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By Terren Trott
Barack H Obama
Health care policy often shifts when the country’s leadership changes. That was true when I took office, and it will likely be true with President-elect Donald Trump. I am proud that my administration’s work, through the Affordable Care Act (ACA) and other policies, helped millions more Americans..
January 26, 2017: New England Journal of Medicine
Guillermo Umpierrez, Amado X Freire
BACKGROUND: The aim of the study was to evaluate the incidence and prognosis of abdominal pain in patients with diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic state (HHS). Abdominal pain, sometimes mimicking an acute abdomen, is a frequent manifestation in patients with DKA. The prevalence and clinical significance of gastrointestinal symptoms including abdominal pain in HHS have not been prospectively evaluated. MATERIALS AND METHODS: This is a prospectively collected evaluation of 200 consecutive patients with hyperglycemic crises admitted to a large inner-city teaching hospital in Atlanta, GA...
March 2002: Journal of Critical Care
Yasuharu Tokuda, Fumio Omata, Yusuke Tsugawa, Kyouko Maesato, Kazuhisa Momotura, Atsuko Fujinuma, Gerald H Stein, E Francis Cook
AIMS: To develop a prediction algorithm to rule out diabetic ketoacidosis (DKA) and non-ketotic hyperosmolar syndrome (NKHS) based on vital signs for early triage of patients with diabetes. METHODS: The subjects were consecutive adult diabetic patients with hyperglycemia (blood glucose >or=250mg/dl) who presented at an emergency department. Based on a derivation sample (n=392, 70% of 544 patients at a hospital in Okinawa), recursive partitioning analysis was used to develop a tree-based algorithm...
March 2010: Diabetes Research and Clinical Practice
Sanjay Arora, Sean O Henderson, Theodore Long, Michael Menchine
OBJECTIVE: In the emergency department, hyperglycemic patients are screened for diabetic ketoacidosis (DKA) via a urine dipstick. In this prospective study, we compared the test characteristics of point-of-care β-hydroxybutyrate (β-OHB) analysis with the urine dipstick. RESEARCH DESIGN AND METHODS: Emergency-department patients with blood glucose ≥250 mg/dL had urine dipstick, chemistry panel, venous blood gas, and capillary β-OHB measurements. DKA was diagnosed according to American Diabetes Association criteria...
April 2011: Diabetes Care
Tom Clynes
No abstract text is available yet for this article.
September 8, 2016: Nature
Cristin E Kearns, Laura A Schmidt, Stanton A Glantz
Early warning signals of the coronary heart disease (CHD) risk of sugar (sucrose) emerged in the 1950s. We examined Sugar Research Foundation (SRF) internal documents, historical reports, and statements relevant to early debates about the dietary causes of CHD and assembled findings chronologically into a narrative case study. The SRF sponsored its first CHD research project in 1965, a literature review published in the New England Journal of Medicine, which singled out fat and cholesterol as the dietary causes of CHD and downplayed evidence that sucrose consumption was also a risk factor...
November 1, 2016: JAMA Internal Medicine
Teri M Kozik, Sachin Shah, Mouchumi Bhattacharyya, Teresa T Franklin, Therese Farrell Connolly, Walter Chien, George S Charos, Michele M Pelter
BACKGROUND: Energy drink consumption has increased significantly over the past decade and is associated with greater than 20,000 emergency department visits per year. Most often these visits are due to cardiovascular complaints ranging from palpitations to cardiac arrest. OBJECTIVE: To determine if energy drinks alter; blood pressure, electrolytes, activated bleeding time (ACT), and/or cardiac responses measured with a 12-lead electrocardiographic (ECG) Holter. METHODS: Continuous ECG data was collected for five hours (30 minutes baseline and 4 hours post consumption [PC])...
July 2016: American Journal of Emergency Medicine
Melanie Heniff
No abstract text is available yet for this article.
October 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Howard Blumstein
No abstract text is available yet for this article.
September 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Daniel C Cullinane, Henry J Schiller, Martin D Zielinski, Jaroslaw W Bilaniuk, Bryan R Collier, John Como, Michelle Holevar, Enrique A Sabater, S Andrew Sems, W Matthew Vassy, Julie L Wynne
BACKGROUND: Hemorrhage from pelvic fracture is common in victims of blunt traumatic injury. In 2001, the Eastern Association for the Surgery of Trauma (EAST) published practice management guidelines for the management of hemorrhage in pelvic trauma. Since that time there have been new practice patterns and larger experiences with older techniques. The Practice Guidelines Committee of EAST decided to replace the 2001 guidelines with an updated guideline and systematic review reflecting current practice...
December 2011: Journal of Trauma
Malkeet Gupta, David L Schriger, Jonathan R Hiatt, Henry G Cryer, Areti Tillou, Jerome R Hoffman, Larry J Baraff
STUDY OBJECTIVE: Routine pan-computed tomography (CT, including of the head, neck, chest, abdomen/pelvis) has been advocated for evaluation of patients with blunt trauma based on the belief that early detection of clinically occult injuries will improve outcomes. We sought to determine whether selective imaging could decrease scan use without missing clinically important injuries. METHODS: This was a prospective observational study of 701 patients with blunt trauma at an academic trauma center...
November 2011: Annals of Emergency Medicine
Nicholas D Caputo, Chris Stahmer, George Lim, Kaushal Shah
BACKGROUND: Traumatic injury in the United States is the Number 1 cause of mortality for patients 1 year to 44 years of age. Studies suggest that early identification of major injury leads to better outcomes for patients. Imaging, such as computed tomography (CT), is routinely used to help determine the presence of major underlying injuries. We review the literature to determine whether whole-body CT (WBCT), a protocol including a noncontrast scan of the brain and neck and a contrast-enhanced scan of the chest, abdomen, and pelvis, detects more clinically significant injuries as opposed to selective scanning as determined by mortality rates...
October 2014: Journal of Trauma and Acute Care Surgery
Bala Natarajan, Prateek K Gupta, Samuel Cemaj, Megan Sorensen, Georgios I Hatzoudis, Robert Armour Forse
BACKGROUND: During the last decade, focused assessment with sonography for trauma increasingly has become the initial diagnostic modality of choice in trauma patients. It is still questionable, however, whether its use results in the underdiagnosis of intra-abdominal injury. It also remains doubtful whether a positive focused assessment with sonography for trauma affects clinical decision making in hemodynamically stable blunt trauma patients as evidenced through abdominal computerized tomography use...
October 2010: Surgery
Jeffrey W Carter, Mark H Falco, Michael S Chopko, William J Flynn, Charles E Wiles Iii, Weidun Alan Guo
INTRODUCTION: The Focused Assessment with Sonography in Trauma examination (FAST) is currently taught and recommended in the ATLS(®), often as an addendum to the primary survey for patients with blunt abdominal trauma. Although it is non-invasive and rapidly performed at bedside, the utility of FAST in blunt abdominal trauma has been questioned. We designed this study to examine our hypothesis that FAST is not an efficacious screening tool for identifying intra-abdominal injuries. METHODS: We performed a retrospective chart review of all patients with confirmatory diagnosis of blunt abdominal injuries with CT and/or laparotomy for a period of 1...
May 2015: Injury
Kenji Inaba, Konstantinos Chouliaras, Scott Zakaluzny, Stuart Swadron, Thomas Mailhot, Dina Seif, Pedro Teixeira, Emre Sivrikoz, Crystal Ives, Galinos Barmparas, Nikolaos Koronakis, Demetrios Demetriades
OBJECTIVE: The objective of this study was to examine the ability of Focused Assessment Using Sonography for Trauma (FAST) to discriminate between survivors and nonsurvivors undergoing resuscitative thoracotomy (RT). BACKGROUND: RT is a high-risk, low-salvage procedure performed in arresting trauma patients with poorly defined indications. METHODS: Patients undergoing RT from 10/2010 to 05/2014 were prospectively enrolled. A FAST examination including parasternal/subxiphoid cardiac views was performed before or concurrent with RT...
September 2015: Annals of Surgery
Carmen Camacho Leis, Consuelo Canencia Hernández, Ma José Garcia-Ochoa Blanco, Paloma Covadonga Rey Paterna, Ramón de Elias Hernández, Ervigio Corral Torres
BACKGROUND: Several studies recommend not initiating advanced life support in traumatic cardiac arrest (TCA), mainly owing to the poor prognosis in several series that have been published. This study aimed to analyze the survival of the TCA in our series and to determine which factors are more frequently associated with recovery of spontaneous circulation (ROSC) and complete neurologic recovery (CNR). METHODS: This is a cohort study (2006-2009) of treatment benefits...
February 2013: Journal of Trauma and Acute Care Surgery
Brian R Plaisier
BACKGROUND: Accidental hypothermia resulting in cardiac arrest poses numerous therapeutic challenges. Cardiopulmonary bypass (CPB) should be used if feasible since it optimally provides both central rewarming and circulatory support. However, this modality may not be available or is contraindicated in certain cases. Thoracic lavage (TL) provides satisfactory heat transfer and may be performed by a variety of physicians. This paper presents the physiological rationale, technique, and role for TL in accidental hypothermia with cardiac arrest...
July 2005: Resuscitation
A Schober, F Sterz, C Handler, I Kürkciyan, A Laggner, M Röggla, M Schwameis, C Wallmueller, C Testori
BACKGROUND: Accidental hypothermic cardiac arrest is associated with unfortunate prognosis and large studies are rare. We therefore have performed an outcome analysis in patients that were admitted to Vienna University Hospital with the diagnosis of accidental hypothermic cardiac arrest. METHODS: This study employed a retrospective outcome analysis of prospectively collected data in a selected cohort of hypothermic cardiac arrest patients. We screened 3800 cardiac arrest patients, treated at our department between 1991 and 2010, for eligibility...
June 2014: Resuscitation
Jonas Hilmo, Torvind Naesheim, Mads Gilbert
Hypothermic cardiac arrest has high mortality and few known prognostic factors. We studied retrospectively 34 victims of accidental hypothermia with cardiac arrest admitted to The University Hospital of North Norway during 1985-2013 who were resuscitated and rewarmed by extracorporeal circulation. No patient survived prior to 1999, while nine out of 24 (37.5%) survived hypothermic cardiac arrest from 1999 to 2013. The lowest measured core temperature among survivors was 13.7°C; the longest time from cardiac arrest to return of spontaneous circulation was 6 h and 52 min...
September 2014: Resuscitation
S U Vassallo, K A Delaney, R S Hoffman, W Slater, L R Goldfrank
OBJECTIVE: To determine the effects of body temperature, ethanol use, electrolyte status, and acid-base status on the electrocardiograms (ECGs) of hypothermic patients. METHODS: Prospective, two-year, observational study of patients presenting to an urban ED with temperature < or =95 degrees F (< or =35 degrees C). All patients had at least one ECG obtained. Electrocardiograms were interpreted by a cardiologist blinded to the patient's temperature. J-point elevations known as Osborn waves were defined as present if they were at least 1 mm in height in two consecutive complexes...
November 1999: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
2016-01-06 22:01:18
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