The American journal of emergency medicine
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This study examined the pH, lactate dehydrogenase (LDH), and heart rate values on the first day of hospitalization in patients with a prediagnosis of sepsis and biomarkers that may predict mortality. ⋯ Systemic pH, LDH, and heart rate values may be used to determine the best time to discharge patients from intensive care to other, more affordable hospital units.
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Review Comparative Study
Bleeding with direct oral anticoagulants vs warfarin: clinical experience.
The risk of bleeding in the setting of anticoagulant therapy continues to be re-evaluated following the introduction of a new generation of direct oral anticoagulants (DOACs). Interruption of DOAC therapy and supportive care may be sufficient for the management of patients who present with mild or moderate bleeding, but in those with life-threatening bleeding, a specific reversal agent is desirable. We review the phase 3 clinical studies of dabigatran, rivaroxaban, apixaban, and edoxaban in patients with nonvalvular atrial fibrillation, in the context of bleeding risk and management.
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After decades of research, effective chest compressions have emerged as a key component of high-quality cardiopulmonary resuscitation (CPR) for cardiac arrest patients. Minimizing interruptions in chest compressions is garnering increasing attention as a method to improve CPR quality and outcomes. Hands-on defibrillation has been suggested as both a safe and effective means of reducing interruptions in chest compressions. This article discusses the safety and efficacy of a novel and controversial method to reduce interruptions: hands-on defibrillation.
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In the United States, urolithiasis affects approximately 1 in 11 people, and there is evidence that the prevalence is increasing. A relatively recent treatment strategy for urolithiasis involves using medical expulsive therapy (MET) to increase the likelihood of spontaneous passage of ureteral stones. The 2 leading drug classes for MET are alpha-1-andrenergic receptor blockers and calcium channel blockers. ⋯ The number of procedures, length of hospital stay, and health care costs after the initial ED visit could potentially be reduced. Tamsulosin may also increase patient satisfaction by reducing the invasive treatment and decreasing the time to stone passage. This review focuses on the efficacy of tamsulosin based on stone location, after shock wave lithotripsy, compared with other MET drugs and in the acute setting of the ED.
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Multicenter Study
A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules.
The aim of this study was to evaluate patients presenting to the emergency department (ED) with wrist trauma using physical examination findings and functional tests and to identify findings with high sensitivity and specificity among the parameters assessed in patients with fracture in the wrist. The ultimate objective was thus to establish a reliable and widely usable clinical decision rule for determining the necessity of radiography in wrist trauma. ⋯ With their 100% sensitivity and 100% negative predictive values, the Karadeniz wrist rules may represent a clinical decision rule that can be used in practice in EDs. If all 5 findings are negative, there is no indication for wrist radiography.