The American journal of emergency medicine
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Evidence-based clinical practice guidelines (CPGs) for managing febrile neutropenia (FN) are widely available; however, the integration of guidelines into routine practice is often incomplete. This study evaluated the uptake and clinical impact of implementing an electronic CPG on the management and outcomes of patients presenting with FN at 4 urban emergency departments (ED). ⋯ The electronic CPG is a useful clinical tool that can improve patient management in the ED, and strategies to increase its utilization in this and other regions should be pursued.
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The objective of the study was to quantitatively characterize peripheral tissue microvascular oxygenation during emergency department (ED) treatment of acute heart failure (HF). ⋯ Oxygen extraction in acute HF is significantly increased, but approaches values found in the stable HF population after ED treatment. The OER(M) may deserve closer examination as a possible goal-directed variable in the treatment of acute HF.
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A 24-year-old male patient was admitted to the coronary intensive care unit with atrial fibrillation with rapid ventricular response. He was given amiodarone (Cordarone 150 mg i.v., Sanofi-Aventis) intravenous loading dose of 300 mg in 100 mL dextrose 5% in water (D5W) over 1 hour, followed by a maintenance dose of 900 mg in 500 mL D5W for infusion up to 24 hours. At the emergency department, the patient was conscious and cooperative; his pretreatment arterial blood pressure was 120/80 mm Hg, and the arrhythmic tachycardia was 145 per minute. ⋯ Once again, the patient was given physiologic serum (2000 mL), dopamine (20 mg/kg per minute), and, additionally, 250 mg of methyprednisolone sodium succinate intravenous, whereby the clinical condition improved within 20 minutes. Anaphylactic shock cases due to amiodarone are rare; it is important to take a history of drug-mediated anaphylaxis before prescribing amiodarone. An addition to a review of the literature regarding treatment of amiodarone-related anaphylactic shock cases had not been reported before.
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Case Reports
Patent foramen ovale appearance with association of left ventricular assist device and mechanical ventilation.
We report on a 62-year-old man referred to the cardiac intensive care unit less than 24 hours after anterior ST-segment elevated myocardial infarction. The patient developed cardiogenic shock requiring elective intubation, vasopressor, and inotropic support. Emergency coronary angiography, revascularization, and insertion of an intraaortic balloon pump were performed. ⋯ The shunt resulted from abnormal left-to-right pressure gradient due to left ventricular unloading and increased right ventricular afterload induced by mechanical ventilation. Transesophageal echocardiography was used to regulate both LVAD output and positive end-expiratory pressure settings to optimize oxygen transport. Because patent foramen ovale is common in humans, transesophageal echocardiography should be performed systematically after LVAD insertion.
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This study was performed to evaluate clinical features of community-onset Enterobacter bacteremia and determine the risk factors for Enterobacter bacteremia among patients admitted to the emergency department. ⋯ Enterobacter species were important pathogens among community-onset gram-negative bacteremia, in association with health care-associated infections. Pneumonia, tube insertion, solid tumor, and health care-associated infections were found to be significantly associated with Enterobacter bacteremia.