The American journal of emergency medicine
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Hyperglycemia and hyperosmolality are associated with poor outcomes among acute ischemic stroke (AIS) patients. ⋯ Hyperglycemia was associated with poor outcome, even after excluding the effect of hyperosmolality. However, hyperosmolality without hyperglycemia was not associated with poor outcome. An additive effect, likely reflecting severe hyperglycemia, was observed.
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Randomized Controlled Trial Comparative Study
Does practice make perfect? Prospectively comparing effects of 2 amounts of practice on tourniquet use performance.
Although a lifesaving skill, currently, there is no consensus for the required amount of practice in tourniquet use. We compared the effect of 2 amounts of practice on performance of tourniquet use by nonmedical personnel. ⋯ Three applications per monthly practice session were superior to one. This is the first prospective validation of a tourniquet practice program based on objective measurements.
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To determine if the increase in transient focal enhancement of the liver adjacent to the gallbladder seen on dynamic computed tomography (CT) is greater in gangrenous cholecystitis than in nongangrenous cholecystitis by determining the CT attenuation value. ⋯ The increase in transient focal enhancement of the liver adjacent to the gallbladder during the arterial phase of dynamic CT was greater in gangrenous cholecystitis than in nongangrenous cholecystitis.
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Review Meta Analysis
Chemical agents for the sedation of agitated patients in the ED: a systematic review.
Chemical agents commonly used to sedate agitated patients in the emergency department include benzodiazepines, antipsychotics, or a combination of the 2 classes. Our objective was to determine if a class or combination therapy is (1) more effective, as measured by the proportion sedated at 15-20 minutes and the need for repeat sedation, and (2) safer, as measured by the proportion of reported adverse events. ⋯ Combination therapy sedated a greater proportion of patients at 15-20 minutes than benzodiazepines alone. Antipsychotics and combination therapy were more effective, requiring less repeat doses for sedation than benzodiazepines. The risk of any adverse event was higher with benzodiazepines.
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The changes of the optic nerve sheath diameter (ONSD) have been used to assess changes of the intracranial pressure for 20 years. The aim of this research was to further quantify the technique of measuring the ONSD for this purpose. ⋯ The ONSD and the ONSD/ETD ratio can indicate low intracranial pressure, but quantification is impossible at intracranial pressure less than 13 mm Hg. In elevated intracranial pressure, the ONSD and the ratio provide readings that correspond to readings in millimeters of mercury. The ONSD method, reinforced with additional calculations, may help to indicate a raised intracranial pressure, evaluate its severity quantitatively, and establish quantitative goals for treatment of intracranial hypertension, but the limitations of the method are to be taken into account.