European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
Multicenter Study
Effect of chest ultrasound on diagnostic workup in elderly patients with acute respiratory failure in the emergency department: a prospective study.
We carried out a prospective study performed in our ED, included patients older than 75 years presenting with acute respiratory failure. Noninclusion criteria were documented palliative care or the need for immediate intensive care. After informed consent approval and routine diagnostic procedure (clinical, radiological and laboratory tests), the ED physician established the first diagnosis. Chest ultrasound was then performed, and a second diagnosis was established. An adjudication committee also established a diagnosis. The unweighted Cohen's kappa (κ) coefficient was used to measure the strength of agreement between routine diagnostic approach, chest ultrasound and adjudication committee diagnosis. ⋯ In our study, chest ultrasound add-on investigation to standard approach improved diagnosis performance in elderly patients presenting to the ED with acute respiratory failure. Further multicenter randomized trials are warranted to confirm this finding.
-
Meta Analysis
Effect of oxygen supply on mortality in acute ST-elevation myocardial infarction: systematic review and meta-analysis.
Previous studies stated that high oxygen supply in patients with myocardial infarction (MI) was not associated with improved outcomes. However, the particularities of ST-elevation myocardial infarction (STEMI) and the results of a recent trial raised the question if this subgroup of patients benefits from high oxygen supply. This study aims to evaluate the clinical effect of high oxygen supply in patients with STEMI using a systematic review of the available literature. ⋯ Recurrent MI presented a contradictory result, favouring the lower oxygen protocol (RR 1.47; 95% CI, 0.84-2.56; I2 = 0%). The GRADE analysis was very low. High oxygen supply may be associated with a decrease in short-term mortality in STEMI patients, but the pooled data are not robust enough to allow definitive conclusions.
-
Multicenter Study
Effect of gender on out-of-hospital cardiac arrest survival: a registry-based study.
The aim of the study was to compare outcomes after out-of-hospital cardiac arrest (OHCA) between comparable female and male OHCA cohorts in a large nationwide registry. ⋯ In this large nationwide matched OHCA study, female patients had a better chance of survival with no significant difference in neurological outcome. We also noticed that female patients received delayed care with a shorter resuscitation effort compared to men; these complex issues warrant further specific investigation. Encouraging bystanders to act as quickly as possible and medical teams to care for female patients in the same way as male patients should increase survival rates.
-
Abnormal biochemical measurements have previously been described in runners following marathons. The incidence of plasma sodium levels outside the normal range has been reported as 31%, and the incidence of raised creatinine at 30%. This study describes the changes seen in electrolytes and creatinine in collapsed (2010-2019 events) and noncollapsed (during the 2019 event) runners during a UK marathon. ⋯ In this study, incidence of a raised creatinine was higher than previously reported. However, the significance of such a rise remains unclear with a similar rise seen in collapsed and noncollapsed runners, and resolution noted within 24 h. Abnormal sodium concentrations were observed infrequently, and severely abnormal results were not seen, potentially reflecting current advice to drink enough fluid to quench thirst.
-
The time factor in diagnosis and management of a deep vein thrombosis of the lower extremities (LE DVT) is of increasing importance in the era of crowding of emergency departments (ED). Current techniques used to detect LE DVT include a two-point regional compression ultrasound (rCUS), yet assessments are usually performed only during office hours. Outside office hours ultrasonography is postponed and low molecular weight heparin (LMWH) prescribed. ⋯ Emergency physicians show comparable agreement in diagnosing LE DVT using rCUS when compared to radiologists. Average time benefit is over an hour, thereby reducing unnecessary waiting and improving time to disposition. ED residents demonstrated similar results in both agreement and time-saving.