Showing papers in "World journal of emergency medicine in 2013"
TL;DR: Evaluated epinephrine by intramuscular injection is a safe therapy for anaphylaxis but training may still be necessary in emergency care settings to minimize drug dosing and administration errors and to allay concerns about its safety.
Abstract: Background While epinephrine is the recommended first-line therapy for the reversal of anaphylaxis symptoms, inappropriate use persists because of misunderstandings about proper dosing and administration or misconceptions about its safety. The objective of this review was to evaluate the safety of epinephrine for patients with anaphylaxis, including other emergent conditions, treated in emergency care settings. Methods A MEDLINE search using PubMed was conducted to identify articles that discuss the dosing, administration, and safety of epinephrine in the emergency setting for anaphylaxis and other conditions. Results Epinephrine is safe for anaphylaxis when given at the correct dose by intramuscular injection. The majority of dosing errors and cardiovascular adverse reactions occur when epinephrine is given intravenously or incorrectly dosed. Conclusion Epinephrine by intramuscular injection is a safe therapy for anaphylaxis but training may still be necessary in emergency care settings to minimize drug dosing and administration errors and to allay concerns about its safety.
49 citations
TL;DR: This is the first cross-sectional survey to provide “real-world” data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis, treatment, and follow-up of patients with anaphylaxis.
Abstract: BACKGROUND: Anaphylaxis is characterized by acute episodes of potentially life-threatening symptoms that are often treated in the emergency setting. Current guidelines recommend: 1) quick diagnosis using standard criteria; 2) first-line treatment with epinephrine; and 3) discharge with a prescription for an epinephrine auto-injector, written instructions regarding long-term management, and a referral (preferably, allergy) for follow-up. However, studies suggest low concordance with guideline recommendations by emergency medicine (EM) providers. The study aimed to evaluate how emergency departments (EDs) in the United States (US) manage anaphylaxis in relation to guideline recommendations. METHODS: This was an online anonymous survey of a random sample of EM health providers in US EDs. RESULTS: Data analysis included 207 EM providers. For respondent EDs, approximately 9% reported using agreed-upon clinical criteria to diagnose anaphylaxis; 42% reported administering epinephrine in the ED for most anaphylaxis episodes; and <50% provided patients with a prescription for an epinephrine auto-injector and/or an allergist referral on discharge. Most provided some written materials, and follow-up with a primary care clinician was recommended. CONCLUSIONS: This is the first cross-sectional survey to provide "real-world" data showing that practice in US EDs is discordant with current guideline recommendations for the diagnosis, treatment, and follow-up of patients with anaphylaxis. The primary gaps are low (or no) utilization of standard criteria for defining anaphylaxis and inconsistent use of epinephrine. Prospective research is recommended.
38 citations
TL;DR: The study suggests that health care managers should organize systematic and dynamic policies and procedures in dealing with PTSD to assist both groups of personnel.
Abstract: METHODS: The study employed a descriptive design and was conducted in four hospital emergency wards and a pre-hospital emergency base supervised by Kerman Medical University. Using Mississippi PTSD, we assessed the prevalence rate in paramedics ( n=150) and emergency personnel ( n=250). RESULTS: The two groups had different levels of education, marital status, experience of traumatic events, work hours per month, and gender. Most (94%) of paramedic and hospital emergency personnel reported moderate PTSD. The two groups had significant different levels of PTSD in all subscale. CONCLUSION: The study suggests that health care managers should organize systematic and dynamic policies and procedures in dealing with PTSD to assist both groups of personnel.
29 citations
TL;DR: The composite MEWS did not perform well in predicting poor patient outcomes for critically ill patients presenting to an ED, and was chosen as the cut-off value for poor prognosis based on previous studies.
Abstract: Background This study was undertaken to validate the use of the modified early warning score (MEWS) as a predictor of patient mortality and intensive care unit (ICU)/ high dependency (HD) admission in an Asian population. Methods The MEWS was applied to a retrospective cohort of 1 024 critically ill patients presenting to a large Asian tertiary emergency department (ED) between November 2006 and December 2007. Individual MEWS was calculated based on vital signs parameters on arrival at ED. Outcomes of mortality and ICU/HD admission were obtained from hospital records. The ability of the composite MEWS and its individual components to predict mortality within 30 days from ED visit was assessed. Sensitivity, specificity, positive and negative predictive values were derived and compared with values from other cohorts. A MEWS of !4 was chosen as the cut-off value for poor prognosis based on previous studies. Results A total of 311 (30.4%) critically ill patients were presented with a MEWS !4. Their mean age was 61.4 years (SD 18.1) with a male to female ratio of 1.10. Of the 311 patients, 53 (17%) died within 30 days, 64 (20.6%) were admitted to ICU and 86 (27.7%) were admitted to HD. The area under the receiver operating characteristic curve was 0.71 with a sensitivity of 53.0% and a specificity of 72.1% in addition to a positive predictive value (PPV) of 17.0% and a negative predictive value (NPV) of 93.4% (MEWS cut-off of !4) for predicting mortality. Conclusion The composite MEWS did not perform well in predicting poor patient outcomes for critically ill patients presenting to an ED.
29 citations
TL;DR: In the younger generation, males were predominantly the primary victims of poly trauma injury, and road traffi c accident was the major etiological factor.
Abstract: METHODS: A retrospective cross sectional study was done on 210 patients in the emergency OPD for a period of 2 months. All the records of the patients with poly trauma were studied and the problems during their management were measured against 6 predetermined steps (step I to step VI). RESULTS: In the younger generation, males were predominantly the primary victims of poly trauma injury, and road traffi c accident was the major etiological factor. Injuries involving more than 2 specialties induced many problems during the management of patients with poly trauma. Of 210 patients we studied, 32 patients had problems at various steps and maximum problems in step III , i.e. co-ordination between various specialties in the management of patients with poly trauma.
28 citations
TL;DR: Elect Electrolyte imbalances are of particular importance in the treatment of ED patients, and ED physicians must be acknowledged of their fluid-electrolyte balance dynamics and general characteristics.
Abstract: RESULTS: The mean age of the patients was 59.28±16.79, and 55% of the patients were male. The common symptoms of the patients were dyspnea (14.7%), fever (13.7%), and systemic deterioration (11.9%); but the most and least frequent electrolyte imbalances were hyponatremia and hypermagnesemia, respectively. Most frequent fi ndings in physical examination were confusion (14%), edema (10%) and rales (9%); and most frequent pathological findings in ECG were tachycardia in 24%, and atrial fi brillation in 7% of the patients. Most frequent comorbidity was malignancy (39%). Most frequent diagnoses in the patients were sepsis (11%), pneumonia (9%), and acute renal failure (7%). CONCLUSIONS: Electrolyte imbalances are of particular importance in the treatment of ED patients. Therefore, ED physicians must be acknowledged of their fl uid-electrolyte balance dynamics and general characteristics.
28 citations
TL;DR: The level of S100B protein in serum is elevated after ischemic brain injury, but its mechanism is unclear and the severity of brain damage is unclear.
Abstract: Background S100B protein in patients with cardiac arrest, hemorrhagic shock and other causes of global cerebral ischemic injury will be dramatically increased Ischemic brain injury may elevate the level of serum S100B protein and the severity of brain damage Methods This article is a critical and descriptive review on S100B protein in serum after ischemic brain injury We searched Pubmed database with key words or terms such as "S100B protein", "cardiac arrest", "hemorrhagic shock" and "ischemia reperfusion injury" appeared in the last five years Results S100B protein in patients with cardiac arrest, hemorrhagic shock and other causes of ischemic brain injury will be dramatically increased Ischemic brain injury elevated the level of serum S100B protein, and the severity of brain damage Conclusion The level of S100B protein in serum is elevated after ischemic brain injury, but its mechanism is unclear
23 citations
TL;DR: The Acinetobacter baumannii group comprises three distinct clinical entities, and their clinical value are not equal, according to a review of the differences among them.
Abstract: Background The Acinetobacter baumannii group, including Acinetobacter baumannii, Acinetobacter genomospecies 3 and 13TU, is phenotypically indistinguishable and uniformly identified as Acinetobacter baumannii by laboratories of clinical microbiology. This review aimed to demonstrate the differences among them. Methods Literatures associated with the Acinetobacter baumannii group were identified and selected from PubMed databases and relevant journals. Results Acinetobacter genospecies 3 and 13TU possess a certain proportion in clinical isolates. There were considerable differences in epidemiologic features, clinical manifestations, antimicrobial resistances and therapeutic options among the Acinetobacter baumannii group. Compared with Acinetobacter genomospecies 3 and 13TU, Acinetobacter baumannii with a higher resistance to antimicrobial agents are easier to be treated inappropriately, and present a worse outcome in patients. Conclusion The Acinetobacter baumannii group comprises three distinct clinical entities, and their clinical value are not equal.
21 citations
TL;DR: The bBP value can be evaluated by the noninvasive measurements of rBP, and the rBP was positively correlated with the bBP.
Abstract: BACKGROUND: In this study, we attempted to fithe relations between blood pressure (BP) measured on the brachial artery (bBP) and BP assessed on the radial artery (rBP) in the right arm. METHODS: Three hundred and fifteen patients were enrolled in this study. Those who had peripheral vascular disease, wounds of arm skin or subcutaneous tissue infection were excluded. After a 15-minute equilibration and stabilization period after inducation of anesthesia, three bBP and rBP records were obtained sequentially using an oscillometric device with an adult cuff and infant cuff, respectively. Order for each BP was randomized. RESULTS: The bBP was signifi cantly lower than the rBP ( P<0.05). The difference between the two values varied from 13 to 18 mmHg in systolic BP (SBP), diastolic BP (DBP) and mean blood pressure (MAP) respectively. And the rBP was positively correlated with the bBP ( r=0.872, 0.754, 0.765; P<0.001, <0.001, <0.001; SBP, DBP, MAP, respectively). CONCLUSION: The bBP value can be evaluated by the noninvasive measurements of rBP
20 citations
TL;DR: Cardiac etiology, shockable rhythms and CPR duration ≤15 minutes were favorable predictors of 24-hour survival, whereas traumatic etiology was unfavorable, but previous terminal illness or multiple organ failure (MOF) was unfavorable.
Abstract: BACKGROUND: The outcome of cardiopulmonary resuscitation (CPR) may depend on a variety of factors related to patient status or resuscitation management. To evaluate the factors influencing the outcome of CPR after cardiac arrest (CA) will be conducive to improve the effectiveness of resuscitation. Therefore, a study was designed to assess these factors in the emergency department (ED) of a city hospital. METHODS: A CPR registry conforming to the Utstein-style template was conducted in the ED of the First Affiliated Hospital of Wenzhou Medical College from January 2005 to December 2011. The outcomes of CPR were compared in various factors groups. The primary outcomes were rated to return of spontaneous circulation (ROSC), 24-hour survival, survival to discharge and discharge with favorable neurological outcomes. Univariate analysis and multivariable logistic regression analysis were performed to evaluate factors associated with survival. RESULTS: A total of 725 patients were analyzed in the study. Of these patients, 187 (25.8%) had ROSC, 100 (13.8%) survived for 24 hours, 48 (6.6%) survived to discharge, and 23 (3.2%) survived to discharge with favorable neurologic outcomes. A logistic regression analysis demonstrated that the independent predictors of ROSC included traumatic etiology, fi rst monitored rhythms, CPR duration, and total adrenaline dose. The independent predictors of 24-hour survival included traumatic etiology, cardiac etiology, fi rst monitored rhythm and CPR duration. Previous status, cardiac etiology, first monitored rhythms and CPR duration were included in independent predictors of survival to discharge and neurologically favorable survival to discharge. CONCLUSIONS: Shockable rhythms, CPR duration "15 minutes and total adrenaline dose "5 mg were favorable predictors of ROSC, whereas traumatic etiology was unfavorable. Cardiac etiology, shockable rhythms and CPR duration "15 minutes were favorable predictors of 24-hour survival, whereas traumatic etiology was unfavorable. Cardiac etiology, shockable rhythms, CPR duration "15 minutes were favorable predictors of survival to discharge and neurologically favorable survival to discharge, but previous terminal illness or multiple organ failure (MOF) was unfavorable.
18 citations
TL;DR: There is a close relationship between the language spoken at home and the LOS at EDs, indicating that language could be an important predictor of prolonged LOS in EDs and improving language services might reduce LOS and ease overcrowding inEDs in Queensland's public hospitals.
Abstract: RESULTS: The interpreter requirement was the highest among Vietnamese speakers (23.1%) followed by Chinese (19.8%) and Arabic speakers (18.7%). There were significant differences in the distributions of the departure statuses among the language groups (Chi-squared=3236.88, P<0.001). Compared with English speakers, the Beta coeffi cient for the LOS in the EDs measured in minutes was among Vietnamese, 26.3 (95%CI: 22.1 –30.5); Arabic, 10.3 (95%CI: 7.3 –13.2); Spanish, 9.4 (95%CI: 7.1 –11.7); Chinese, 8.6 (95%CI: 2.6 –14.6); Hindi, 4.0 (95%CI: 2.2 –5.7); Italian, 3.5 (95%CI: 1.6 –5.4); and German, 2.7 (95%CI: 1.0 –4.4). The fi nal regression model explained 17% of the variability in LOS. CONCLUSION: There is a close relationship between the language spoken at home and the LOS at EDs, indicating that language could be an important predictor of prolonged LOS in EDs and improving language services might reduce LOS and ease overcrowding in EDs in Queensland's public hospitals.
TL;DR: There is evidence that both constant inflammatory reaction and epithelial cell apoptosis may affect mucosal reestablishment of the intestine at the onset of sepsis.
Abstract: METHODS: Mice were subjected to cecal ligation and puncture (CLP) for induction of sepsis to assess intestinal mucosal damage, epithelial cell apoptosis, and transformed number of goblet cells, and to detect the concentration of TNF-", IL-1 and TGF-#1 and TFF3 (trefoil factor 3) expression in the small intestinal mucosa. All above were performed by HE staining, western blot, ELISA and immunohistochemistry respectively. The experimental animals were divided into a sepsis group and a sham-operation group. The animals with sepsis were separately killed at 6 (7 animals), 24 (7 animals) and 48 hours (7 animals) after CLP. RESULTS: Injured intestinal mucosa was observed in the 3 groups under a light microscope, in which damage scores in the 24-hour and 48-hour groups were higher than in the 6-hour group and no difference was found between the two groups. Moreover, less of goblet cells or other epithelial cells adjacent to the injured surface migrated into the wound to cover the denuded area. The number of goblet cells was substantially decreased in the three CLP groups compared with the shamoperation group. Protein levels of IL-1 and TNF-" were signifi cantly increased by 3–4 fold at all time points when compared with the sham-operation group, and cleaved caspase-3 by 4 fold. Although TFF3 expression was modestly increased for 6 hours after the onset of CLP, it appeared to decline at 24 hours and 48 hours as shown by Western blot. A similar tendency was observed upon TGF-#1, i.e. the protein level was not elevated at 24 hours and 48 hours, but increased modestly at 6 hours. CONCLUSIONS: Sepsis from CLP shows less restitution on the surface of injured intestinal mucosa. There is evidence that both constant infl ammatory reaction and epithelial cell apoptosis may affect mucosal reestablishment of the intestine at the onset of sepsis. Mucosa after severe sepsis showed the state of high infl ammation, and declined goblet cell function and mucosal reconstruction, which affected the repair of damaged intestinal barrier. Constant infl ammatory reaction, and declined goblet cell function and mucosal reconstruction ability may affect the reestablishment of intestinal mucosa at the onset of sepsis.
TL;DR: Early emergency endoscopy should be considered to determine the extent of upper gastrointestinal damage in the emergency department after suicidal ingestion of potassium permanganate.
Abstract: BACKGROUND Potassium permanganate is used clinically as an antiseptic and antifungal agent. Ingestion of potassium permanganate may result in damage to the upper gastrointestinal tract. Burns and ulceration of the mouth, esophagus and stomach occur due to its action. Emergency endoscopy is useful to assess the severity of damage and also to guide management. METHODS We reported a patient presenting to the emergency department after suicidal ingestion of potassium permanganate. RESULTS After treatment, the patient was discharged home on the 7th day after admission. CONCLUSION Early emergency endoscopy should be considered to determine the extent of upper gastrointestinal damage in the emergency department.
TL;DR: Wang et al. as mentioned in this paper found that TCM can provide some assistance in emergency although to combine them in practice is still its infant form and is mainly at TCM hospitals in China.
Abstract: METHODS: Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) were searched using the terms: Traditional Chinese Medicine/ Chinese Medicine, Emergency Medicine, China In addition, three leading TCM Journals in China were searched via Oriprobe Information Services for relevant articles (published from 1990—2012) Particular attention was paid to those articles that are related to TCM treatments or combined medicine in dealing with intensive and critical care RESULTS: TCM is a systematic traditional macro medicine The clinical practice of TCM is guided by the TCM theoretical framework – a methodology founded thousands of years ago As the methodologies between TCM and Biomedicine are signifi cantly different, it provides an opportunity to combine two medicines, in order to achieve clinical effi cacy Nowadays, combined medicine has become a common clinical model particular in TCM hospitals in China CONCLUSIONS: It is evident that TCM can provide some assistance in emergency although to combine them in practice is still its infant form and is mainly at TCM hospitals in China The future effort could be put into TCM research, both in laboratories and clinics, with high quality designs, so that TCM could be better understood and then applied in emergency medicine
TL;DR: On the basis of conventional treatment, the early combination of low-dose spironolactone (20 mg/d) could inhibit cardiac remodeling at late stage and prevent heart failure.
Abstract: RESULTS: The echocardiography indicators such as LVESD, LVEDD, LVEF, LAD-ML and LADSI were signifi cantly improved in the treatment group compared with the control group at one year (P<0.05). In the treatment group, LVESD, LVEDD, LVPWT, LVEF, LAD-ML and LAD-SI were more significantly improved at one year than one month (P<0.05, P=0.007 to LVEF), and in the control group LVEF was more signifi cantly improved at one year than one month ( P=0.0277). There were no signifi cant differences in serum potassium and serum creatinine levels between the two groups. CONCLUSION: On the basis of conventional treatment, the early combination of low-dose spironolactone (20 mg/d) could inhibit cardiac remodeling at late stage and prevent heart failure.
TL;DR: As controlling bleeding after a life-threatening arterial damage is critical for increasing the chance of survival, the results obtained in this study indicate the significant efficacy of CoolClot in shortening the bleeding time.
Abstract: METHODS: In this study, nine healthy hybrid dogs were selected and after induction of anesthesia with ether, either arterial puncture by a needle or arteriotomy was performed on both groin regions of the dogs. For control arteries (either the right or left femoral artery), only pressure by sterilized gauze was performed, while for the femoral arteries of the opposite side, our invented hemostatic agent, namely CoolClot, was topically used before applying the pressure. In the second stage of the study, to assess the coagulation time, blood samples were collected from 10 volunteer students. RESULTS: CoolClot significantly decreased the bleeding time in animals whose femoral arteries were cut or punctured. In the human phase of the study, the mean coagulation time in control blood samples was 253.4±44.1 seconds, whereas it was 149.5±50.0, 162.3±74.6 and 143.4±114.6 seconds, respectively in blood samples treated with bentonite, zeolite and CoolClot (P<0.05). CONCLUSIONS: As controlling bleeding after a life-threatening arterial damage is critical for increasing the chance of survival, the results obtained in this study indicate the signifi cant effi cacy of CoolClot in shortening the bleeding time. Our experiments also indicate that CoolClot can signifi cantly reduce the clotting time in human blood samples.
TL;DR: The concentration of plasma s-CD62P is elevated as a early biomarker in patients with sepsis, and it serves as one of the pathogenic factors responsible for endothelial cell damage.
Abstract: RESULTS: Compared with the control group and SIRS group, the sepsis group demonstrated signifi cantly higher levels of s-CD62P, TNF-" and highly sensitive C-reactive protein (hs-CRP) ( P<0.05). The plasma levels of D-dimer, PT, and APTT in the sepsis and SIRS groups were signifi cantly higher than those in the control group, while the platelet count and the activity of AT-III were obviously lower (P<0.05). In the sepsis group, the plasma levels of hs-CRP and TNF-" were positively correlated with PT, APTT, and D-dimer, and negatively correlated with AT-III and PLT ( P<0.05). The plasma levels of s-CD62P were signifi cantly correlated with the plasma levels of TNF-", hs-CRP, D-dimer, PT, and APTT, whereas they were correlated negatively well with PLT and AT-III ( P<0.05). CONCLUSIONS: The concentration of plasma s-CD62P is elevated as a early biomarker in patients with sepsis, and it serves as one of the pathogenic factors responsible for endothelial cell damage. Coagulation and mediators of inflammation promote each other, aggravating the severity of sepsis. Plasma s-CD62P may be an important factor for the development of coagulation and infl ammatory reaction.
TL;DR: Patients who received norepinephrine ≥0.7 μg/kg per minute had an increased ICU mortality, an increased in-hospital mortality, and a decreased 510-day survival rate.
Abstract: BACKGROUND: Consensus guidelines suggested that both dopamine and norepinephrine may be used, but specific doses are not recommended. The aim of this study is to determine the predictive role of vasopressors in patients with shock in intensive care unit. METHODS: One hundred and twenty-two patients, who had received vasopressors for 1 hour or more in intensive care unit (ICU) between October 2008 and October 2011, were included.There were 85 men and 37 women, with a median age of 65 years (55–73 years). Their clinical data were retrospectively collected and analyzed. RESULTS: The median simplified acute physiological score 3 (SAPS 3) was 50 (42–55). Multivariate analysis showed that septic shock ( P=0.018, relative risk: 4.094; 95% confi dential interval: 1.274–13.156), SAPS 3 score at ICU admission ( P=0.028, relative risk: 1.079; 95% confidential interval: 1.008–1.155), and norepinephrine administration ( P<0.001, relative risk: 9.353; 95% confidential interval: 2.667–32.807) were independent predictors of ICU death. Receiver operating characteristic curve analysis demonstrated that administration of norepinephrine "0.7 #g/kg per minute resulted in a sensitivity of 75.9% and a specifi city of 90.3% for the likelihood of ICU death. In patients who received norepinephrine "0.7 #g/kg per minute there was more ICU death (71.4% vs. 44.8%) and in-hospital death (76.2% vs. 48.3%) than in those who received norepinephrine <0.7 #g/kg per minute. These patients had also a decreased 510-day survival rate compared with those who received norepinephrine <0.7 #g/kg per minute (19.2% vs. 64.2%). CONCLUSION: Septic shock, SAPS 3 score at ICU admission, and norepinephrine administration were independent predictors of ICU death for patients with shock. Patients who received norepinephrine "0.7 #g/kg per minute had an increased ICU mortality, an increased inhospital mortality, and a decreased 510-day survival rate.
TL;DR: It is necessary to offer CPR training courses regularly to change the practitioner before fatigue, especially for females or weak practitioners, and more attention should be paid to the control of compression rate in order to delay the fatigue, guarantee enough compression depth and improve the quality of chest compression.
Abstract: BACKGROUND: Cardiopulmonary resuscitation (CPR) is a kind of emergency treatment for cardiopulmonary arrest, and chest compression is the most important and necessary part of CPR. The American Heart Association published the new Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in 2010 and demanded for better performance of chest compression practice, especially in compression depth and rate. The current study was to explore the relationship of quality indexes of chest compression and to identify the key points in chest compression training and practice. METHODS: Totally 219 healthcare workers accepted chest compression training by using Laerdal ACLS advanced life support resuscitation model. The quality indexes of chest compression, including compression hands placement, compression rate, compression depth, and chest wall recoil as well as self-reported fatigue time were monitored by the Laerdal Computer Skills and Reporting System. RESULTS: The quality of chest compression was related to the gender of the compressor. The indexes in males, including self-reported fatigue time, the accuracy of compression depth and the compression rate, the accuracy of compression rate, were higher than those in females. However, the accuracy of chest recoil was higher in females than in males. The quality indexes of chest compression were correlated with each other. The self-reported fatigue time was related to all the indexes except the compression rate. CONCLUSION: It is necessary to offer CPR training courses regularly. In clinical practice, it might be better to change the practitioner before fatigue, especially for females or weak practitioners. In training projects, more attention should be paid to the control of compression rate, in order to delay the fatigue, guarantee enough compression depth and improve the quality of chest compression.
TL;DR: The new triage method shows good inter-rater reliability for rating triage acuity and good accuracy in predicting the triage code rating of a reference standard.
Abstract: RESULTS: Inter-rater reliability was K=0.42 (95%CI: 0.37–0.46) before the course on TEM, and K=0.61 (95%CI: 0.56–0.67) after. The accuracy of students' triage rating for the reference standard triage code was good: 81% (95%CI: 71–90). After the TEM course, the proportion of cases assigned to each acuity triage level was similar for the student group and the panel of experts. CONCLUSION: Among the group of nursing students, a brief course on triage and on a new inhospital triage method seems to improve the quality of rating codes. The new triage method shows good inter-rater reliability for rating triage acuity and good accuracy in predicting the triage code rating of the reference standard.
TL;DR: ROSC rate, survival rate at 24 hours and survival rate to hospital discharge with favorable neurological function indicated that ACD-CPR is superior to S-CRP, with relative risk (RR) values of 1.39 (95% CI 0.99–1.60) and 1.73 ( 95%CI 0.73-1.38).
Abstract: BACKGROUND: Active compression-decompression cardiopulmonary resuscitation (ACDCPR) has been popular in the treatment of patients with cardiac arrest (CA). However, the effect of ACD-CPR versus conventional standard CPR (S-CRP) is contriversial. This study was to analyze the effi cacy and safety of ACD-CPR versus S-CRP in treating CA patients. METHODS: Randomized or quasi-randomized controlled trials published from January 1990 to March 2011 were searched with the phrase "active compression-decompression cardiopulmonary resuscitation and cardiac arrest" in PubMed, EmBASE, and China Biomedical Document Databases. The Cochrane Library was searched for papers of meta-analysis. Restoration of spontaneous circulation (ROSC) rate, survival rate to hospital admission, survival rate at 24 hours, and survival rate to hospital discharge were considered primary outcomes, and complications after CPR were viewed as secondary outcomes. Included studies were critically appraised and estimates of effects were calculated according to the model of fior random effects. Inconsistency across the studies was evaluated using the I 2 statistic method. Sensitivity analysis was made to determine statistical heterogeneity. RESULTS: Thirteen studies met the criteria for this meta-analysis. The studies included 396 adult CA patients treated by ACD-CPR and 391 patients by S-CRP. Totally 234 CA patients were found out hospitals, while the other 333 CA patients were in hospitals. Two studies were evaluated with high-quality methodology and the rest 11 studies were of poor quality. ROSC rate, survival rate at 24 hours and survival rate to hospital discharge with favorable neurological function indicated that ACD-CPR is superior to S-CRP, with relative risk (RR) values of 1.39 (95% CI 0.99–1.97), 1.94 (95% CI 1.45–2.59) and 2.80 (95% CI 1.60–5.24). No significant differences were found in survival rate to hospital admission and survival rate to hospital discharge for ACD-CPR versus S-CRP with RR values of 1.06 (95% CI 0.76–1.60) and 1.00 (95% CI 0.73–1.38).
TL;DR: Therapeutic mild hypothermia improves neurologic outcome and survival in patients successfully resuscitated from CA and there was no significant difference in adverse events between the normothermia and Hypothermia groups, nor heterogeneity and publication bias.
Abstract: BACKGROUND Good neurological outcome after cardiac arrest (CA) is hard to achieve for clinicians. Experimental and clinical evidence suggests that therapeutic mild hypothermia is beneficial. This study aimed to assess the effectiveness and safety of therapeutic mild hypothermia in patients successfully resuscitated from CA using a meta-analysis. METHODS We searched the MEDLINE (1966 to April 2012), OVID (1980 to April 2012), EMBASE (1980 to April 2012), Chinese bio-medical literature & retrieval system (CBM) (1978 to April 2012), Chinese medical current contents (CMCC) (1995 to April 2012), and Chinese medical academic conference (CMAC) (1994 to April 2012). Studies were included if 1) the study design was a randomized controlled trial (RCT); 2) the study population included patients successfully resuscitated from CA, and received either standard post-resuscitation care with normothermia or mild hypothermia; 3) the study provided data on good neurologic outcome and survival to hospital discharge. Relative risk (RR) and 95% confidence interval (CI) were used to pool the effect. RESULTS The study included four RCTs with a total of 417 patients successfully resuscitated from CA. Compared to standard post-resuscitation care with normothermia, patients in the hypothermia group were more likely to have good neurologic outcome (RR=1.43, 95% CI 1.14-1.80, P=0.002) and were more likely to survive to hospital discharge (RR=1.32, 95% CI 1.08-1.63, P=0.008). There was no significant difference in adverse events between the normothermia and hypothermia groups (P>0.05), nor heterogeneity and publication bias. CONCLUSION Therapeutic mild hypothermia improves neurologic outcome and survival in patients successfully resuscitated from CA.
TL;DR: Peripheral perfusion was improved after EGDT in patients with septic shock, and it was not exactly reflected by the index of systemic perfusion.
Abstract: Background This study aimed to observe the effect of early goal directed therapy (EGDT) on tissue perfusion, microcirculation and tissue oxygenation in patients with septic shock. Methods Patients with early septic shock ( Results Twenty patients were involved, but one patient wasn't analyzed because he didn't meet the EGDT criteria. PtcO2 and PtcCO2 were monitored in 19 patients, of whom sublingual microcirculation was obtained. After EGDT, PtcO2 increased from 62.7±24.0 mmHg to 78.0±30.9 mmHg (P 0.05). PtcO2, PtcO2/FiO2, and PtcCO2 were not linearly related to central venous saturation, lactate, oxygen delivery, and oxygen consumption (P>0.05). Conclusion Peripheral perfusion was improved after EGDT in patients with septic shock, and it was not exactly reflected by the index of systemic perfusion.
TL;DR: S 100A8 interaction with TLR4 might be involved in brain damage and in inflammation triggered by I/R injury, indicating that a close relationship might exist between the levels of S100A8 andTLR4.
Abstract: RESULTS: Compared with C3H/HeN mice, TLR4-deficient mice (C3H/HeJ) had lower infarct volumes and better outcomes in neurological tests. The levels of S100A8 increased sharply in the brains of mice after I/R injury. In addition, mice that lacked TLR4 (C3H/HeJ) had lower expression of I/R-induced S100A8 than C3H/HeN mice in the model group, indicating that a close relationship might exist between the levels of S100A8 and TLR4. CONCLUSION: S100A8 interaction with TLR4 might be involved in brain damage and in
TL;DR: Exogenous EPO has cardioprotective effects on sepsis-induced myocardial injury and reduced the production of proinflmmatory cytokines in rats produced by cecal ligation and perforation surgery.
Abstract: RESULTS: In the CLP group, myocardial enzyme index and inflammatory index increased at 3, 6, 12 and 24 hours after CLP compared with the sham group, and EPO significantly blocked the increase. Compared with the CLP group, EPO signifi cantly improved LVSP, LV + dp/d tmax , LV $d p/d tmin , and decreased LVEDP at different time. EPO blocked the reduction of mitochondrial transmembrane potential, suppressed the cardiomyocyte apoptosis, inhibited the activation of NF-"B, and reduced the production of proinfl mmatory cytokines. No difference in the survival rate at 7 days was observed between the CLP group and the EPO group.
TL;DR: This is a review of the current literature discussing the evolving practice of traumatic brain injury, and the guidelines taken from the Brain Trauma Foundation Guidelines are reviewed.
Abstract: BACKGROUND:
Traumatic brain injuries are common and costly to hospital systems. Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines. This is a review of the current literature discussing the evolving practice of traumatic brain injury.
TL;DR: A history of chronic obstructive pulmonary diseases, surgery-related infection, hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insuffi ciency and Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory Insufficiency.
Abstract: cancer patients with postoperative acute respiratory insuffi ciency. METHODS: The data of 190 critically ill cancer patients with postoperative acute respiratory insuffi ciency were retrospectively reviewed. The data of 321 patients with no acute respiratory insuffi ciency as controls were also collected. Clinical variables of the fi rst 24 hours after admission to intensive care unit were collected, including age, sex, comorbid disease, type of surgery, admission type, presence of shock, presence of acute kidney injury, presence of acute lung injury/acute respiratory distress syndrome, acute physiologic and chronic health evaluation (APACHE II) score, sepsis-related organ failure assessment (SOFA), and PaO 2/FiO 2 ratio. Duration of mechanical ventilation, length of intensive care unit stay, intensive care unit death, length of hospitalization, hospital death and one-year survival were calculated. RESULTS: The incidence of acute respiratory insufficiency was 37.2% (190/321). Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases ( P=0.001), surgeryrelated infection ( P=0.004), hypo-volemic shock ( P<0.001), and emergency surgery ( P=0.018), were independent risk factors of postoperative acute respiratory insufficiency. Compared with the patients without acute respiratory insuffi ciency, the patients with acute respiratory insuffi ciency had a prolonged length of intensive care unit stay ( P<0.001), a prolonged length of hospitalization ( P=0.006), increased intensive care unit mortality ( P=0.001), and hospital mortality ( P<0.001). Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency ( P=0.029, RR: 8.522, 95%CI: 1.243–58.437, B=2.143, SE=0.982, Wald=4.758). Compared with the patients without acute respiratory insufficiency, those with acute respiratory insuffi ciency had a shortened one-year survival rate (78.7% vs. 97.1%, P<0.001). CONCLUSION: A history of chronic obstructive pulmonary diseases, surgery-related infection, hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insuffi ciency. Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency. Compared with patients without acute respiratory insufficiency, those with acute respiratory insufficiency had adverse shortterm outcome and a decreased one-year survival rate.
TL;DR: Ulinastatin can alleviate the paraquat-induced A549 cell damage by reducing the levels of MDA, MPO, and ROS after 24-hour-exposure.
Abstract: RESULTS: The survival rate of A549 cells treated with different concentrations of paraquat decreased in a concentration-dependent manner. Whereas there was no decrease in the survival rate of cells treated with 0–4 000 U/mL ulinastatin. The levels of MDA, MPO, and ROS were signifi cantly higher in the paraquat group than in the normal control group after 24-hour-exposure. And the survival rate of the paraquat+ulinastatin group was higher than that of the paraquat group, but lower than that of the normal control group. The levels of MDA, MPO, and ROS were lower than those of the paraquat group. CONCLUSION: Ulinastatin can alleviate the paraquat-induced A549 cell damage by reducing
TL;DR: The expression of HIF-1! is increased in rat cerebral cortex after ROSC, and SA up-regulates the expression of S100 and NSE, which improves the resistance of the cortex to ischemia and hypoxia and contributes to neuroprotection.
Abstract: BACKGROUND: This study was undertaken to investigate the expression of hypoxia-inducible factor-1! (HIF-1!) in rat cerebral cortex and the effects of "-sodium aescinate (SA) administration after return of spontaneous circulation (ROSC). METHODS: Sixty rats were divided into three groups: SA group, injected intraperitoneally with SA instantly after ROSC; control group, injected intraperitoneally with normal saline; and shamoperated group, without cardiac arrest or SA. The cardiac arrest model was established using asphyxiation and intravenous potassium chloride. Blood was sampled 1, 6, 12, and 24 hours after ROSC. Protein and mRNA levels of HIF-1!, VEGF and EPO were detected in the cerebral cortex by immunohistochemistry and real-time RT-PCR; serum levels of NSE and S100" were determined by enzyme-linked immunosorbent assays. RESULTS: Serum S100" and NSE were signifi cantly increased in the control group versus the sham-operated group 1, 6, 12 and 24 hours after ROSC (P<0.05). Protein and mRNA levels of HIF1!, VEGF and EPO were signifi cantly increased in the control rats ( P<0.05). Serum NSE and S100" were significantly decreased in the SA group versus the control group 1, 6, 12 and 24 hours after ROSC (P<0.05). Protein and mRNA levels of HIF-1!, VEGF and EPO were signifi cantly increased in the SA group (P<0.05). CONCLUSIONS: The expression of HIF-1! is increased in rat cerebral cortex after ROSC, and SA up-regulates the expression of HIF-1!. The up-regulation of HIF-1! improves the resistance of the cortex to ischemia and hypoxia and contributes to neuroprotection, possibly because of up-regulation of EPO and VEGF expression.
TL;DR: The frequency of EBV infection was similar in lymphoma patients with PRF1 mutations and those without the mutations, suggesting that these mutations may be of germ-line origin.
Abstract: METHODS: Seventy-seven patients with lymphoma, including 6 patients with Hodgkin lymphoma and 71 patients with non-Hodgkin lymphoma, were recruited. DNA samples from peripheral blood were used for PRF1 mutation detection by the PCR-sequencing method. RESULTS: Eleven novel PRF1 mutations were found in 8 of the 77 patients with lymphoma. Biallelic or compound monoallelic missense mutations in 3 patients indicated the severe impairment of perforin function, monoallelic missense mutations in 3 patients possibly contributed a genetic predisposition to malignancies, and synonymous mutations in 2 patients showed unknown signifi cance. CONCLUSIONS: The frequency of EBV infection was similar in lymphoma patients with PRF1 mutations and those without the mutations. The same PRF1 mutations were also found in DNA samples from nails or hair follicles from 4 patients with PRF1 mutations, suggesting that these mutations may be of germ-line origin.