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1.
Hannah Kempton Ruan Vlok Christopher Thang Thomas Melhuish Leigh White 《The American journal of emergency medicine》2019,37(3):511-517
Introduction
Out of hospital cardiac arrest (OHCA) is a time critical and heterogeneous presentation. The most appropriate management strategies remain an issue for debate. The aim of this systematic review and meta-analysis was to determine the association of epinephrine versus placebo with return of spontaneous circulation, survival to hospital admission, survival to hospital discharge and neurological outcomes in out of hospital cardiac arrest.Methods
A systematic review of five databases was performed from inception to August 2018. Only randomised controlled trials were considered eligible for inclusion. The primary outcome was survival to hospital discharge. Secondary outcomes were ROSC, survival to hospital admission, neurological function on discharge and three-month survival. All studies were assessed for level of evidence and risk of bias.Results
Five randomised controlled trials with 17,635 patients were identified for inclusion. Use of epinephrine was associated with increased ROSC (OR?=?3.10; 95% CI?=?2.16 to 4.45; I2?=?74%; p?<?0.0001) and increased survival to hospital admission OR?=?2.52; 95% CI?=?1.63 to 3.88; I2?=?94%; p?<?0.0001). However, epinephrine was not associated with increased survival to discharge (OR?=?1.09; 95% CI?=?0.48 to 2.47; I2?=?77%; p?=?0.84) or differences in neurological outcomes (OR?=?0.81; 95% CI?=?0.34 to 1.96).Discussion
This study was a systematic review and meta-analysis of epinephrine versus placebo in OHCA. The use of epinephrine was associated with improved ROSC and survival to hospital admission. However, use of epinephrine was not associated with a significant difference in survival to hospital discharge, neurological outcomes or survival to 3?months. Further research is required to control for the confounders during inpatient management. 相似文献2.
3.
Ping Lin Fangyu Shi Lei Wang Zong-An Liang 《The American journal of emergency medicine》2019,37(3):524-529
Introduction
The relationship between time of day and the clinical outcomes of patients with out-of-hospital cardiac arrest (OHCA) remains inconclusive. We undertook a meta-analysis to assess the available evidence on the relationship between nighttime and prognosis for patients with OHCA.Materials and methods
PubMed and EMBASE were searched through June 20, 2018, to identify all studies assessing the relationship between nighttime and prognosis for patients with OHCA. Random effects modes were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs).Results
Eight observational studies met the inclusion criteria. Meta-analysis of 8 studies showed that compared with nighttime, the daytime OHCA patients had higher 1-month/in-hospital survival (OR, 1.25; 95% CI, 1.15–1.37; P?=?0.00), with high heterogeneity among the studies (I2?=?82.8%, P?=?0.00).Conclusions
Patients who experienced OHCA during the nighttime had lower 1-month/in-hospital survival than those with daytime OHCA. In addition to arrest event and pre-hospital care factors, patients' comorbidity and hospital-based care may also be responsible for lower survival at night. 相似文献4.
Yosuke Homma Takashi Shiga Hiraku Funakoshi Dai Miyazaki Atsushi Sakurai Yoshio Tahara Ken Nagao Naohiro Yonemoto Arino Yaguchi Naoto Morimura 《The American journal of emergency medicine》2019,37(2):241-248
Objective
This study assessed the association between the timing of first epinephrine administration (EA) and the neurological outcomes following out-of-hospital cardiac arrests (OHCAs) with both initial shockable and non-shockable rhythms.Methods
This was a post-hoc analysis of a multicenter prospective cohort study (SOS-KANTO 2012), which registered OHCA patients in the Kanto region of Japan from January 2012 to March 2013. We included consecutive adult OHCA patients who received epinephrine. The primary result included 1-month favorable neurological outcomes defined as cerebral performance category (CPC) 1 or 2. Secondary results included 1-month survival and return of spontaneous circulation (ROSC) after arrival at the hospital. Multivariable logistic regression analysis determined the association between delay per minute of the time from call to first EA in both pre- or in-hospital settings and outcomes.Results
Of the 16,452 patients, 9344 were eligible for our analyses. In univariable analysis, the delay in EA was associated with decreased favorable neurological outcomes only when the initial rhythm was a non-shockable rhythm. In multivariable analyses, delay in EA was associated with decreased ROSC (adjusted odds ratio [OR] for one minute delay, 0.97; 95% confidence interval [CI], 0.96–0.98) and 1-month survival (adjusted OR, 0.95; 95% CI, 0.92–0.97) when the initial rhythm was a non-shockable rhythm, whereas during a shockable rhythm, delay in EA was not associated with decreased ROSC and 1-month survival.Conclusions
While assessing the effectiveness of epinephrine for OHCA, we should consider the time-limited effects of epinephrine. Additionally, consideration of early EA based on the pathophysiology is needed. 相似文献5.
Michelle Ng Jerrold Perrott Sarah Burgess 《The American journal of emergency medicine》2019,37(3):444-449
Introduction
Tranexamic acid (TXA) has been shown to decrease mortality in adult trauma patients with or at significant risk of hemorrhage when administered within 3?h of injury. The use and appropriateness of TXA in adult trauma patients presenting to Royal Columbian Hospital (RCH) was investigated.Methods
This retrospective chart review utilized the British Columbia Trauma Registry to identify 100 consecutive trauma patients that presented to the emergency department at RCH between April 2012 to June 2015 and met the following indications for TXA: systolic blood pressure <90?mm?Hg and/or heart rate >110?bpm and presentation within 8?h of injury. Primary outcomes included: percentage that met indications for TXA, received TXA according to the CRASH-2 protocol, received a pre-hospital dose, and received TXA ≤1, >1 to ≤3, or >3?h from injury.Results
During the given time period, 117 subjects (2.7%) met indications for TXA. 67 patients (57%) received TXA in any dose, with 10 subjects (8.5%) receiving TXA according to the CRASH-2 protocol. Of the 67 patients who received any TXA, 76% did so ≤3?h. 22 patients (19%) received TXA as a pre-hospital dose.Conclusions
<10% of adult trauma patients that met the indication for TXA received it according to the CRASH-2 protocol. Of those patients that received TXA, 76% did so within 3?h. Further inquiry to identify reasons trauma patients are not receiving TXA as well as quality improvement initiatives in trauma care are required.Level of evidence
IIIStudy type
Therapeutic 相似文献6.
7.
Objectives
This study examined the incidence of symptomatological post-traumatic stress disorder (PTSD) in bereaved Tibetan adolescents 3?years after the 2010 Yushu earthquake, then to identify possible and relational risk factors of PTSD by a cross-sectional study.Methods
A total of 867 bereaved Tibetan adolescents seriously impacted by the 2010 earthquake were investigated. Symptomatological PTSD was evaluated by the PTSD Checklist–Civilian Version. And coping styles were evaluated by the Coping Styles Scale. Exposure of trauma to the 2010 Yushu earthquake was evaluated by a checklist about earthquake containing sociodemographic variables.Results
3?years after the Yushu earthquake, 24.4% of the bereaved Tibetan adolescents had symptomatological PTSD. The results also indicated that coping styles and disaster-related experiences after the 2010 earthquake were connected with PTSD among survivors. When the 2010 earthquake struck, those having symptomatological PTSD were more probably to be buried/injured/amputated, and to witness burial/injury/death, and to have property damage. An individual who adopted positive coping skill was probably to have less symptomatological PTSD.Conclusions
The results showed that the existence of PTSD in bereaved Tibetan adolescents in the Yushu earthquake was very prevailing after 3?years. Effective psychological rescue work should be carried out, especially targeting bereaved Tibetan adolescents with more severe PTSD. 相似文献8.
Itay Zmora Yonit Wiener-Well Evan Avraham Alpert 《The American journal of emergency medicine》2019,37(5):1006.e5-1006.e7
Background
Purulent bacterial pericarditis is a rare and potentially fatal disease. The course may be fulminant, and the presentation may pose a diagnostic challenge.Case report
An otherwise healthy 75-year-old male was brought to the emergency department in a state of general deterioration, confusion, and shock. Bedside ultrasound showed a significant pericardial effusion. His condition quickly deteriorated and the resuscitation included emergent bedside pericardiocentesis. The drainage was purulent and later cultures grew out Streptococcus pneumoniae.Why should an emergency physician be aware of this?
Purulent pericarditis is extremely rare but should be considered in the patient with a fulminant infectious process (particularly pneumonia) and signs of pericardial effusion. Treatment should include appropriate antibiotics and early drainage. 相似文献9.
10.
Pelayia H. Soto Nicole E. Reid Toby L. Litovitz 《The American journal of emergency medicine》2019,37(5):805-809
Introduction
New strategies recently proposed to mitigate injury caused by lithium coin cell batteries lodged in the esophagus include prehospital administration of honey to coat the battery and prevent local hydroxide generation and in-hospital administration of sucralfate suspension (or honey). This study was undertaken to define the safe interval for administering coating agents by identifying the timing of onset of esophageal perforations.Methods
A retrospective study of 290 fatal or severe battery ingestions with esophageal lodgment was undertaken to identify cases with esophageal perforations.Results
Esophageal perforations were identified in 189 cases (53 fatal, 136 severe; 95.2% in children ≤4?years). Implicated batteries were predominantly lithium (91.0%) and 92.0% were ≥20?mm diameter. Only 2% of perforations occurred in <24?h following ingestion, including 3 severe cases with perforations evident at 11–17?h, 12?h, and 18?h. Another 7.4% of perforations (11 cases) became evident 24 to 47?h post ingestion and 10.1% of perforations (15 cases) became evident 48 to 71?h post ingestion. By 3?days post ingestion, 26.8% of perforations were evident, 36.9% by 4?days, 46.3% by 5?days, and 66.4% by 9?days.Conclusion
Esophageal perforation is unlikely in the 12?h after battery ingestion, therefore the administration of honey or sucralfate carries a low risk of extravasation from the esophagus. This first 12?h includes the period of peak electrolysis activity and battery damage, thus the risk of honey or sucralfate is low while the benefit is likely high. 相似文献11.
Introduction
Transgender and gender non-conforming (TGNC) people in the United States face disproportionate rates of mental health disorders, including suicidality, depression, anxiety, and substance use disorders than the general population. Patients' experiences utilizing mental healthcare is a determinant in their care-seeking behaviors and treatment success.Aim/question
The purpose of this integrative review is to better understand the firsthand mental healthcare experiences of TGNC persons.Method
The authors sought to locate recent English-language articles that described the mental healthcare experiences of TGNC persons. To do so, only articles that conducted data collection with a TGNC sample were considered for review.Results
Seven articles met criteria for review. Four themes emerged that depicted experiences of health promotion (welcoming environments, staff knowledge and response) and health prevention (enacted stigma, racial disparities and intersectional insensitivity).Discussion
Themes indicated that TGNC persons have mixed experiences (excellent to harmful/damaging) when receiving mental healthcare. There is room for healthcare provider growth in skills to increase TGNC cultural competency.Implications for practice
Mental healthcare providers and nurses would benefit from interventions to promote TGNC culturally competent care, including in-service training or continuing education for the current work force as well as incorporating TGNC content into pre-licensure educational curricula. 相似文献12.
Jenna Garlock Leborah Lee Michaelia Cucci Lawrence A. Frazee Chanda Mullen 《The American journal of emergency medicine》2019,37(5):884-889
Background
In the ED, patients are treated empirically for suspected gonorrhea and/or chlamydia (GC). Limited studies have evaluated the treatment of sexually transmitted diseases (STDs) in conjunction with predictor variables. This study will allow providers to better identify patients with potential GC to streamline antibiotic treatment.Objectives
The primary objective was to determine the incidence of positive assay in patients that underwent GC screening. The secondary objectives included the proportion of patients assayed that received empiric therapy and the predictive value of risk factors to identify positive assays.Methods
This retrospective cohort study included adult patients who presented to the health-system EDs and underwent GC screening. Subjects were excluded if they were victims of sexual assault, left AMA or eloped.Results
A total of 490 assayed patients were included, of which 84 (17%) were found to be positive for GC assay. Of the 278 patients treated empirically, 74% had a negative assay. Of the entire sample (n?=?490), risk factors found to predict a positive assay (p?<?0.05) included male, women <25?years of age, concomitant bacterial vaginosis, pelvic inflammatory disease or trichomonas, penile discharge, inconsistent condom use, previous/coexisting STDs, and uninsured.Conclusions
Compared to previous reports, this study found a higher incidence of positive GC assays for patients with suspected infection. This is the first study to evaluate GC testing in both men and women in the ED, and risk factors not previously reported by the CDC were identified. 相似文献13.
Background
Within nursing education research, protection of students as human subjects must be the highest priority. This protection can be provided via student anonymity. A subject-generated identification code, comprised of responses to a series of questions, can link data across time points while protecting student anonymity.Method
Two studies, focused on palliative care education, used a subject-generated identification code to link student data across multiple time points. Refinements to the code were made between studies to further enhance anonymity and response consistency.Results
The subject-generated identification code fostered linking of student responses across three time points in study one and two time points in study two.Conclusion
There are many benefits to utilizing a subject-generated identification code in nursing education studies. Researchers must consider the need for a data management expert and balancing transposition errors and the power to differentiate between responses. 相似文献14.
Mark W. Kroll Mollie B. Ritter Eric A. Kennedy Nora K. Siegal Roman Shinder Michael A. Brave Howard E. Williams 《The American journal of emergency medicine》2019,37(3):427-432
Purpose
While generally reducing morbidity and mortality, TASER® electrical weapons have risks associated with their usage, including burn injuries and head and cervical trauma associated with uncontrolled falls. The primary non-fatal complications appear to be significant eye injury but no analysis of the mechanisms or suggested treatments has been published.Methods
We used a biomechanical model to predict the risk of eye injury as a function of distance from the weapon muzzle to the eye. We compared our model results to recently published epidemiological findings. We also describe the typical presentation and suggest treatment options.Results
The globe rupture model predicted that a globe rupture can be expected (50% risk) when the eye is within 6?m of the muzzle and decreases rapidly beyond that. This critical distance is 9?m for lens and retinal damage which is approximately the range of the most common probe cartridges. Beyond 9?m, hyphema is expected along with a perforation by the dart portion of the probe. Our prediction of globe rupture out to 6?m (out of a typical range of 9?m) is consistent with the published risk of enucleation or unilateral blindness being 69?±?18%, with an eye penetration.Conclusions
Significant eye injury is expected from a penetration by an electrical weapon probe at close range. The risk decreases rapidly at extended distances from the muzzle. Not all penetrating globe injuries from electrical weapon probes will result in blindness. 相似文献15.
Jae Yun Jung Eun Mi Ham Hyuksool Kwon Young Ho Kwak Do Kyun Kim Jin Hee Lee Jin Hee Jung 《The American journal of emergency medicine》2019,37(3):468-471
Background
Coronary artery dilatation (CAD) is a great concern with Kawasaki disease (KD). This study aimed to investigate the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and CAD in patients with the hyperacute phase (≤4?days of fever) of KD.Methods
Serum NT-proBNP levels were compared between patients with and those without CAD, who underwent transthoracic echocardiography (TTE) within 24?h of the hyperacute phase of KD in the pediatric emergency department (PED). Electronic medical records of patients aged 1?month to 15?years who visited the PED were retrospectively assessed from January 2010 to December 31, 2014.Results
One hundred nine patients were enrolled in the study. Twenty-three of those patients had CAD within 24?h of TTE. Median serum NT-proBNP levels were significantly higher in patients with CAD (824.1?pg/ml; interquartile range [IQR], 515.4–1570.0184.8–767.8?pg/ml) than in patients without CAD (396.4?pg/ml; IQR, 184.8–767.8?pg/ml) (p?≤?0.001). The cutoff value of serum NT-proBNP, which predicted CAD during the hyperacute phase of KD, was 515.4?pg/ml, which yielded sensitivity of 78.26% and specificity of 61.63%. The area under the curve for NT-proBNP for predicting CAD during hyperacute KD was 0.749 (95% CI, 0.642–0.856).Conclusion
Serum NT-proBNP might be an additional laboratory marker for detecting early CAD during the hyperacute phase of KD in the PED. 相似文献16.
Background
This study was conducted to assess and clarify the predictive risk factor of neurologic outcome in patients with acute carbon monoxide (CO) poisoning.Methods
A total of 453 patients with acute CO poisoning were admitted to the emergency department of Samsung Changwon Hospital from January 2010 to June 2017. Patients with acute CO poisoning who were followed for >6?months were studied. Initial Glasgow Coma Score (GCS), serum neuron-specific enolase (NSE), and lactate were measured after emergency department arrival. Patients were divided into two groups (good vs poor neurologic outcome).Results
A total of 432 patients (median age: 55?years, range: 17–91?years) were enrolled. There was a statistical difference between the good neurologic outcome group and the poor neurologic outcome group in terms of Exposure time, WBC, aspartate aminotransferase (AST), CK-MB, Troponin-I, creatinine kinase, NSE, lactate, CO-Hb, and GCS. NSE, lactate, and GCS were the early predictors of development of poor neurologic outcome. The areas under the curve in the ROC curve analysis for the GCS, NSE, and lactate were 0.842, 0.795, and 0.894, respectively.Conclusion
Initial serum lactate level may correlate with the patient neurologic outcomes and prove to be a useful prognostic factor. Also NSE, and GCS might be a useful additional parameters that could predict the neurologic outcome on acute CO poisoned patients. 相似文献17.
Amy Hammerich Julie Whitman Paul Mintken Thomas Denninger Venu Akuthota Eric E. Sawyer Melissa Hofmann John D. Childs Joshua Cleland 《Archives of physical medicine and rehabilitation》2019,100(5):797-810
Objective
To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in individuals with lumbar spinal stenosis (LSS).Design
Randomized clinical trial.Setting
Orthopedic spine clinics.Participants
A total of 390 individuals were screened with 60 eligible and randomly selected to receive ESI and education with or without PT (N=54).Interventions
A total of 54 individuals received 1-3 injections and education in a 10-week intervention period, with 31 receiving injections and education only (ESI) and 23 additionally receiving 8-10 sessions of multimodal PT (ESI+PT).Main Outcome Measures
Disability, pain, quality of life, and global rating of change were collected at 10 weeks, 6 months, and 1 year and analyzed using linear mixed model analysis.Results
No significant difference was found between ESI and ESI+PT in the Oswestry Disability Index at any time point, although the sample had significant improvements at 10 weeks (P<.001; 95% confidence interval [CI], ?18.01 to ?5.51) and 1 year (P=.01; 95% CI, ?14.57 to ?2.03) above minimal clinically important difference. Significant differences in the RAND 36-Item Short Form Health Survey 1.0 were found for ESI+PT at 10 weeks with higher emotional role function (P=.03; 95% CI, ?49.05 to ?8.01), emotional well-being (P=.02; 95% CI, ?19.52 to -2.99), and general health perception (P=.05; 95% CI, ?17.20 to ?.78).Conclusions
Epidural steroid injection plus PT was not superior to ESI alone for reducing disability in individuals with LSS. Significant benefit was found for the addition of PT related to quality of life factors of emotional function, emotional well-being, and perception of general health. 相似文献18.
Gloria McKee-Lopez Leslie Robbins Elias Provencio-Vasquez Hector Olvera 《Journal of Professional Nursing》2019,35(2):112-119
Background
Research evidence strongly suggests that Adverse Childhood Experiences (ACEs) predispose individuals to development of an increased sensitivity to stress and negative physical and mental health outcomes in adulthood.Purpose
To determine if there was a relationship between the number of ACEs reported by first semester BSN students and their reported level of Burnout and Depression.Methods
211 students enrolled in the first semester of upper division courses of their BSN program completed self-report questionnaires which measured the number of ACEs, the level of Depression and the level of Burnout.Results
The number of reported ACEs by participants had a significant relationship on the levels of burnout and severity of depressive symptoms. Female students with a higher number of ACEs were more likely to report higher levels of Burnout A (Emotional Exhaustion) and Burnout B (Depersonalization), and higher depression severity scores compared to males.Conclusion
Nursing programs should educate faculty concerning the frequency and range of adverse experiences that students may have had prior to admission to the nursing program, and the possible relationship with Burnout and Depression. Faculty can provide early information on counseling and support services. 相似文献19.
Nancy Hoffart Thomas P. McCoy Lynne P. Lewallen Shemeka Thorpe 《Journal of Professional Nursing》2019,35(2):93-100
Background
The New Careers in Nursing (NCIN) program provided scholarships and other supports to accelerated degree students at 130 nursing schools and collected data from the scholars at three time-points.Purpose
The NCIN database was analyzed to identify gender-based differences in scholars' profile characteristics, program experiences, and post-graduation outcomes.Method
An adaptation of Jeffreys's Nursing Universal Retention and Success Model guided the analysis. Gender differences were assessed after multiplicity adjustments for false positive rates.Results
Differences based on gender were found for profile characteristics, student affective factors, academic factors, professional integration factors, environmental factors, as well as academic, psychological and NCIN program outcomes. Results suggest that males were influenced by economic factors more than females when choosing nursing as a career. They had fewer concerns about financial aspects associated with being a student again yet secured employment sooner after graduation than female scholars. They did not view support services as important as did female students. They expressed confidence in their leadership competence more than their female counterparts.Conclusion
Efforts are needed to better understand and address the nuanced gender-based perceptions and needs of nursing students who are male. 相似文献20.
Young Jin Gu Jae Hoon Lee Jung In Seo 《The American journal of emergency medicine》2019,37(3):539-542