Annals of emergency medicine
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Epidemiologic data on emergency department (ED) patients with sepsis are limited. Inpatient discharge records from 1979 to 2000 show that hospitalizations for sepsis are increasing. We examine the epidemiology of sepsis in US EDs and the hypothesis that sepsis visits are increasing. ⋯ In contrast to data from hospital discharges, ED visits for sepsis demonstrated no increase. Most ED visits for sepsis resulted in admission to non-critical care units.
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The Thrombolysis in Myocardial Infarction (TIMI) risk score is a 7-item tool derived from trials of patients with unstable angina/non-ST segment elevation myocardial infarction for risk stratification with respect to outcomes. It has been retrospectively evaluated in emergency department (ED) patients with potential acute coronary syndrome but has not been prospectively validated in this patient population. To validate the use of the TIMI risk score in the ED, we prospectively assess its potential utility in a broad ED chest pain patient population. ⋯ Among ED patients with chest pain, the TIMI risk score does correlate with outcome. However, in our study the TIMI risk score failed to stratify these patients into discrete groups according to risk score. Also, patients with the lowest risk as defined by a TIMI score of zero had a 1.7% incidence of adverse events. Therefore, the TIMI risk score should not be used in isolation to determine disposition of ED chest pain patients.
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Review Meta Analysis
The use of noninvasive ventilation in emergency department patients with acute cardiogenic pulmonary edema: a systematic review.
Acute cardiogenic pulmonary edema is a common cause of respiratory distress in emergency department (ED) patients. Noninvasive ventilation by noninvasive positive pressure ventilation or continuous positive airway pressure has been studied as a treatment strategy. We critically evaluate the evidence for the use of noninvasive ventilation on rates of hospital mortality and endotracheal intubation. ⋯ Our results suggest that noninvasive ventilation with standard medical therapy is advantageous over standard medical therapy alone in ED patients with acute cardiogenic pulmonary edema. Future studies, powered appropriately for mortality and intubation rates, are necessary to confirm these findings.
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Survival from traumatic cardiac arrest is poor, and some consider resuscitation of this patient group futile. This study identified survival rates and characteristics of the survivors in a physician-led out-of-hospital trauma service. The results are discussed in relation to recent resuscitation guidelines. ⋯ The survival rates described are poor but comparable with (or better than) published survival rates for out-of-hospital cardiac arrest of any cause. Patients who arrest after hypoxic insults and those who undergo out-of-hospital thoracotomy after penetrating trauma have a higher chance of survival. Patients with hypovolemia as the primary cause of arrest rarely survive. Adherence to recently published guidelines may result in withholding resuscitation in a small number of patients who have a chance of survival.
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Case Reports
Treatment of severe carbon monoxide poisoning using a portable hyperbaric oxygen chamber.
We report the first case of suspected carbon monoxide poisoning treated by hyperbaric oxygen therapy by using a portable hyperbaric stretcher. A 40-year-old British man in Kabul, Afghanistan, was found unresponsive in his apartment. Initial treatment consisted of oxygen by mask at a Combat Support Hospital for several hours, with minimal improvement. ⋯ He was subsequently treated twice using an Emergency Evacuation Hyperbaric Stretcher, according to the US Navy Diving Manual treatment Table 9. The patient showed marked neurologic improvement after the first treatment and experienced near complete recovery before eventual evacuation. This case illustrates the practical use of portable chambers for the treatment of suspected cases of carbon monoxide poisoning in an austere environment.