The American journal of emergency medicine
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Case Reports
Using suboccipital release to control singultus: a unique, safe, and effective treatment.
Hiccups, or singultus, are the result of spontaneous and repetitive contractions of the diaphragm. In most cases, episodes of singultus are benign and self-limited. However, prolonged attacks can result in significant discomfort, morbidity, and even death. ⋯ With this approach, gentle traction and pressure is applied to the posterior neck, stretching the suboccipital muscles and fascia. The manual decompression of the vagus, and possibly phrenic, nerves interrupts the hiccup reflex and allows for normal autonomic function to be reestablished. We propose that the suboccipital release, noninvasive, simple, and with virtually no side effects, is an ideal initial treatment of singultus.
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Multicenter Study Clinical Trial
Combined copeptin and troponin to rule out myocardial infarction in patients with chest pain and a history of coronary artery disease.
The main objective of this multicentric study was to evaluate the additional value of copeptin to conventional cardiac troponin (cTn) for a rapid ruling out of acute myocardial infarction (AMI) in patients with acute chest pain and a previous history of coronary artery disease (CAD). ⋯ In triage patients with acute chest pain lasting for less than 6 hours and a previous history of CAD, the combination of copeptin and cTn allows for the ruling out AMI, with a negative predictive value greater than 95%.
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Overcrowding is an important issue facing many emergency departments (EDs). Access block (admitted patients occupying ED stretchers) is a leading contributor, and expeditious placement of admitted patients is an area of research interest. This review examined the effectiveness of full capacity protocols (FCPs) on mitigating ED overcrowding. ⋯ Although FCPs may be a promising alternative for overcrowded EDs, the available evidence upon which to support implementation of an FCP is limited. Additional efforts are required to improve the outcome reporting of FCP research using high-quality research methods.
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A myriad of hospital-wide initiatives have been implemented with the goal of decreasing door-to-balloon time. Much of the evidence behind the common strategies used is unknown; multiple strategies have been suggested in the reduction to the use of this important time-sensitive intervention. Among 8 primary strategies, 2 have substantial evidence to support their implementation in the attempt to reduce door-to-balloon time in ST-segment elevation myocardial infarction (STEMI), including emergency physician activation of the cardiac catheterization laboratory and prehospital activation of the STEMI alert process. ⋯ Although all the STEMI systems of care reviewed are associated with a decreased in time to treatment, only a few have sufficient quantitative evidence to support their implementation. To be effective, the movement to decrease time to treatment of STEMI at any hospital must be composed of an institutional response that includes multiple disciplines. Success also requires active participation from nurses, members of the catheterization team, and hospital leadership.