The American journal of emergency medicine
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In this study, we retrospectively reviewed the patients' outcomes after cardiac arrest based on age in one center, to determine whether geriatric patients had worse outcomes. ⋯ Elderly patients with OHCA had a poor neurological outcome; but several other factors were also related with the outcome. In decision-making for resuscitation, physicians should consider the patients' physiologic factors as well as age.
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Review Meta Analysis Comparative Study
The effect of high-flow nasal cannula in reducing the mortality and the rate of endotracheal intubation when used before mechanical ventilation compared with conventional oxygen therapy and noninvasive positive pressure ventilation. A systematic review and meta-analysis.
The effects of high flow nasal cannula (HFNC) on adult patients when used before mechanical ventilation (MV) are unclear. We aimed to determine the effectiveness of HFNC when used before MV by comparison to conventional oxygen therapy (COT) and noninvasive positive pressure ventilation (NIPPV). ⋯ When used before MV, HFNC can improve the prognosis of patients compared both with the COT and NIPPV.
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Review Meta Analysis
Utilization of ultrasound for the evaluation of small bowel obstruction: A systematic review and meta-analysis.
Small bowel obstruction (SBO) is a common presentation to the Emergency Department (ED). While computed tomography (CT) is frequently utilized to confirm the diagnosis, this modality is expensive, exposes patients to radiation, may lead to time delays, and is not universally available. This study aimed to determine the test characteristics of ultrasound for the diagnosis of SBO. ⋯ The existing literature suggests that ultrasound is a valuable tool in the diagnosis of SBO with a sensitivity and specificity comparable to that of CT. Ultrasound may save time and radiation exposure, while also allowing for serial examinations of patients to assess for resolution of the SBO. It may be particularly valuable in settings with limited or no access to CT. Future studies should include more studies in the Emergency Department setting, comparison of probe choices, and inclusion of more pediatric patients.
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Acute Respiratory Distress Syndrome (ARDS) was first recognized during the 1960s. It is a distinct type of hypoxemic respiratory failure characterized by acute abnormality of both lungs. Extracorporeal membrane oxygenation (ECMO) is being increasingly used for patients with severe ARDS refractory to otherwise conventional management. ⋯ After an extensive hospitalization, the patient was ultimately transferred to an acute medical rehabilitation center. With the current opioid crisis, emergency physicians and providers need to be aware that opioids can induce severe ARDS refractory to mechanical ventilation. ECMO as a treatment option can be used safely and successfully as described in this unique patient case report.
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A recent study reported a high prevalence of pulmonary embolism (PE) among patients admitted with syncope. We sought to determine whether these findings were validated in our patient population. ⋯ In contrast to a previous study, our findings do not support a high rate of PE among ED patients presenting with syncope.