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EM Pharmacology

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44 papers 25 to 100 followers
By Terren Trott terren.trott@gmail.com
https://www.readbyqxmd.com/read/27776827/intranasal-dexmedetomidine-sedation-as-adjuvant-therapy-in-acute-asthma-exacerbation-with-marked-anxiety-and-agitation
#1
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...
October 5, 2016: 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
#2
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
#3
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
#4
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...
June 30, 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
#5
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
#6
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
#7
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
#8
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
#9
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
https://www.readbyqxmd.com/read/27130801/for-adults-with-nausea-and-vomiting-in-the-emergency-department-what-medications-provide-rapid-relief
#10
EDITORIAL
Andrew C Meltzer, Maryann Mazer-Amirshahi
No abstract text is available yet for this article.
December 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27102743/a-prospective-study-of-ketamine-versus-haloperidol-for-severe-prehospital-agitation
#11
Jon B Cole, Johanna C Moore, Paul C Nystrom, Benjamin S Orozco, Samuel J Stellpflug, Rebecca L Kornas, Brandon J Fryza, Lila W Steinberg, Alex O'Brien-Lambert, Peter Bache-Wiig, Kristin M Engebretsen, Jeffrey D Ho
CONTEXT: Ketamine is an emerging drug for the treatment of acute undifferentiated agitation in the prehospital environment, however no prospective comparative studies have evaluated its effectiveness or safety in this clinical setting. OBJECTIVE: We hypothesized 5 mg/kg of intramuscular ketamine would be superior to 10 mg of intramuscular haloperidol for severe prehospital agitation, with time to adequate sedation as the primary outcome measure. METHODS: This was a prospective open label study of all patients in an urban EMS system requiring chemical sedation for severe acute undifferentiated agitation that were subsequently transported to the EMS system's primary Emergency Department...
August 2016: Clinical Toxicology
https://www.readbyqxmd.com/read/27083327/transfusion-reactions-prevention-diagnosis-and-treatment
#12
Meghan Delaney, Silvano Wendel, Rachel S Bercovitz, Joan Cid, Claudia Cohn, Nancy M Dunbar, Torunn O Apelseth, Mark Popovsky, Simon J Stanworth, Alan Tinmouth, Leo Van De Watering, Jonathan H Waters, Mark Yazer, Alyssa Ziman
Blood transfusion is one of the most common procedures in patients in hospital so it is imperative that clinicians are knowledgeable about appropriate blood product administration, as well as the signs, symptoms, and management of transfusion reactions. In this Review, we, an international panel, provide a synopsis of the pathophysiology, treatment, and management of each diagnostic category of transfusion reaction using evidence-based recommendations whenever available.
April 12, 2016: Lancet
https://www.readbyqxmd.com/read/26822172/safety-of-a-four-factor-prothrombin-complex-concentrate-versus-plasma-for-vitamin-k-antagonist-reversal-an-integrated-analysis-of-two-phase-iiib-clinical-trials
#13
Truman J Milling, Majed A Refaai, Ravi Sarode, Brandon Lewis, Antoinette Mangione, Billie L Durn, Amy Harman, Martin L Lee, Joshua N Goldstein
OBJECTIVES: Clinicians often need to rapidly reverse vitamin K antagonists (VKAs) in the setting of major hemorrhage or urgent need for surgery. Little is known about the safety profile of the traditional reversal agent, plasma, or the newly approved agent, four-factor prothrombin complex concentrate (4F-PCC), in a randomized setting. This is an integrated analysis of safety data from two clinical trials that evaluated 4F-PCC versus plasma for the treatment of patients requiring rapid VKA reversal for acute major bleeding or prior to an urgent surgical/invasive procedure...
April 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/26801209/incidence-of-adverse-events-in-adults-undergoing-procedural-sedation-in-the-emergency-department-a-systematic-review-and-meta-analysis
#14
REVIEW
M Fernanda Bellolio, Waqas I Gilani, Patricia Barrionuevo, M Hassan Murad, Patricia J Erwin, Joel R Anderson, James R Miner, Erik P Hess
OBJECTIVES: This was a systematic review and meta-analysis to evaluate the incidence of adverse events in adults undergoing procedural sedation in the emergency department (ED). METHODS: Eight electronic databases were searched, including MEDLINE, EMBASE, EBSCO, CINAHL, CENTRAL, Cochrane Database of Systematic Reviews, Web of Science, and Scopus, from January 2005 through 2015. Randomized controlled trials and observational studies of adults undergoing procedural sedation in the ED that reported a priori selected outcomes and adverse events were included...
February 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/26720490/intravenous-ondansetron-and-the-qt-interval-in-adult-emergency-department-patients-an-observational-study
#15
Peter M Moffett, Laquisha Cartwright, Elizabeth A Grossart, Dustin O'Keefe, Christopher S Kang
OBJECTIVES: Ondansetron is known to cause QT interval prolongation, but this effect and clinical significance has not been prospectively studied in adult emergency department (ED) patients. The primary objective was to determine the mean maximal corrected QT interval (QTc) prolongation after intravenous (IV) administration of 4 mg of ondansetron. The secondary objective was to report any serious adverse cardiac electrical events. METHODS: This was a prospective, observational, single-center cohort study conducted between 2012 and 2013 in an academic, military hospital ED...
January 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/15494903/practice-guidelines-for-the-management-of-bacterial-meningitis
#16
Allan R Tunkel, Barry J Hartman, Sheldon L Kaplan, Bruce A Kaufman, Karen L Roos, W Michael Scheld, Richard J Whitley
No abstract text is available yet for this article.
November 1, 2004: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/18184957/hydrocortisone-therapy-for-patients-with-septic-shock
#17
RANDOMIZED CONTROLLED TRIAL
Charles L Sprung, Djillali Annane, Didier Keh, Rui Moreno, Mervyn Singer, Klaus Freivogel, Yoram G Weiss, Julie Benbenishty, Armin Kalenka, Helmuth Forst, Pierre-Francois Laterre, Konrad Reinhart, Brian H Cuthbertson, Didier Payen, Josef Briegel
BACKGROUND: Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. METHODS: In this multicenter, randomized, double-blind, placebo-controlled trial, we assigned 251 patients to receive 50 mg of intravenous hydrocortisone and 248 patients to receive placebo every 6 hours for 5 days; the dose was then tapered during a 6-day period...
January 10, 2008: New England Journal of Medicine
https://www.readbyqxmd.com/read/23184813/adjuvant-steroid-therapy-in-community-acquired-pneumonia-a-systematic-review-and-meta-analysis
#18
REVIEW
Majid Shafiq, Muhammad S Mansoor, Adnan A Khan, M Rizwan Sohail, Mohammad H Murad
BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality among adults. Although steroids appear to be beneficial in animal models of CAP, clinical trial data in humans are either equivocal or conflicting. PURPOSE: Our purpose was to perform a systematic review and meta-analysis of studies examining the impact of steroid therapy on clinical outcomes among adults admitted with CAP. DATA SOURCES AND STUDY SELECTION: We identified randomized controlled trials (RCTs) through a systematic search of published literature up to July 2011...
February 2013: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/26258555/corticosteroid-therapy-for-patients-hospitalized-with-community-acquired-pneumonia-a-systematic-review-and-meta-analysis
#19
REVIEW
Reed A C Siemieniuk, Maureen O Meade, Pablo Alonso-Coello, Matthias Briel, Nathan Evaniew, Manya Prasad, Paul E Alexander, Yutong Fei, Per O Vandvik, Mark Loeb, Gordon H Guyatt
BACKGROUND: Community-acquired pneumonia (CAP) is common and often severe. PURPOSE: To examine the effect of adjunctive corticosteroid therapy on mortality, morbidity, and duration of hospitalization in patients with CAP. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through 24 May 2015. STUDY SELECTION: Randomized trials of systemic corticosteroids in hospitalized adults with CAP...
October 6, 2015: Annals of Internal Medicine
https://www.readbyqxmd.com/read/26014852/safety-of-peripheral-intravenous-administration-of-vasoactive-medication
#20
Jose Cardenas-Garcia, Karen F Schaub, Yuly G Belchikov, Mangala Narasimhan, Seth J Koenig, Paul H Mayo
BACKGROUND: Central venous access is commonly performed to administer vasoactive medication. The administration of vasoactive medication via peripheral intravenous access is a potential method of reducing the need for central venous access. The aim of this study was to evaluate the safety of vasoactive medication administered through peripheral intravenous access. METHODS: Over a 20-month period starting in September 2012, we monitored the use of vasoactive medication via peripheral intravenous access in an 18-bed medical intensive care unit...
September 2015: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
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