The American journal of emergency medicine
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Is pulseless electrical activity a reason to refuse cardiopulmonary resuscitation with ECMO support?
Cardiopulmonary resuscitation with ECMO support (ECPR) has shown to improve outcome in patients after cardiac arrest under resuscitation. Most current recommendations for ECPR do not include patients with a non-shockable rhythm such as PEA and asystole. ⋯ Survival to discharge in patients with PEA as initial rhythm at the time of decision for ECPR is 23.8% while no patients with asystole as initial rhythm survived discharge. Patients with PEA should be carefully considered for ECPR.
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Randomized Controlled Trial
Kinect-based real-time audiovisual feedback device improves cardiopulmonary resuscitation quality of lower-body-weight rescuers.
Chest compression (CC) quality is associated with rescuer posture and body weight. We designed a Kinect module-based real-time audiovisual feedback (AVF) device to investigate the relationship between rescuer posture, body weight, and CC quality. ⋯ The Kinect-based AVF device can significantly improve CC quality in manikin training in rescuers with their body weight<71kg.
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Comparative Study
Comparison of bronchodilator administration with vibrating mesh nebulizer and standard jet nebulizer in the emergency department.
Projects comparing bronchodilator response by aerosol devices in the ED are limited. Evidence suggests that the vibrating mesh nebulizer (VMN) provides 5-fold greater aerosol delivery to the lung as compared to a jet nebulizer (JN). The aim of this project was to evaluate a new nebulizer deployed in an Emergency Department. ⋯ The VMN was associated with fewer admissions to the hospital, shorter length of stay in the ED and a reduction in albuterol dose. The device type was a predictor of discharge, disposition and amount of drug used. Randomized controlled studies are needed to corroborate these findings.
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Historical Article
Ultrasound assisted evaluation of chest pain in the emergency department.
Chest pain is a commonly encountered emergency department complaint, with a broad differential including several life-threatening possible conditions. Ultrasound-assisted evaluation can potentially be used to rapidly and accurately arrive at the correct diagnosis. ⋯ Information is kept on a checklist. We hypothesize that this will result in a quicker, more accurate evaluation of chest pain in the ED leading to timely treatment and disposition of the patient, less provider anxiety, a reduction in the number of diagnostic errors, and the removal of false assumptions from the diagnostic process.
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Cirrhosis is a significant cause of death in the U.S. and has a variety of causes, most commonly Hepatitis C and alcohol. Liver fibrosis and nodule formation result in significant complications due to portal system hypertension. There are several deadly complications emergency physicians must consider. ⋯ Decompensating cirrhotics may require extensive resuscitation, and knowledge of the evaluation and management of complications associated with cirrhosis can improve care for patients with severe liver disease.