The American journal of emergency medicine
-
Randomized Controlled Trial Comparative Study
Comparison of ultrarapid and rapid intravenous hydration in pediatric patients with dehydration.
The purpose of this study is to test the efficacy of ultrarapidly infused vs rapidly infused intravenous (IV) hydration in pediatric patients with acute gastroenteritis and moderate dehydration. ⋯ Based on this pilot study, ultrarapid hydration for 1 hour preliminarily appears to be an efficacious alternative to standard rapid hydration for 3 hours and improves emergency department throughput time.
-
It has been established that plasma brain natriuretic peptide (BNP) concentrations in patients with acute cardiogenic pulmonary edema (ACPE) increase in proportion to heart failure. ⋯ The preliminary results of the present study show that CPAP, after 3 hours, lowers BNP levels in patients with ACPE and preserved LV systolic function compared with patients affected by systolic ACPE dysfunction where BNP levels do not change significantly.
-
Ischemia-modified albumin (IMA) has been proposed as a useful rule-out marker for the diagnosis of acute coronary syndrome (ACS) in the emergency department. This study evaluated the ability of IMA to predict the acute myocardial infarction (AMI) diagnosis in a population of chest pain patients. ⋯ Thirty-three percent of the patients (n = 35) had a final diagnosis of AMI. The sensitivity of admission IMA for a final diagnosis of ACS was 0.86 (95% confidence interval [95% CI], 0.69-0.95). Specificity was 0.49 (95% CI, 0.36-0.60). Negative predictive value was 0.88 (95% CI, 0.72-0.95). The optimal cutoff threshold derived from the receiver operating characteristics (ROC) curve (ROC analysis) was determined as 91 U/mL. The area under the ROC curve was 0.73. Ischemia-modified albumin did not, at any time, provide superior sensitivity or specificity compared with other biomarkers. We do not find the data supportive of IMA as a standard marker in the emergency department.
-
Outcomes from low versus high-flow cardiopulmonary resuscitation in a swine model of cardiac arrest.
Return of spontaneous circulation (ROSC) is improved by greater vital organ blood flow during cardiopulmonary resuscitation (CPR). We tested the hypothesis that myocardial flow above the threshold needed for ROSC may be associated with greater vital organ injury and worse outcome. ⋯ High-flow CPR significantly improved arrest hemodynamics, rates of ROSC, and post-ROSC indicators of myocardial status, all indicating less injury with higher flows. No evidence of organ injury from vital organ blood flow substantially above the threshold for ROSC was found.