The American journal of emergency medicine
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The most recent joint guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC) on the management of non-ST-elevation acute coronary syndromes (NSTE-ACS) are a result of a substantial and considered undertaking, and those involved deserve much recognition for their efforts. However, the handling of anticoagulants seems somewhat inadequate, and this is a highly-relevant matter when managing NSTE-ACS. ⋯ Although current guidelines from the AHA and ACC suggest enoxaparin has better evidence than other anticoagulants in the setting of NSTE-ACS management, careful review of the evidence shows this is not actually clearly supported by the available evidence in the era of contemporary management. Unless and until better contemporary data emerge, emergency medicine professionals must carefully weigh the available evidence, its limitations, and the possible clinical implications of the various anticoagulant options when managing NSTE-ACS.
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Chest decompression can be performed by different techniques, like needle thoracocentesis (NT), lateral thoracostomy (LT), or tube thoracostomy (TT). The aim of this study was to report the incidence of prehospital chest decompression and to analyse the effectiveness of these techniques. ⋯ Prehospital NT or TT is infrequently attempted in trauma patients. Especially NT is associated with a high failure rate of more than 80%, potentially due to an inadequate ratio between chest wall thickness and catheter length as previously published as well as a possible different pathophysiological cause of respiratory distress. Therefore, TT may be considered already in the prehospital setting to retain sufficient pleural decompression upon admission.
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This was a pilot retrospective case-series study performed to investigate whether synthesized 18-lead electrocardiogram (ECG) could improve the accuracy of infarction site diagnosis in patients presenting with ST-elevation myocardial infarction (STEMI). ⋯ The diagnosis of STEMI by synthesized 18-lead ECG is useful to identify the site of infarction in patients with infarction of the right ventricular wall (supplied by the RCA) or posterior wall of the left ventricle (supplied by the LCX), which often fail to be diagnosed by the standard 12-lead ECG.
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To investigate the difference in pentraxin 3 (PTX 3) levels between patients with pulmonary contusion and healthy volunteers. ⋯ PTX 3 levels in pulmonary contusion increased significantly compared to the healthy control group. If supported by wider series, PTX 3 may be expected to be capable of use as a marker in pulmonary contusion.
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Health emergency medical service (HEMS) plays an important role in reducing injuries by providing advanced medical care in the shortest time and reducing the transfer time to advanced treatment centers. In the regions without ground relief coverage, it would be faster to transfer emergency patients to the hospital by a helicopter. In this paper, an integer nonlinear programming model is presented for the integrated locating of helicopter stations and helipads by considering uncertainty in demand points. ⋯ It is also assumed that demands in an area decrease errors in the distances between each two cities. The purpose of this model is to minimize the transfer time from demand points to the hospital by considering different modes. The proposed model is examined in terms of validity and applicability in Lorestan Province and a sensitivity analysis is also conducted on the total allocated budget.