The American journal of emergency medicine
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American Heart Association/American College of Cardiology guidelines recommend that patients with definite unstable angina or non-ST-segment elevation myocardial infarction (NSTEMI) receive dual antiplatelet therapy on presentation to the hospital when undergoing early invasive management or "as soon as possible" after admission when being managed conservatively. The guidelines do not specify whether these medications should be administered in the emergency department (ED). Our aim was to determine whether ED administration of a thienopyridine was associated with clinical outcomes among patients with NSTEMI. ⋯ There was no association between ED thienopyridine administration and in-hospital major bleeding or mortality. Emergency department length of stay, electrocardiographic changes, and elevated troponin were associated with ED thienopyridine administration.
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Most medications administered to children are weight-based, and inaccurate weight estimation may contribute to medical errors. Previous studies have been limited to hypothetical patients and those in cardiopulmonary arrest. We aim to determine the accuracy of weight estimates by Emergency Medical Services (EMS) personnel of children receiving medications and to identify factors associated with accuracy. ⋯ EMS personnel are generally accurate in estimating weights of children. There was an association between underestimated weights and inaccurate medication dosing. Younger children or those presenting with seizure or cardiopulmonary arrest were more likely to have inaccurate weight estimates.
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EDTA-dependent pseudothrombocytopenia (EDTA-PTCP) is a phenomenon that occurs in vitro when EDTA reacts with harvested blood. EDTA-dependent pseudothrombocytopenia usually does not indicate thrombocytopenia in vivo. Here, we report the first case of EDTA-PTCP complicated by eosinophilic pneumonia. ⋯ The patient's bronchoalveolar lavage contained 45% eosinophils, and a diagnosis of acute eosinophilic pneumonia was made. In recent studies, the occurrence of eosinophilic disease has been shown in idiopathic thrombocytopenic purpura. EDTA-dependent pseudothrombocytopenia is an in vitro phenomenon, although platelet activation that results in eosinophil invasion may occur in severe cases.
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Prevention of secondary neurologic injury is critical during the airway management of a trauma patient. Trauma patients are assumed to have an unstable cervical spine (C-spine) until proven otherwise: orotracheal intubation during airway management may result in a certain amount of C-spine movement. This study, therefore, aimed to compare C-spine movement within different advanced airway devices (Macintosh blade, McCoy Blade, LMA, I-LMA, and Combitube) during airway management. ⋯ Supraglottic devices used during airway management cause C-spine movement less or equal to conventional laryngoscopes. Furthermore, because of ease of training and blind insertion, supraglottic devices can be safely used with trauma patients when C-spine integrity is a concern.