The American journal of emergency medicine
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Review Meta Analysis
Effects of morphine on P2Y12 platelet inhibitors in patients with acute myocardial infarction: A meta-analysis.
To explore the effects of morphine on P2Y12 platelet inhibitors in patients with acute myocardial infarction (AMI). ⋯ Morphine effectively suppresses the inhibition effect of P2Y12 platelet inhibitors in patients with AMI.
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The American Heart Association (AHA) recently established the Resuscitation Quality Improvement (RQI) program, which requires physicians to perform quarterly cardiopulmonary resuscitation (CPR) skill checks. The aim of this study was to determine if timing of last training impacted skill performance of emergency physicians. ⋯ There was no difference between delivery of high-quality CPR in EM physicians who had recent BLS training and those who did not.
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Comparative Study
Delay to initiation of out-of-hospital cardiac arrest EMS treatments.
Time to initial treatment is important in any response to out-of-hospital cardiac arrest (OHCA). The purpose of this paper was to quantify the time delay for providing initial EMS treatments supplemented by comparison with those of other EMS systems conducting clinical trials. ⋯ Delay to EMS treatments are common and may affect clinical outcomes. Neither Utstein out-of-hospital guidelines [1] nor U.S. Cardiac Arrest Registry to Enhance Survival (CARES) databases require capture of these elements. EMS is often not providing treatments quickly enough to optimize clinical outcomes. Further regulatory change/research are needed to determine whether OHCA outcome can be improved by novel changes such as enhancing bystander effectiveness through drone-delivered drugs/devices & real-time dispatcher direction on their use.
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No guidelines exist for the management of massive pulmonary embolism (PE) in COVID-19. We present a COVID-19 patient with refractory acute respiratory syndrome (ARDS), and life-threatening PE who underwent successful thrombolysis. ⋯ Thrombolysis may have a critical therapeutic role for massive PE in COVID-19; however the risk of potential bleeding should not be underestimated. Point-of-care ultrasound has a pivotal role in the management of refractory ARDS in COVID-19.
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Randomized Controlled Trial Comparative Study
Comparison of manual and mechanical chest compression techniques using cerebral oximetry in witnessed cardiac arrests at the emergency department: A prospective, randomized clinical study.
We aimed to compare regional cerebral oxygen saturation (rSO2) levels during cardiopulmonary resuscitation (CPR), performed either manually or using a mechanical chest compression device (MCCD), in witnessed cardiac arrest cases in the emergency department (ED), and to evaluate the effects of both the CPR methods and perfusion levels on patient survival and neurological outcomes. ⋯ A relationship between ROSC and high rSO2 levels in witnessed cardiac arrests exists. Monitoring rSO2 levels during CPR would be useful in CPR management and ROSC prediction. During CPR, MCCD or manual chest compression has no distinct effect on oxygen delivery to the brain.