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21 papers 0 to 25 followers Virginia Tech Carilion Family Medicine Residency
Borja Gomez, Santiago Mintegi, Silvia Bressan, Liviana Da Dalt, Alain Gervaix, Laurence Lacroix
BACKGROUND: A sequential approach to young febrile infants on the basis of clinical and laboratory parameters, including procalcitonin, was recently described as an accurate tool in identifying patients at risk for invasive bacterial infection (IBI). Our aim was to prospectively validate the Step-by-Step approach and compare it with the Rochester criteria and the Lab-score. METHODS: Prospective study including infants ≤90 days with fever without source presenting in 11 European pediatric emergency departments between September 2012 and August 2014...
August 2016: Pediatrics
Luis A Serrano, Erik P Hess, M Fernanda Bellolio, Mohammed H Murad, Victor M Montori, Patricia J Erwin, Wyatt W Decker
STUDY OBJECTIVE: We assess the methodological quality and prognostic accuracy of clinical decision rules in emergency department (ED) syncope patients. METHODS: We searched 6 electronic databases, reviewed reference lists of included studies, and contacted content experts to identify articles for review. Studies that derived or validated clinical decision rules in ED syncope patients were included. Two reviewers independently screened records for relevance, selected studies for inclusion, assessed study quality, and abstracted data...
October 2010: Annals of Emergency Medicine
Hernando Gomez, John A Kellum
The concentration of hydrogen ions is regulated in biologic solutions. There are currently 3 recognized approaches to assess changes in acid base status. First is the traditional Henderson-Hasselbalch approach, also called the physiologic approach, which uses the relationship between HCO3(-) and Pco2; the second is the standard base excess approach based on the Van Slyke equation. The third approach is the quantitative or Stewart approach, which uses the strong ion difference and the total weak acids. This article explores the origins of the current concepts framing the existing methods to analyze acid base balance...
October 2015: Critical Care Clinics
Steven M Rothman, Sarah W Alander
OBJECTIVES: We aimed to characterize the utility of neuroimaging for head trauma in a suburban community hospital and determine whether imaging practices conform to most recent pediatric guidelines. METHODS: The electronic medical record was surveyed for computed tomographic and magnetic resonance imaging head scans on patients aged 1 to 18 years who were evaluated for trauma. The query included the following: date, sex, type of scan (computed tomography or magnetic resonance imaging), age, patient location, reason for scan, Glasgow Coma Scale (GCS) score (if entered), result, and text from physician's notes...
February 2018: Pediatric Emergency Care
Margaret Menoch, Harold K Simon, Daniel Hirsh, Young Shim, Amy L Baxter, Matthew Clifton, Daniel Kim, Jesse J Sturm
BACKGROUND: Little is known regarding the effect of different emergency department (ED) practice models on computed tomography (CT) and ultrasound (US) utilization for suspected appendicitis in the ED and through the potential inpatient hospital stay. OBJECTIVES: Examination rates of CT and US for suspected appendicitis at 2 different pediatric EDs (PEDs) through hospital admission: an academic affiliated tertiary PED (site A) compared with a private practice tertiary care PED (site B)...
March 2017: Pediatric Emergency Care
Richard H Sterns, Marvin Grieff, Paul L Bernstein
Treatment options for hyperkalemia have not changed much since the introduction of the cation exchange resin, sodium polystyrene sulfonate (Kayexalate, Covis Pharmaceuticals, Cary, NC), over 50 years ago. Although clinicians of that era did not have ready access to hemodialysis or loop diuretics, the other tools that we use today-calcium, insulin, and bicarbonate-were well known to them. Currently recommended insulin regimens provide too little insulin to achieve blood levels with a maximal kalemic effect and too little glucose to avoid hypoglycemia...
March 2016: Kidney International
Stavros V Konstantinides, Stefano Barco, Mareike Lankeit, Guy Meyer
Pulmonary embolism (PE) remains a major contributor to global disease burden. Risk-adapted treatment and follow-up contributes to a favorable outcome. Age-adjusted cutoff levels increase D-dimer specificity and may decrease overuse of imaging procedures and overdiagnosis of PE. Primary systemic fibrinolysis has an unfavorable risk-benefit ratio in intermediate-risk PE; catheter-directed techniques are an option for patients with hemodynamic decompensation and high bleeding risk. New oral anticoagulant agents are effective and safe alternatives to standard anticoagulation regimens...
March 1, 2016: Journal of the American College of Cardiology
Fernando Maria de Benedictis, Marina Attanasi
Several topics on childhood asthma were addressed in the Paediatric Clinical Year in Review session at the 2015 European Respiratory Society International Congress. With regard to the relationship between lower respiratory tract infections and asthma, it emerges that is the number of respiratory episodes in the first years of life, but not the particular viral trigger, to be associated with later asthma development. Understanding which characteristics of individual patients are associated with an increased risk for asthma exacerbation is a critical step to implement strategies preventing these seasonal events...
March 2016: European Respiratory Review: An Official Journal of the European Respiratory Society
Manu Shankar-Hari, Gary S Phillips, Mitchell L Levy, Christopher W Seymour, Vincent X Liu, Clifford S Deutschman, Derek C Angus, Gordon D Rubenfeld, Mervyn Singer
IMPORTANCE: Septic shock currently refers to a state of acute circulatory failure associated with infection. Emerging biological insights and reported variation in epidemiology challenge the validity of this definition. OBJECTIVE: To develop a new definition and clinical criteria for identifying septic shock in adults. DESIGN, SETTING, AND PARTICIPANTS: The Society of Critical Care Medicine and the European Society of Intensive Care Medicine convened a task force (19 participants) to revise current sepsis/septic shock definitions...
February 23, 2016: JAMA: the Journal of the American Medical Association
(no author information available yet)
No abstract text is available yet for this article.
February 16, 2016: Circulation
Frank J Rybicki, James E Udelson, W Frank Peacock, Samuel Z Goldhaber, Eric M Isselbacher, Ella Kazerooni, Michael C Kontos, Harold Litt, Pamela K Woodard
No abstract text is available yet for this article.
February 23, 2016: Journal of the American College of Cardiology
Surya P Bhatt, Xavier Soler, Xin Wang, Susan Murray, Antonio R Anzueto, Terri H Beaty, Aladin M Boriek, Richard Casaburi, Gerard J Criner, Alejandro A Diaz, Mark T Dransfield, Douglas Curran-Everett, Craig J Galbán, Eric A Hoffman, James C Hogg, Ella A Kazerooni, Victor Kim, Gregory L Kinney, Amir Lagstein, David A Lynch, Barry J Make, Fernando J Martinez, Joe W Ramsdell, Rishindra Reddy, Brian D Ross, Harry B Rossiter, Robert M Steiner, Matthew J Strand, Edwin J R van Beek, Emily S Wan, George R Washko, J Michael Wells, Chris H Wendt, Robert A Wise, Edwin K Silverman, James D Crapo, Russell P Bowler, MeiLan K Han
RATIONALE: The small conducting airways are the major site of airflow obstruction in chronic obstructive pulmonary disease and may precede emphysema development. OBJECTIVES: We hypothesized a novel computed tomography (CT) biomarker of small airway disease predicts FEV1 decline. METHODS: We analyzed 1,508 current and former smokers from COPDGene with linear regression to assess predictors of change in FEV1 (ml/yr) over 5 years. Separate models for subjects without and with airflow obstruction were generated using baseline clinical and physiologic predictors in addition to two novel CT metrics created by parametric response mapping (PRM), a technique pairing inspiratory and expiratory CT images to define emphysema (PRM(emph)) and functional small airways disease (PRM(fSAD)), a measure of nonemphysematous air trapping...
July 15, 2016: American Journal of Respiratory and Critical Care Medicine
Karen J Bosma, Brooke A Read, Mohammad J Bahrgard Nikoo, Philip M Jones, Fran A Priestap, James F Lewis
OBJECTIVES: Despite protocols incorporating spontaneous breathing trials, 31% of ICU patients experience difficult or prolonged weaning from mechanical ventilation. Nonfatiguing modes such as pressure support ventilation are recommended. Proportional assist ventilation provides assistance in proportion to patient effort, which may optimize weaning. However, it is not known how proportional assist ventilation performs relative to pressure support ventilation over a prolonged period in the complex ICU setting...
June 2016: Critical Care Medicine
Sion Jo, Taeoh Jeong, Jae Baek Lee, Youngho Jin, Jaechol Yoon, Boyoung Park
STUDY OBJECTIVE: The aim of this study was to investigate the prognostic prediction power of a newly introduced early warning score modified by serum lactate level, the National Early Warning Score-Lactate (NEWS-L) score, among community-acquired pneumonia (CAP) patients. We also compared the NEWS-L score with the pneumonia severity index (PSI) and CURB-65. METHODS: We designed a retrospective observational study and collected data on confirmed adult CAP patients who visited the study hospital between October 2013 and September 2014...
March 2016: American Journal of Emergency Medicine
Kolja Schürmann, Omid Nikoubashman, Björn Falkenburger, Simone C Tauber, Martin Wiesmann, Jörg B Schulz, Arno Reich
Despite the potential immediate access to diagnosis and care, in-hospital stroke (IHS) is associated with delay in diagnosis, lower rates of reperfusion treatment, and unfavorable outcome. Endovascular reperfusion therapy has shown promising results in recent trials for community-onset strokes (COS) and is limited by less contraindications than systemic thrombolysis. Thus, endovascular approaches may offer additional acute treatment options for IHS. We performed a retrospective, observational monocentric analysis of patients with acute ischemic stroke between January 2010 and December 2014...
March 2016: Journal of Neurology
J Carlos Flores-González, Miguel A Matamala-Morillo, Patricia Rodríguez-Campoy, Juan J Pérez-Guerrero, Belén Serrano-Moyano, Paloma Comino-Vazquez, Encarnación Palma-Zambrano, Rocio Bulo-Concellón, Vanessa Santos-Sánchez, Alfonso M Lechuga-Sancho
BACKGROUND AND AIMS: There is no evidence that the epinephrine-3% hypertonic saline combination is more effective than 3% hypertonic saline alone for treating infants hospitalized with acute bronchiolitis. We evaluated the efficacy of nebulized epinephrine in 3% hypertonic saline. PATIENTS AND METHODS: We performed a randomized, double-blind, placebo-controlled clinical trial in 208 infants hospitalized with acute moderate bronchiolitis. Infants were randomly assigned to receive nebulized 3% hypertonic saline with either 3 mL of epinephrine or 3 mL of placebo, administered every four hours...
2015: PloS One
John J Cronin, Siobhan McCoy, Una Kennedy, Sinéad Nic An Fhailí, Abel Wakai, John Hayden, Gloria Crispino, Michael J Barrett, Sean Walsh, Ronan O'Sullivan
STUDY OBJECTIVE: In acute exacerbations of asthma in children, corticosteroids reduce relapses, subsequent hospital admission, and the need for ß2-agonist bronchodilators. Prednisolone is the most commonly used corticosteroid, but prolonged treatment course, vomiting, and a bitter taste may reduce patient compliance. Dexamethasone has a longer half-life and has been used safely in other acute pediatric conditions. We examine whether a single dose of oral dexamethasone is noninferior to prednisolone in the emergency department (ED) treatment of asthma exacerbations in children, as measured by the Pediatric Respiratory Assessment Measure (PRAM) at day 4...
May 2016: Annals of Emergency Medicine
Christopher P Cannon, Michael A Blazing, Robert P Giugliano, Amy McCagg, Jennifer A White, Pierre Theroux, Harald Darius, Basil S Lewis, Ton Oude Ophuis, J Wouter Jukema, Gaetano M De Ferrari, Witold Ruzyllo, Paul De Lucca, KyungAh Im, Erin A Bohula, Craig Reist, Stephen D Wiviott, Andrew M Tershakovec, Thomas A Musliner, Eugene Braunwald, Robert M Califf
BACKGROUND: Statin therapy reduces low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events, but whether the addition of ezetimibe, a nonstatin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further is not known. METHODS: We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter (1...
June 18, 2015: New England Journal of Medicine
Justin A Ezekowitz, Robert C Welsh, Courtney Gubbels, Neil Brass, Michael Chan, William Keeble, Fadi Khadour, Thomas L Koshy, Darren Knapp, Sanjay Sharma, Sunil Sookram, Wayne Tymchak, Dale Weiss, Cynthia M Westerhout, Paul W Armstrong
BACKGROUND: The outcomes of acute cardiovascular symptom presentations are potentially modifiable with the use of biomarkers to accelerate accurate diagnosis. This randomized trial tested troponin and B-type natriuretic peptide before hospital guidance in patients with acute cardiovascular symptoms. METHODS: Patients with either chest pain or shortness of breath were randomized to usual care or biomarkers analyzed using a point-of-care device in the ambulance. The primary end point was time to final disposition (discharge from the emergency department or admission to hospital)...
October 2014: Canadian Journal of Cardiology
2016-03-25 04:34:04
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