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EM Critical care

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71 papers 100 to 500 followers
By Terren Trott terren.trott@gmail.com
https://www.readbyqxmd.com/read/28499516/improving-cpr-performance
#1
REVIEW
Boulos S Nassar, Richard Kerber
Cardiac arrest continues to represent a public health burden with most patients having dismal outcomes. Cardiopulmonary resuscitation (CPR) is a complex set of interventions requiring leadership, coordination, and best practices. Despite the widespread adoption of new evidence in various guidelines, the provision of CPR remains variable with poor adherence to published recommendations. Key steps health care systems can take to enhance the quality of CPR and, potentially, to improve outcomes, include optimizing chest compressions; avoiding hyperventilation; encouraging intraosseus access, and monitoring capnography...
May 9, 2017: Chest
https://www.readbyqxmd.com/read/27618681/early-identification-of-patients-with-out-of-hospital-cardiac-arrest-with-no-chance-of-survival-and-consideration-for-organ-donation
#2
Patricia Jabre, Wulfran Bougouin, Florence Dumas, Pierre Carli, Corinne Antoine, Laurent Jacob, Benjamin Dahan, Frankie Beganton, Jean-Philippe Empana, Eloi Marijon, Nicole Karam, Alexandre Loupy, Carmen Lefaucheur, Daniel Jost, Alain Cariou, Frédéric Adnet, Thomas D Rea, Xavier Jouven
Background: In patients with out-of-hospital cardiac arrest (OHCA), care requirements can conflict with the need to promptly focus efforts on organ donation in patients who are pronounced dead. Objective: To evaluate objective criteria for identifying patients with OHCA with no chance of survival during the first minutes of cardiopulmonary resuscitation to enable prompt orientation toward organ donation. Design: Retrospective assessment using OHCA data from 2 registries and 1 trial...
December 6, 2016: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27666168/association-between-chest-compression-rates-and-clinical-outcomes-following-in-hospital-cardiac-arrest-at-an-academic-tertiary-hospital
#3
J Hope Kilgannon, Michael Kirchhoff, Lisa Pierce, Nicholas Aunchman, Stephen Trzeciak, Brian W Roberts
AIMS: Recent guidelines for management of cardiac arrest recommend chest compression rates of 100-120 compressions/min. However, animal studies have found cardiac output to increase with rates up to 150 compressions/min. The objective of this study was to test the association between chest compression rates during cardiopulmonary resuscitation for in-hospital cardiac arrest (IHCA) and outcome. METHODS: We conducted a prospective observational study at a single academic medical center...
January 2017: Resuscitation
https://www.readbyqxmd.com/read/28232056/prophylactic-corticosteroids-for-prevention-of-postextubation-stridor-and-reintubation-in-adults-a-systematic-review-and-meta-analysis
#4
Akira Kuriyama, Noriyuki Umakoshi, Rao Sun
BACKGROUND: Corticosteroid administration before elective extubation has been used to prevent postextubation stridor and reintubation. We updated a systematic review to identify which patients would benefit from prophylactic corticosteroid administration before elective extubation. METHODS: We searched PubMed, EMBASE, the Wanfang Database, the China Academic Journal Network Publishing Database, and the Cochrane Central Register of Controlled Trials for eligible trials from inception through February 29, 2016...
May 2017: Chest
https://www.readbyqxmd.com/read/28174032/emergency-medicine-myths-epinephrine-in-cardiac-arrest
#5
Brit Long, Alex Koyfman
BACKGROUND: Sudden cardiac arrest accounts for approximately 15% of deaths in developed nations, with poor survival rate. The American Heart Association states that epinephrine is reasonable for patients with cardiac arrest, though the literature behind its use is not strong. OBJECTIVE: To review the evidence behind epinephrine for cardiac arrest. DISCUSSION: Sudden cardiac arrest causes over 450,000 deaths annually in the United States. The American Heart Association recommends epinephrine may be reasonable in patients with cardiac arrest, as part of Advanced Cardiac Life Support...
February 4, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/22370007/factors-complicating-interpretation-of-capnography-during-advanced-life-support-in-cardiac-arrest-a-clinical-retrospective-study-in-575-patients
#6
Bård E Heradstveit, Kjetil Sunde, Geir-Arne Sunde, Tore Wentzel-Larsen, Jon-Kenneth Heltne
BACKGROUND: End tidal carbon dioxide (ETCO(2)) monitoring during advanced life support (ALS) using capnography, is recommended in the latest international guidelines. However, several factors might complicate capnography interpretation during ALS. How the cause of cardiac arrest, initial rhythm, bystander cardiopulmonary resuscitation (CPR) and time impact on the ETCO(2) values are not completely clear. Thus, we wanted to explore this in out-of-hospital cardiac arrested (OHCA) patients...
July 2012: Resuscitation
https://www.readbyqxmd.com/read/28117180/the-role-of-resuscitative-endovascular-balloon-occlusion-of-the-aorta-reboa-as-an-adjunct-to-acls-in-non-traumatic-cardiac-arrest-a-review-of-key-concepts-physiology-current-evidence-and-future-directions
#7
James Daley, Jonathan James Morrison, John Sather, Lisa Hile
Non-traumatic cardiac arrest is a major public health problem that carries an extremely high mortality rate. If we hope to increase the survivability of this condition, it is imperative that alternative methods of treatment are given due consideration. Balloon occlusion of the aorta can be used as a method of circulatory support in the critically ill patient. Intra-aortic balloon pumps have been used to temporize patients in cardiogenic shock for decades. More recently, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been utilized in the patient in hemorrhagic shock or cardiac arrest secondary to trauma...
January 12, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28098591/surviving-sepsis-campaign-international-guidelines-for-management-of-sepsis-and-septic-shock-2016
#8
Andrew Rhodes, Laura E Evans, Waleed Alhazzani, Mitchell M Levy, Massimo Antonelli, Ricard Ferrer, Anand Kumar, Jonathan E Sevransky, Charles L Sprung, Mark E Nunnally, Bram Rochwerg, Gordon D Rubenfeld, Derek C Angus, Djillali Annane, Richard J Beale, Geoffrey J Bellinghan, Gordon R Bernard, Jean-Daniel Chiche, Craig Coopersmith, Daniel P De Backer, Craig J French, Seitaro Fujishima, Herwig Gerlach, Jorge Luis Hidalgo, Steven M Hollenberg, Alan E Jones, Dilip R Karnad, Ruth M Kleinpell, Younsuck Koh, Thiago Costa Lisboa, Flavia R Machado, John J Marini, John C Marshall, John E Mazuski, Lauralyn A McIntyre, Anthony S McLean, Sangeeta Mehta, Rui P Moreno, John Myburgh, Paolo Navalesi, Osamu Nishida, Tiffany M Osborn, Anders Perner, Colleen M Plunkett, Marco Ranieri, Christa A Schorr, Maureen A Seckel, Christopher W Seymour, Lisa Shieh, Khalid A Shukri, Steven Q Simpson, Mervyn Singer, B Taylor Thompson, Sean R Townsend, Thomas Van der Poll, Jean-Louis Vincent, W Joost Wiersinga, Janice L Zimmerman, R Phillip Dellinger
OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015...
March 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28073314/safety-of-the-peripheral-administration-of-vasopressor-agents
#9
Tyler Lewis, Cristian Merchan, Diana Altshuler, John Papadopoulos
Vasopressors are an integral component of the management of septic shock and are traditionally given via a central venous catheter (CVC) due to the risk of tissue injury and necrosis if extravasated. However, the need for a CVC for the management of septic shock has been questioned, and the risk of extravasation and incidence of severe injury when vasopressors are given via a peripheral venous line (PVL) remains poorly defined. We performed a retrospective chart review of 202 patients who received vasopressors through a PVL...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27522622/lactic-acidosis-an-update
#10
REVIEW
Jansen Seheult, Gerard Fitzpatrick, Gerard Boran
Lactate is one of the most crucial intermediates in carbohydrate and nonessential amino acid metabolism. The complexity of cellular interactions and metabolism means that lactate can be considered a waste product for one cell but a useful substrate for another. The presence of elevated lactate levels in critically ill patients has important implications for morbidity and mortality. In this review, we provide a brief outline of the metabolism of lactate, the pathophysiology of lactic acidosis, the clinical significance of D-lactate, the role of lactate measurement in acutely ill patients, the methods used to measure lactate in blood or plasma and some of the methodological issues related to interferences in these assays, especially in the case of ethylene glycol poisoning...
March 1, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28012882/out-of-hospital-cardiac-arrest-without-return-of-spontaneous-circulation-in-the-field-who-are-the-survivors
#11
Yan Xiong, Hong Zhan, Yuanzheng Lu, Kaipan Guan, Ngozi Okoro, Denise Mitchell, Megan Dwyer, Auna Leatham, Gilberto Salazar, Xiaoxing Liao, Ahamed Idris
BACKGROUND: Return of spontaneous circulation (ROSC) in the field is a vital determinant contributing to survival from out-of-hospital cardiac arrest (OHCA). However, nearly one third of survivors at the Dallas-Fort Worth (DFW) Resuscitation Outcomes Consortium (ROC) site did not obtain ROSC in the field. METHODS: A retrospective, observational analysis was performed on all adult patients with non-traumatic OHCA treated on scene and transported to hospital, who did not gain ROSC in the field at DFW ROC site between 2006 through 2011...
March 2017: Resuscitation
https://www.readbyqxmd.com/read/27923115/a-comparison-of-the-universal-tor-guideline-to-the-absence-of-prehospital-rosc-and-duration-of-resuscitation-in-predicting-futility-from-out-of-hospital-cardiac-arrest
#12
Ian R Drennan, Erin Case, P Richard Verbeek, Joshua C Reynolds, Zachary D Goldberger, Jamie Jasti, Mark Charleston, Heather Herren, Ahamed H Idris, Paul R Leslie, Michael A Austin, Yan Xiong, Robert H Schmicker, Laurie J Morrison
INTRODUCTION: The Universal Termination of Resuscitation (TOR) Guideline accurately identifies potential out-of-hospital cardiac arrest (OHCA) survivors. However, implementation is inconsistent with some Emergency Medical Service (EMS) agencies using absence of return of spontaneous circulation (ROSC) as sole criterion for termination. OBJECTIVE: To compare the performance of the Universal TOR Guideline with the single criterion of no prehospital ROSC. Second, to determine factors associated with survival for patients transported without a ROSC...
February 2017: Resuscitation
https://www.readbyqxmd.com/read/27693280/emergency-department-point-of-care-ultrasound-in-out-of-hospital-and-in-ed-cardiac-arrest
#13
Romolo Gaspari, Anthony Weekes, Srikar Adhikari, Vicki E Noble, Jason T Nomura, Daniel Theodoro, Michael Woo, Paul Atkinson, David Blehar, Samuel M Brown, Terrell Caffery, Emily Douglass, Jacqueline Fraser, Christine Haines, Samuel Lam, Michael Lanspa, Margaret Lewis, Otto Liebmann, Alexander Limkakeng, Fernando Lopez, Elke Platz, Michelle Mendoza, Hal Minnigan, Christopher Moore, Joseph Novik, Louise Rang, Will Scruggs, Christopher Raio
BACKGROUND: Point-of-care ultrasound has been suggested to improve outcomes from advanced cardiac life support (ACLS), but no large studies have explored how it should be incorporated into ACLS. Our aim was to determine whether cardiac activity on ultrasound during ACLS is associated with improved survival. METHODS: We conducted a non-randomized, prospective, protocol-driven observational study at 20 hospitals across United States and Canada. Patients presenting with out-of-hospital arrest or in-ED arrest with pulseless electrical activity or asystole were included...
December 2016: Resuscitation
https://www.readbyqxmd.com/read/16032611/does-the-presence-or-absence-of-sonographically-identified-cardiac-activity-predict-resuscitation-outcomes-of-cardiac-arrest-patients
#14
MULTICENTER STUDY
Philip Salen, Larry Melniker, Carolyn Chooljian, John S Rose, Janet Alteveer, James Reed, Michael Heller
This study evaluated the ability of cardiac sonography performed by emergency physicians to predict resuscitation outcomes of cardiac arrest patients. A convenience sample of cardiac arrest patients prospectively underwent bedside cardiac sonography at 4 emergency medicine residency-affiliated EDs as part of the Sonography Outcomes Assessment Program. Cardiac arrest patients in pulseless electrical activity (PEA) and asystole underwent transthoracic cardiac ultrasound B-mode examinations during their resuscitations to assess for the presence or absence of cardiac kinetic activity...
July 2005: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27673307/will-this-hemodynamically-unstable-patient-respond-to-a-bolus-of-intravenous-fluids
#15
REVIEW
Peter Bentzer, Donald E Griesdale, John Boyd, Kelly MacLean, Demetrios Sirounis, Najib T Ayas
IMPORTANCE: Fluid overload occurring as a consequence of overly aggressive fluid resuscitation may adversely affect outcome in hemodynamically unstable critically ill patients. Therefore, following the initial fluid resuscitation, it is important to identify which patients will benefit from further fluid administration. OBJECTIVE: To identify predictors of fluid responsiveness in hemodynamically unstable patients with signs of inadequate organ perfusion. DATA SOURCES AND STUDY SELECTION: Search of MEDLINE and EMBASE (1966 to June 2016) and reference lists from retrieved articles, previous reviews, and physical examination textbooks for studies that evaluated the diagnostic accuracy of tests to predict fluid responsiveness in hemodynamically unstable adult patients who were defined as having refractory hypotension, signs of organ hypoperfusion, or both...
September 27, 2016: JAMA: the Journal of the American Medical Association
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
#16
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/26507493/a-rational-approach-to-fluid-therapy-in-sepsis
#17
REVIEW
P Marik, R Bellomo
Aggressive fluid resuscitation to achieve a central venous pressure (CVP) greater than 8 mm Hg has been promoted as the standard of care, in the management of patients with severe sepsis and septic shock. However recent clinical trials have demonstrated that this approach does not improve the outcome of patients with severe sepsis and septic shock. Pathophysiologically, sepsis is characterized by vasoplegia with loss of arterial tone, venodilation with sequestration of blood in the unstressed blood compartment and changes in ventricular function with reduced compliance and reduced preload responsiveness...
March 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27543137/echocardiography-in-shock-management
#18
REVIEW
Anthony S McLean
Echocardiography is pivotal in the diagnosis and management of the shocked patient. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied.In the acute situation a basic study often yields immediate results allowing for the initiation of therapy, while a follow-up advanced study brings the advantage of further refining the diagnosis and providing an in-depth hemodynamic assessment. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available...
August 20, 2016: Critical Care: the Official Journal of the Critical Care Forum
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/27318408/improving-survival-from-cardiac-arrest-a-review-of-contemporary-practice-and-challenges
#20
REVIEW
Jacob C Jentzer, Casey M Clements, R Scott Wright, Roger D White, Allan S Jaffe
Cardiac arrest is a common and lethal condition frequently encountered by emergency medicine providers. Resuscitation of persons after cardiac arrest remains challenging, and outcomes remain poor overall. Successful resuscitation hinges on timely, high-quality cardiopulmonary resuscitation. The optimal method of providing chest compressions and ventilator support during cardiac arrest remains uncertain. Prompt and effective defibrillation of ventricular arrhythmias is one of the few effective therapies available for treatment of cardiac arrest...
December 2016: Annals of Emergency Medicine
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