Ugeskrift for laeger
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Ugeskrift for laeger · Jan 2013
Review[Acute coronary angiography should be considered in patients with ST segment elevation after out-of-hospital cardiac arrest].
Guidelines suggest that acute coronary angiography (CAG) is considered in patients resuscitated from out-of-hospital cardiac arrest with presumed cardiac aetiology. Since specialized post-resuscitation care, including therapeutic hypothermia, has proved beneficial in randomized studies, CAG should be offered to patients with a high likelihood of thrombotic coronary lesions, i.e. patients with ST-segment elevation in electrocardiogram (ECG) following resuscitation. This article suggests a triage and referral based on electronic transmission of ECG and teleconference with specialized centres in all patients.
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Ugeskrift for laeger · Jan 2013
Review[Primary percutaneous coronary intervention as a national Danish reperfusion strategy of ST-elevation myocardial infarction].
The use of primary percutaneous coronary intervention (PCI) as the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI) requires optimal systems-of-care and logistics in order to enable rapid treatment of all patients. In Denmark, this has been achieved through prehospital electrocardiogram diagnosis, field triage and dedicated PCI centres 24/7. Today, primary PCI is an option for all Danish patients with STEMI, regardless of the distance to a PCI centre. This has led to a decline in both mortality and morbidity.
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Ugeskrift for laeger · Jan 2013
Case Reports[Nebulized salbutamol as a possible cause of lactate acidosis in a patient with acute asthma].
A 50-year-old man was in the emergency department treated for acute asthma with repeated doses of nebulized salbutamol according to guidelines, and as a result of this treatment he developed marked lactate acidosis. Lactate acidosis is not commonly listed as a side effect to nebulized salbutamol. House officers in the emergency department handling acute asthma should be aware of this paradox, though the condition may resolve in spite of continued treatment with salbutamol.
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Ugeskrift for laeger · Jan 2013
Case Reports[Lactic acidosis in a patient with exercabation of asthma receiving inhalation therapy].
We present a case of severe lactic acidosis due to exacerbation of asthma in presence of normal tissue perfusion and oxygenation in a 35-year-old woman with poorly controlled asthma. After admission, she was treated continuously with inhalation of salbutamol (a beta-agonist) resulting in lactic acidosis, which was misinterpreted as treatment failure. The lactic acidosis reversed on discontinuation of the inhalation therapy. Although lactic acidosis is a rare complication to inhalation of beta-agonists, it is important for the clinicians to recognize this.
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Ugeskrift for laeger · Jan 2013
Review[Radiofrequency ablation as acute treatment of ventricular arrhythmia].
The role of radiofrequency ablation in the acute management of electrical storm is reviewed. Electrical storm is defined as three or more intervention-requiring episodes of ventricular fibrillation or ventricular tachycardia within 24 hours. The management of electrical storm includes antiarrhythmic therapy including beta blockers and correction of initiating causes as myocardial ischaemia and electrolyte disturbances. Radiofrequency ablation provides an alternative in the management of electrical storm in the case of failure of the medical therapy.