共查询到20条相似文献，搜索用时 31 毫秒
1.
Zaffer Qasim Kevin Bradley Heather Panichelli Josie Robinson Susan Coffey Zern 《The Journal of emergency medicine》2018,54(4):419-426
Background
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a relatively innovative procedure designed to control critical non-compressible torso hemorrhage. In the United States, this procedure is currently in active use at only a small number of trauma centers.Objective
We describe how we developed our REBOA program at an independent academic-affiliated community trauma center.Discussion
Through a close interprofessional and multidisciplinary collaboration led by emergency physicians and trauma surgeons, we were able to successfully develop our program.Conclusions
Successful implementation of a REBOA program requires close attention to multimodal training, interprofessional roles, team dynamics, financial considerations, and quality assurance processes to safely deliver this potentially life-saving procedure to our trauma patient population. 相似文献2.
Kevin M. Lowe Alan C. Heffner Colleen H. Karvetski 《The Journal of emergency medicine》2018,54(1):16-24
Background
Infection is the second leading cause of death in end-stage renal disease (ESRD) patients. Prior investigations of acute septic shock in this specific population are limited.Objective
We aimed to evaluate the clinical presentation and factors associated with outcome among ESRD patients with acute septic shock.Methods
We reviewed patients prospectively enrolled in an emergency department (ED) septic shock treatment pathway registry between January 2014 and May 2016. Clinical and treatment variables for ESRD patients were compared with non-ESRD patients. A second analysis focused on ESRD septic shock survivors and nonsurvivors.Results
Among 4126 registry enrollees, 3564 (86.4%) met inclusion for the study. End-stage renal disease was present in 3.8% (n = 137) of ED septic shock patients. Hospital mortality was 20.4% and 17.1% for the ESRD and non-ESRD septic shock patient groups (p = 0.31). Septic shock patients with ESRD had a higher burden of chronic illness, but similar admission clinical profiles to non-ESRD patients. End-stage renal disease status was independently associated with lower fluid resuscitation dose, even when controlling for severity of illness. Age and admission lactate were independently associated with mortality in ESRD septic shock patients.Conclusion
ESRD patients comprise a small but important portion of patients with ED septic shock. Although presentation clinical profiles are similar to patients without ESRD, ESRD status is independently associated with lower fluid dose and compliance with the 30-mL/kg fluid goal. Hyperlactatemia is a marker of mortality in ESRD septic shock. 相似文献3.
Takayuki Ogura Alan Kawarai Lefor Mitsunobu Nakamura Kenji Fujizuka Kousuke Shiroto Minoru Nakano 《The Journal of emergency medicine》2017,52(5):715-722
Background
In trauma resuscitation with resuscitative endovascular balloon occlusion of the aorta (REBOA), urgent and accurate placement of the catheter in the resuscitation area without fluoroscopy can shorten the time from admission to REBOA, allowing rapid, temporary control of bleeding.Discussion
The experience-based protocol in our center for ultrasound-guided REBOA in the resuscitation area without fluoroscopy is as follows: the femoral artery is punctured and a guidewire inserted; sonography is used to verify that the guidewire is in the abdominal aorta; the position of the balloon is confirmed with ultrasound after estimating the distance to the clavicle, and the pressure in the radial artery and sheath is used to monitor correct positioning; connect the pressure transducer to the catheter sheath for continuous monitoring of the blood pressure in the sheath, and inflate the balloon until the blood pressure tracing at the sheath has disappeared; check the pulse in the left radial artery, and withdraw the catheter slightly if the pulse in the radial artery is not palpable or is decreased (if this pulse is not palpable or decreased, the balloon is in the aortic arch). In this retrospective review of our REBOA protocol, between April 2012 and March 2016, 34 patients were enrolled. Two patients had complications, including dissection of the femoral artery in one and difficult percutaneous vascular access in another. Median time needed to complete the procedure was 8 min. Overall, 24 of 34 patients survived more than 24 h (72%), and overall mortality was 47%. Patients who lived more than 24 h, and then died had severe traumatic brain injury or septic shock.Conclusions
Ultrasound-guided REBOA is presented. Monitoring the blood pressure in the left radial artery allows us to determine adequate positioning of the balloon, and the blood pressure in the catheter sheath located in the femoral artery should also be monitored to prevent aortic injuries caused by the overinflation of the balloon. 相似文献4.
In-Hospital Sepsis Mortality Rates Comparing Tertiary and Non-Tertiary Hospitals in Washington State
Gail G. Salvatierra Bernice G. Gulek Baran Erdik Deborah Bennett Kenn B. Daratha 《The Journal of emergency medicine》2018,54(6):785-792
Background
More than a million people a year in the United States experience sepsis or sepsis-related complications, and sepsis remains the leading cause of in-hospital deaths. Unlike many other leading causes of in-hospital mortality, sepsis detection and treatment are not dependent on the presence of any technology or services that differ between tertiary and non-tertiary hospitals.Objective
To compare sepsis mortality rates between tertiary and non-tertiary hospitals in Washington State.Methods
A retrospective longitudinal, observational cohort study of 73 Washington State hospitals for 2010–2015 using data from a standardized state database of hospital abstracts. Abstract records on adult patients (n = 86,378) admitted through the emergency department (ED) from 2010 through 2015 in all tertiary (n = 7) and non-tertiary (n = 66) hospitals in Washington State.Results
The overall mortality rate for all hospitals was 6.5%. In the fully adjusted model, the odds ratio for in-hospital death was higher in non-tertiary hospitals compared with tertiary hospitals (odds ratio 1.25; 95% confidence interval 1.17–1.35; p < 0.001).Conclusions
We observed higher sepsis mortality rates in non-tertiary hospitals, compared with tertiary hospitals. Because most patients who are treated for sepsis are treated outside of tertiary hospitals, and the number of patients treated for sepsis in non-tertiary hospitals seems to be rising, a better understanding of the cause or causes for this differential is crucial. 相似文献5.
Ali Pourmand Jen Liao Jesse M. Pines Maryann Mazer-Amirshahi 《The Journal of emergency medicine》2018,54(5):630-635
Background
The Segway® Personal Transporter? (SPT) is used widely as a means of transport for city sightseeing tours, law enforcement, and professionals working in large facilities and factories.Methods
We conducted a systematic review of the literature to assess SPT-related injuries. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, we queried PubMed from 1990 to 2017. The search terms Segway, personal transporter, and injury were used. Only English-language studies were included. Data were extracted from each article, specifically the sample size, study setting, and design, as well as the prevalence of specific injuries.Results
A total of six articles were included that included data on 135 patients. Sample size per study varied from 1 to 41 patients. Studies occurred in both the emergency department and inpatient settings, including medical-surgical wards, and intensive care units. The most commonly reported injuries were orthopedic cases (n = 45), maxillofacial cases (n = 13), neurologic cases (n = 8), and thoracic cases (n = 10).Conclusions
The SPT is an innovative transportation method; however, its use is associated with a wide range of injuries. Many of these injuries require hospital admission and surgical intervention, incurring significant morbidity and high costs. 相似文献6.
Roberta de Matos Brunelli Braghin Elisa Cavalheiro Libardi Carina Junqueira Marcello Henrique Nogueira – Barbosa Daniela Cristina Carvalho de Abreu 《Journal of bodywork and movement therapies》2018,22(1):76-82
Objectives
To assess balance and function of symptomatic and asymptomatic subjects with knee osteoarthritis (OA) and investigate the influence of physical exercise.Design
Subjects were divided into three groups: Group 1 (n = 15), symptomatic knee OA; Group 2 (n = 11), asymptomatic knee OA; and Group 3 (n = 16), knee OA and no intervention. History of falls, the WOMAC questionnaire, balance and functionality were assessed.Results
After intervention, there was a significant difference in the total WOMAC score and in the pain and function domains only in Group 1. After intervention, Group 2 showed significant differences in decreased time on the Step Up/Over test and postural sway increased.Conclusion
After the intervention, the symptomatic group reported improvement in pain and function on the WOMAC, while the asymptomatic group showed improvement in performance in the Step Up/Over test. There were no new episodes of falls in groups 1 and 2. 相似文献7.
Neeraj Chhabra Renee P. Gimbar Lisa M. Walla Trevonne M. Thompson 《The Journal of emergency medicine》2018,54(4):435-439
Background
Electronic dance music (EDM) festivals are increasingly common and psychoactive substance use is prevalent. Although prehospital care can obviate the transfer of many attendees to health care facilities (HCFs), little is known regarding the emergency department (ED) burden of patients presenting from EDM festivals.Objectives
This study describes the patient volume, length of stay (LOS), and presenting complaints of patients from a 3-day EDM festival in close proximity to an area ED.Methods
Medical charts of patients presenting to one HCF from an EDM festival were reviewed for substances used, ED LOS, and sedative medications administered. Additionally, preparedness techniques are described.Results
Over the 3-day festival, 28 patients presented to the ED (median age 21 years; range 18–29 years). Twenty-five had complaints related to substance use including ethanol (n = 18), “molly” or “ecstasy” (n = 13), and marijuana (n = 8). Three patients required intensive care or step-down unit admission for endotracheal intubation, rhabdomyolysis, and protracted altered mental status. The median LOS for discharged patients was 265 min (interquartile range 210–347 min). Eleven patients required the use of sedative medications, with cumulative doses of 42 mg of lorazepam and 350 mg of ketamine. All patients presented within the hours of 5:00 pm and 2:15 am.Conclusion
The majority of ED visits from an EDM festival were related to substance use. ED arrival times clustered during the evening and were associated with prolonged LOS. Few patients required hospital admission, but admitted patients required high levels of care. HCFs should use these data as a guide in planning for future events. 相似文献8.
9.
Flávia Belavenuto Rangon Vânia Tiê Koga Ferreira Monique Silva Rezende Amanda Apolinário Ana Paula Ferro Elaine Caldeira de Oliveira Guirro 《Journal of bodywork and movement therapies》2018,22(1):69-75
Objective
assess the effects of ischemic compression and kinesiotherapy on the rehabilitation of breast cancer survivors with chronic myofascial pain.Methods
A randomized, controlled, blinded clinical trial was performed with 20 breast cancer survivors with myofascial trigger point in the upper trapezius muscle. Patients were randomly allocated to ischemic compression + kinesiotherapy (G1, n = 10) and kinesiotherapy (G2, n = 10). Both groups were submitted to 10 sessions of treatment. The variables evaluated were: Numeric Rating Scale, Pain Related Self-Statement Scale, pressure pain threshold, Functional Assessment of Cancer Therapy-Breast and Infrared thermography.Results
A significant reduction (p < 0.05) was observed in pain intensity after 10 sessions in Groups 1 and 2, a significant increase (p < 0.05) in pressure pain threshold in both the operated and non-operated side after 10 sessions for Group 1.Conclusion
Ischemic compression associated with kinesiotherapy increases the pressure pain threshold on the myofascial trigger point in the upper trapezius muscle and reduces the intensity of pain in breast cancer survivors with myofascial pain. 相似文献10.
Sabrina Eun Kyung Lee Claudio Andre Barbosa de Lira Viviane Louise Andree Nouailhetas Rodrigo Luiz Vancini Marilia Santos Andrade 《Journal of bodywork and movement therapies》2018,22(2):430-437
Introduction
Several studies have been developed to determine which type of muscular action (isometric, isotonic and isokinetic) elicits more gains in functional strength and muscle mass. The comparisons between training outcomes are inconclusive due to lack of exercise standardization.Objective
To compare muscle strength, mass, and functional performance in response to isometric, isotonic, and isokinetic contractions, when training loads (volume and intensity) are equated.Method
Data were derived from a university community-recruited sample (n = 31 men).Interventions
Untrained men were assigned to isotonic (IT), isometric (IM), or isokinetic (IK) group, and trained their dominant quadriceps muscle 3 sessions/week for 8 weeks with a dynamometer. Muscle strength was assessed using Cybex 6000 dynamometer; the triple-hop-distance test was used to assess functional performance, and dual energy x-ray absorptiometry to assess lean muscle mass.Results
After training, muscle lean muscle mass increased in isometric (+3.1%, p < 0.01) and isotonic groups (+3.9%, p < 0.01); only the isokinetic group showed a significant improvement in the triple-hop-distance test (4.84%, p < 0.01).Conclusion
Clinicians should consider isometric training as an alternative for isotonic training to gain muscle mass, and isokinetic training to improve functional performance of daily activities and/or sports. 相似文献11.
Brian H. Rowe Leeor Eliyahu Justin Lowes Lindsay A. Gaudet Jeremy Beach Martin Mrazik Garnet Cummings Donald Voaklander 《The Journal of emergency medicine》2018,54(6):774-784
Background
Patients with mild traumatic brain injury or concussion commonly present to the emergency department for assessment; providing patients with information on usual symptoms and their progression may encourage faster recovery.Objectives
This study aimed to document the role of an electronic clinical practice guideline (eCPG) patient handout on concussion recovery in adult patients discharged from the hospital.Methods
A prospective cohort study was carried out in 3 Canadian urban emergency departments. Adults (≥17 years of age) with a Glasgow Coma Scale score of 13 to 15 who sustained a concussion were recruited by on-site research assistants. Physician use of a concussion-specific eCPG was documented from physician and patient reports. Patient follow-up calls at 30 and 90 days documented return to work/school activities and patient symptoms. Multivariate analyses were performed using logistic regression methods.Results
Overall, 250 patients were enrolled; the median age was 35 (interquartile range 23–49) and 52% were female. Approximately half (n = 119, 48%) of patients received the eCPG handout, and return to work/school recommendations varied. Symptoms persisted in 60% of patients at 30 days; patients in the eCPG group had fewer symptoms (odds ratio 0.57, 95% confidence interval 0.33–0.99). At 90 days, 40% of patients reported persistent symptoms, with no significant difference between groups.Conclusion
An eCPG handout improved patients’ short-term outcomes; however, physician use and adherence to guideline recommendations was low. To further facilitate physician compliance and therefore patient recovery, barriers to use of the eCPG handout need to be identified and addressed. 相似文献12.
Kamal Medlej Amin Antoine Kazzi Ahel El Hajj Chehade Mothana Saad Eldine Ali Chami Rana Bachir Dina Zebian Gilbert Abou Dagher 《The Journal of emergency medicine》2018,54(1):47-53
Background
The placement of a central venous catheter for the administration of vasopressors is still recommended and required by many institutions because of concern about complications associated with peripheral administration of vasopressors.Objective
Our aim was to determine the incidence of complications from the administration of vasopressors through peripheral venous catheters (PVC) in patients with circulatory shock, and to identify the factors associated with these complications.Methods
This was a prospective, observational study conducted in the emergency department (ED) of a tertiary care medical center. Patients presenting to the ED with circulatory shock and in whom a vasopressor was started through a PVC were included. Research fellows examined the i.v. access site for complications twice daily during the period of peripheral vasopressor administration, then daily up to 48 h after treatment discontinuation or until the patient expired.Results
Of the 55 patients that were recruited, 3 (5.45% overall, 6% of patients receiving norepinephrine) developed complications; none were major. Two developed local extravasation and one developed local thrombophlebitis. All three complications occurred during the vasopressor infusion, none in the 48 h after discontinuation, and none required any medical or surgical intervention. Two of the three complications occurred in the hand, and all occurred in patients receiving norepinephrine and with 20-gauge catheters.Conclusions
The incidence of complications from the administration of vasopressors through a PVC is small and did not result in significant morbidity in this study. Larger prospective studies are needed to better determine the factors that are associated with these complications, and identify patients in whom this practice is safe. 相似文献13.
Background
Emergency department crowding has led to innovative “front end” care models to safely and efficiently care for medium and lower acuity patients. In the United States, most treatment algorithms rely on the emergency severity index (ESI) triage tool to sort patients. However, there are no objective criteria used to differentiate ESI 3 patients.Objective
We seek to derive and validate a model capable of predicting patient discharge disposition (DD) using variables present on arrival to the emergency department for ESI 3 patients.Methods
Our retrospective cohort study included adult patients with an ESI triage designation 3 treated in an academic emergency department over the course of 2 successive years (2013–2015). The main outcome was DD. Two datasets were used in the modeling process. One dataset, the derivation dataset (n = 25,119), was used to develop the statistical model, while the second dataset, the validation dataset (n = 24,639), was used to evaluate the statistical model's prediction performance.Results
All variables included in the derivation model were uniquely associated with DD status (p < 0.001). We assessed multivariate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for age (2.50 [95% CI 2.35–2.65]), arrival mode (1.85 [95% CI 1.74–1.96]), heart rate (1.31 [95% CI 1.26–1.37]), sex (1.35 [95% CI 1.28–1.43]), oxygen saturation (1.06 [95% CI 1.01–1.10]), temperature (1.10 [95% CI 1.06–1.15]), systolic blood pressure (1.18 [95% CI 1.12–1.25]), diastolic blood pressure (1.16 [95% CI 1.09–1.22]), respiratory rate (1.05 [95% CI 1.01–1.10]), and pain score (1.13 [95% CI 1.06–1.21]). The validation C-statistic was 0.73.Conclusion
We derived and validated a model and created a nomogram with acceptable discrimination of ESI 3 patients on arrival for purposes of predicting DD. Incorporating these variables into the care of these patients could improve patient flow by identifying patients who are likely to be discharged. 相似文献14.
Brit Long Alex Koyfman Katharine L. Modisett Christian J. Woods 《The Journal of emergency medicine》2017,52(4):472-483
Background
Sepsis is a common condition managed in the emergency department, and the majority of patients respond to resuscitation measures, including antibiotics and i.v. fluids. However, a proportion of patients will fail to respond to standard treatment.Objective
This review elucidates practical considerations for management of sepsis in patients who fail to respond to standard treatment.Discussion
Early goal-directed therapy revolutionized sepsis management. However, there is a paucity of literature that provides a well-defined treatment algorithm for patients who fail to improve with therapy. Refractory shock can be defined as continued patient hemodynamic instability (mean arterial pressure, ≤ 65 mm Hg, lactate ≥ 4 mmol/L, altered mental status) after adequate fluid loading (at least 30 mL/kg i.v.), the use of two vasopressors (with one as norepinephrine), and provision of antibiotics. When a lack of improvement is evident in the early stages of resuscitation, systematically considering source control, appropriate volume resuscitation, adequate antimicrobial coverage, vasopressor selection, presence of metabolic pathology, and complications of resuscitation, such as abdominal compartment syndrome and respiratory failure, allow emergency physicians to address the entire clinical scenario.Conclusions
The care of sepsis has experienced many changes in recent years. Care of the patient with sepsis who is not responding appropriately to initial resuscitation is troublesome for emergency physicians. This review provides practical considerations for resuscitation of the patient with septic shock. When a septic patient is refractory to standard therapy, systematically evaluating the patient and clinical course may lead to improved outcomes. 相似文献15.
Background
It has been suggested that an adult 8.0 endotracheal tube (ETT) connected to a neonatal meconium aspirator would improve suctioning during emergent endotracheal intubation compared to the Yankauer suction instrument, the standard tool used by emergency physicians.Objectives
This study was designed to compare the effectiveness of a Yankauer vs. an ETT-meconium aspirator set-up in suctioning liquids of different viscosities.Methods
The Yankauer and ETT-meconium aspirator device underwent a head-to-head timed comparison, suctioning 250 mL of three different fluids, varying in viscosity. The first comparison test used tap water to represent simple oral secretions. The second comparison test used porcine whole blood as a proxy for human blood. The third comparison test used a coarsely blended mixture of a hamburger, French fries, and a soda to simulate emesis from a recently ingested meal. Five separate time trials were conducted for each liquid and for each suction device.Results
The ETT-meconium aspirator device compared to the Yankauer suctioned faster in both the water comparison test (mean = 2.6 s vs. 3.4 s; p < 0.001) and the porcine whole blood comparison test (mean = 2.9 s vs. 4.3 s; p = 0.0015). In the emesis trial, the Yankauer immediately clogged, whereas the ETT-meconium aspirator apparatus managed to suction an average of 90 mL prior to clogging.Conclusion
Compared to the Yankauer, an adult 8.0 ETT connected to a meconium aspirator was superior in suctioning liquids of varying viscosities and should be considered when encountering a difficult airway due to copious secretions, blood, or emesis. 相似文献16.
Suvi Aura Kirsimarja Metsävainio Heikki Paakkonen Susanna Saano Tuomas Selander Sue Jordan Hannele Turunen 《Journal of Radiology Nursing》2017,36(4):253-260.e1
Introduction
There are concerns that the high incidence of medicine-related adverse events is compromising patient safety. System errors and human factors, particularly inadequate knowledge of pharmacotherapy, are significant causes of medication errors. Little has been published on the continuing professional education of radiographers. We report on a study undertaken in Finland between 2012 and 2014.Methods
In this quasi-experimental study, we explored the relationship between radiographers' backgrounds (e.g., age, clinical experience, sex) and intravenous (IV) medication theoretical competence before (n = 77) continuing pharmacotherapy education delivered with two different learning methods, 1 to 2 weeks after (n = 56) and 6 months later (n = 37).Results
After the education programs, younger age, less clinical experience, and education in higher education institute (University of Applied Sciences) were significantly associated with performing better than average (more than median score) in the IV pharmacotherapy knowledge test. Both immediately after education and 6 months later, more participants performed better than average and passed more than 80% of correct answers limit after simulation-based than web-based education, respectively.Discussion
Continuing IV pharmacotherapy education improved theoretical medication competence, particularly for younger and less experienced radiographers. Evidence-based continuing education for radiographers is needed to assure patient safety. 相似文献17.
Edward Kuzmack Travis Inglis David Olvera Allen Wolfe Kona Seng Daniel Davis 《The Journal of emergency medicine》2018,54(4):395-401
Background
Difficult-airway prediction tools help identify optimal airway techniques, but were derived in elective surgery patients and may not be applicable to emergency rapid sequence intubation (RSI). The HEAVEN criteria (Hypoxemia, Extremes of size, Anatomic abnormalities, Vomit/blood/fluid, Exsanguination, Neck mobility issues) may be more relevant to emergency RSI patients.Objective
To validate the HEAVEN criteria for difficult-airway prediction in emergency RSI using a large air medical cohort.Methods
This was a retrospective analysis using a large air medical airway registry using data from 160 bases over a 1-year period. Standard test characteristics (sensitivity, specificity, positive predictive value, negative predictive value [NPV]) for the HEAVEN criteria were calculated for overall intubation success, first-attempt success, and first-attempt success without desaturation. In addition, multivariable logistic regression was used to quantify the independent association between each of the HEAVEN criteria, as well as the total number of criteria present and intubation success after adjusting for age, gender, and clinical category (burn, medical, trauma, nontraumatic shock).Results
A total of 2419 patients undergoing air medical RSI were included. Excellent NPV was observed (97% for each of the HEAVEN criteria except “Exsanguination,” which had an NPV of 87% but specificity of 99%). First-attempt success was lower for each of the HEAVEN criteria, with an inverse relationship observed between total HEAVEN criteria and intubation success (first-attempt success with no criteria = 94% and with 5 + criteria = 43%). Multivariable logistic regression revealed independent associations between each of the HEAVEN criteria, as well as total number of criteria and intubation success.Conclusions
The HEAVEN criteria seem to be a useful tool to predict difficult airways in emergency RSI. 相似文献18.
Osnat Wittmann Ayelet Rimon Dennis Scolnik Miguel Glatstein 《The Journal of emergency medicine》2018,54(3):315-319
Background
Neutropenia may alarm clinicians and prompt extensive evaluation in children with fever, even in immunocompetent patients.Objective
Our aim was to determine outcomes in previously healthy febrile children presenting to the emergency department with severe neutropenia.Methods
We reviewed data from infants and children aged 3–36 months with fever and severe neutropenia, defined as a peripheral neutrophil count <500 × 103/μL, at our institution between January 1, 2012 and December 31, 2015. We compared our results to those from a similar study of children with a peripheral neutrophil count of 500–1000 × 103/μL.Results
Severe neutropenia was recorded in 52 patients; severe bacterial infection (SBI) was found in 1 (1.9%), but none had a positive blood culture. Incidence of SBI was not different from that found in a study of similar patients with moderate neutropenia.Conclusions
Immunocompetent patients with fever and severe neutropenia do not carry a higher risk for SBI compared to patients with fever and moderate neutropenia. Such patients could potentially be followed closely with serial blood counts to ensure bone marrow recovery, without the use of antibiotics. 相似文献19.
20.
Leyla Sefiddashti Nastaran Ghotbi Mahyar Salavati Ali Farhadi Masood Mazaheri 《Journal of bodywork and movement therapies》2018,22(3):805-809