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EM Chest

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68 papers 25 to 100 followers
By Terren Trott terren.trott@gmail.com
https://www.readbyqxmd.com/read/28844200/oxygen-therapy-in-suspected-acute-myocardial-infarction
#1
Robin Hofmann, Stefan K James, Tomas Jernberg, Bertil Lindahl, David Erlinge, Nils Witt, Gabriel Arefalk, Mats Frick, Joakim Alfredsson, Lennart Nilsson, Annica Ravn-Fischer, Elmir Omerovic, Thomas Kellerth, David Sparv, Ulf Ekelund, Rickard Linder, Mattias Ekström, Jörg Lauermann, Urban Haaga, John Pernow, Ollie Östlund, Johan Herlitz, Leif Svensson
Background The clinical effect of routine oxygen therapy in patients with suspected acute myocardial infarction who do not have hypoxemia at baseline is uncertain. Methods In this registry-based randomized clinical trial, we used nationwide Swedish registries for patient enrollment and data collection. Patients with suspected myocardial infarction and an oxygen saturation of 90% or higher were randomly assigned to receive either supplemental oxygen (6 liters per minute for 6 to 12 hours, delivered through an open face mask) or ambient air...
August 28, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28792873/acute-respiratory-distress-syndrome
#2
REVIEW
B Taylor Thompson, Rachel C Chambers, Kathleen D Liu
New England Journal of Medicine, Volume 377, Issue 6, Page 562-572, August 2017.
August 10, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28791782/predicting-short-term-risk-of-arrhythmia-among-patients-with-syncope-the-canadian-syncope-arrhythmia-risk-score
#3
Venkatesh Thiruganasambandamoorthy, Ian G Stiell, Marco L A Sivilotti, Brian H Rowe, Muhammad Mukarram, Kirtana Arcot, Kenneth Kwong, Andrew D McRae, George A Wells, Monica Taljaard
BACKGROUND: Syncope can be caused by serious occult arrhythmias not evident during initial emergency department (ED) evaluation. We sought to develop a risk-tool for predicting 30-day arrhythmia or death after ED disposition. METHODS: We conducted a multicenter prospective cohort study at six tertiary-care EDs and included adults (≥16 years) with syncope. We collected standardized variables from clinical evaluation, and investigations including ECG and troponin at index presentation...
August 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28787100/pulmonary-embolism-testing-among-emergency-department-patients-who-are-pulmonary-embolism-rule-out-criteria-negative
#4
Ian Buchanan, Troy Teeples, Margaret Carlson, Jacob Steenblik, Joseph Bledsoe, Troy Madsen
INTRODUCTION: Previous studies have demonstrated that rates of pulmonary embolism (PE) testing have increased without a concomitant decrease in PE related mortality. The Pulmonary Embolism Rule-out Criteria (PERC) intend to reduce testing for PE in the emergency department (ED) by identifying low-risk patients ("PERC-negative") who do not require d-dimer, computed tomography pulmonary angiogram (CTPA), or ventilation/perfusion (VQ) scan for PE. This study assesses PE testing rates among PERC-negative patients presenting to an urban academic ED...
August 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28549662/simplified-diagnostic-management-of-suspected-pulmonary-embolism-the-years-study-a-prospective-multicentre-cohort-study
#5
Tom van der Hulle, Whitney Y Cheung, Stephanie Kooij, Ludo F M Beenen, Thomas van Bemmel, Josien van Es, Laura M Faber, Germa M Hazelaar, Christian Heringhaus, Herman Hofstee, Marcel M C Hovens, Karin A H Kaasjager, Rick C J van Klink, Marieke J H A Kruip, Rinske F Loeffen, Albert T A Mairuhu, Saskia Middeldorp, Mathilde Nijkeuter, Liselotte M van der Pol, Suzanne Schol-Gelok, Marije Ten Wolde, Frederikus A Klok, Menno V Huisman
BACKGROUND: Validated diagnostic algorithms in patients with suspected pulmonary embolism are often not used correctly or only benefit subgroups of patients, leading to overuse of computed tomography pulmonary angiography (CTPA). The YEARS clinical decision rule that incorporates differential D-dimer cutoff values at presentation, has been developed to be fast, to be compatible with clinical practice, and to reduce the number of CTPA investigations in all age groups. We aimed to prospectively evaluate this novel and simplified diagnostic algorithm for suspected acute pulmonary embolism...
July 15, 2017: Lancet
https://www.readbyqxmd.com/read/28552271/comparing-the-success-rates-of-standard-and-modified-valsalva-maneuvers-to-terminate-psvt-a-randomized-controlled-trial
#6
Şeref Kerem Çorbacıoğlu, Emine Akıncı, Yunsur Çevik, Halit Aytar, Mehmet Veysel Öncül, Sedat Akkan, Hüseyin Uzunosmanoğlu
PURPOSE: The study aimed to detect whether modified Valsalva maneuver (VM) is more effective than the standard VM in terminating paroxysmal supraventricular tachycardia (PSVT). METHODOLOGY: This randomized controlled trial was conducted in the emergency department of a training and research hospital between Dec. 1, 2015 and Dec. 31, 2016. Participants were divided into two groups, randomly assigned standard VM or modified VM, as the first treatment with two-dimensional permutation blocks; in the order of arrival of the patients...
May 22, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28363616/an-end-user-s-guide-to-the-heart-score-and-pathway
#7
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/28135357/hypertension-in-2017-what-is-the-right-target
#8
Aram V Chobanian
No abstract text is available yet for this article.
February 14, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28108220/missed-myocardial-infarctions-in-ed-patients-prospectively-categorized-as-low-risk-by-established-risk-scores
#9
MULTICENTER STUDY
A J Singer, M P Than, S Smith, P McCullough, T W Barrett, R Birkhahn, M Reed, H C Thode, W D Arnold, L B Daniels, C de Filippi, G Headden, W F Peacock
STUDY OBJECTIVES: Few studies have prospectively compared multiple cardiac risk prediction scores. We compared the rate of missed acute myocardial infarction (AMI) in chest pain patients prospectively categorized as low risk by unstructured clinical impression, and by HEART, TIMI, GRACE, and EDACS scores, in combination with two negative contemporary cardiac troponins (cTn) available in the U.S. METHODS: We enrolled 434 patients with chest pain presenting to one of seven emergency departments (ED)...
May 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28045663/caustic-ingestion
#10
REVIEW
Mircea Chirica, Luigi Bonavina, Michael D Kelly, Emile Sarfati, Pierre Cattan
Corrosive ingestion is a rare but potentially devastating event and, despite the availability of effective preventive public health strategies, injuries continue to occur. Most clinicians have limited personal experience and rely on guidelines; however, uncertainty persists about best clinical practice. Ingestions range from mild cases with no injury to severe cases with full thickness necrosis of the oesophagus and stomach. CT scan is superior to traditional endoscopy for stratification of patients to emergency resection or observation...
May 20, 2017: Lancet
https://www.readbyqxmd.com/read/27989538/clinical-profile-of-patients-of-acute-aortic-dissection-presenting-to-the-ed-without-chest-pain
#11
Kit Ling Fan, Ling Pong Leung
No abstract text is available yet for this article.
April 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27893526/effect-of-oxygen-therapy-on-myocardial-salvage-in-st-elevation-myocardial-infarction-the-randomized-soccer-trial
#12
Ardavan Khoshnood, Marcus Carlsson, Mahin Akbarzadeh, Pallonji Bhiladvala, Anders Roijer, David Nordlund, Peter Höglund, David Zughaft, Lizbet Todorova, Arash Mokhtari, Håkan Arheden, David Erlinge, Ulf Ekelund
OBJECTIVE: Recent studies suggest that administration of O2 in patients with acute myocardial infarction may have negative effects. With the use of cardiac MRI (CMR), we evaluated the effects of supplemental O2 in patients with ST elevation myocardial infarction (STEMI) accepted for acute percutaneous coronary intervention (PCI). MATERIALS AND METHODS: This study was a randomized-controlled trial conducted at two university hospitals in Sweden. Normoxic STEMI patients were randomized in the ambulance to either supplemental O2 (10 l/min) or room air until the conclusion of the PCI...
November 23, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/20215043/r-wave-peak-time-at-dii-a-new-criterion-for-differentiating-between-wide-complex-qrs-tachycardias
#13
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
#14
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...
January 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27797317/prevalence-of-pulmonary-embolism-among-patients-hospitalized-for-syncope
#15
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
#16
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
#17
REVIEW
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...
November 2016: Resuscitation
https://www.readbyqxmd.com/read/27528647/state-of-the-art-evaluation-of-emergency-department-patients-presenting-with-potential-acute-coronary-syndromes
#18
REVIEW
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
#19
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
#20
MULTICENTER STUDY
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
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