bo Hasselbalch, Louis Lind Plesner, Mia Pries-Heje, Lisbet Ravn, Morten Lind, Rasmus Greibe, Birgitte Nybo Jensen, Lars S Rasmussen, Kasper Iversen
BACKGROUND: Crowding in the emergency department (ED) is a well-known problem resulting in an increased risk of adverse outcomes. Effective triage might counteract this problem by identifying the sickest patients and ensuring early treatment. In the last two decades, systematic triage has become the standard in ED's worldwide. However, triage models are also time consuming, supported by limited evidence and could potentially be of more harm than benefit. The aim of this study is to develop a quicker triage model using data from a large cohort of unselected ED patients and evaluate if this new model is non-inferior to an existing triage model in a prospective randomized trial...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27677258/time-for-a-breath-of-fresh-air-rethinking-training-in-airway-management
#14
EDITORIAL
S D Marshall, N Chrimes
No abstract text is available yet for this article.
November 2016: Anaesthesia
https://www.readbyqxmd.com/read/27523885/ultrasonography-in-the-emergency-department
#15
REVIEW
Micah R Whitson, Paul H Mayo
Point-of-care ultrasonography (POCUS) is a useful imaging technique for the emergency medicine (EM) physician. Because of its growing use in EM, this article will summarize the historical development, the scope of practice, and some evidence supporting the current applications of POCUS in the adult emergency department. Bedside ultrasonography in the emergency department shares clinical applications with critical care ultrasonography, including goal-directed echocardiography, echocardiography during cardiac arrest, thoracic ultrasonography, evaluation for deep vein thrombosis and pulmonary embolism, screening abdominal ultrasonography, ultrasonography in trauma, and guidance of procedures with ultrasonography...
August 15, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27592289/echocardiography-as-a-guide-for-fluid-management
#16
REVIEW
John H Boyd, Demetrios Sirounis, Julien Maizel, Michel Slama
BACKGROUND: In critically ill patients at risk for organ failure, the administration of intravenous fluids has equal chances of resulting in benefit or harm. While the intent of intravenous fluid is to increase cardiac output and oxygen delivery, unwelcome results in those patients who do not increase their cardiac output are tissue edema, hypoxemia, and excess mortality. Here we briefly review bedside methods to assess fluid responsiveness, focusing upon the strengths and pitfalls of echocardiography in spontaneously breathing mechanically ventilated patients as a means to guide fluid management...
September 4, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/17513645/the-coagulation-changes-induced-by-rapid-in-vivo-crystalloid-infusion-are-attenuated-when-magnesium-is-kept-at-the-upper-limit-of-normal
#17
RANDOMIZED CONTROLLED TRIAL
Thomas G Ruttmann, Luis F Montoya-Pelaez, Michael F M James
BACKGROUND: Rapid crystalloid infusion enhances coagulation, regardless of electrolytes, pH or osmolality, an effect thought to be related to deep vein thrombosis and other clot formations. Altered serum magnesium may play a role in the balance of coagulation. In this in vivo study we investigated the coagulation response to rapid hemodilution when serum magnesium is maintained or partially increased. METHODS: Twenty-five healthy volunteers were investigated on three occasions, randomly receiving normal saline, Balsol (magnesium 1...
June 2007: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27495820/lactated-ringer-is-associated-with-reduced-mortality-and-less-acute-kidney-injury-in-critically-ill-patients-a-retrospective-cohort-analysis
#18
Fernando G Zampieri, Otavio T Ranzani, Luciano Cesar Pontes Azevedo, Izanio D S Martins, John A Kellum, Alexandre B Libório
OBJECTIVES: To assess the impact of the percentage of fluid infused as Lactated Ringer (%LR) during the first 2 days of ICU admission in hospital mortality and occurrence of acute kidney injury. DESIGN: Retrospective cohort. SETTING: Analysis of a large public database (Multiparameter Intelligent Monitoring in Intensive Care-II). PATIENTS: Adult patients with at least 2 days of ICU stay, admission creatinine lower than 5 mg/dL, and that received at least 500 mL of fluid in the first 48 hours...
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27288278/validation-of-nice-diagnostic-guidance-for-rule-out-of-myocardial-infarction-using-high-sensitivity-troponin-tests
#19
W A Parsonage, C Mueller, J H Greenslade, K Wildi, J Pickering, M Than, S Aldous, J Boeddinghaus, C J Hammett, T Hawkins, T Nestelberger, T Reichlin, S Reidt, M Rubin Gimenez, J R Tate, R Twerenbold, J P Ungerer, L Cullen
OBJECTIVE: To validate the National Institute for Health and Care Excellence (NICE) recommended algorithms for high-sensitivity troponin (hsTn) assays in adults presenting with chest pain. METHODS: International post hoc analysis of three prospective, observational studies from tertiary hospital emergency departments. The primary endpoint was cardiac death or acute myocardial infarction (AMI) within 24 hours of presentation, and the secondary endpoint was major adverse cardiac events (MACE) at 30 days...
August 15, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27276234/intensive-blood-pressure-lowering-in-patients-with-acute-cerebral-hemorrhage
#20
RANDOMIZED CONTROLLED TRIAL
Adnan I Qureshi, Yuko Y Palesch, William G Barsan, Daniel F Hanley, Chung Y Hsu, Renee L Martin, Claudia S Moy, Robert Silbergleit, Thorsten Steiner, Jose I Suarez, Kazunori Toyoda, Yongjun Wang, Haruko Yamamoto, Byung-Woo Yoon
Background Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intracerebral hemorrhage. Methods We randomly assigned eligible participants with intracerebral hemorrhage (volume, <60 cm(3)) and a Glasgow Coma Scale (GCS) score of 5 or more (on a scale from 3 to 15, with lower scores indicating worse condition) to a systolic blood-pressure target of 110 to 139 mm Hg (intensive treatment) or a target of 140 to 179 mm Hg (standard treatment) in order to test the superiority of intensive reduction of systolic blood pressure to standard reduction; intravenous nicardipine to lower blood pressure was administered within 4...
September 15, 2016: New England Journal of Medicine
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