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EM Chest

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56 papers 25 to 100 followers
By Terren Trott terren.trott@gmail.com
https://www.readbyqxmd.com/read/20215043/r-wave-peak-time-at-dii-a-new-criterion-for-differentiating-between-wide-complex-qrs-tachycardias
#1
Luis Fernando Pava, Pablo Perafán, Marisol Badiel, Juan José Arango, Lluis Mont, Carlos A Morillo, Josep Brugada
BACKGROUND: Differential diagnosis of wide QRS complex tachycardias using the 12-lead ECG may be difficult in many clinical settings. OBJECTIVE: The purpose of this study was to determine the value of ECG lead II, specifically, the duration at its beginning, defined as R-wave peak time (RWPT), in differentiating ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in patients with wide QRS complex tachycardia. METHODS: Two hundred eighteen ECGs showing wide QRS complex tachycardias were evaluated...
July 2010: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/27793505/emergency-physician-performed-tricuspid-annular-plane-systolic-excursion-in-the-evaluation-of-suspected-pulmonary-embolism
#2
James Daley, John Grotberg, Joseph Pare, Amanda Medoro, Rachel Liu, Michael Kennedy Hall, Andrew Taylor, Christopher L Moore
OBJECTIVES: The primary objectives were to describe the diagnostic characteristics tricuspid annular plane systolic excursion (TAPSE) for pulmonary embolism (PE) and to optimize the measurement cutoff of TAPSE for the diagnosis of PE. Secondary objectives included assessment of interrater reliability and the quantitative visual estimation of TAPSE. METHODS: This is a prospective observational cohort study involving a convenience sample of patients at an urban academic emergency department...
October 11, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27797317/prevalence-of-pulmonary-embolism-among-patients-hospitalized-for-syncope
#3
Paolo Prandoni, Anthonie W A Lensing, Martin H Prins, Maurizio Ciammaichella, Marica Perlati, Nicola Mumoli, Eugenio Bucherini, Adriana Visonà, Carlo Bova, Davide Imberti, Stefano Campostrini, Sofia Barbar
Background The prevalence of pulmonary embolism among patients hospitalized for syncope is not well documented, and current guidelines pay little attention to a diagnostic workup for pulmonary embolism in these patients. Methods We performed a systematic workup for pulmonary embolism in patients admitted to 11 hospitals in Italy for a first episode of syncope, regardless of whether there were alternative explanations for the syncope. The diagnosis of pulmonary embolism was ruled out in patients who had a low pretest clinical probability, which was defined according to the Wells score, in combination with a negative d-dimer assay...
October 20, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/27694410/corticosteroids-for-community-acquired-pneumonia-a-critical-view-of-the-evidence
#4
EDITORIAL
James D Chalmers
No abstract text is available yet for this article.
October 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/27640933/patients-without-st-elevation-after-return-of-spontaneous-circulation-may-benefit-from-emergent-percutaneous-intervention-a-systematic-review-and-meta-analysis
#5
Michael G Millin, Angela C Comer, Jose V Nable, Peter V Johnston, Benjamin J Lawner, Nathan Woltman, Matthew J Levy, Kevin G Seaman, Jon Mark Hirshon
INTRODUCTION: The American Heart Association recommends that post-arrest patients with evidence of ST elevation myocardial infarction (STEMI) on electrocardiogram (ECG) be emergently taken to the catheterization lab for percutaneous coronary intervention (PCI). However, recommendations regarding the utility of emergent PCI for patients without ST elevation are less specific. This review examined the literature on the utility of PCI in post-arrest patients without ST elevation compared to patients with STEMI...
September 15, 2016: Resuscitation
https://www.readbyqxmd.com/read/27528647/state-of-the-art-evaluation-of-emergency-department-patients-presenting-with-potential-acute-coronary-syndromes
#6
Judd E Hollander, Martin Than, Christian Mueller
It is well established that clinicians cannot use clinical judgment alone to determine whether an individual patient who presents to the emergency department has an acute coronary syndrome. The history and physical examination do not distinguish sufficiently between the many conditions that can cause acute chest pain syndromes. Cardiac risk factors do not have sufficient discriminatory ability in symptomatic patients presenting to the emergency department. Most patients with non-ST-segment-elevation myocardial infarction do not present with electrocardiographic evidence of active ischemia...
August 16, 2016: Circulation
https://www.readbyqxmd.com/read/27422214/pulseless-electrical-activity-in-pulmonary-embolism-treated-with-thrombolysis-from-the-peapett-study
#7
Mohsen Sharifi, Jeremy Berger, Paul Beeston, Curt Bay, Zoltan Vajo, Seyed Javadpoor
OBJECTIVE: Pulseless electrical activity (PEA) during cardiac arrest portends a poor prognosis. There is a paucity of data in the use of thrombolytic therapy in PEA and cardiopulmonary arrest due to confirmed pulmonary embolism (PE). We evaluated the outcome of low-dose systemic thrombolysis with tissue plasminogen activator (tPA) in patients presenting with PEA due to PE. METHODS: During a 34-month period, we treated 23 patients with PEA and cardiopulmonary arrest due to confirmed massive PE...
October 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27378464/development-of-the-canadian-syncope-risk-score-to-predict-serious-adverse-events-after-emergency-department-assessment-of-syncope
#8
Venkatesh Thiruganasambandamoorthy, Kenneth Kwong, George A Wells, Marco L A Sivilotti, Muhammad Mukarram, Brian H Rowe, Eddy Lang, Jeffrey J Perry, Robert Sheldon, Ian G Stiell, Monica Taljaard
BACKGROUND: Syncope can be caused by serious conditions not evident during initial evaluation, which can lead to serious adverse events, including death, after disposition from the emergency department. We sought to develop a clinical decision tool to identify adult patients with syncope who are at risk of a serious adverse event within 30 days after disposition from the emergency department. METHODS: We prospectively enrolled adults (age ≥ 16 yr) with syncope who presented within 24 hours after the event to 1 of 6 large emergency departments from Sept...
September 6, 2016: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/27354046/randomized-comparison-of-intravenous-procainamide-vs-intravenous-amiodarone-for-the-acute-treatment-of-tolerated-wide-qrs-tachycardia-the-procamio-study
#9
Mercedes Ortiz, Alfonso Martín, Fernando Arribas, Blanca Coll-Vinent, Carmen Del Arco, Rafael Peinado, Jesús Almendral
AIMS: Intravenous procainamide and amiodarone are drugs of choice for well-tolerated ventricular tachycardia. However, the choice between them, even according to Guidelines, is unclear. We performed a multicentre randomized open-labelled study to determine the safety and efficacy of intravenous procainamide and amiodarone for the acute treatment of tolerated wide QRS complex (probably ventricular) tachycardia. METHODS AND RESULTS: Patients were randomly assigned to receive intravenous procainamide (10 mg/kg/20 min) or amiodarone (5 mg/kg/20 min)...
June 28, 2016: European Heart Journal
https://www.readbyqxmd.com/read/27395439/a-population-based-analysis-of-outcomes-in-patients-with-a-primary-diagnosis-of-hypertension-in-the-emergency-department
#10
Sameer Masood, Peter C Austin, Clare L Atzema
STUDY OBJECTIVE: Patients treated primarily for hypertension are common in the emergency department (ED). The outcomes of these patients who were given a primary ED diagnosis of hypertension have not been described at a population level. In this study, we describe the characteristics and outcomes of these patients, as well as changes over time. METHODS: This retrospective cohort study used linked health databases from the province of Ontario, Canada, to assess ED visits made between April 1, 2002, and March 31, 2012, with a primary diagnosis of hypertension...
September 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27353283/managing-troponin-testing
#11
Judd E Hollander
No abstract text is available yet for this article.
June 25, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27306263/high-sensitivity-troponin-and-right-ventricular-function-in-acute-pulmonary-embolism
#12
Gustavo Daquarti, Nicolás March Vecchio, Cecilia Soledad Mitrione, Juan Furmento, María Clara Ametrano, María Paz Dominguez Pace, Juan Pablo Costabel
INTRODUCTION: Right ventricular (RV) dysfunction has proved to be an important predictor of morbidity and mortality in patients with pulmonary embolism (PE). Tricuspid annular plane systolic excursion (TAPSE) is one of the parameters that have been validated as predictor of outcomes. The aim of our study was to evaluate the performance (sensitivity and specificity) of high-sensitivity cardiac troponin T (hs-cTnT) to predict RV dysfunction defined as TAPSE <16 mm. METHODS: We conducted a single-center retrospective analysis of 40 patients prospectively included...
August 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27178670/short-term-prognosis-and-current-management-of-syncopal-patients-at-intermediate-risk-results-from-the-iris-intermediate-risk-syncope-study
#13
Filippo Numeroso, Gianluigi Mossini, Michela Giovanelli, Giuseppe Lippi, Gianfranco Cervellin
OBJECTIVES: Despite guidelines, admission rates and expenditures for syncope remain high. This may be caused by an imprecise definition of cardiovascular disease considered at risk and an overestimation of the role of comorbidities and advanced age. In a cohort of patients with undetermined syncope, we prospectively compared the short-term prognosis of patients at intermediate risk (i.e., with stable heart diseases or comorbidities, of any age) versus those at high risk for cardiogenic syncope and identified factors associated with serious events...
August 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25176151/point-of-care-ultrasonography-for-the-diagnosis-of-acute-cardiogenic-pulmonary-edema-in-patients-presenting-with-acute-dyspnea-a-systematic-review-and-meta-analysis
#14
REVIEW
Mohammad Al Deeb, Skye Barbic, Robin Featherstone, Jerrald Dankoff, David Barbic
OBJECTIVES: Acute dyspnea is a common presenting complaint to the emergency department (ED), and point-of-care (POC) lung ultrasound (US) has shown promise as a diagnostic tool in this setting. The primary objective of this systematic review was to determine the sensitivity and specificity of US using B-lines in diagnosing acute cardiogenic pulmonary edema (ACPE) in patients presenting to the ED with acute dyspnea. METHODS: A systematic review protocol adhering to Cochrane Handbook guidelines was created to guide the search and analysis, and we searched the following databases: PubMed, EMBASE, Ovid MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, and the Cochrane Database of Systematic Reviews...
August 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/26993075/ed-evaluation-and-management-of-implantable-cardiac-defibrillator-electrical-shocks
#15
REVIEW
Saher Iftikhar, Amal Mattu, William Brady
Patients with implantable cardiac defibrillators not infrequently present to the emergency department after experiencing an implantable cardiac defibrillator shock. This review considers the management of such patients in the emergency department, including appropriate, inappropriate, and phantom shocks as well as electrical storm.
June 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/24731521/the-3mg-trial-a-randomised-controlled-trial-of-intravenous-or-nebulised-magnesium-sulphate-versus-placebo-in-adults-with-acute-severe-asthma
#16
RANDOMIZED CONTROLLED TRIAL
Steve Goodacre, Judith Cohen, Mike Bradburn, John Stevens, Alasdair Gray, Jonathan Benger, Tim Coats
BACKGROUND: Magnesium sulphate, administered by the intravenous (i.v.) or inhaled (nebulised) route, has been proposed as a treatment for adults with acute severe asthma. Existing trials show mixed results and uncertain evidence of benefit. OBJECTIVES: We aimed to determine whether i.v. or nebulised magnesium sulphate improves symptoms of breathlessness and reduces the need for hospital admission in adults with acute severe asthma. DESIGN: Multicentre, double-blind, placebo-controlled, three-arm, randomised trial...
April 2014: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/26964827/the-effect-of-nebulized-magnesium-sulfate-in-the-treatment-of-moderate-to-severe-asthma-attacks-a-randomized-clinical-trial
#17
RANDOMIZED CONTROLLED TRIAL
Shaker Hossein, Akhavan Pegah, Farsi Davood, Abbasi Said, Mahshidfar Babak, Mofidi Mani, Rezai Mahdi, Hafezimoghadam Peyman
OBJECTIVE: Thirty percent of people with asthma do not respond to standard treatment, and complementary therapies are needed. The objective of this study was to investigate the impact of inhaled magnesium sulfate on the treatment response in emergency department (ED) patients with moderate to severe attacks of asthma. METHODS: This study is a randomized controlled trial, enrolling patients with moderate to severe asthma in the ED. Subjects allocated to the study group were treated with the standard, plus 3 ml of 260 mmol/L solution of magnesium sulfate every 20 to 60 minutes...
May 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/26973178/diagnostic-accuracy-of-right-ventricular-dysfunction-markers%C3%A2-in%C3%A2-normotensive-emergency-department-patients%C3%A2-with%C3%A2-acute-pulmonary%C3%A2-embolism
#18
Anthony J Weekes, Gregory Thacker, Daniel Troha, Angela K Johnson, Jordan Chanler-Berat, H James Norton, Michael Runyon
STUDY OBJECTIVE: We determine the diagnostic accuracy of goal-directed echocardiography, cardiac biomarkers, and computed tomography (CT) in early identification of severe right ventricular dysfunction in normotensive emergency department patients with pulmonary embolism compared with comprehensive echocardiography. METHODS: This was a prospective observational study of consecutive normotensive patients with confirmed pulmonary embolism. Investigators, blinded to clot burden and biomarkers, performed qualitative goal-directed echocardiography for right ventricular dysfunction: right ventricular enlargement (diameter greater than or equal to that of the left ventricle), severe right ventricular systolic dysfunction, and septal bowing...
September 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/26910112/diagnosing-acute-heart-failure-in-the-emergency-department-a-systematic-review-and-meta-analysis
#19
REVIEW
Jennifer L Martindale, Abel Wakai, Sean P Collins, Phillip D Levy, Deborah Diercks, Brian C Hiestand, Gregory J Fermann, Ian deSouza, Richard Sinert
BACKGROUND: Acute heart failure (AHF) is one of the most common diagnoses assigned to emergency department (ED) patients who are hospitalized. Despite its high prevalence in the emergency setting, the diagnosis of AHF in ED patients with undifferentiated dyspnea can be challenging. OBJECTIVES: The primary objective of this study was to perform a systematic review and meta-analysis of the operating characteristics of diagnostic elements available to the emergency physician for diagnosing AHF...
March 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/26740484/effect-of-supplemental-oxygen-exposure-on-myocardial-injury-in-st-elevation-myocardial-infarction
#20
RANDOMIZED CONTROLLED TRIAL
Ziad Nehme, Dion Stub, Stephen Bernard, Michael Stephenson, Janet E Bray, Peter Cameron, Ian T Meredith, Bill Barger, Andris H Ellims, Andrew J Taylor, David M Kaye, Karen Smith
OBJECTIVE: Supplemental oxygen therapy may increase myocardial injury following ST-elevation myocardial infarction (STEMI). In this study, we aimed to evaluate the effect of the dose and duration of oxygen exposure on myocardial injury after STEMI. METHODS: Descriptive analysis of data from a multicentre, prospective, randomised, controlled trial of 441 patients with STEMI randomised to supplemental oxygen therapy or room air breathing. The primary endpoint was myocardial infarct size as assessed by cardiac biomarkers, troponin (cTnI) and creatine kinase (CK)...
March 2016: Heart: Official Journal of the British Cardiac Society
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