Articles: outcome.
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End-stage renal disease (ESRD) is associated with an increased propensity for critical illness, but whether ESRD is independently associated with a greater risk of death after major surgical procedures is unclear. ⋯ In this large cohort of surgical ICU patients, presence of ESRD at ICU admission was associated with greater morbidity and mortality and independently associated with a greater risk of in-hospital death. Our data can be useful in preoperative risk stratification.
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ABSTRACTTraumatic dislocation of the elbow is rare in children and can most often be managed in the emergency department using procedural sedation and closed reduction with good functional outcome. Radiographs must be evaluated for associated avulsions and fractures around the elbow. We present the case of a 14-year-old girl who sustained a fracture of the radial neck subsequent to repeated attempts at closed reduction of a pure posterior elbow dislocation that was missed on postreduction radiographs. Careful use of reduction techniques and avoidance of repeated forceful manipulations is emphasized.
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Clinical questionDoes epinephrine (adrenaline) used in the context of out-of-hospital cardiac arrest improve outcomes?Article chosenJacobs IG, Finn JC, Jelinek GA, et al. Effect of adrenaline on survival in out-of-hospital cardiac arrest: a randomised double-blind placebo-controlled trial. Resuscitation 2011;82:1138-43. ObjectiveTo determine the effect of epinephrine in out-of-hospital cardiac arrest on patient survival to hospital discharge, prehospital return of spontaneous circulation, and neurologic outcomes.
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ABSTRACTBackground:Cardiac troponin elevation portends a worse prognosis in diverse patient populations. The significance of troponin elevation in patients discharged from emergency departments (EDs) without inpatient admission is not well known. Methods:Patients without a diagnosis of acute coronary syndrome discharged from two EDs between April 1, 2006, and December 31, 2007, with an abnormal cardiac troponin (troponin positive [TP]) were compared to a troponin-negative (TN) cohort matched for age, sex, and primary discharge diagnosis. ⋯ There was no significant difference in death (OR 1.3, 95% CI 0.6-2.9, p = 0.5) after adjustment. Conclusions:A positive troponin assay during ED stay in discharged patients is an independent marker of risk of subsequent admission. Our findings suggest that the prognostic power of an abnormal troponin extends to patients discharged from the ED.
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ABSTRACTObjectives:Blood glucose can be lowered via insulin and/or fluid administration. Insulin, although efficacious, can cause hypoglycemia and hypokalemia. Fluids do not cause hypoglycemia or hypokalemia, but the most effective route of fluid administration has not been well described. ⋯ No adverse events were observed in either group. Conclusion:In this unblinded randomized trial, oral and intravenous fluids were equally efficacious in lowering blood glucose levels in stable hyperglycemic patients and no adverse events were noted. Physicians should be mindful that, although similar, the reduction in blood glucose was modest in both groups.