The Mount Sinai journal of medicine, New York
-
Randomized Controlled Trial
The effects of the prophylactic tropisetron-propofol combination on postoperative nausea and vomiting in patients undergoing thyroidectomy under desflurane anesthesia.
To evaluate the efficacies of tropisetron and tropisetron-propofol combination in the prophylaxis for postoperative nausea and vomiting in patients undergoing thyroidectomy under desflurane anesthesia. (This combination has apparently not been previously investigated for this particular surgery and anesthesia.) ⋯ The tropisetron-propofol combination is more effective than tropisetron alone in the prevention of postoperative nausea and vomiting after thyroidectomy.
-
Heart failure is a disease that effects affects approximately 5 million Americans, accounts for 1 million hospitalizations annually, and represents the most common hospital discharge diagnosis for patients over the age of 65. Despite the significant impact of this disease, the accepted approach to treatment of acute decompensated heart failure (ADHF) has changed little in over 40 years. ⋯ This article, the first of a two-part series, will explore the historically accepted disease models for heart failure and their relevance to developing a therapeutic approach to ADHF. Additionally, diagnostic issues in heart failure will be examined, particularly the emerging role of natriuretic peptide assays for the identification of ADHF.
-
Review
New diagnostic and treatment modalities for pulmonary embolism: one path through the confusion.
Pulmonary embolism is one of the greatest diagnostic challenges in emergency medicine. New techniques and strategies constantly arise for the diagnosis and treatment of this disease. A review of the new diagnostic and treatment modalities for pulmonary embolism (PE) suggests that it should be suspected in any patient with unexplained dyspnea, tachypnea, or chest pain. ⋯ Both heparin and low molecular weight heparin are equally effective initial treatments for stable patients with suspected or confirmed PE. Because accurate screening and identification of pulmonary embolism frequently requires more than a single test, knowledge of existing diagnostic techniques allows an evidence-based strategy for diagnosis. New therapeutic choices may benefit patients with confirmed pulmonary embolism.
-
The diagnosis and management of blunt cardiac injury, formerly known as myocardial contusion, has challenged clinicians for decades. Caused primarily by motor vehicle collisions, significant blunt cardiac injury carries a high mortality rate. ⋯ A literature search using the MEDLINE database was performed to compose a review of epidemiology, diagnostic intervention, and therapeutic approach. The results of the search indicate that, along with a high index of suspicion, utilizing a combination of electrocardiogram, troponin, and echocardiography for appropriate patients may improve the diagnosis, risk stratification and disposition of patients sustaining blunt cardiac injury.
-
Out-of-hospital cardiac arrest (OOH-CA) is a leading cause of mortality and the focus of significant research. Recent studies provide new evidence that may change our management of OOH-CA and improve outcomes. The findings of two recently published studies of OOH-CA are reviewed in this article. ⋯ The study demonstrated that vasopressin is similar to epinephrine for OOH-CA due to ventricular fibrillation or pulseless electrical activity, and superior to epinephrine for the initial treatment of asystolic arrest; it also demonstrated that the combination of vasopressin and epinephrine is superior to epinephrine alone in the treatment of refractory, out-of-hospital cardiac arrest. Studies on alternative CPR techniques and adjunctive devices for CPR were also reviewed. We conclude that pre-hospital access to defibrillators and the use of vasopressin in the management of asystole hold promise for improving survival for patients with out-of-hospital cardiac arrest.