The American journal of emergency medicine
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Although heatstroke is often associated with dehydration, the clinical significance of serum sodium abnormalities in patients with heat-related illness during heat wave has been poorly documented. ⋯ Serum sodium abnormalities are frequently observed in patients with a nonexertional heatstroke during heat wave; however, only hypernatremia should be considered as an independent risk factor of death. Rapid measurement of serum sodium concentration is mandatory to appropriately guide electrolyte resuscitation.
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The aim of this study was to assess the ability of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system, and Trauma and Injury Severity Score (TRISS) method to predict group mortality for intensive care unit (ICU) trauma patients. ⋯ The results from the present study showed that the SOFA score was not different from APACHE II scoring system and TRISS in predicting the outcomes for ICU trauma patients. However, the method for calculating SOFA scores is easier and simpler than APACHE II and TRISS.
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Randomized Controlled Trial
Standard-length catheters vs long catheters in ultrasound-guided peripheral vein cannulation.
Ultrasound (US) is a useful tool for peripheral vein cannulation in patients with difficult venous access. However, few data about the survival of US-guided peripheral catheters in acute care setting exist. Some studies showed that the survival rate of standard-length catheters (SC) is poor especially in obese patients. The use of longer than normal catheters could provide a solution to low survival rate. The aim of the present study was to compare US-guided peripheral SCs vs US-guided peripheral long catheters inserted with Seldinger technique (LC) in acute hospitalized patients with difficult venous access. ⋯ Both SC and LC US-guided cannulations have a high success rate in patients with difficult venous access. Notwithstanding a higher time to cannulation, LC US-guided procedure is associated with a lower risk of catheter failure compared with SC US-guided procedure.
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Our study compares treatment times of morbidly obese patients (body mass index [BMI]>40 kg/m2) with patients having BMI less than 35 kg/m2. ⋯ In our institution, morbidly obese patients take significantly longer to disposition home than patients of more normal weight.
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The objective of this study is to evaluate the types and rates of adverse events associated with the use of propofol for procedural sedation by physicians from our emergency medicine residency program and compare those adverse event rates with those rates already published for all moderate and deep sedatives for procedural sedation, including propofol. ⋯ The adverse event rates from our study correlate with those of numerous earlier as well as recently published studies of moderate and deep sedatives, including propofol. The disciplined use of propofol by emergency physicians should continue to provide ED patients with the best available management options and care while additional focused and larger scale research is conducted to definitively confirm the premise that emergency physicians can continue to safely perform procedural sedation with propofol.