The American journal of emergency medicine
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Multicenter Study
Experience of carbon monoxide poisoning and the outcome predicting score: A multicenter retrospective study.
Carbon monoxide poisoning (COP), resulting from accidental and intentional exposure, is a leading cause of fatal poisoning worldwide. Except for early death, neurological sequelae are common and impose a large burden on patients, caregivers, and the society. ⋯ The FIRED score could predict the outcomes of non-OHCA patients with a carboxyhemoglobin level > 10% after COP using five factors that can be obtained by history taking and basic examination. An FIRED score ≥ 10 was associated with a poor outcome (sensitivity, 89.6%; specificity, 82.4%; AUC0.930).
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Multicenter Study
Frontal QRS/T angle can predict mortality in COVID-19 patients.
The frontal QRS-T (fQRS) angle has been investigated in the general population, including healthy people and patients with heart failure. The fQRS angle can predict mortality due to myocarditis, ischaemic and non-ischaemic cardiomyopathies, idiopathic dilated cardiomyopathy, and chronic heart failure in the general population. Moreover, no studies to date have investigated fQRS angle in coronavirus disease 2019 (COVID-19) patients. Thus, the purpose of this retrospective multicentre study was to evaluate the fQRS angle of COVID-19 patients to predict in-hospital mortality and the need for mechanical ventilation. ⋯ In conclusion, a wide fQRS angle >90° was a predictor of in-hospital mortality and associated with the need for mechanical ventilation among COVID-19 patients.
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Multicenter Study
Optimal temperature in targeted temperature management without automated devices using a feedback system: A multicenter study.
Targeted temperature management (TTM) at 32 °C-36 °C improves patient outcomes following out-of-hospital cardiac arrest (OHCA). TTM using automated temperature management devices with feedback systems (TFDs) is recommended, but the equipment is often unavailable. This study aimed to investigate therapeutic relations between targeted temperatures and TFDs on the outcomes of OHCA patients with TTM. ⋯ In OHCA patients receiving TTM without TFDs, the adjusted predicted probability of survival and good neurological outcomes at hospital discharge was greater for TTM at 36 °C than that at 33 °C. This suggests that a TTM of 36 °C rather than 33 °C is associated with more favorable clinical outcomes if TFDs are unavailable.
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Randomized Controlled Trial Multicenter Study
Risk factors for trimethoprim and sulfamethoxazole-resistant Escherichia coli in emergency department patients with urinary tract infections.
While trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as one of the first-line empiric therapies for treatment of acute uncomplicated cystitis, institutions that observe resistance rates exceeding 20% for Escherichia coli (E. coli) should utilize alternative empiric antibiotic therapy per the Infectious Diseases Society of America (IDSA). Identifying risk factors associated with TMP-SMX resistance in E. coli may help guide empiric antibiotic prescribing for urinary tract infections (UTIs). ⋯ TMP-SMX should likely be avoided as first-line therapy for UTI in patients who have recurrent UTIs, genitourinary abnormalities, or have previously received TMP-SMX within the past 90 days. The use of an ED-specific antibiogram should be considered for assessing local resistance rates in this population.
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Multicenter Study Comparative Study
Comparison of 4F-PCC and aPCC time to administration and outcomes for oral anticoagulant-related ICH.
Intracranial hemorrhages (ICHs) are associated with increased morbidity and mortality. Use of oral anticoagulants are a potential risk factor for ICH, and reversal of the anticoagulant with agents such as Four-Factor Prothrombin Complex Concentrate (4F-PCC) or Activated Prothrombin Complex Concentrate (aPCC) is vital to prevent hematoma expansion. The objective of the study was to the compare the time to administration and outcomes of 4F-PCC or aPCC in patients with ICH taking an oral anticoagulant. ⋯ In patients with ICH taking oral anticoagulants, there was no significant difference in the time to administration between 4F-PCC and aPCC. More prospective randomized controlled trials are warranted to determine an ideal reversal time to improve patient outcomes.