The American journal of emergency medicine
-
Previous studies have shown that an elevated prehospital National Early Warning Score (preNEWS) is associated with increased levels of adverse outcomes in patients with trauma. However, whether preNEWS is a predictor of massive transfusion (MT) in patients with trauma is currently unknown. This study investigated the accuracy of preNEWS in predicting MT and hospital mortality among trauma patients. ⋯ preNEWS is a useful, rapid predictor for MT and 24 h mortality. Calculation of preNEWS would be helpful for making the decision at the scene such as transfer straightforward to trauma center and advanced treatment.
-
Synthetic cannabinoids (SC) are chemical substances, which activate cannabinoid receptors in a similar fashion to tetrahydrocannabinol, but with increased efficacy, and are used as illicit recreational drugs. ⋯ SC are potentially harmful drugs of abuse which can lead to life-threatening complications. Acute care personnel should be aware of the broad range of signs and symptoms of SC use. Testing with short turn around times is available to assess SC use.
-
Currently the videographic review of emergency intubations is an unstructured, qualitative process. We created a taxonomy of errors that impede the optimal procedural performance of emergency intubation. ⋯ We developed a taxonomy of 13 performance errors of laryngoscopy. Further study is warranted to determine how to best incorporate these into emergency airway training and the airway review process.
-
High flow nasal cannula (HFNC) is used to prevent invasive ventilation in COVID-19-associated hypoxemia. The respiratory rate‑oxygenation (ROX) index has been reported to predict failure of HFNC in patients with COVID-19 pneumonia during the intensive care unit stay when measured in first hours of therapy. However, the clinical course of ICU patients may change substantially in the first days of admission. The objective of this study was to investigate whether ROX index obtained in the first four days of ICU admission could predict the need for invasive respiratory support within the next 24 h of measurements. ⋯ In COVID-19 patients in high flow nasal cannula, daily ROX index measurements successfully predicted transition to mechanical ventilation within the next 24 h.
-
ST-elevation Myocardial Infarction (STEMI) guidelines encourage monitoring of false positives (Code STEMI without culprit) but ignore false negatives (non-STEMI with occlusion myocardial infarction [OMI]). We evaluated the hospital course of emergency department (ED) patients with acute coronary syndrome (ACS) using STEMI vs OMI paradigms. ⋯ STEMI criteria miss a majority of OMI, and discharge diagnoses highlight false positive STEMI but never false negative STEMI. The OMI paradigm reveals quality gaps and opportunities for improvement.