European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Meta Analysis
Outcomes of out-of-hospital cardiac arrest in patients with SARS-CoV-2 infection: a systematic review and meta-analysis.
Out-of-hospital cardiac arrests increased during the COVID-19 pandemic and a direct mechanism of cardiac arrest in infected patients was hypothesized. Therefore, we conducted a systematic review and meta-analysis to assess outcomes of SARS-CoV-2 patients with out-of-hospital cardiac arrest. ⋯ PROSPERO - CRD42021243540.
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Cardiac arrhythmia, specifically paroxysmal supraventricular tachycardia (SVT), accounts for a substantial proportion of emergency medical services resources utilisation. Reconversion requires increasing the atrioventricular node's refractoriness, which can be achieved by vagal manoeuvres, pharmacological agents or electrical cardioversion. There are multiple variants of vagal manoeuvres, including the Valsalva manoeuvre (VM). While the effectiveness of the standard VM has already been systematically reviewed, there has been no such analysis for the modified VM. ⋯ The available evidence is highly suggestive to support the use of the modified VM compared to the standard VM in the treatment of adult patients with SVT. Meta-analysis showed a higher success rate, required less medication use, and resulted in an equal number of adverse events. However, these results cannot be regarded as definitive in the absence of higher-quality studies.
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Cholecystitis secondary to gallstone migration is the most common suspected diagnosis for right upper quadrant pain in emergency departments, with radiology-performed ultrasound (RADUS) being the main diagnostic tool. The primary aim of this review was to assess the ability of emergency physicians to perform emergency ultrasound (EUS) compared to RADUS to diagnose cholelithiasis and cholecystitis. A systematic search was performed using Embase, Central (Cochrane library), Web of Science, MEDLINE, Google Scholar, prospective trial registries, and OpenSIGLE databases as well as hand-search of articles. ⋯ This review shows there is good agreement between EUS and RADUS to assess the gallbladder for cholelithiasis and therefore supports its use by emergency physicians for that matter. Nevertheless, this work identified clinical and methodological heterogeneity along with a poor description EUS operators' experience. In the future, larger studies should include a larger population of EUS operators, specify their background, and compare EUS to the final diagnosis to evaluate performances for gallbladder diagnostic accuracy.
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Optimizing emergency care for the aging population is an important future challenge, as the proportion of older patients at the emergency department (ED) rapidly increases. Older patients, particularly those who are frail, have a high risk of adverse outcomes after an ED visit, such as functional decline, institutionalization, and death. The ED can have a key position in identifying frail older patients who benefit most from comprehensive geriatric care [including delirium preventive measures, early evaluation of after-discharge care, and a comprehensive geriatric assessment (CGA)]. ⋯ Therefore, quick and easy-to-use instruments are needed to identify older patients at risk for adverse outcomes. This narrative review outlines the importance and complexity of frailty assessment at the ED. It aligns the available screening instruments, including clinical judgment as frailty assessment, and summarizes arguments for and against frailty assessment at the ED.
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Meta Analysis
Use of backboards in cardiopulmonary resuscitation: a systematic review and meta-analysis.
To achieve optimal chest compression depth, victims of cardiac arrest should be placed on a firm surface. Backboards are usually placed between the mattress and the back of a patient in the attempt to increase cardiopulmonary resuscitation (CPR) quality, but their effectiveness remains controversial. A systematic search was performed to include studies on humans and simulation manikins assessing CPR quality with or without backboards. ⋯ Out of 557 records, 16 studies were included in the review and all were performed on manikins. The meta-analysis, performed on 15 articles, showed that the use of backboards during CPR increases chest compression depth by 1.46 mm in manikins. Despite statistically significant, this increase could have a limited clinical impact on CPR, due to the substantial heterogeneity of experimental conditions and the scarcity of other CPR quality indicators.