The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study
Comparison of two glycemic discharge goals in ED patients with hyperglycemia, a randomized trial.
Hyperglycemia is commonly encountered in the ED; the importance of glucose reduction in patients well enough to be discharged is unknown. ⋯ In the intention-to-treat analysis, ED length of stay and 7-day outcomes were not significantly different whether moderate or loose glycemic control was pursued. However, the length of stay for those with discharge glucose <350 mg/dL was approximately 29 min longer. ED glycemic control did not appear to be associated negative short-term outcomes. Glucose reduction in well-appearing ED patients may consume time and resources without conferring short- or long-term benefits.
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Multicenter Study
Prognosis of cirrhotic patients admitted to Emergency Departments: A multicenter study.
Life threatening complications can occur at any stage of cirrhosis progression. There are few studies on the prognosis of cirrhotic patients managed in an Emergency Department (ED) although management of patients will occur in the ED. The objective of our study was to determine the risk factors for mortality in cirrhotic patients who visited to the ED. ⋯ The mortality rate of cirrhotic patients attending an ED was high. The prognosis of cirrhotic patients admitted to the ED depended on the severity of the liver and other organ dysfunction. The presence of a hepatocellular carcinoma on admission was also a risk factor for death.
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Multicenter Study Observational Study
Assessment of proadrenomedullin as diagnostic or prognostic biomarker of acute appendicitis in children with acute abdominal pain.
Acute appendicitis (AA) is one of the most frequent surgical pathologies in pediatrics. ⋯ Children with AA presented higher pro-ADM values than children with AAP of other etiologies, especially in cases of complicated AA. The combination of low values of pro-ADM and CRP can help to select children with low risk of AA.
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Several clinical trials and literature reviews have been conducted to evaluate the impact of corticosteroids on the physiological markers and clinical outcomes of patients in septic shock. While the findings have been somewhat contradictory, there is evidence of moderate benefit from the administration of low-dose corticosteroids to patients in septic shock. In this review, we discuss recent studies evaluating the impact of corticosteroids on morbidity and mortality in septic shock and explore future directions to fully elucidate when and how the administration of corticosteroid therapies can be beneficial. ⋯ There remains a need for improved therapy for patients in septic shock. Corticosteroids have shown some potential in improving mortality rates and clinical markers. Additional studies are needed to determine the optimal role of corticosteroids in septic shock.
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Randomized Controlled Trial
The effects of spinal immobilization at 20° on intracranial pressure.
In this study, it was aimed to evaluate whether spinal immobilization at 20°, instead of the traditional 0°, affects intracranial pressure (ICP) via the ultrasonographic (USG) measurement of optic nerve sheath diameter (ONSD). ⋯ Spinal immobilization at 0° as a part of routine trauma management increased ONSD and thus ICP. Secondly, we found that similar to immobilization at 0°, spinal immobilization at 20° increased ONSD.