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EM Pharmacology

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55 papers 25 to 100 followers
By Terren Trott terren.trott@gmail.com
https://www.readbyqxmd.com/read/28135357/hypertension-in-2017-what-is-the-right-target
#1
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/28174032/emergency-medicine-myths-epinephrine-in-cardiac-arrest
#2
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/28187918/diazepam-is-no-better-than-placebo-when-added-to-naproxen-for-acute-low-back-pain
#3
Benjamin W Friedman, Eddie Irizarry, Clemencia Solorzano, Nauman Khankel, Jennifer Zapata, Eleftheria Zias, E John Gallagher
STUDY OBJECTIVE: Low back pain causes more than 2.5 million visits to US emergency departments (EDs) annually. Low back pain patients are often treated with nonsteroidal anti-inflammatory drugs and benzodiazepines. The former is an evidence-based intervention, whereas the efficacy of the latter has not been established. We compare pain and functional outcomes 1 week and 3 months after ED discharge among patients randomized to a 1-week course of naproxen+diazepam versus naproxen+placebo...
January 19, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/25568981/single-induction-dose-of-etomidate-versus-other-induction-agents-for-endotracheal-intubation-in-critically-ill-patients
#4
REVIEW
Eric A Bruder, Ian M Ball, Stacy Ridi, William Pickett, Corinne Hohl
BACKGROUND: The use of etomidate for emergency airway interventions in critically ill patients is very common. In one large registry trial, etomidate was the most commonly used agent for this indication. Etomidate is known to suppress adrenal gland function, but it remains unclear whether or not this adrenal gland dysfunction affects mortality. OBJECTIVES: The primary objective was to assess, in populations of critically ill patients, whether a single induction dose of etomidate for emergency airway intervention affects mortality...
January 8, 2015: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28073314/safety-of-the-peripheral-administration-of-vasopressor-agents
#5
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/22250698/laryngospasm-and-hypoxia-after-intramuscular-administration-of-ketamine-to-a-patient-in-excited-delirium
#6
Aaron M Burnett, Benjamin J Watters, Kelly W Barringer, Kent R Griffith, Ralph J Frascone
An advanced life support emergency medical services (EMS) unit was dispatched with law enforcement to a report of a male patient with a possible overdose and psychiatric emergency. Police restrained the patient and cleared EMS into the scene. The patient was identified as having excited delirium, and ketamine was administered intramuscularly. Sedation was achieved and the patient was transported to the closest hospital. While in the emergency department, the patient developed laryngospasm and hypoxia. The airway obstruction was overcome with bag-valve-mask ventilation...
July 2012: Prehospital Emergency Care
https://www.readbyqxmd.com/read/26799349/succinylcholine-is-associated-with-increased-mortality-when-used-for-rapid-sequence-intubation-of-severely-brain-injured-patients-in-the-emergency-department
#7
Asad E Patanwala, Brian L Erstad, Denise J Roe, John C Sakles
OBJECTIVE: To compare succinylcholine and rocuronium regarding mortality in patients with traumatic brain injury (TBI) who are intubated in the emergency department (ED). METHODS: This was a retrospective cohort study conducted in an academic ED in the United States. Adult patients with TBI who underwent rapid sequence intubation (RSI) in the ED with rocuronium or succinylcholine between October 2010 and October 2014 were included. The main outcome of interest was in-hospital mortality...
January 2016: Pharmacotherapy
https://www.readbyqxmd.com/read/20237045/rapid-sequence-induction-and-intubation-current-controversy
#8
REVIEW
Mohammad El-Orbany, Lois A Connolly
The changing opinion regarding some of the traditional components of rapid sequence induction and intubation (RSII) creates wide practice variations that impede attempts to establish a standard RSII protocol. There is controversy regarding the choice of induction drug, the dose, and the method of administration. Whereas some prefer the traditional rapid injection of a predetermined dose, others use the titration to loss of consciousness technique. The timing of neuromuscular blocking drug (NMBD) administration is different in both techniques...
May 1, 2010: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27353284/discharge-glucose-is-not-associated-with-short-term-adverse-outcomes-in-emergency-department-patients-with-moderate-to-severe-hyperglycemia
#9
Brian E Driver, Travis D Olives, Johanna E Bischof, Marcus R Salmen, James R Miner
STUDY OBJECTIVE: Hyperglycemia is frequently encountered in the emergency department (ED), and there is no consensus on optimal care before discharge. The importance of glucose reduction in the ED is unknown. We seek to determine whether an association exists between discharge glucose and 7-day adverse outcomes. METHODS: A cohort design with retrospective chart review was conducted at a high-volume urban ED. Patients were included if any glucose level was greater than or equal to 400 mg/dL and they were discharged from the ED...
June 25, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/19573904/etomidate-versus-ketamine-for-rapid-sequence-intubation-in-acutely-ill-patients-a-multicentre-randomised-controlled-trial
#10
RANDOMIZED CONTROLLED TRIAL
Patricia Jabre, Xavier Combes, Frederic Lapostolle, Mohamed Dhaouadi, Agnes Ricard-Hibon, Benoit Vivien, Lionel Bertrand, Alexandra Beltramini, Pascale Gamand, Stephane Albizzati, Deborah Perdrizet, Gaelle Lebail, Charlotte Chollet-Xemard, Virginie Maxime, Christian Brun-Buisson, Jean-Yves Lefrant, Pierre-Edouard Bollaert, Bruno Megarbane, Jean-Damien Ricard, Nadia Anguel, Eric Vicaut, Frederic Adnet
BACKGROUND: Critically ill patients often require emergency intubation. The use of etomidate as the sedative agent in this context has been challenged because it might cause a reversible adrenal insufficiency, potentially associated with increased in-hospital morbidity. We compared early and 28-day morbidity after a single dose of etomidate or ketamine used for emergency endotracheal intubation of critically ill patients. METHODS: In this randomised, controlled, single-blind trial, 655 patients who needed sedation for emergency intubation were prospectively enrolled from 12 emergency medical services or emergency departments and 65 intensive care units in France...
July 25, 2009: Lancet
https://www.readbyqxmd.com/read/27876541/diagnostic-performance-of-a-biomarker-panel-as-a-negative-predictor-for-acute-appendicitis-in-adult-emergency-department-patients-with-abdominal-pain
#11
David S Huckins, Karen Copeland, Wesley Self, Cheryl Vance, Phyllis Hendry, Keith Borg, Joseph Gogain
OBJECTIVES: Evaluate the diagnostic accuracy of the APPY1TM biomarker panel, previously described for use in pediatric patients, for identifying adult ED patients with abdominal pain who are at low risk of acute appendicitis. METHODS: This study prospectively enrolled subjects >18years of age presenting to seven U.S. emergency departments with <72hours of abdominal pain suggesting possible acute appendicitis. The APPY1 panel was performed on blood samples drawn from each patient at the time of initial evaluation and results were correlated with the final diagnosis either positive or negative for acute appendicitis...
November 11, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27776827/intranasal-dexmedetomidine-sedation-as-adjuvant-therapy-in-acute-asthma-exacerbation-with-marked-anxiety-and-agitation
#12
Giorgio Cozzi, Sara Lega, Rita Giorgi, Egidio Barbi
We describe 2 patients with acute asthma exacerbation who were admitted to the emergency department (ED) with severe agitation and restlessness as a prominent finding, for which bedside asthma treatment sedation with intranasal dexmedetomidine was performed. In both cases, dexmedetomidine allowed the patients to rest and improved tolerance to treatment. Dexmedetomidine is a unique sedative with an excellent safety profile and minimal effect on respiratory function. These properties render it particularly promising for the management of severe agitation in children admitted to the ED with acute asthma exacerbation...
January 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27695824/effect-of-hydrocortisone-on-development-of-shock-among-patients-with-severe-sepsis-the-hypress-randomized-clinical-trial
#13
RANDOMIZED CONTROLLED TRIAL
Didier Keh, Evelyn Trips, Gernot Marx, Stefan P Wirtz, Emad Abduljawwad, Sven Bercker, Holger Bogatsch, Josef Briegel, Christoph Engel, Herwig Gerlach, Anton Goldmann, Sven-Olaf Kuhn, Lars Hüter, Andreas Meier-Hellmann, Axel Nierhaus, Stefan Kluge, Josefa Lehmke, Markus Loeffler, Michael Oppert, Kerstin Resener, Dirk Schädler, Tobias Schuerholz, Philipp Simon, Norbert Weiler, Andreas Weyland, Konrad Reinhart, Frank M Brunkhorst
Importance: Adjunctive hydrocortisone therapy is suggested by the Surviving Sepsis Campaign in refractory septic shock only. The efficacy of hydrocortisone in patients with severe sepsis without shock remains controversial. Objective: To determine whether hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock. Design, Setting, and Participants: Double-blind, randomized clinical trial conducted from January 13, 2009, to August 27, 2013, with a follow-up of 180 days until February 23, 2014...
November 1, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27694410/corticosteroids-for-community-acquired-pneumonia-a-critical-view-of-the-evidence
#14
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/27422214/pulseless-electrical-activity-in-pulmonary-embolism-treated-with-thrombolysis-from-the-peapett-study
#15
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/27354046/randomized-comparison-of-intravenous-procainamide-vs-intravenous-amiodarone-for-the-acute-treatment-of-tolerated-wide-qrs-tachycardia-the-procamio-study
#16
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
#17
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/27233380/prevention-of-contrast-associated-acute-kidney-injury-what-should-we-do
#18
EDITORIAL
Steven D Weisbord, Paul M Palevsky
No abstract text is available yet for this article.
October 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27216835/optimal-dosing-of-intravenous-ketamine-for-procedural-sedation-in-children-in-the-ed-a-randomized-controlled-trial
#19
RANDOMIZED CONTROLLED TRIAL
Nirupama Kannikeswaran, Mary Lieh-Lai, Monica Malian, Bo Wang, Ahmad Farooqi, Mark G Roback
OBJECTIVE: The objective of the study is to compare need for redosing, sedation efficacy, duration, and adverse events between 3 commonly administered doses of parenteral ketamine in the emergency department (ED). METHODS: We conducted a prospective, double-blind, randomized controlled trial on a convenience sample of children 3 to 18years who received intravenous ketamine for procedural sedation. Children from each age group (3-6, 7-12, and 13-18years) were assigned in equal numbers to 3 dosing groups (1, 1...
August 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27184564/advances-in-antibiotic-therapy-in-the-critically-ill
#20
REVIEW
Jean-Louis Vincent, Matteo Bassetti, Bruno François, George Karam, Jean Chastre, Antoni Torres, Jason A Roberts, Fabio S Taccone, Jordi Rello, Thierry Calandra, Daniel De Backer, Tobias Welte, Massimo Antonelli
Infections occur frequently in critically ill patients and their management can be challenging for various reasons, including delayed diagnosis, difficulties identifying causative microorganisms, and the high prevalence of antibiotic-resistant strains. In this review, we briefly discuss the importance of early infection diagnosis, before considering in more detail some of the key issues related to antibiotic management in these patients, including controversies surrounding use of combination or monotherapy, duration of therapy, and de-escalation...
May 17, 2016: Critical Care: the Official Journal of the Critical Care Forum
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