The American journal of emergency medicine
-
The risk of tPA in the treatment of stroke, is that approximately 5% of patients may have significant intracranial bleeding, increasing mortality to 45%. Use of tPA can also cause other forms of life-threatening bleeding, most commonly gastrointestinal bleeding. In this case review, we discuss the presentation and management of a patient with post-tPA pulmonary hemorrhage and the use of tranexamic acid (TXA) for the cessation of bleeding. ⋯ A 78-year-old female reported dysarthria, left-sided facial droop, left sided weakness of 1-hour duration with an initial NIH stroke scale (NIHSS) of 7. The patient had tPA administered, had an abrupt change in mental status and was ultimately intubated for airway protection. After endotracheal intubation, the patient began to hemorrhage from the endotracheal tube and was administered nebulized TXA totaling 2 g over the course of 20 min, with subsequent cessation of bleeding. tPA administration comes with inherent risks given the known bleeding complications and no consensus for the reversal of bleeding secondary to tPA. TXA may be a viable option in the setting of tPA induced pulmonary hemorrhage.
-
End stage heart failure is associated with high mortality. However, recent developments such as the ventricular assist device (VAD) have improved patient outcomes, with left ventricular assist devices (LVAD) most commonly implanted. ⋯ Emergency clinician knowledge of LVAD function, components, and complications is integral in optimizing care of these patients.
-
Observational Study
Corrected carotid flow time and passive leg raise as a measure of volume status.
The aim of this study was to investigate the value of corrected carotid flow time (FTc) with passive leg raise (PLR) as a non-invasive marker of volume status in end stage renal disease (ESRD) patients. ⋯ Corrected flow time in conjunction with passive leg raise seem to correlate with volume status in hemodialysis patients.
-
To describe opioid prescribing practice patterns and trends in emergency department visits (EDs) by provider type: physicians and advanced practice providers (APPs), which include nurse practitioners (NPs) and physician assistants (PAs). ⋯ From 2005 to 2015, APPs, particularly NPs played an increasing role in opioid prescribing in EDs. Opioid prescribing practices of APPs and physicians varied by patient condition as well as by opioid type.
-
Head injuries frequently occur in combat. Tactical Combat Casualty Care (TCCC) guidelines recommend pre-hospital use of ketamine for analgesia. Yet the use of this medication in patients with head injuries remains controversial, particularly among pediatric patients. We compare survival to hospital discharge rates among pediatric head injury subjects who received prehospital ketamine versus those who did not. ⋯ Within this data set, we were unable to detect any differences in mortality among pediatric head trauma subjects administered ketamine compared to subjects not receiving this medication in the prehospital setting.