The American journal of emergency medicine
-
Meta Analysis
Premorbid angiotensin converting enzyme inhibitors or angiotensin II receptor blockers in patients with sepsis.
The aim of this study was to conduct a systematic review and meta-analysis to investigate the effect of the premorbid use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEI/ARB) on short-term mortality in patients with sepsis. ⋯ In this meta-analysis, the premorbid ACEI/ARB was associated with significantly lower short-term mortality in patients with sepsis despite the significantly higher risk of AKI.
-
Randomized Controlled Trial
Diagnostic accuracy of ultrasound to confirm endotracheal tube depth.
Endotracheal intubation is commonly performed in the Emergency Department. Traditional measures for estimating and confirming the endotracheal tube (ETT) depth may be inaccurate or lead to delayed recognition. Ultrasound may offer a rapid tool to confirm ETT depth at the bedside. ⋯ Ultrasound was moderately accurate for identifying the ETT location in a cadaveric model and was more accurate when sonographers felt confident with their visualization. Future research should determine the accuracy of combining transtracheal ultrasound with lung sliding and other modifications to improve the accuracy.
-
Comment Letter Randomized Controlled Trial
Letter to the editor: Transcutaneous electrical nerve stimulation (TENS) for the treatment of renal colic in the ED: A randomized, double-blind, placebo-controlled trial.
-
Acute mesenteric ischemia (AMI) is a condition that results from a sudden decline in blood flow through the mesenteric vessels that has a high morbidity and mortality. Non-occlusive AMI often presents in critically ill, hypotensive patients that suffer from decreased organ perfusion. ⋯ The patient required rapid fluid resuscitation in the emergency department. He did not require surgical intervention and was able to be discharged home with resolution of symptoms after a 7-day inpatient stay.
-
Observational Study
Trauma center designation level and survival of patients with chest wall instability.
Chest wall instability is a potentially life-threatening condition that should be evaluated at a trauma center. While patients with chest wall instability are sent to different trauma center levels, the impact of this on outcomes has not been evaluated yet. This study examines survival to hospital discharge of patients with chest wall instability treated at different trauma center levels. ⋯ Survival rates for patients having chest wall instability were similar when transported to level II or level III versus level I centers. This finding can help guide pre-hospital field triage criteria for this specific type of injury and highlights the need for more outcome research in organized trauma systems.