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NUEM Literature of Note

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38 papers 0 to 25 followers
Adam L Sharp, Jason P Jones, Ivan Wu, Dan Huynh, Keith E Kocher, Nirav R Shah, Michael K Gould
OBJECTIVES: Pneumonia severity tools were primarily developed in cohorts of hospitalized patients, limiting their applicability to the emergency department (ED). We describe current community ED admission practices and examine the accuracy of the CURB-65 to predict 30-day mortality for patients, either discharged or admitted with community-acquired pneumonia (CAP). METHODS: A retrospective, observational study of adult CAP encounters in 14 community EDs within an integrated healthcare system...
April 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Brit Long, Alex Koyfman
BACKGROUND: Emergency physicians must be masters of the airway. The patient with tracheostomy can present with complications, and because of anatomy, airway and resuscitation measures can present several unique challenges. Understanding tracheostomy basics, features, and complications will assist in the emergency medicine management of these patients. OBJECTIVE OF REVIEW: The aim of this review is to provide an overview of the basics and features of the tracheostomy, along with an approach to managing tracheostomy complications...
June 2016: American Journal of Emergency Medicine
Alexander Lam, Megha Nayyar, Mohammad Helmy, Roozbeh Houshyar, Wanda Marfori, Chandana Lall
PURPOSE: The purpose of this study is to evaluate the utility of color Doppler ultrasound (CDU) in the assessment of ovarian torsion following a negative contrast-enhanced computed tomography (CT) examination. METHODS: This is a retrospective study of women who presented to the ED with abdominal pain and received both a contrast-enhanced CT and CDU within a 24-h period. The abdominal/pelvic CT examinations were evaluated for findings specific to torsion, including ovarian size greater than 5 cm, the presence of free fluid, uterine deviation, fallopian tube thickening, ovarian fat stranding, smooth wall thickening, the presence of the "twisted pedicle" sign, and abnormal ovarian enhancement...
October 2015: Abdominal Imaging
Peter J Kudenchuk, Siobhan P Brown, Mohamud Daya, Thomas Rea, Graham Nichol, Laurie J Morrison, Brian Leroux, Christian Vaillancourt, Lynn Wittwer, Clifton W Callaway, James Christenson, Debra Egan, Joseph P Ornato, Myron L Weisfeldt, Ian G Stiell, Ahamed H Idris, Tom P Aufderheide, James V Dunford, M Riccardo Colella, Gary M Vilke, Ashley M Brienza, Patrice Desvigne-Nickens, Pamela C Gray, Randal Gray, Norman Seals, Ron Straight, Paul Dorian
BACKGROUND: Antiarrhythmic drugs are used commonly in out-of-hospital cardiac arrest for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, but without proven survival benefit. METHODS: In this randomized, double-blind trial, we compared parenteral amiodarone, lidocaine, and saline placebo, along with standard care, in adults who had nontraumatic out-of-hospital cardiac arrest, shock-refractory ventricular fibrillation or pulseless ventricular tachycardia after at least one shock, and vascular access...
May 5, 2016: New England Journal of Medicine
Daniel K Nishijima, Steven R Offerman, Dustin W Ballard, David R Vinson, Uli K Chettipally, Adina S Rauchwerger, Mary E Reed, James F Holmes
STUDY OBJECTIVE: Patients receiving warfarin or clopidogrel are considered at increased risk for traumatic intracranial hemorrhage after blunt head trauma. The prevalence of immediate traumatic intracranial hemorrhage and the cumulative incidence of delayed traumatic intracranial hemorrhage in these patients, however, are unknown. The objective of this study is to address these gaps in knowledge. METHODS: A prospective, observational study at 2 trauma centers and 4 community hospitals enrolled emergency department (ED) patients with blunt head trauma and preinjury warfarin or clopidogrel use from April 2009 through January 2011...
June 2012: Annals of Emergency Medicine
Saher Iftikhar, Amal Mattu, William Brady
Patients with implantable cardiac defibrillators not infrequently present to the emergency department after experiencing an implantable cardiac defibrillator shock. This review considers the management of such patients in the emergency department, including appropriate, inappropriate, and phantom shocks as well as electrical storm.
June 2016: American Journal of Emergency Medicine
Tanveer Rab, Karl B Kern, Jacqueline E Tamis-Holland, Timothy D Henry, Michael McDaniel, Neal W Dickert, Joaquin E Cigarroa, Matthew Keadey, Stephen Ramee
Patients who are comatose after cardiac arrest continue to be a challenge, with high mortality. Although there is an American College of Cardiology Foundation/American Heart Association Class I recommendation for performing immediate angiography and percutaneous coronary intervention (when indicated) in patients with ST-segment elevation myocardial infarction, no guidelines exist for patients without ST-segment elevation. Early introduction of mild therapeutic hypothermia is an established treatment goal. However, there are no established guidelines for risk stratification of patients for cardiac catheterization and possible percutaneous coronary intervention, particularly in patients who have unfavorable clinical features in whom procedures may be futile and affect public reporting of mortality...
July 7, 2015: Journal of the American College of Cardiology
Mervyn Singer, Clifford S Deutschman, Christopher Warren Seymour, Manu Shankar-Hari, Djillali Annane, Michael Bauer, Rinaldo Bellomo, Gordon R Bernard, Jean-Daniel Chiche, Craig M Coopersmith, Richard S Hotchkiss, Mitchell M Levy, John C Marshall, Greg S Martin, Steven M Opal, Gordon D Rubenfeld, Tom van der Poll, Jean-Louis Vincent, Derek C Angus
IMPORTANCE: Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. OBJECTIVE: To evaluate and, as needed, update definitions for sepsis and septic shock. PROCESS: A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine...
February 23, 2016: JAMA: the Journal of the American Medical Association
Bhavani Shankar Kodali, Richard D Urman
Capnography continues to be an important tool in measuring expired carbon dioxide (CO2). Most recent Advanced Cardiac Life Support (ACLS) guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR). Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO2 (PETCO2) and cardiac output that can indicate the return of spontaneous circulation (ROSC)...
October 2014: Journal of Emergencies, Trauma, and Shock
Erdal Komut, Nalan Kozacı, Bedriye Müge Sönmez, Fevzi Yılmaz, Seval Komut, Zeliha Nilgün Yıldırım, İnan Beydilli, Cihat Yel
BACKGROUND: Ocular ultrasonography of optic nerve sheath diameter (ONSD) to determine intracranial pressure (ICP) has become favorable in recent years. OBJECTIVE: To demonstrate the efficacy of ONSD measurement in determining the ICP increase due to nontraumatic events in the emergency department. METHODS: A total of 100 patients with suspected nontraumatic intracranial event were enrolled in this prospective study. Patients were divided equally into 2 groups including 50 patients as group I with pathology on cranial computed tomography (CT) and group II with normal cranial CT...
June 2016: American Journal of Emergency Medicine
Y Passi, M Sathyamoorthy, J Lerman, C Heard, M Marino
BACKGROUND: Miller laryngoscope blades are preferred for laryngoscopy in infants and children <2 yr of age. Despite their long history, the laryngeal view with the Miller blade size 1 has never been compared with that with the Macintosh (MAC) blade in children. This prospective, single-blinded, randomized study was designed to compare the laryngeal views with the size 1 Miller and MAC blades in children <2 yr. METHODS: With IRB approval, 50 ASA I and II children <2 yr undergoing elective surgery were enrolled...
November 2014: British Journal of Anaesthesia
Mathew Macias, Jordan Peachey, Amal Mattu, William J Brady
ST-segment elevation myocardial infarction (STEMI) is defined as pathologic ST-segment elevation occurring in at least 2 anatomically contiguous leads in a patient with a clinical presentation consistent with acute myocardial infarction (AMI); these findings can suggest the need for urgent revascularization. Unfortunately, the electrocardiogram (ECG) may be nondiagnostic in a large portion of patients who initially present with AMI; furthermore, it is now recognized that ECG patterns that do not meet the traditional diagnostic criteria for STEMI may represent significant AMI--these patterns are generally referred to as the STEMI equivalent patterns in that they are caused by occlusion of an epicardial coronary artery, place significant portions of the left ventricle in jeopardy, and can result in a poor outcome if not recognized and treated appropriately...
March 2016: American Journal of Emergency Medicine
Daniel Peterson, Shelley McLeod, Karen Woolfrey, Andrew McRae
BACKGROUND: Despite several expert panel recommendations and cellulitis treatment guidelines, there are currently no clinical decision rules to assist clinicians in deciding which emergency department (ED) patients should be treated with oral antibiotics and which patients require intravenous (IV) therapy at first presentation of cellulitis amenable to outpatient treatment. OBJECTIVES: The objective was to determine risk factors associated with adult patients presenting to the ED with cellulitis who fail initial antibiotic therapy as outpatients and require a change of antibiotics or admission to hospital...
May 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Daniel J Pallin, Richard C Dwyer, Ron M Walls, Calvin A Brown
STUDY OBJECTIVE: We describe emergency department (ED) intubation practices for children younger than 16 years through multicenter prospective surveillance. METHODS: Academic and community EDs in the United States, Canada, and Australia recorded data electronically, from 2002 to 2012, with verified greater than or equal to 90% reporting. RESULTS: Ten of 18 participating centers provided qualifying data, reporting 1,053 encounters. Emergency physicians initiated 85% of intubations...
May 2016: Annals of Emergency Medicine
Ken Nagao, Hiroshi Nonogi, Naohiro Yonemoto, David F Gaieski, Noritoshi Ito, Morimasa Takayama, Shinichi Shirai, Singo Furuya, Sigemasa Tani, Takeshi Kimura, Keijiro Saku
BACKGROUND: During out-of-hospital cardiac arrest, it is unclear how long prehospital resuscitation efforts should be continued to maximize lives saved. METHODS AND RESULTS: Between 2005 and 2012, we enrolled 282 183 adult patients with bystander-witnessed out-of-hospital cardiac arrest from the All-Japan Utstein Registry. Prehospital resuscitation duration was calculated as the time interval from call receipt to return of spontaneous circulation in cases achieving prehospital return of spontaneous circulation or from call receipt to hospital arrival in cases not achieving prehospital return of spontaneous circulation...
April 5, 2016: Circulation
Marcus Ong Eng Hock, S B S Ooi, S M Saw, S H Lim
STUDY OBJECTIVE: We evaluate a new technique of treating scalp lacerations, the hair apposition technique (HAT). After standard cleaning procedures, hair on both sides of a laceration is apposed with a single twist. This is then held with tissue adhesives. HAT was compared with standard suturing in a multicenter, randomized, prospective trial. METHODS: All linear lacerations of the scalp less than 10 cm long were included. Severely contaminated wounds, actively bleeding wounds, patients with hair strand length less than 3 cm, and hemodynamically unstable patients were excluded...
July 2002: Annals of Emergency Medicine
Brian Cohn
No abstract text is available yet for this article.
January 2015: Annals of Emergency Medicine
Brian Wai Lin
BACKGROUND: Distal fingertip pad dermal avulsion injuries can be challenging for emergency physicians. A common occurrence with these injuries is difficult-to-control bleeding. The nature of these wounds is such that conventional primary closure to achieve hemostasis is not feasible. Often, direct pressure, even for prolonged periods, will not adequately control the bleeding. Currently recommended techniques are inadequate to control bleeding, and commercially available hemostatic products may be more costly and not widely available...
June 2015: Journal of Emergency Medicine
Clive Kearon, Elie A Akl, Joseph Ornelas, Allen Blaivas, David Jimenez, Henri Bounameaux, Menno Huisman, Christopher S King, Timothy A Morris, Namita Sood, Scott M Stevens, Janine R E Vintch, Philip Wells, Scott C Woller, Lisa Moores
BACKGROUND: We update recommendations on 12 topics that were in the 9th edition of these guidelines, and address 3 new topics. METHODS: We generate strong (Grade 1) and weak (Grade 2) recommendations based on high- (Grade A), moderate- (Grade B), and low- (Grade C) quality evidence. RESULTS: For VTE and no cancer, as long-term anticoagulant therapy, we suggest dabigatran (Grade 2B), rivaroxaban (Grade 2B), apixaban (Grade 2B), or edoxaban (Grade 2B) over vitamin K antagonist (VKA) therapy, and suggest VKA therapy over low-molecular-weight heparin (LMWH; Grade 2C)...
February 2016: Chest
Jacob D Shopp, Lauren K Stewart, Thomas W Emmett, Jeffrey A Kline
OBJECTIVES: Treatment guidelines for acute pulmonary embolism (PE) recommend risk stratifying patients to assess PE severity, as those at higher risk should be considered for therapy in addition to standard anticoagulation to prevent right ventricular (RV) failure, which can cause hemodynamic collapse. The hypothesis was that 12-lead electrocardiography (ECG) can aid in this determination. The objective of this study was to measure the prognostic value of specific ECG findings (the Daniel score, which includes heart rate > 100 beats/min, presence of the S1Q3T3 pattern, incomplete and complete right bundle branch block [RBBB], and T-wave inversion in leads V1-V4, plus ST elevation in lead aVR and atrial fibrillation suggestive of RV strain from acute pulmonary hypertension), in patients with acute PE...
October 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
2016-02-23 01:08:55
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