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jrgEmergency medicine

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By Jesse Guscott McMaster Family Practice Anesthesia program director. Medical educator, ER, Anesthesia Twitter:@GuscottJesse
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
Airton Leonardo de Oliveira Manoel, Alberto Goffi, Fernando Godinho Zampieri, David Turkel-Parrella, Abhijit Duggal, Thomas R Marotta, R Loch Macdonald, Simon Abrahamson
Spontaneous intracerebral hemorrhage (ICH), defined as nontraumatic bleeding into the brain parenchyma, is the second most common subtype of stroke, with 5.3 million cases and over 3 million deaths reported worldwide in 2010. Case fatality is extremely high (reaching approximately 60 % at 1 year post event). Only 20 % of patients who survive are independent within 6 months. Factors such as chronic hypertension, cerebral amyloid angiopathy, and anticoagulation are commonly associated with ICH. Chronic arterial hypertension represents the major risk factor for bleeding...
2016: Critical Care: the Official Journal of the Critical Care Forum
Matthew J Eckert, Thomas M Wertin, Stuart D Tyner, Daniel W Nelson, Seth Izenberg, Matthew J Martin
BACKGROUND: Early administration of tranexamic acid (TXA) has been associated with a reduction in mortality and blood product requirements in severely injured adults. It has also shown significantly reduced blood loss and transfusion requirements in major elective pediatric surgery, but no published data have examined the use of TXA in pediatric trauma. METHODS: This is a retrospective review of all pediatric trauma admissions to the North Atlantic Treaty Organization Role 3 hospital, Camp Bastion, Afghanistan, from 2008 to 2012...
December 2014: Journal of Trauma and Acute Care Surgery
Jeffrey J Dehmer, William T Adamson
Hemorrhagic shock in the pediatric trauma patient is an uncommon but fundamental problem for the treating clinician. Current management of hemorrhagic shock involves initial resuscitation with crystalloid fluids followed by infusion of blood components as necessary. In management of the adult trauma patient, many institutions have implemented massive transfusion protocols to guide transfusion in situations requiring or anticipating the use of greater than 10 U of packed red blood cells. In the pediatric population, guidelines for massive transfusion are vague or nonexistent...
November 2010: Seminars in Pediatric Surgery
Jeanne E Hendrickson, Beth H Shaz, Greg Pereira, Paul M Parker, Paula Jessup, Falisha Atwell, Beth Polstra, Elizabeth Atkins, Karen K Johnson, Gaobin Bao, Kirk A Easley, Cassandra D Josephson
BACKGROUND: Massive transfusion protocols (MTPs) with fixed ratios of blood products may improve outcomes in coagulopathic adult trauma patients. However, there is a paucity of data on transfusion support protocols for pediatric trauma patients, whose mechanisms of injury may differ from those seen in adults. We hypothesized that an MTP would improve outcomes in children, through a balanced blood product resuscitation. STUDY DESIGN AND METHODS: A pediatric trauma MTP, with a fixed ratio of red blood cells (RBCs):fresh-frozen plasma (FFP):platelets:cryoprecipitate in quantities based on the patient's weight, was initiated at a pediatric hospital...
June 2012: Transfusion
Suzanne Beno, Alun D Ackery, Jeannie Callum, Sandro Rizoli
Trauma is a leading cause of death in pediatrics. Currently, no medical treatment exists to reduce mortality in the setting of pediatric trauma; however, this evidence does exist in adults. Bleeding and coagulopathy after trauma increases mortality in both adults and children. Clinical research has demonstrated a reduction in mortality with early use of tranexamic acid in adult trauma patients in both civilian and military settings. Tranexamic acid used in the perioperative setting safely reduces transfusion requirements in children...
July 2, 2014: Critical Care: the Official Journal of the Critical Care Forum
Yeon-Dong Kim, Seon-Jeong Park, Junho Shim, Hyungtae Kim
The recently introduced pectoral nerve (Pecs) block is a simple alterative to the conventional thoracic paravertebral block or epidural block for breast surgery. It produces excellent analgesia and can be used to provide balanced anesthesia and as a rescue block in cases where performing a neuraxial blockade is not possible. In the thoracic region, a neuraxial blockade is often used to manage zoster-associated pain. However, this can be challenging for physicians due to the increased risk of hemodynamic instability in the upper thoracic level, and comorbid and contraindicated medical conditions such as coagulopathy...
September 20, 2016: Journal of Anesthesia
Edward Durant, Brittany Dixon, Josh Luftig, Daniel Mantuani, Andrew Herring
No abstract text is available yet for this article.
July 19, 2016: American Journal of Emergency Medicine
Charles Feldman, Ronald Anderson
Improving the outcome of patients with community-acquired pneumonia (CAP) is an ongoing challenge, even in the setting of significant advances in antimicrobial chemotherapy and critical care. Recognition of the underlying involvement of inflammation-mediated organ dysfunction as a determinant of adverse outcomes in CAP has aroused intense interest in the protective potential of adjunctive anti-inflammatory therapies in CAP, particularly the role of corticosteroids (CS). This is the primary topic of the current review which is focused on an evaluation of the latest meta-analyses encompassing both recent and earlier clinical trials, with particular emphasis on the stringent meta-analysis undertaken by Siemieniuk and colleagues (Ann Intern Med 2015;163:519-528)...
March 2016: Journal of Thoracic Disease
Laurie J Morrison, Allan de Caen, Farhan Bhanji, Blair L Bigham, Ian E Blanchard, Steven C Brooks, Anne-Marie Guerguerian, Jan L Jensen, Andrew H Travers, Christian Vaillancourt, Michelle Welsford, Karen Woolfrey
No abstract text is available yet for this article.
May 2016: CJEM
Sarah Luckett-Gatopoulos, Brent Thoma, Ken Milne, Chris Bond
No abstract text is available yet for this article.
July 2016: CJEM
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
Lauren M Westafer, William K Milne, Christopher R Carpenter
No abstract text is available yet for this article.
June 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Frédérique Hovaguimian, Paul S Myles
BACKGROUND: Blood transfusions are associated with morbidity and mortality. However, restrictive thresholds could harm patients less able to tolerate anemia. Using a context-specific approach (according to patient characteristics and clinical settings), the authors conducted a systematic review to quantify the effects of transfusion strategies. METHODS: The authors searched MEDLINE, EMBASE, CENTRAL, and grey literature sources to November 2015 for randomized controlled trials comparing restrictive versus liberal transfusion strategies applied more than 24 h in adult surgical or critically ill patients...
July 2016: Anesthesiology
Susan R Wilcox, Jeremy B Richards, Daniel F Fisher, Jeffrey Sankoff, Todd A Seigel
OBJECTIVE: Mechanical ventilation with low tidal volumes has been shown to improve outcomes for patients both with and without acute respiratory distress syndrome. This study aims to characterize mechanically ventilated patients in the emergency department (ED), describe the initial ED ventilator settings, and assess for associations between lung protective ventilation strategies in the ED and outcomes. METHODS: This was a multicenter, prospective, observational study of mechanical ventilation at 3 academic EDs...
August 2016: American Journal of Emergency Medicine
Yuqi Gu, Joshua Robert, George Kovacs, Andrew D Milne, Ian Morris, Orlando Hung, Kirk MacQuarrie, Sean Mackinnon, J Adam Law
INTRODUCTION: During video laryngoscopy (VL) with angulated or hyper-curved blades, it is sometimes difficult to complete tracheal intubation despite a full view of the larynx. When using indirect VL, it has been suggested that it may be preferable to obtain a deliberately restricted view of the larynx to facilitate passage of the endotracheal tube. We used the GlideScope® GVL video laryngoscope (GVL) to test whether deliberately obtaining a restricted view would result in faster and easier tracheal intubation than with a full view of the larynx...
August 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Won Young Kim, Myoung Kwan Kwak, Byuk Sung Ko, Jae Chol Yoon, Chang Hwan Sohn, Kyoung Soo Lim, Lars W Andersen, Michael W Donnino
OBJECTIVES: Emergency tracheal intubation has achieved high success and low complication rates in the emergency department (ED). The objective of this study was to evaluate the incidence of post-intubation CA and determine the clinical factors associated with this complication. METHODS: A matched case-control study with a case to control ratio of 1:3 was conducted at an urban tertiary care center between January 2007 and December 2011. Critically ill adult patients requiring emergency airway management in the ED were included...
2014: PloS One
Tyler W Barrett, David L Schriger
No abstract text is available yet for this article.
February 2016: Annals of Emergency Medicine
Taneisha Wilson, Elizabeth M Goldberg
No abstract text is available yet for this article.
May 2016: Annals of Emergency Medicine
Paul Albertine, Samuel Borofsky, Derek Brown, Smita Patel, Woojin Lee, Anthony Caputy, M Reza Taheri
With advancing technology, the sensitivity of computed tomography (CT) for the detection of subdural hematoma (SDH) continues to improve. In some cases, the finding is limited to one or 2 images of the CT examination. At our institution, all patients with an SDH require intensive care unit (ICU) admission, regardless of size. In this report, we tested the hypothesis that patients with a small traumatic SDH on their presenting CT examination do not require the intensive monitoring offered in the ICU and can instead be managed on a hospital unit with a lower level of monitoring...
March 2016: American Journal of Emergency Medicine
2016-02-02 03:09:34
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