The American journal of emergency medicine
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Brain injury often occurs after cardiac arrest, and the regulation of PaCO2 plays a crucial role in mediating cerebral blood flow. The current guidelines recommend maintaining normocapnia through ventilation in post-arrest patients. However, the effects of hypercapnia on neurological outcomes remain controversial. To address this issue, we undertook a meta-analysis to compare the effects of hypercapnia and normocapnia on the neurological outcomes in patients with cardiac arrest. ⋯ CRD42023457027. Registered 3 September 2023.
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Data describing hypothermic cardiac arrest (HCA) outcomes predominantly originate from patients involved in wilderness accidents. We describe the incidence and outcomes of HCA in an urban environment, with a subgroup analysis of patients with witnessed HCA in the prehospital or emergency department (ED) setting. ⋯ Patients with severe hypothermia secondary to environmental exposure in an urban environment are at high-risk of HCA. Witnessed HCA accounts for a significant portion of HCA patients, and patients with witnessed HCA in an ED setting can achieve excellent outcomes.
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Superabsorbent polymers (SAPs) are hydrophilic polymers that expand many-fold from their original size after contact with water. Ingestions of "water beads" by young children have been reported to cause bowel obstruction however, the incidence of bowel obstructions is unknown. ⋯ In our study, no bowel obstructions, admissions, or severe or fatal outcomes were documented, indicating a generally favorable outcome from SAP ingestions. Given reports of serious outcomes in literature, clinicians should continue to use clinical judgement to evaluate patients on a case-by-case basis for potential complications.
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Opioids are commonly used for acute pain management in patients with rib fractures, but their use poses known risks of addiction and respiratory depression. Regional anesthesia, namely the erector spinae plane(ESP) block, has shown promise as an alternative to opioids in case series. Our aim was to evaluate the efficacy and safety of continuous ropivacaine infusion ESP catheters performed by emergency physicians (EP) for patients with multiple unilateral rib fractures. ⋯ Opioid use decreased after ESP catheter implementation and there were no meaningful complications. Although there was no significant difference in opioid use between groups, ESP catheter placement and continuous regional anesthesia by EP is a safe, reasonable adjunct to treat pain from rib fractures.
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Cerebral infarction associated with myocardial hypertrabeculation is a rare condition that requires optimal management to reduce the risk of thromboembolism and stroke. As intravenous thrombolysis (IVT) is a standard treatment for acute ischemic stroke, it is important to investigate whether it is safe and effective in patients with this rare condition. ⋯ This case report provides evidence that IVT is safe and effective in the treatment of cerebral infarction associated with myocardial hypertrabeculation in adults.