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1.
Lucas Oliveira J. e Silva M. Fernanda Bellolio Elisa M. Smith David J. Daniels Christine M. Lohse Ronna L. Campbell 《The American journal of emergency medicine》2017,35(10):1485-1489
Background
Motor vehicle–related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States.Objectives
To describe motocross-related head and spine injuries of adult patients presenting to an academic emergency department (ED).Methods
We performed an observational cohort study of adult ED patients evaluated for motocross-related injuries from 2010 through 2015. Electronic health records were reviewed and data extracted using a standardized review process.Results
A total of 145 motocross-related ED visits (143 unique patients) were included. Overall, 95.2% of patients were men with a median age of 25 years. Sixty-seven visits (46.2%) were associated with head or spine injuries. Forty-three visits (29.7%) were associated with head injuries, and 46 (31.7%) were associated with spine injuries. Among the 43 head injuries, 36 (83.7%) were concussions. Seven visits (16.3%) were associated with at least 1 head abnormality identified by computed tomography, including skull fracture (n = 2), subdural hematoma (n = 1), subarachnoid hemorrhage (n = 4), intraparenchymal hemorrhage (n = 3), and diffuse axonal injury (n = 3). Among the 46 spine injuries, 32 (69.6%) were acute spinal fractures. Seven patients (4.9%) had clinically significant and persistent neurologic injuries. One patient (0.7%) died, and 3 patients had severe TBIs.Conclusion
Adult patients evaluated in the ED after motocross trauma had high rates of head and spine injuries with considerable morbidity and mortality. Almost half had head or spine injuries (or both), with permanent impairment for nearly 5% and death for 0.7%. 相似文献2.
Jonathan G. Rogg Robert Huckman Michael Lev Ali Raja Yuchiao Chang Benjamin A. White 《The American journal of emergency medicine》2017,35(10):1510-1513
Study objectives
Facing increased utilization and subsequent capacity and budget constraints, ED's must better understand bottlenecks and their effect on process flow to improve process efficiency. The primary objective of this study was to identify bottlenecks in obtaining a head CT and investigate patient waiting time based on those bottlenecks.Methods
This observational study included all patients undergoing a head CT between July 1, 2013 and June 30, 2014 at a large, urban academic ED with over 100,000 visits per year.The primary study outcome was total cycle time, defined as the elapsed time between patient arrival and head CT preliminary report, divided into four components of workflow.Results
8312 patients who had a head CT were included in this study. The median cycle time from patient arrival to head CT preliminary report was 3 h and 13 min with 39 min of waiting time resulting from bottlenecks. In the 4-step model (time from patient arrival to head CT order, time from head CT order to head CT scheduled, time from head CT scheduled to head CT completed, and time from head CT completed to head CT preliminary report), each process was the bottleneck 30%, < 1%, 27%, and 42% of the time, respectively.Conclusion
Demand capacity mismatch in head CT scanning has a significant impact on patient waiting times. This study suggests opportunities to improve wait times through future research to understand the causes of delays in CT ordering, CT completion and timeliness of radiology reports. 相似文献3.
Liang Sun Meng-jiang Ding Tian-cai Cai Hao-jun Fan Hong-mei Gao Jian-peng Zhang 《The American journal of emergency medicine》2017,35(10):1536-1541
Objectives
To validate the effects of the new plateau hyperbaric chamber on alleviating high altitude hypoxia on Mount Kun Lun.Methods
A prospective, controlled study of rabbits and adult volunteers was conducted at altitudes of 355, 2880 and 4532 m. We obtained arterial blood samples from rabbits and volunteers before and after hyperbaric treatment. The respiratory rate, heart rate, and blood pressure (BP) of adult volunteers were monitored during hyperbaric treatment.Results
The mean PaO2 levels of experimental group rabbits and volunteers increased significantly after 60 min of hyperbaric treatment at 350, 2880 and 4532 m. The mean PaCO2 and pH levels of rabbits were not significant different before and after hyperbaric treatment at each altitude. The mean PaCO2 and pH levels were not significant different at 355 m in the human study. However, at 2880 and 4532 m, pH fell with increasing PaCO2 levels in humans before and after hyperbaric treatment.Conclusions
The new multiplace plateau hyperbaric chamber may be used to alleviate plateau hypoxia by increasing patient PaO2. However, its value in treating AMS must be confirmed in field conditions. 相似文献4.
Lukasz Szarpak Zenon Truszewski Lukasz Czyzewski Michael Frass Oliver Robak 《The American journal of emergency medicine》2017,35(1):96-100
Introduction
European Resuscitation Council as well as American Heart Association guidelines for cardiopulmonary resuscitation (CPR) stress the importance of uninterrupted and effective chest compressions (CCs). Manual CPR decreases in quality of CCs over time because of fatigue which impacts outcome. We report the first study with the Lifeline ARM automated CC device for providing uninterrupted CCs.Methods
Seventy-eight paramedics participated in this randomized, crossover, manikin trial. We compared the fraction of effective CCs between manual CPR and automated CPR using the ARM.Results
Using the ARM during resuscitation resulted in a higher percentage of effective CCs (100/min [interquartile range, 99-100]) compared with manual CCs (43/min [interquartile range, 39-46]; P < .001). The number of effective CCs decreased less over time with the ARM (P < .001), more often reached the required depth of 5 cm (97% vs 63%, P < .001), and more often reached the recommended CC rate (P < .001). The median tidal volume was higher and hands-off time was lower when using the ARM.Conclusion
Mechanical CCs in our study adhere more closely to current guidelines than manual CCs. The Lifeline ARM provides more effective CCs, more ventilation time and minute volume, less hands-off time, and less decrease in effective CCs over time compared with manual Basic Life Support and might therefore impact outcome. 相似文献5.
Payman Moharamzadeh Seyedhossein Ojaghihaghighi Mohsen Amjadi Farzad Rahmani Arezoo Farjamnia 《The American journal of emergency medicine》2017,35(12):1922-1925
Objective
Local forms of the tranexamic acid have been effective in treating many haemorrhagic cases. So that the aim of the current study is to assess the effectiveness of local tranexamic acid in controlling painless hematuria in patients referred to the emergency department.Methods
This is a randomized, double-blind clinical trial study, which was conducted on 50 patients with complaints of painless lower urinary tract bleeding during June 2014 and August 2015. The patients were randomly divided into two groups of 25 people each, one group receiving tranexamic acid and the other given a placebo. During bladder irrigation, local tranexamic acid and the placebo were injected into the bladder via Foley catheter. Patients were examined over 24 h in terms of the amount of normal saline serum used for irrigation, level of hemoglobin, and blood in urine.Results
In this study it was observed that consumption of tranexamic acid significantly decreased the volume of used serum for bladder irrigation (P = 0.041) and the microscopic status of urine decreased significantly in terms of the hematuria after 24 h (P = 0.026). However, the rate of packed cell transfusion and drop in hemoglobin levels showed no significant difference in both groups of patients (P ? 0.05).Conclusion
The results of this study showed that tranexamic acid could significantly reduce the volume of required serum for bladder irrigation to clear urine, but it had no significant effect on the drop in serum hemoglobin levels. 相似文献6.
Mauro Giordano Tiziana Ciarambino Pietro Castellino Lorenzo Malatino Alessandro Cataliotti Luca Rinaldi Giuseppe Paolisso Luigi Elio Adinolfi 《The American journal of emergency medicine》2017,35(5):749-752
Study objective
We investigated seasonal prevalence of hyponatremia in the emergency department (ED).Design
A cross-sectional study using clinical chart review.Setting
University Hospital ED, with approximately 28 000 patient visits a year.Type of participants
We reviewed 15 049 patients, subdivided in 2 groups: the adult group consisting of 9822 patients aged between 18 and 64 years old and the elderly group consisting of 5227 patients aged over 65 years presenting to the ED between January 1st, 2014 and December 31st, 2015.Intervention
Emergency patients were evaluated for the presence of hyponatremia by clinical chart review.Measurements and main results
Hyponatremia was defined as a serum sodium level < 135 mmol/l. Mean monthly prevalence of hyponatremia was of 3.74 ± 0.5% in the adult group and it was significantly increased to 10.3 ± 0.7% in the elderly group (p < 0.05 vs adults). During the summer, hyponatremia prevalence was of 4.14 ± 0.2% in adult and markedly increased to 12.52 ± 0.7% (zenith) in elderly patients (p < 0.01 vs adult group; p < 0.05 vs other seasons in elderly group). In the elderly group, we reported a significant correlation between weather temperature and hyponatremia prevalence (r: 0.491; p < 0.05).Conclusion
We observed a major influence of climate on the prevalence of hyponatremia in the elderly in the ED. Decline in renal function, salt loss, reduced salt intake and increased water ingestion could all contribute to developing hyponatremia in elderly patients during the summer. These data could be useful for emergency physicians to prevent hot weather-induced hyponatremia in the elderly. 相似文献7.
Matthew J. Binks Rhys S. Holyoak Thomas M. Melhuish Ruan Vlok Elyse Bond Leigh D. White 《The American journal of emergency medicine》2017,35(10):1542-1546
Background
Hypoxemia increases the risk of intubation markedly. Such concerns are multiplied in the emergency department (ED) and during retrieval where patients may be unstable, preparation or preoxygenation time limited and the environment uncontrolled. Apneic oxygenation is a promising means of preventing hypoxemia in this setting.Aim
To test the hypothesis that apnoeic oxygenation reduces the incidence of hypoxemia during endotracheal intubation in the ED and during retrieval.Methods
We undertook a systematic review of six databases for all relevant studies published up to November 2016. Included studies evaluated apneic oxygenation during intubation in the ED and during retrieval. There were no exemptions based on study design. All studies were assessed for level of evidence and risk of bias. The Review Manager 5.3 software was used to perform meta-analysis of the pooled data.Results
Six trials and a total 1822 cases were included for analysis. The study found a significant reduction in the incidence of desaturation (RR = 0.76, p = 0.002) and critical desaturation (RR = 0.51, p = 0.01) when apneic oxygenation was implemented. There was also a significant improvement in first pass intubation success rate (RR = 1.09, p = 0.004).Conclusion
Apneic oxygenation may reduce patient hypoxemia during intubation performed in the ED and during retrieval. It also improves intubation first-pass success rate in this setting. 相似文献8.
Background
Rhnull is a rare autosomal recessive phenotype, which is characterized by the lack of Rh antigen expression on the red blood cells (RBCs). Rhnull of the regulator type is caused by RHAG mutation. In this study, a novel nonsense mutation in RHAG gene was identified in a Chinese Rhnull individual.Objectives and methods
Rh phenotypes of the Rhnull individual and his family members were typed by standard serological methods. DNA sequences of all ten exons of RHAG gene were analyzed using genomic DNA by polymerase chain reaction (PCR) and direct-sequencing.Results
Serological testing results showed a D-C-c-E-e- phenotype in the proband. Molecular analyses revealed a 540C > A mutation in exon 4 of RHAG gene was present at the homozygous state in the proband. His parents were heterozygous for the mutation, and his brother didn’t carry the mutation. The 540C > A mutation was nonsense mutation, which led to a premature stop codon (Tyr180stop).Conclusion
These results indicated that the 540C > A nonsense mutation in RHAG gene caused the regulator type of Rhnull phenotype in a Chinese individual. Our results contributed to a greater understanding of the genetic mechanisms of Rhnull phenotype. 相似文献9.
Murat Yesilaras Turgay Yilmaz Kilic Suveyda Yesilaras Ozge Duman Atilla Dilek Öncel Mahmut Çamlar 《The American journal of emergency medicine》2017,35(10):1408-1413
Introduction
The aim of this study was to investigate the relationship between the optic nerve sheath diameter (ONSD) measured on non-contrast head computed tomography (CT) and the diagnosis and prognosis of spontaneous subarachnoid hemorrhage (SAH) on emergency department (ED) patients.Method
We used a matched control group of patients with the same age and gender who were diagnosed in the ED with spontaneous SAH and who admitted to the ED with headache. Four emergency medicine attending physicians made the ONSD measurements. For measurements, the 3-mm posterior location where the optic nerve enters the eyeball was used.Results
This study was done with 61 spontaneous SAHs with an equal number of control patients. The median ONSD for control and spontaneous SAH groups was 5.76 [interquartile range (IQR): 0.96] mm and 6.72 (IQR: 1.42) mm, respectively (p < 0.001). The area under the receiver operating characteristic curve was determined as 0.791 (confidence interval 95% 0.710–0.872). At an ONSD threshold value of 6.1 mm, the sensitivity and specificity of SAH was 72%. There was no significant relationship between ONSD and in-hospital mortality in spontaneous SAH patients (p > 0.05). The intra-class correlation coefficients for inter and intra-rater reliability were 0.84 and 0.95, respectively.Conclusion
In patients with spontaneous SAH, the ONSD measured in the orbital sections of a head CT is strongly correlated with a SAH diagnosis. Assessment of ONSD in head CTs taken with spontaneous SAH suspicion may contribute to the diagnoses of spontaneous SAH. 相似文献10.
C. Kajetanek R. Rousseau K. Makridis M. Sanchez C. Delin P. Djian 《Journal de Traumatologie du Sport》2017,34(1):37-43
Background
Anterior cruciate ligament (ACL) rupture is a common pathology. Risk factors include significant tibial slope. The purpose of this study was to determine whether this relationship is observed in recurrent rupture of the ACL. Our hypothesis was that significant tibial slope is a risk factor for rupture.Material and methods
We reviewed at two years follow-up 386 ligamentoplasties performed from 2000 to 2012. There were 20 recurrent ruptures in this series (5.2%). These patients, mean age 21 ± 6.3 years, underwent 3D EOS goniometry to measure the medial and lateral tibial slope (MTS and LTS, respectively). These same measures were made in a comparative group of controls that had ACL surgery without secondary rupture and seen at mean 33.4 (range 28–37) months follow-up.Results
Mean MTS was significantly lower in the recurrent rupture group (10.5 ± 3.3° vs. 12.8 ± 2.7°; P = 0.02). This led to asymmetrical tibial slope with a mean LTS in the recurrent rupture group greater than the mean MTS (delta = –0.52 vs. +0.83). The mean LTS was not significantly different between groups (11 ± 3.4° vs. 12 ± 3.4°; P = 0.30).Conclusion
This study demonstrated that asymmetrical tibial slope due to a MTS lower than the LTS can be a risk factor for recurrent rupture of the ACL.Case-control
Level III. 相似文献11.
Background
There is a need of comprehensive work dealing with the quality of plasma for fractionation with respect to the IgG content as today most plasma derivates are used to treat patients with immunodeficiencies and autoimmune disorders. Therefore, a prospective study was carried out to analyse IgG levels before plasmapheresis and every 200 ml collected plasma.Materials and methods
Fifty-four experienced plasmapheresis donors were recruited for subsequent 850 ml plasmapheresis using the Aurora Plasmapheresis System. Donor? peripheral blood counts were analysed before and after plasmapheresis using an electronic counter. Total protein, IgG and citrate were measured turbidometrically before, during and after apheresis as well as in the plasma product. Furthermore, platelets, red and white blood cells were analysed as parameters of product quality.Results
An average of 2751 ± 247 ml blood was processed in 47 ± 6 min. The collected plasma volume was 850 ± 1 mL and citrate consumption was 177 ± 15 mL. A continuous drop of donors’ IgG level was observed during plasmapheresis. The drop was 13% of the IgG baseline value at 800 mL collected plasma. Total protein, IgG and cell counts of the plasma product met current guidelines of plasma for fractionation.Conclusion
Donors’ IgG levels during apheresis showed a steady decrease without compromising the quality of plasma product. 相似文献12.
Søren R. Boysen Jessica M. Pang John R. Mikler Cameron G. Knight Hugh A. Semple Nigel A. Caulkett 《The American journal of emergency medicine》2017,35(2):227-233
Introduction
There is a lack of information regarding intraosseous (IO) administration of tranexamic acid (TXA). Our hypothesis was that a single bolus IO injection of TXA will have a similar pharmacokinetic profile to TXA administered at the same dose IV.Methods
Sixteen male Landrace cross swine (mean body weight 27.6 ± 2.6 kg) were divided into an IV group (n = 8) and an IO group (n = 8). Each animal received 30 mg/kg TXA via an IV or IO catheter, respectively. Jugular blood samples were collected for pharmacokinetic analysis over a 3 h period. The maximum TXA plasma concentration (Cmax) and corresponding time as well as distribution half-life, elimination half-life, area under the curve, plasma clearance and volume of distribution were calculated. One- and two-way analysis of variance for repeated measures (time, group) with Tukey's and Bonferonni post hoc tests were used to compare TXA plasma concentrations within and between groups, respectively.Results
Plasma concentrations of TXA were significantly higher (p < 0.0001) in the IV group during the TXA infusion. Cmax occurred at 4 min after initiation of the bolus in the IV group (9.36 ± 3.20 ng/μl) and at 5 min after initiation of the bolus in the IO group (4.46 ± 0.49 ng/μl). Plasma concentrations were very similar from the completion of injection onwards. There were no significant differences between the two administration routes for any other pharmacokinetic variables measured.Conclusion
The results of this study support pharmacokinetic bioequivalence of IO and IV administration of TXA. 相似文献13.
Min Li Wei Song Yan-hong Ouyang Duo-hu Wu Jun Zhang Li-xiang Wang Jing Li 《The American journal of emergency medicine》2017,35(12):1892-1894
Background
Chest compression is a standard recommendation during cardiopulmonary resuscitation (CPR). However, chest compression cannot be effectively applied under certain situations, such as chest wall deformity, rib fracture, or hemopneumothorax. An alternative method, abdominal compression, was reported to achieve better resuscitation outcomes in these patients.Materials and methods
A prospective study was performed in adult patients with cardiac arrest and anticipated ineffective chest compression (thoracic trauma, chest deformity, rib fracture, and hemopneumothorax). Active abdominal lifting and compression cardiopulmonary resuscitation was used. Primary outcome was success rate of restoration of spontaneous circulation (ROSC). Secondary outcomes included heart rate (HR), mean arterial pressure (MAP), pulse oximetry saturation (SpO2), arterial blood pH value, arterial oxygen pressure (PaO2), and arterial carbon dioxide tension (PaCO2), which were measured during the periods of pre-CPR, CPR, and 30 min post-ROSC.Results
A total of 35 patients were enrolled into the study. Five of them had ROSC (14.3%), which was statistically significantly higher than that (0%) reported in the 2015 Advanced Cardiovascular Life Support manual. HR, MAP, and SpO2 during CPR were also statistically significantly higher during CPR when compared to the period of pre-CPR period (HR 58 versus 0 beats/min, P < 0.01; MAP 25 versus 0 mm Hg, P < 0.01; SpO2 0.68 versus 0.48%, P < 0.01). In post-ROSC period, HR was statistically significantly higher than that during pre-CPR period (121 versus 0 best/min, P < 0.01).Conclusions
Active abdominal lifting and compression cardiopulmonary resuscitation could reach better resuscitation outcomes in certain cardiac arrest patients. 相似文献14.
Chih-Chia Hsieh Ching-Chi Lee Hsiang-Chin Hsu Hsin-I Shih Chien-Hsin Lu Chih-Hao Lin 《The American journal of emergency medicine》2017,35(1):39-44
Background/Purpose
To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED).Methods
This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records. The primary and secondary outcome measures were a prolonged hospital stay (>30 days) and the in-hospital crude mortality within 90 days, respectively.Results
For 267 eligible patients (age range 21.0-98.0 years, mean 70.5 ± 15.1 years; male 184, 68.9%), multivariate analysis was used to determine the significant adverse effects of an ED stay >1.0 hour on in-hospital crude mortality (odds ratio 2.19, P < .05), which was thus defined as delayed ICU admission. In-hospital mortality significantly differed between patients with delayed ICU admission and those without delayed admission, as revealed by the Kaplan-Meier survival curves (P < .05). Moreover, a linear-by-linear correlation was observed between the length of ICU waiting time in the ED and the lengths of total hospital stay (r = 0.152, P < .05), ICU stay (r = 0.148, P < .05), and ventilator support (r = 0.222, P < .05).Conclusions
For patients with ARF who required mechanical ventilation support and intensive care, a delayed ICU admission more than 1.0 hour is a strong determinant of mortality and is associated with a longer ICU stay and a longer need for ventilation. 相似文献15.
Brittany A. Walsh Thiphalak Chounthirath Laura Friedenberg Gary A. Smith 《The American journal of emergency medicine》2017,35(11):1666-1671
Objective
This study investigates unintentional non-fatal golf-related injuries in the US using a nationally representative database.Methods
This study analyzed golf-related injuries treated in US hospital emergency departments from 1990 through 2011 using the National Electronic Injury Surveillance System database. Injury rates were calculated using golf participation data.Results
During 1990 through 2011, an estimated 663,471 (95% CI: 496,370–830,573) individuals ≥ 7 years old were treated in US emergency departments for golf-related injuries, averaging 30,158 annually or 12.3 individuals per 10,000 golf participants. Patients 18–54 years old accounted for 42.2% of injuries, but injury rates per 10,000 golf participants were highest among individuals 7–17 years old (22.1) and ≥ 55 years old (21.8) compared with 18–54 years old (7.6). Patients ≥ 55 years old had a hospital admission rate that was 5.01 (95% CI: 4.12–6.09) times higher than that of younger patients. Injured by a golf club (23.4%) or struck by a golf ball (16.0%) were the most common specified mechanisms of injury. The head/neck was the most frequently injured body region (36.2%), and sprain/strain (30.6%) was the most common type of injury. Most patients were treated and released (93.7%) and 5.9% required hospitalization.Conclusions
Although golf is a source of injury among all age groups, the frequency and rate of injury were higher at the two ends of the age spectrum. Given the higher injury and hospital admission rates of patients ≥ 55 years, this age group merits the special attention of additional research and injury prevention efforts. 相似文献16.
Yuji Shono Tomohiko Akahoshi Satomi Mezuki Kenta Momii Noriyuki Kaku Jun Maki Kentaro Tokuda Tetsuro Ago Takanari Kitazono Yoshihiko Maehara 《The American journal of emergency medicine》2017,35(12):1836-1838
Background and purpose
Accurate diagnosis of acute aortic dissection (AAD) is sometimes difficult because of accompanying central nervous system (CNS) symptoms. The purpose of this study was to investigate the clinical characteristics of Type A AAD (TAAAD) with CNS symptoms.Methods
We retrospectively reviewed the medical records of 8403 patients ambulanced to our emergency and critical care center between April 2009 and May 2014.Results
We identified 59 TAAAD patients for the analysis (mean age, 67.3 ± 10.5 years; 37 (62.0%) male). Eleven patients (18.6%) presented CNS symptoms at the onset of TAAAD, and these patients complained less frequently of typical chest and back pain than those without CNS symptoms (p < 0.0001). Initial systolic and diastolic blood pressure were lower (p = 0.003, and p = 0.049, respectively) and involvement of the supra-aortic artery was more frequent in patients with CNS symptoms (p < 0.0001).Conclusion
Because CNS symptom can mask chest and back pain caused by TAAAD, physicians should always consider the possibility of TAAAD in patients with CNS symptoms in emergency medicine settings. 相似文献17.
Rex Pui Kin Lam Wai Lam Yip Chi Keung Wan Matthew Sik Hon Tsui 《The American journal of emergency medicine》2017,35(4):665.e1-665.e4
Background
Chemical restraint is often required to control agitation induced by methamphetamine. Dexmedetomidine is an α-2 adrenergic receptor agonist with sedative, analgesic, and sympatholytic properties. Its use in the emergency department (ED) to control methamphetamine-induced agitation has not been reported.Objective
To report two cases of methamphetamine-induced agitation successfully sedated with dexmedetomidine in the ED.Case Report
The first case was a 42-year-old man with unstable emotion and violent behaviours after smoking methamphetamine. His agitation did not respond to a large cumulative dose of benzodiazepines (10 mg of diazepam and 332 mg of midazolam) administered over 48 h and sedation was achieved with dexmedetomidine. The second case was a 38-year-old methamphetamine user with unstable emotion and recurrent episodes of agitation despite repeated doses of benzodiazepines, whose agitation was controlled with dexmedetomidine infusion.Discussion
In both cases, dexmedetomidine apparently reduced the dose of benzodiazepines needed to achieve adequate sedation. Transient falls in blood pressure and slowing of the heart rate were noted, which resolved either spontaneously or after reducing the infusion rate without requiring drug treatment.Conclusion
Dexmedetomidine can be considered as an adjunct for chemical restraint when standard treatment fails to control the agitation induced by methamphetamine, but patient's hemodynamic state should be monitored closely during administration. Its efficacy and safety in the ED warrant further evaluation with prospective controlled trials. 相似文献18.
Pawel Gawlowski Jacek Smereka Marcin Madziala Lukasz Szarpak Michael Frass Oliver Robak 《The American journal of emergency medicine》2017,35(3):484-487
Introduction
Endotracheal intubation (ETI) using a Macintosh laryngoscope (MAC) requires the head to be positioned in a modified Jackson position, slightly reclined and elevated. Intubation of trauma patients with an injured neck or spine is therefore difficult, since the neck usually cannot be turned or is already immobilized in order to prevent further injury. The iGEL supraglottic airway seems optimal for such conditions due to its blind insertion without the need of a modified Jackson position.Methods
Prospective, randomized, crossover study in 46 paramedics. Participants performing standard intubation and blind intubation via iGEL supraglottic airway device in three airway scenarios: Scenario A – normal airway; Scenario B - manual inline cervical immobilization, performed by an independent instructor; scenario C: cervical immobilization using a standard Patriot cervical extraction collar.Results
In Scenario A, nearly all participants performed ETI successfully both with MAC and iGEL (100% vs. 95.7%). The time to intubation (TTI) using the MAC and iGEL amounted to 19 [IQR, 18–21]s vs. 12 [IQR, 11–13]s (P < 0.001). Head extension angle as well as tooth compression were significantly better with the iGEL compared to the MAC (P < 0.001). In scenario B and C, the results with the iGEL were significantly better than with MAC for all analyzed variables (TTI, success of first intubation attempt, head extension angle, tooth compression and VAS scores).Conclusion
We showed that blind intubation with the iGEL supraglottic airway was superior to ETI performed by paramedics in a simulated cervical immobilization scenario in a manikin in terms of success rate, time to definite tube placement, head extension angle, tooth compression, and rating. 相似文献19.
Sarah D. Meskill Paula A. Revell Lakshmi Chandramohan Andrea T. Cruz 《The American journal of emergency medicine》2017,35(3):495-498
Background
Respiratory syncytial virus (RSV) and influenza have varying degree of seasonal overlap.Objective
To determine the prevalence of co-infection of RSV and influenza compared to the prevalence of those infections independently when both are in season.Methods
This was a retrospective cross-sectional study of children evaluated between July 2010 and June 2013 for viral respiratory infection using multiplex PCR. Seasonality was defined retrospectively as weeks when > 2% of the total annual positive tests were obtained and was calculated for influenza A, influenza B, and RSV independently. Periods of overlapping seasonality of RSV and influenza A and RSV and influenza B were identified. The expected incidences of co-infection were modeled as the product of the incidences of the individual viruses.Results
13,664 specimens were sent for PCR during the study period. Over all 3 seasons, RSV overlapped with influenza A and B for 22 and 18 weeks, respectively; in 2011–12, RSV overlapped with neither influenza A nor B. Based on modeling, there were 6–7 fold fewer cases of RSV/influenza co-infection observed than expected: RSV/influenza A 77 vs. 12, (p ≤ 0.001; RSV/influenza B 76 vs. 11 (p ≤ 0.001).Conclusions
The observed incidence of co-infectivity of RSV and influenza was significantly less than the expected incidence even when both were co-circulating. In light of these data, it may be reasonable to forgo rapid influenza testing or empiric antiviral treatment for children whom rapid RSV testing is positive and who are at low risk of influenza-related complications, especially in times of antiviral therapy shortages. 相似文献20.
Peter Pruitt Joshua Penn David Peak Pierre Borczuk 《The American journal of emergency medicine》2017,35(2):255-259