J Emerg Med
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Observational Study
Characteristics of Anaphylactic Reactions: A Prospective Observational Study in Japan.
Anaphylaxis is a systemic, life-threating, allergic reaction in which the clinical features may vary in different populations or due to the allergic triggers. Moreover, the timing and characteristics of biphasic anaphylactic reactions remain unclear. ⋯ In this prospective ED study, foods were the most common triggers of anaphylaxis, and epinephrine administration was associated with a decreased occurrence of biphasic anaphylactic reactions. Over half of patients experiencing biphasic anaphylactic reactions developed symptoms more than 10 h after presentation.
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The 2010 Advanced Cardiac Life Support guidelines stated that routine sodium bicarbonate (SB) use for cardiac arrest patients was not recommended. However, SB administration during resuscitation is still common. ⋯ SB use was not associated with improvement in ROSC or survival-to-discharge rates in cardiac resuscitation. In addition, mortality was significantly increased in the North American group with SB administration.
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Randomized Controlled Trial
Ultrasound Guidance Versus Landmark-Guided Palpation for Radial Arterial Line Placement by Novice Emergency Medicine Interns: A Randomized Controlled Trial.
More than 10 million arterial lines are placed annually worldwide, many of which happen in the emergency department. Before the introduction of point-of-care ultrasound, landmark-guided palpation (LMGP) was considered standard of care. ⋯ USG improved first-pass and overall success of radial arterial line cannulation while reducing time to access and attempts when used by novice emergency medicine interns.
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There is a significant variability in survival rates for cardiopulmonary resuscitation (CPR) in out of-hospital cardiac arrest (OHCA), and some data indicate that ultrasound improves CPR. ⋯ Our study has demonstrated that CPR in OHCA can be improved using ultrasound and changing the position of the hands. This finding was connected with the ETCO2 and confirmed by chest CT scans.
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Case Reports
Acute Angle-Closure Glaucoma Secondary to Vitreous Hemorrhage Diagnosed with the Aid of Point-of-Care Ultrasound.
Acute angle-closure glaucoma (AACG) caused by vitreous hemorrhage is a rare complication of intravitreal injection that often leads to permanent vision loss without prompt treatment. ⋯ This is a case of vitreous hemorrhage with secondary AACG in an 80-year-old man who presented to the emergency department (ED) with pain and vision loss in his left eye after undergoing intravitreal injection to treat exudative macular degeneration. The diagnosis was made with the use of point-of-care ultrasound after intraocular pressure (IOP) was found to be significantly elevated in the left eye. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should have a high level of suspicion for AACG in patients who are diagnosed with a vitreous hemorrhage after intravitreal injection and should immediately measure IOP for elevation upon presentation to the ED.