European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
The use of emergency medical services increases with the age of patients. Some care providers hold on to the prejudice that these alarms are unnecessary or of a lower importance. We assessed the relation of age and age-dependent emergency characteristics, taking into consideration the ratings of emergency physicians on whether or not emergency cases were considered truly in need of emergency physician attendance. ⋯ Despite common prejudices, emergency cases in elder patients are rated more often as in need of emergency physician attendance compared with those involving younger patients.
-
Presentation with acute chest pain is common, but the conventional 12-lead ECG has limitations in the detection of regional myocardial ischaemia. The previously described method of the body surface mapping system (BSM) Delta map, derived from an 80-electrode BSM, as well as a novel parameter total ischaemic burden (IB), may offer improved diagnostic sensitivity and specificity in patients with myocardial ischaemia. ⋯ This pilot study confirms the feasibility of using the Delta map for the diagnosis of ACS in patients presenting to the ED with cardiac-sounding chest pain and suggests that it has promising diagnostic accuracy and has superior sensitivity and specificity to the 12-lead ECG. The novel parameter of IB shows a significant correlation with troponin-I and is a promising tool for describing the extent of ischaemia. The use of the BSM Delta map in the ED setting could improve the diagnosis of clinically important ischaemic heart disease and furthermore presents the result in an intuitive manner, requiring little specialist experience. Further larger scale study is now warranted.
-
Observational Study
Peripheral venous and arterial lactate agreement in septic patients in the Emergency Department: a pilot study.
Lactate measurements are routinely used in sepsis for prognostication and for guiding treatment. Although venous lactate measurements have widely been used, most studies have used arterial lactate (A-LACT). The interchangeability between the measurements is debatable. ⋯ The mean difference between the measurements (venous-arterial) was 0.54 mmol/l, with 95% limits of agreement of -0.11 to 1.18 mmol/l. This pilot study demonstrates the potential use of PV-LACT as a substitute for A-LACT measurement in septic ED patients. However, further definitive investigation is needed to support widespread clinical adoption of peripheral venous lactate.