The American journal of emergency medicine
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Patients with Duchenne muscular dystrophy are living longer and are increasingly seen in Emergency Departments. Though the most common cause of death remains progressive respiratory failure, increased life expectancies have unmasked the significance of progressive myocardial dysfunction, now associated with nearly 40% of mortalities in the DMD population. ⋯ Emergency physicians may encounter DMD patients with untreated, undiagnosed or worsening of known heart disease. This review will initially familiarize the emergency physician with the pathophysiology and lifetime trajectory of care for these patients before describing specific emergency department evaluation and treatment.
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Comparative Study
Comparison of the T-MACS score with the TIMI score in patients presenting to the emergency department with chest pain.
Guidelines recommend the use of risk scoring in patients with chest pain. In this study, we aimed to compare the thrombolysis in myocardial infarction risk index (TIMI) score with the Troponin Only Manchester Acute Coronary Syndrome Score (T-MACS) score and to investigate the usability of the T-MACS score in the emergency department. ⋯ The findings obtained in this study suggest that the T-MACS score is more successful than the TIMI score in determining the low risk (very low risk for T-MACS score), high risk, and estimated 1-month MACE risk in cases who presented to the emergency department with chest pain.
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Case Reports
Cases of prolonged cardiac arrest with preserved gasping successfully resuscitated with ECPR.
Longer cardiopulmonary resuscitation (CPR) time is associated with worsened neurological outcomes in out-of-hospital cardiac arrest (OHCA). Gasping during CPR is a favorable neurological predictor for OHCA. Recently, the efficacy of extracorporeal cardiopulmonary resuscitation (ECPR) in refractory cardiac arrest has been reported. ⋯ He was diagnosed with acute myocardial infarction. ECMO was withdrawn on day 4 and he was discharged from the hospital without any neurological impairment. Resuscitation and ECPR should not be abandoned in case of preserved gasping, even when the low-flow time is extremely long.
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Delayed neurological sequelae (DNS) are a severe complication of carbon monoxide poisoning (COP) and high predisposing rates of disability and mortality, yet the relationship between exposure factors and DNS remains unknown. The aim was to investigate the association between domestic sources of COP and DNS. ⋯ This study indicates that domestic COP caused by charcoal burning is more likely to trigger DNS than gas-emitting heaters.
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Association between resuscitation in the critical care resuscitation unit and in-hospital mortality.
Patients who present in shock have high expected mortality and early resuscitation is crucial to improve their outcomes. The Critical Care Resuscitation Unit (CCRU) is a specialized unit at the University of Maryland Medical Center (UMMC) that prioritizes early resuscitation of critically ill patients. We hypothesized that lactate clearance and reduction of Sequential Organ Failure Assessment (SOFA) score during CCRU stay would be associated with lower in-hospital mortality. ⋯ Care in the CCRU is more effective at reducing lactate than SOFA scores in patients with severe shock. However, SOFA score reduction in the resuscitation phase during the CCRU stay was associated with decreased odds of in-hospital mortality in this group of patients. Further studies are necessary to confirm our observations.