The American journal of emergency medicine
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Traumatic arthrotomy (TA) is a rare but serious condition associated with a high morbidity and mortality that can be mitigated with prompt diagnosis and appropriate management. ⋯ An understanding of an evidenced-based approach to TA can assist emergency clinicians in diagnosing and managing this challenging clinical presentation.
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Review Case Reports
Local anesthetic systemic toxicity in the pediatric patient: A case report and review of the literature.
Lidocaine and prilocaine are local anesthetics, a class of medications which are frequently used in clinical medicine to minimize pain in a variety of procedures. They are commonly found in over-the-counter products such as topical anesthetic creams advertised to relieve localized muscle and joint pain. While safe and well-tolerated when used appropriately, an overdose of these anesthetics increases the risk for local anesthetic systemic toxicity (LAST), which in severe cases can present with seizures, cardiac dysrhythmias, and ultimately cardiovascular collapse. ⋯ After stabilization, the patient was transferred to the Pediatric ICU and ultimately made a complete recovery. LAST is a life-threatening presentation which requires early recognition by clinicians, as well as an understanding of the appropriate treatment modalities. We review the assessment and management of LAST, with special focus on the pediatric patient.
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Meta Analysis
The effect of previous oral anticoagulant use on clinical outcomes in COVID-19: A systematic review and meta-analysis.
Data on the prognosis of patients treated with oral anticoagulation (OAC) prior to hospital admission for COVID-19 remains controversial and insufficient. Therefore, we endeavored to perform a systematic review and meta-analysis to evaluate the effect of chronic use of OAC prior to the diagnosis of COVID-19 on intensive care unit (ICU) admission and mortality. An electronic search of the Pubmed, Embase, Cochrane library databases was conducted. ⋯ Moreover, the meta-analysis of adjusted results showed no lower risk of mortality (OR = 1.08, 95% CI: 0.90 to 1.30, P = 0.415) or ICU admission (OR = 1.50, 95% CI: 0.72 to 3.12, P = 0.284) in patients with prior OAC use compared to patients without previous OAC use. In conclusion, the results of this study revealed that the use of OAC prior to hospital admission appeared to be ineffective in reducing the risk of intensive care need and mortality in COVID-19 patients. Randomized controlled trials are needed to evaluate and optimize the use of OAC in COVID-19 infection.
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Review
Unrecognized cardiac arrests: A one-year review of audio from emergency medical dispatch calls.
Immediate recognition of out-of-hospital cardiac arrest (OHCA) by Emergency Medical Dispatch (EMD) operators is crucial to facilitate timely initiation of telephone cardiopulmonary resuscitation (T-CPR) and to enable the appropriate level of Emergency Medical Services (EMS) response. The goal of this study was to identify patterns that can increase EMD-level recognition of cardiac arrests prior to EMS arrival. ⋯ Lack of recognition of OHCA by EMD occurred in most calls due to difficulty communicating the subject's respiratory status. Further emphasis should be placed on identifying non-viable respirations in unconscious patients in EMD training and algorithms to increase recognition of OHCA and initiation of T-CPR. A multi-year review of a comparable dataset from geographically and socioeconomically diverse regions in the United States can validate and expand these preliminary trends.
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Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. ⋯ This review provides a focused update of the presentation and evaluation of COVID-19 for emergency clinicians.