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1.
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2.
3.
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4.
R. Jouffroy A. Saade P. Alexandre P. Philippe P. Carli B. Vivien 《The American journal of emergency medicine》2019,37(3):387-390
Background
Epinephrine is recommended for the treatment of non-shockable out of hospital cardiac arrest (OHCA) to obtain return of spontaneous circulation (ROSC). Epinephrine efficiency and safety remain under debate.Objective
We propose to describe the association between the cumulative dose of epinephrine and the failure of ROSC during the first 30?min of advanced life support (ALS).Methodology
A retrospective observational cohort study using the Paris SAMU 75 registry including all non-traumatic OHCA. All OHCA receiving epinephrine during the first 30?min of ALS were enrolled. Cumulative epinephrine dose given during ALS to ROSC was retrieved from medical reports.Results
Among 1532 patients with OHCA, 776 (51%) had initial non-shockable rhythm. Fifty-four patients were excluded for missing data.The mean value of cumulative dose of epinephrine was 10?±?4?mg in patients who failed to achieve ROSC (ROSC?) and 4?±?3?mg (p?=?0.04) for those who achieved ROSC.ROC curve analysis indicated a cut-off point of 7?mg total cumulative epinephrine associated with ROSC? (AUC?=?0.89 [0.86–0.92]).Using propensity score analysis including age, sex and no-flow duration, association with ROSC? only remained significant for epinephrine?>?7?mg (p?≤10–3, OR [CI95]?=?1.53 [1.42–1.65]).Conclusion
An association between total cumulative epinephrine dose administered during OHCA resuscitation and ROSC? was reported with a threshold of 7?mg, best identifying patients with refractory OHCA. We suggest using this threshold in this context to guide the termination of ALS and early decide on the implementation of extracorporeal life support or organ harvesting in the first 30?min of ALS. 相似文献5.
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6.
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7.
8.
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9.
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10.
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11.
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12.
Cody Andrews Sean Smith Maggi Kennel Steve Schilling Claire Kalpakjian 《Archives of physical medicine and rehabilitation》2019,100(4):606-612
Objective
Determine the relationship between functional status and degree of specific organ involvement, physical performance, and subjective well-being chronic graft-vs-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation.Design
Observational cohort.Setting
Outpatient clinic.Participants
Adult patients (N=121) with cGVHD with 634 assessments.Interventions
Not applicable.Main Outcome Measures
Karnofsky Performance Status (KPS). Skin, fascia/joints, lungs, upper and lower extremity range of motion, liver, eye, mucosal, and gastrointestinal involvement were measured using the National Institutes of Health GVHD scale. Physical performance was assessed with the 2-minute walk test (2MWT) and hand grip strength. Subjective measures were the Patient Health Questionnaire 9 (PHQ-9) and Lee Symptom Burden (LSB) scale.Results
Myofascial (P<.001) and lung (P=.001) involvement, 2MWT (P<.001), LSB (P<.001), and PHQ-9 (P=.03) had the largest associations with KPS with liver (P=.05) and hand grip strength (P<.001) more modest associations with KPS.Conclusions
Patients with cGVHD experience multifactorial impairment in function associated with potentially modifiable symptoms physiatrists have the expertise to address to enhance function. More research is needed to determine rehabilitation interventions to mitigate the impact of cGVHD on function. 相似文献13.
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14.
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15.
Jill Chamberlain Susan McCarty Joanne Sorce Betsy Leesman Sarah Schmidt Elizabeth Meyrick Simone Parlier Linda Kennedy Debra Crowley Lori Coultas 《Journal of neonatal nursing : JNN》2019,25(2):74-77
Objective
Determine impact delayed newborn bathing for 24 hours has on exclusive breastfeeding rates, temperature and glucose stability, and percentage of weight loss and, to determine if there was a difference in the nurses’ knowledge and comfort levels regarding delayed bathing pre and post implementation.Design
Pre-post retrospective chart review and, pre-post survey.Setting
Midwestern health system with three hospitals that has a combined average delivery rate of 2100 births.Participants
330 charts were reviewed pre-implementation, 330 charts were reviewed post-implementation, and 100 RNs were asked to participate in the pre and post-survey.Methods
Newborn baths were delayed 24 hours after birth unless contraindicated by a blood borne pathogen or upon parental requests.Results
Post-intervention there was a significant decrease in the number of blood glucose level checks (p?=?.002) and the amount of blood glucose levels equal or below 45 (p?=?.001). There was a trend in decreased weight loss post-intervention, but was not significant (p?=?.227). Cold stress significantly decreased (p?<?.001) post-intervention. Exclusive breastfeeding rates did not change. Nurses’ perception of comfort and knowledge level increased post-intervention.Conclusion
Delaying an infant's bath until 24 hours after birth seems to have positive impact on the infant's temperature regulation as well as glucose stability. 相似文献16.
Young Jin Gu Jae Hoon Lee Jung In Seo 《The American journal of emergency medicine》2019,37(3):539-542
Background
Increasing the size of the central veins is required to increase the success rate of central line placement and decrease complication risk. Right-sided approach for the central veins, Valsalva maneuver, and Trendelenburg position have been recommended, but these may not be available for some cases. This study aimed to determine a more convenient patient position that can result in the largest central vein diameter.Methods
Recruited subjects were placed in 60° and 30° upper body elevation, supine position, and 30° and 60° lower body elevation, and lumbar elevation (LE) was consecutively performed, with one position maintained for 10?min. Diameters of the subclavian vein (SCV) and internal jugular vein (IJV) were measured using high-resolution two-dimensional ultrasonography at each position.Results
The most suitable position on the ordinary bed for increasing central vein diameter was LE. The maximum and minimum SCV and IJV diameters in LE were significantly larger than those in the supine position (SCV: coefficients ?0.633 and ?0.863, p?=?0.08 and 0.011, respectively; IJV: coefficients ?1.09 and ?1.15, p?<?0.001 and?=?0.001, respectively). Leg elevation for 10?min failed to dilate the central vein diameter.Conclusion
The LE without leg elevation produced a greater and more significant increase in central vein diameter than the supine position and may be useful for central line placement. 相似文献17.
Jui-Yuan Chung Chien-Chin Hsu Jiann-Hwa Chen Wei-Lung Chen Hung-Jung Lin How-Ran Guo Chien-Cheng Huang 《The American journal of emergency medicine》2019,37(3):391-394
Background
The shock index is a rapid and simple tool used to predict mortality in patients with acute illnesses including sepsis, multiple trauma, and postpartum hemorrhage. However, its ability to predict mortality in geriatric patients with influenza in the emergency department (ED) remains unclear. This study was conducted to clarify this issue.Methods
We conducted a retrospective case-control study, recruiting geriatric patients (≥ 65?years) with influenza visiting the ED of a medical center between January 01, 2010 and December 31, 2015. Demographic data, vital signs, shock index, past histories, subtypes of influenza, and outcomes were included for the analysis. We investigated the association between shock index ≥1 and 30-day mortality.Results
In total, 409 geriatric ED patients with mean age of 79.5?years and nearly equal sex ratio were recruited. The mean shock index?±?standard deviation was 0.7?±?0.22 and shock index ≥1 was accounted for in 7.1% of the total patients. Logistic regression showed that shock index ≥1 predicted mortality (odds ratio: 6.80; 95% confidence interval: 2.39–19.39). The area under the receiver operating characteristic was 0.62 and the result of the Hosmer–Lemeshow goodness-of-fit test was 0.23. The sensitivity, specificity, positive predictive value, and negative predictive value of a shock index ≥1 were 30.0%, 94.1%, 20.0%, and 96.4%.Conclusions
A shock index ≥1 has a high specificity, negative predictive value, and good reliability to predict 30-day mortality in geriatric ED patients with influenza. 相似文献18.
Problem
Throughout the world people who are homeless experience high rates of hospitalisation. Nurses who work in hospitals have the potential to improve outcomes for this group. To date, a review of qualitative literature pertaining to hospital-based nursing for people who are homeless has been lacking.Aim
To synthesize findings of contemporary qualitative studies related to hospital-based nursing care for people who are homeless in Organisation for Economic Cooperation and Development (OECD) nations.Design
A systematic database search was conducted in mid-2017 using search terms: homeless*, hospital* and nurs*, combined by the Boolean operator ‘AND’. Inclusion and exclusion criteria that mandated publication year, language, method, quality, participants, and setting were applied. 341 abstracts were screened for relevancy resulting in the final inclusion of 8 qualitative and 2 mixed method studies.Findings
Three overarching themes emerged; (1) Homelessness challenges rigid approaches to hospital-based care (2) Stigma impedes healthcare for people who are homeless (3) Hospitals can provide a platform to address homelessness.Discussion
Delivering flexible, non-stigmatising nursing in a way that empowers people experiencing homelessness challenges hospitals around the globe. Research is needed to explore local approaches and subgroups within the homeless population.Conclusion
Experiences of homelessness vary across nations and between cities necessitating local solutions. Within hospitals, if nurses can provide flexible, non-stigmatising care, they have potential to make a huge difference both the lives of individuals who are homeless and in the wellbeing of society as a whole. 相似文献19.
Tessa Hart John Whyte Monica Vaccaro Amanda R. Rabinowitz 《Archives of physical medicine and rehabilitation》2019,100(5):987-989
Objective
Determine agreement between self-reported dose and dose reflected in administrative records of outpatient physical, occupational, and speech therapies at 6 and 12 months after severe traumatic brain injury (TBI), for the purpose of examining accuracy and predictors of accuracy of self-reported health care utilization in this population.Design
Secondary analysis of survey used in a larger study; participants were queried about therapy doses using a structured interview, either alone or assisted by relatives if they so chose, with responses compared to administrative records.Setting
Rehabilitation center providing outpatient TBI therapies.Participants
Sixty-five people with severe TBI living in the community provided 6-month data (N=65); 54 provided 12-month data.Interventions
Not applicable.Main Outcome Measures
Degree of agreement with administrative records of scheduled and billed therapy appointments, measured using intraclass correlation coefficients (ICCs), with linear regression used to predict accuracy from demographic variables and cognitive status.Results
ICCs were in the moderate range at 6 months, but were more variable, with some in the poor range, at 12 months. Agreement was higher for scheduled than for billed (attended) appointments. Assisted and unassisted patients provided comparable agreement with records. No demographic factors were associated with accuracy, but lower cognitive FIM scores, as hypothesized, tended to predict lower agreement at 6 months.Conclusions
People with severe TBI can provide reasonable estimates of commonly prescribed outpatient therapy doses at 6 months postinjury. Accuracy may be improved by inviting patients to request assistance from relatives and by asking them to consider attended (vs scheduled) sessions. 相似文献20.
Trauma team activation criteria and outcomes of geriatric trauma: 10 year single centre cohort study
Kevin Kei-ching Hung Janice H.H. Yeung Catherine S.K. Cheung Ling-yan Leung Raymond C.H. Cheng N.K. Cheung Colin A. Graham 《The American journal of emergency medicine》2019,37(3):450-456