The American journal of emergency medicine
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Comparative Study
Effect of emergency critical care nurses and emergency department boarding time on in-hospital mortality in critically ill patients.
We hypothesized that establishing a program of specialized emergency critical care (ECC) nurses in the ED would improve mortality of ICU patients boarding in the ED. ⋯ During the post-intervention period, there was a significant increase in illness severity, hospital congestion, ED boarding time, and downgrades in the ED, but no significant change in mortality. These findings suggest that ECC nurses may improve the safety of boarding ICU patients in the ED. Longer ED boarding times were not associated with higher mortality in either the pre- or post-intervention periods.
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Laboratory testing is commonly performed in patients with COVID-19. Each of the laboratory parameters has potential value for risk stratification and prediction of COVID-19 outcomes. This systematic review and meta-analysis aimed to evaluate the difference between these parameters in severe and nonsevere disease and to provide the optimal cutoff value for predicting severe disease. ⋯ This meta-analysis suggests elevated procalcitonin, CRP, D-dimer, and LDH and decreased albumin can be used for predicting severe outcomes in COVID-19.
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Early recognition and management of hemorrhage, damage control resuscitation, and blood product administration have optimized management of severe trauma. Recent data suggest hypocalcemia exacerbates the ensuing effects of coagulopathy in trauma. ⋯ Calcium is a key component of trauma resuscitation and the coagulation cascade. Recent data portray the intricate physiologic reverberations of hypocalcemia in the traumatically injured patient; however, future research is needed to further guide the management of these patients.
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Supraventricular tachycardia is a common cardiac arrhytmia with recurrent episodes. The rapid resolution of supraventricular tachycardia remains a challenge. Vagal manoeuvres are simple and non-invasive but yield positive results in less than half the cases. ⋯ We report in this series 11 cases of supraventricular tachycardia, 10 of which were effectively reduced after the completion of the reverse Valsava manoeuvre. The very encouraging results of this series of cases will have to be quickly evaluated by a randomised controlled trial. This new technique, which is simple to learn and carry out, could be easily taught throughout the world, including in regions with few health-care resources.
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Intracranial Hemorrhage (ICH) is an important cause of out-of-hospital cardiac arrest (OHCA), yet there are no United States (US), European, or Australian prospective studies examining its incidence in patients who sustained OHCA. This study aims to identify the incidence of ICH in US patients with OHCA who obtain return of spontaneous circulation (ROSC). ⋯ In our US cohort, ICH was an uncommon finding in patients who sustained OHCA and survived to hospital admission, and no patients with ICH survived to discharge with good neurologic outcome. Additionally, the incidence of ICH was lower than reported in previous studies.