European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Meta Analysis
Outcomes of out-of-hospital cardiac arrest in patients with SARS-CoV-2 infection: a systematic review and meta-analysis.
Out-of-hospital cardiac arrests increased during the COVID-19 pandemic and a direct mechanism of cardiac arrest in infected patients was hypothesized. Therefore, we conducted a systematic review and meta-analysis to assess outcomes of SARS-CoV-2 patients with out-of-hospital cardiac arrest. ⋯ PROSPERO - CRD42021243540.
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Cardiac arrhythmia, specifically paroxysmal supraventricular tachycardia (SVT), accounts for a substantial proportion of emergency medical services resources utilisation. Reconversion requires increasing the atrioventricular node's refractoriness, which can be achieved by vagal manoeuvres, pharmacological agents or electrical cardioversion. There are multiple variants of vagal manoeuvres, including the Valsalva manoeuvre (VM). While the effectiveness of the standard VM has already been systematically reviewed, there has been no such analysis for the modified VM. ⋯ The available evidence is highly suggestive to support the use of the modified VM compared to the standard VM in the treatment of adult patients with SVT. Meta-analysis showed a higher success rate, required less medication use, and resulted in an equal number of adverse events. However, these results cannot be regarded as definitive in the absence of higher-quality studies.
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Previous studies found that septic patients with normothermia have higher mortality than patients with fever. We hypothesize that antibiotic therapy is less frequently initiated if infectious patients present with normothermia to the emergency department (ED). ⋯ Normothermia in patients presenting with infection was associated with receiving less antibiotic therapy in the ED compared to presentations with hyperthermia. Moreover, normothermia was associated with a higher mortality risk than hyperthermia.
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Hyperoxemia may be associated with increased mortality in emergency room or ICU patients. However, its effect during septic shock is still debated. ⋯ We did not find any impact of early hyperoxemia on mortality in this population of mechanically ventilated patients with SEPSIS-3 septic shock criteria.