The American journal of emergency medicine
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Letter Observational Study
A multijurisdictional experience with the EZ-IO intraosseous device in the prehospital setting.
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Observational Study
Determination of a predictive cutoff value of NT-proBNP testing for long-term survival in ED patients with acute heart failure.
The main objective of this study was to determine a predictive cutoff value for plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) that could successfully predict the long-term (4-year) survival of patients with acute heart failure (HF) at the time of admission to the emergency department (ED). To our best knowledge, our study is the first research done to identify a predictive cutoff value for admission NT-proBNP to the prescriptive 4-year survival of patients admitted to ED with acute HF diagnosis. ⋯ Elevated NT-proBNP levels at the time of admission are a strong and independent predictor of all-cause mortality in patients with acute HF 4 years after admission. Furthermore, the optimal cutoff level of NT-proBNP used to predict 4-year survival had high sensitivity. However, especially in the case of long-term survival, additional prospective, large, and multicenter studies are required to confirm our results.
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Cardiac syncope can be classified as being either structural or dysrhythmogenic in origin, and it may be the only warning symptom of sudden cardiac death. One of the causes of dysrhythmic sudden cardiac death in young adults with structurally normal hearts is Brugada syndrome. Electrocardiogram (ECG) of Brugada syndrome is characterized by an ST-segment elevation in the right precordial leads. ⋯ This pattern was reverted back to normal 5 minutes later and never showed up again on his future ECGs. In our case, it was only the earliest ECG that made the diagnosis possible since all future ECGs showed a perfectly normal pattern throughout the follow-up period. In all syncope patients, initial ECGs should be kept and filed to be reviewed again in case the primary physician is not competent enough for the evaluation of ECG.