The American journal of emergency medicine
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Multicenter Study Observational Study
Multi-centered evaluation of a novel fixed-dose four-factor prothrombin complex concentrate protocol for warfarin reversal.
Previous studies have shown fixed-dose 4PCC to be as effective as standard-dose 4PCC for warfarin reversal. However, certain patient populations such as those with high total body weight (TBW) or elevated baseline INR may be at increased risk for treatment failure. The purpose of this study was to validate the efficacy of a novel fixed-dose 4PCC protocol for warfarin reversal. ⋯ A fixed-dose 4PCC regimen for warfarin reversal of 1500 units, with an increased dose of 2000 units for select patients, is as effective as standard-dose 4PCC for INR reversal.
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This case report describes a 26-year-old male who presented with anterior chest pain after weightlifting at the gym. Point-of-care ultrasound was used to diagnose a sternal fracture, which was then confirmed on CT scan. This rare mechanism of sports related sternal fracture is discussed, as well as a review of the literature. The use of ultrasound for this application is also explored.
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To determine if following fluid resuscitation recommendations in the Surviving Sepsis Campaign guidelines affects hospital length of stay (LOS) in chronic kidney disease (CKD) patients who present to the emergency department with sepsis-induced hypotension or septic shock. ⋯ The results of this single-center, retrospective study indicate that CKD patients who receive guideline-directed fluid resuscitation (≥27 mL/kg) for sepsis-induced hypotension or septic shock experience a longer hospital LOS compared to those who receive a reduced initial fluid volume.
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Emergency department management of hypoxemia in the setting of COVID-19 is riddled with uncertainty. The lack of high-quality research has translated to an absence of clarity at the bedside. ⋯ Well known pharmacologic properties of the drug, namely the lack of respiratory depression and its anti-delirium effects, as well as other possible physiologic effects, suggest potential benefit for patients being managed with a delayed intubation approach. If dexmedetomidine can improve compliance with non-invasive oxygen support (the current recommended first-line therapy) while promoting better oxygenation, it may also decrease the need for mechanical ventilation and thus improve mortality.
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Review Meta Analysis
Amiodarone and/or lidocaine for cardiac arrest: A Bayesian network meta-analysis.
Although available studies have not demonstrated that antiarrhythmic drugs could increase long-term survival or survival with favorable neurological outcome, some studies have shown that the rate of hospital admission is higher with amiodarone or lidocaine than with placebo. To study the effects of antiarrhythmic drugs during cardiac arrest, a meta-analysis was conducted to assess the efficacy of amiodarone and/or lidocaine. ⋯ Lidocaine had the best effect on both survival to hospital admission and discharge, while amiodarone was associated with a more favorable neurological outcome.