The American journal of emergency medicine
-
Review Case Reports
Extracorporeal membrane oxygenation for refractory, life-threatening, and herpes simplex virus 1-induced acute respiratory distress syndrome. Our experience and literature review.
We report our first experience of treating an immunocompetent adult patient with acute respiratory distress syndrome (ARDS) due to type 1 herpes simplex (HSV1) pneumonitis, using extracorporeal membrane oxygenation (ECMO). Similar cases reported in literature are reviewed as well. The therapeutic options for this particular complication are discussed. ⋯ Data suggest that severe pulmonary involvement in HVS1 infection associated with septicemia/shock is a rare but often fatal in immunocompetent adult as well. We suggest that ECMO might be the selected treatment for severe refractory ARDS in this clinical scenario. It seems to be an effective and useful ultimate therapeutic strategy for preventing death and furthermore permitting near-full pulmonary function recovery.
-
Review Comparative Study
A systematic review of nicardipine vs labetalol for the management of hypertensive crises.
Hypertensive emergencies are acute elevations in blood pressure (BP) that occur in the presence of progressive end-organ damage. Hypertensive urgencies, defined as elevated BP without acute end-organ damage, can often be treated with oral agents, whereas hypertensive emergencies are best treated with intravenous titratable agents. However, a lack of head-to-head studies has made it difficult to establish which intravenous drug is most effective in treating hypertensive crises. ⋯ A MEDLINE search was conducted using the term "labetalol AND nicardipine AND hypertension." Conference abstracts were searched manually. Ultimately, 10 studies were included, encompassing patients with hypertensive crises across an array of indications and practice environments (stroke, the emergency department, critical care, surgery, pediatrics, and pregnancy). The results of this systematic review show comparable efficacy and safety for nicardipine and labetalol, although nicardipine appears to provide more predictable and consistent BP control than labetalol.
-
Comparative Study
Venous vs arterial blood gases in the assessment of patients presenting with an exacerbation of chronic obstructive pulmonary disease.
The purpose of this study was to investigate the clinical correlation between arterial and venous blood gas (VBG) values in patients presenting to the emergency department (ED) with acute exacerbation of chronic obstructive pulmonary disease. ⋯ Venous pH and HCO(3) values show excellent correlation with arterial values. Using a previously validated screening cutoff of 45 mm Hg, venous CO(2) has 100% sensitivity in detecting arterial hypercarbia. There is insufficient agreement between venous and arterial CO(2) for VBG to replace arterial blood gas in determining the degree of hypercarbia.
-
Multicenter Study
Antimicrobial resistance in uncomplicated urinary tract infections in 3 California EDs.
Increased trimethoprim/sulfamethoxazole (TMP/SMX) resistance has led to changes in empiric treatment of female urinary tract infections (UTI) in the emergency department (ED), particularly increased use of fluoroquinolones (Acad Emerg Med.2009;16(6):500-507). Whether prescribing changes have affected susceptibility in uropathogens is unclear. Using narrow-spectrum agents and therapy tailored to local susceptibilities remain important goals. ⋯ In our population of ambulatory female ED patients, resistance to TMP/SMX is just below the 20% threshold that the Infectious Disease Society of America recommends for continued empiric use (Clin Infect Dis.1999;29(4):745-758, Clin Infect Dis.2011;52(5):e103-120), whereas resistance to other narrow-spectrum agents, such as nitrofurantoin and cephalexin, may be lower than published antibiograms for our sites. Fluoroquinolone resistance remains very low.
-
The use of the automatic external defibrillator (AED) can significantly reduce the time to defibrillation in patients with sudden cardiac death. This early defibrillation via the AED can also improve patient outcome, including survival and neurologic status among survivors. ⋯ In our design of the system, we found little useful information to guide us in the development and construction our system. This article is a review of the process of public access defibrillation AED system development such that other medical and academic leaders at similar institutions can more easily develop such systems.