The American journal of emergency medicine
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The early identification of septic shock patients at high risk of poor outcome is essential to early initiate optimal treatments and to decide on hospital admission. Biomarkers are often used to evaluate the severity. In prehospital settings, the availability of biomarkers, such as lactate, is restricted. In this context, clinical tools such as skin mottling score (SMS) and capillary refill time (CRT) are more suitable. In this study, we describe prehospital SMS and CRT's ability to predict mortality of patients with septic shock initially cared in the prehospital setting by a mobile intensive care unit. ⋯ In this study, we report an association between prehospital SMS and CRT, and mortality of patients with septic shock. SMS and CRT are simple tools that could be used to optimize the triage and to decide early intensive care admission.
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Observational Study
Stimulant drugs are associated with violent and penetrating trauma.
Substance abuse is associated with traumatic injuries. Prior studies of drug use and injury have relied on urine drug of abuse screens, which have false positives, false negatives and inability to detect novel drugs. Our study characterizes the relationship between injury mechanism and drugs of abuse detected in serum via confirmatory testing. ⋯ Many drugs are present in trauma patients that are not routinely detected on urine drug of abuse tests. Both stimulant drugs and cigarette smoking are indicators of multidimensional hazardous behaviors, which were associated with more violent and penetrating trauma.
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Case Reports
Optimal treatment modality for coexisting acute myocardial infarction and ischemic stroke.
The simultaneous occurrence of acute ST-segment elevation myocardial infarction and acute ischemic stroke is an uncommon and complex clinical presentation. Although the medical treatment of both diseases is similar, data regarding optimal reperfusion therapy are limited. Nevertheless, use of tissue plasminogen activator may be a reasonable strategy for treatment of both diseases. We present a rare case of coexisting thrombosis of the coronary artery and mid cerebral artery that was managed successfully with tissue plasminogen activator thrombolytic therapy.
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Case Reports
Traumatic cervical fusion hardware displacement presenting with dysphagia and dysphonia.
Surgery for degenerative cervical myelopathy has been increasing in incidence. Almost 20% of patients have complications related to their surgery, although hardware extrusion is rare and generally reported in the first post-operative month. We report the case of a woman with new dysphagia and hoarseness secondary to traumatic screw dislodgement into her pre-vertebral space 5 months after cervical discectomy.
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Observational Study
Prehospital non-invasive ventilation in acute respiratory failure is justified even if the distance to hospital is short.
Evaluation of the efficacy of prehospital non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary edema (CPE). ⋯ Prehospital NIV-treatment should be performed in patients with COPD-exacerbation and CPE, even if the distance between emergency scene and hospital is short.