The American journal of emergency medicine
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Non-traumatic cardiac arrest is a major public health problem that carries an extremely high mortality rate. If we hope to increase the survivability of this condition, it is imperative that alternative methods of treatment are given due consideration. Balloon occlusion of the aorta can be used as a method of circulatory support in the critically ill patient. ⋯ Animal research has demonstrated improvements in cerebral and coronary perfusion pressure during ACLS that lead to statistically significant differences in mortality. Several case series in humans have replicated these findings, suggesting the efficacy of this procedure. The objectives of this review are to: 1) introduce the reader to REBOA 2) review the physiology of NTCA and examine the current limitations of traditional ACLS 3) summarize the literature regarding the efficacy and feasibility of aortic balloon occlusion to support traditional ACLS.
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Clinical Trial
Utility of point of care assessment of platelet reactivity (using the PFA-100®) to aid in diagnosis of stroke.
Rapid and accurate diagnosis of patients presenting with symptoms of stroke is needed to facilitate the timely delivery of proven effective treatment for patients with acute ischemic stroke (AIS). The aim of this study was to determine whether early assessment of platelet reactivity in patients presenting with symptoms of AIS was associated with a diagnosis of AIS, transient ischemic attack (TIA), or stroke mimic. ⋯ Closure time was not found to be a clinically reliable differentiator of patients with a diagnosis of AIS, TIA, or stroke mimic in the ED.
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Controlled Clinical Trial
Developing a standardized measurement of alcohol intoxication.
We assessed multiple examinations and assessment tools to develop a standardized measurement of alcohol intoxication to aid medical decision making in the Emergency Department. ⋯ HII examination, paired with either a VAS or HII assessment tool, yielded valid and reliable measurements of alcohol intoxication.
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Authors and clinicians advocate lipase as the preferred serological test for the diagnosis for acute pancreatitis. While acute pancreatitis is among the differential diagnosis for elevated lipase levels, several other causes of elevated lipase levels have been identified including several reports Salmonella species as a causative agent. ⋯ However, Salmonella infections may induce elevated pancreatic enzyme levels without clinical pancreatitis or morphological pancreatic abnormalities through a variety of proposed mechanisms. The following is a case that describes a patient who developed Salmonella colitis and demonstrated elevated serum lipase levels without clinical pancreatitis.
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Comparative Study
Creation of an intensive care unit and organizational changes in an adult emergency department: Impact on acute stroke management.
Following the reorganization of a University Medical Center onto a single campus, an Intensive Care Unit was created within the adult Emergency Department (ED ICU). We assessed the effects of these organizational changes on acute stroke management and the intravenous administration of recombinant tissue plasminogen activator (IV rtPA), as characterized by the thrombolysis rate, door-to-needle time (DNT) and outcome at 3months. ⋯ Our results highlight the benefits of a separate ED ICU within conventional ED for acute stroke management, with a higher thrombolysis rate, reduced intrahospital delays and better safety.