The American journal of emergency medicine
-
Comparative Study
Evaluation of methohexital as an alternative to propofol in a high volume outpatient pediatric sedation service.
Propofol is a preferred agent for many pediatric sedation providers because of its rapid onset and short duration of action. It allows for quick turn around times and enhanced throughput. Occasionally, intravenous (IV) methohexital (MHX), an ultra-short acting barbiturate is utilized instead of propofol. ⋯ Methohexital can be used with a high success rate and AEs that are not inconsistent with propofol administration. Methohexital should be considered when propofol is not a preferred option.
-
Comparative Study
Comparison of modified Kampala trauma score with trauma mortality prediction model and trauma-injury severity score: A National Trauma Data Bank Study.
Mortality prediction of trauma patients relies on anatomical, physiological or combined scores. The purpose of this study is to compare the diagnostic accuracy of the modified Kampala Trauma Score (M-KTS) with the Trauma Mortality Prediction Model (TMPM), and Trauma-Injury Severity Score (TRISS) using data from a large dataset from a developed registry, the National Trauma Data Bank (NTDB). ⋯ M-KTS performed worse than TRISS although its' main advantage is simple use in resource-limited settings.
-
Case Reports
Successful treatment of propafenone-induced cardiac arrest by calcium gluconate: A case report.
Propafenone is prescribed for the control of cardiac ventricular arrhythmias. Poisoning from propafenone intoxication is rare, but the survival rate of patients is low. We present a case of a 37-year-old man who developed cardiac arrest due to propafenone intoxication. ⋯ After repeated administrations of calcium gluconate, the patient achieved a full recovery. To the best of our knowledge, this is the first case report in which a full recovery from cardiac arrest was achieved by administration of calcium gluconate. We recommend that for patients poisoned by propafenone, close monitoring for decreased blood calcium is important.
-
Comparative Study
The impact of prolonged waiting time for coronary care unit admission on patients with non ST-elevation acute coronary syndrome.
The boarding of patients in the emergency department consumes nursing and physician resources, and may delay the evaluation of new patients. It may also contribute to poor cardiovascular outcomes in patients with acute coronary syndrome (ACS). This study analyzed the relationship between the delay in coronary care unit (CCU) admission and the clinical outcomes of patients with ACS with non-ST-segment elevation (NSTE-ACS). ⋯ There was no significant difference in the clinical outcomes of NSTE-ACS patients without profound shock between those with CCU waiting times of <12 and >12h. If necessary, CCU admission should be prioritized for patients whose hemodynamic instability or respiratory failure.
-
Case Reports
Consideration of alternative causes of lactic acidosis: Thiamine deficiency in malignancy.
Lactic acidosis is a common metabolic acidosis characterized by increased serum lactate and is usually associated with a decreased blood pH. Lactic acidosis has many different causes but has been differentiated into type A, hypoxic causes, and type B, non-hypoxic causes. Tissue hypoxia, type A, is the most common cause, usually secondary to processes such as sepsis and multi-organ failure. ⋯ However, as most clinicians are more familiar, and likely more initially concerned with hypoxic etiologies, evaluation is directed toward finding the source of hypoperfusion or hypoxia, and thus generally leading to a delay in discovering a type B cause (or mixed type A and type B). Here we describe a case of lactic acidosis in the setting of thiamine deficiency thought to be secondary to advanced lung cancer. The purpose of this paper is to bring awareness to the clinician to consider other causes of lactic acidosis when evaluating a patient.