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Oguz Eroglu Sancar Serbest Tarkan Kufeciler Asim Kalkan 《The American journal of emergency medicine》2019,37(6):1065-1068
Background & aimThe aim of this study was to compare hypothermia patients with and without an Osborn wave (OW) in terms of physical examination findings, laboratory results, and clinical survival.MethodsThe study was carried out retrospectively on hypothermic patients. The hypothermic patients were divided into two groups. Group 1 comprised patients with OW on electrocardiogram (ECG), and Group 2 comprised patients without OW on ECG. The Mann–Whitney U test was used to compare the two groups, and the relationships between the variables and the presence of OW and mortality were analyzed with ANOVA. A value of p < 0.05 was considered statistically significant.ResultsOW was detected on ECG of 41.9% of the patients (Group 1). The mean body temperature was 30.8 ± 4.1 °C in Group 1 and 33.3 ± 1.6 °C in Group 2 (p = 0.106). The mean creatinine level was 1.01 ± 0.6 mg/dl in Group 1 and 0.73 ± 0.5 mg/dl in Group 2 (p = 0.046). The mean bicarbonate level was 15.9 ± 3.8 mmol/l in Group 1 and 18.6 ± 3.5 mmol/l in Group 2 (p = 0.038). A relationship was determined between the presence of OW and pH, bicarbonate, and creatinine levels (p = 0.026; 0.013; 0.042, respectively). The mortality rate was 69.2% in Group 1 and 77.8% in Group 2 (p = 0.689).ConclusionAlthough there is a relationship between the decrease in bicarbonate levels, changes in kidney functions that cause acidosis, and the presence of OW, it has no effect on mortality. The presence of OW in hypothermic patients is insufficient to make a decision regarding mortality. 相似文献
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Jacek Smereka Lukasz Szarpak Adam Smereka Steve Leung Kurt Ruetzler 《The American journal of emergency medicine》2017,35(4):604-609
Background
The impact of high-quality chest compressions during CPR for the patients' outcome is undisputed, as it is essential for maintaining vital organ perfusion. The aim of our study is to compare the quality of chest compression (CC) and ventilation among the two current standard techniques with our novel “nTTT” technique in infant CPR.Methods
In this randomized crossover, manikin trial, participants performed CCs using three techniques in a randomized sequence: standard two finger technique (TFT); standard two thumb technique (TTHT), and the ‘new two-thumb technique’ (nTTT). The novel method of CCs in an infant consists in using two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist.Results
Median depth compression using the distinct chest compression techniques varied and amounted to 26 [IQR, 25–28] mm for TFT, and 39 [IQR, 39–39] mm for TTHT as well as for nTTT. Best percentage of fully released compressions were received using TFT (100[100 ? 100] %), then in the case of nTTT (99[98–100] %), and the worst in situation where TTHT (18[14–19] %). was used. The fastest chest compression rate was achieved with TFT (134[IQR, 129–135]/min) and the slowest when using nTTT (109 [IQR, 105–111]/min).Conclusions
We found that our new nTTT technique's performance, in terms of compression depth, hands-off time, and ventilation quality, is comparable to the current standards. Based on our findings of this initial manikin study, the nTTT technique is superior to TFT in many of parameters that are vital to a quality chest compression during pediatric CPR. 相似文献3.
D. Kılıç E. Göksu T. Kılıç C.S. Buyurgan 《The American journal of emergency medicine》2018,36(5):829-833
Objective
The aim of this randomized cross-over study was to compare one-minute and two-minute continuous chest compressions in terms of chest compression only CPR quality metrics on a mannequin model in the ED.Materials and methods
Thirty-six emergency medicine residents participated in this study. In the 1-minute group, there was no statistically significant difference in the mean compression rate (p = 0.83), mean compression depth (p = 0.61), good compressions (p = 0.31), the percentage of complete release (p = 0.07), adequate compression depth (p = 0.11) or the percentage of good rate (p = 51) over the four-minute time period. Only flow time was statistically significant among the 1-minute intervals (p < 0.001). In the 2-minute group, the mean compression depth (p = 0.19), good compression (p = 0.92), the percentage of complete release (p = 0.28), adequate compression depth (p = 0.96), and the percentage of good rate (p = 0.09) were not statistically significant over time. In this group, the number of compressions (248 ± 31 vs 253 ± 33, p = 0.01) and mean compression rates (123 ± 15 vs 126 ± 17, p = 0.01) and flow time (p = 0.001) were statistically significant along the two-minute intervals. There was no statistically significant difference in the mean number of chest compressions per minute, mean chest compression depth, the percentage of good compressions, complete release, adequate chest compression depth and percentage of good compression between the 1-minute and 2-minute groups.Conclusion
There was no statistically significant difference in the quality metrics of chest compressions between 1- and 2-minute chest compression only groups. 相似文献4.
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Atakan Yilmaz Ramazan Sabirli Mert Ozen Ibrahim Turkcuer Bulent Erdur Cuneyt Arikan Ezgi Demirozogul Ahmet Sarohan Murat Seyit Nusret Ok 《The American journal of emergency medicine》2019,37(5):902-908
Introduction
Musculoskeletal system traumas are among the most common presentations in the emergency departments. In the treatment of traumatic musculoskeletal pain, paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are frequently used. Our aim in this study is to compare the efficacy of intravenous dexketoprofen and paracetamol in the treatment of traumatic musculoskeletal pain.Methods
This prospective, randomised, double blind, controlled study was conducted in a tertiary care emergency unit. The participating patients were randomised into two groups to receive either 50?mg of dexketoprofen or 1000?mg of paracetamol intravenously by rapid infusion in 150?mL of normal saline. Visual analogue scale (VAS), Numeric Rating Scala (NRS) and Verbal Rating Scale (VRS) was employed for pain measurement at baseline, after 15, after 30 and after 60?mins.Results
200 patients were included in the final analysis. The median age of the paracetamol group was 34 (24–48), while that of the dexketoprofen group was 35 (23–50), and 63% (n?=?126) of them consisted of men. Paracetamol and dexketoprofen administration reduced VAS pain scores over time (p?=?0.0001). Median reduction in VAS score at 60?min was 55 (IQR 30–65) for the paracetamol group and 50(IQR 30.25–60) for the dexketoprofen group. There was no statistically significant difference between the paracetamol and dexketoprofen groups in terms of VAS reductions (p?=?0.613).Conclusion
Intravenous paracetamol and dexketoprofen seem to produce equivalent pain relief for acute musculoskeletal trauma in the emergency department.CLINICALTRIALS.GOV NO: NCT03428503 相似文献6.
Lukasz Szarpak Jacek Smereka Jerzy R Ladny 《The American journal of emergency medicine》2017,35(5):796-797
Introduction
In the difficult airway, the intubation skills are critically important. In selected cases, particularly in airway edema, laryngeal or tongue edema, endotracheal intubation can turn out very difficult, and repeated attempts may even worsen the airway edema, causing trauma and bleeding, and finally leading to complete airway obstruction and inability to ventilate the patient.Aim of the study
The aim of the study was to compare the efficacy of endotracheal intubation performed by novice physicians using a standard Macintosh laryngoscope and an Intubrite videolaryngoscope.Material and methods
The study was designed as a prospective, randomized, crossover, simulation study and continues our research assessing the effectiveness of selected endotracheal intubation techniques in prehospital settings. All participants were experienced with the Macintosh direct laryngoscope but remained novice to videolaryngoscopy. Instructions on the correct use of the Macintosh and Intubrite laryngoscopes were given before the procedure, and all the 30 novice physicians were allowed to practice at least 10 times before the study on manikin with normal airways. We employed an airway manikin (Trucorp Airsim Bronchi; Trucorp Ltd., Belfast, Northern Ireland) to simulate difficult airway, with was obtained by inflating the tongue with 50 mL of air. The participants were asked to perform tracheal intubation using an endotracheal tube with 7.5 mm of internal diameter (Portex; Smiths Medical, Hythe, UK) through the vocal cords, applying either a conventional Macintosh laryngoscope with a size 3 blade (MAC; Mercury Medical, Clearwater, FL, USA) or the Intubrite videolaryngoscope, also with a Macintosh No. 3 blade (INT; Intubrite Llc, Vista, CA, USA). In both intubation techniques, a guide stylet (Rusch Inc., Duluth, GA, USA) was introduced into the endotracheal tube in order to obtain a C-shape curve to facilitate tracheal intubation. Each participating physician was randomly assigned to three attempts of tracheal intubation with each device.Results
The effectiveness of the first intubation attempt using MAC and INT was 63.6% and 53.4%, respectively (p = 0.023), and the total percentage of intubation was 100% for both methods. The median time to intubation was 29.5 (interquartile range [IQR], 27–35.5) s with MAC, and 229 (IQR, 25.5–37) s with INT. The total of 24 physicians out of all study participants would choose MAC as a device to intubate with in real terms, while only 6 physicians would choose INT.Conclusions
During the simulation study, the novice physicians were able to perform endotracheal intubation at the same time using both the Macintosh and Intubrite videolaryngoscope. However, the efficacy of the first intubation attempt was higher for MAC. Further studies are needed to confirm the results. 相似文献7.
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Erdal Tekin Ali Ahiskalioglu Muhammed Enes Aydin Emre Sengun Atif Bayramoglu Haci Ahmet Alici 《The American journal of emergency medicine》2019,37(2):375.e1-375.e3
Herpes zoster is a painful, eruptive, viral condition occurring with reactivation in immunosuppressed individuals. The selection of an effective analgesic method in the acute phase of herpes zoster can decrease the incidence of postherpetic neuralgia by reducing neural sensitization. The erector spinae plane block has been reported to provide diffuse and effective analgesia in the cervical, thoracic, and lumbar regions. We report an effective decrease in pain with the application of the high-thoracic erector spinae plane block in the emergency department in a patient with herpes zoster pain in the cervicothoracic and shoulder region. 相似文献
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Evaluation of activated charcoal and lipid emulsion treatment in model of acute rivaroxaban toxicity
Sinan Cem Uzunget Togay Evrin Sezen Baglan Uzunget Zamir Kemal Ertürk Egemen Akıncıoğlu Saffet Özdemir Atila Korkmaz 《The American journal of emergency medicine》2018,36(8):1346-1349
Aim
Reducing or reversing the toxicity effects of new oral anticoagulants is an important question.The purpose of the present study is to evaluate the effect of lipid emulsion (LE) and Activated Charcoal (AC) therapy on the intoxication of rivaroxaban, on mice.Methods
Adult male Balb/c mice weighing approximately 30 g were used in the study. Seven groups were assigned, with six mice in each group. Groups were defined; given only rivaroxaban, given only LE, given only AC, after the administration of rivaroxaban LE applied group in the 1st hour, after the administration of rivaroxaban LE applied group in the 3rd hour, after the administration of rivaroxaban AC applied group in the1st hour, after the administration of rivaroxaban AC applied group in the 1st hour and LE applied group in the 3rd hour. PT and Anti-Factor Xa activity were measured in all blood samples from subjects.Results
A statistically significant difference was found when all groups were compared in terms of mean PT values and Anti-FactorXa values. However, no statistically significant difference was found in the mean PT and Anti-FactorXa values when only rivaroxaban administrated group and after the administration of rivaroxaban LE and/or AC applied groups were compared one to one. No deaths occurred in groups during the observation.Conclusion
Although the administration of either AC or LE alone or in combination resulted in a decrease in the mean values of PT and anti-Factor Xa, in case of rivaroxaban toxicity, but one-to-one comparison of the groups was not statistically significant. 相似文献12.
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Robert M. Rodriguez Gregory W. Hendey William R. Mower 《The American journal of emergency medicine》2017,35(1):164-170
Chest imaging plays a prominent role in blunt trauma patient evaluation, but indiscriminate imaging is expensive, may delay care, and unnecessarily exposes patients to potentially harmful ionizing radiation. To improve diagnostic chest imaging utilization, we conducted 3 prospective multicenter studies over 12 years to derive and validate decision instruments (DIs) to guide the use of chest x-ray (CXR) and chest computed tomography (CT).The first DI, NEXUS Chest x-ray, consists of seven criteria (Age > 60 years; rapid deceleration mechanism; chest pain; intoxication; altered mental status; distracting painful injury; and chest wall tenderness) and exhibits a sensitivity of 99.0% (95% confidence interval [CI] 98.2–99.4%) and a specificity of 13.3% (95% CI, 12.6%–14.0%) for detecting clinically significant injuries.We developed two NEXUS Chest CT DIs, which are both highly reliable in detecting clinically major injuries (sensitivity of 99.2%; 95% CI 95.4–100%). Designed primarily to focus on detecting major injuries, the NEXUS Chest CT-Major DI consists of six criteria (abnormal CXR; distracting injury; chest wall tenderness; sternal tenderness; thoracic spine tenderness; and scapular tenderness) and exhibits higher specificity (37.9%; 95% CI 35.8–40.1%). Designed to reliability detect both major and minor injuries (sensitivity 95.4%; 95% CI 93.6–96.9%) with resulting lower specificity (25.5%; 95% CI 23.5–27.5%), the NEXUS CT-All rule consists of seven elements (the six NEXUS CT-Major criteria plus rapid deceleration mechanism).The purpose of this review is to synthesize the three DIs into a novel, cohesive summary algorithm with practical implementation recommendations to guide selective chest imaging in adult blunt trauma patients. 相似文献
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Sangil Lee Karisa K. Harland Morgan Bobb Swanson Sara Lawson Elijah Dahlstrom Lance Clemson Elaine Himadi 《The American journal of emergency medicine》2018,36(11):1967-1974