J Emerg Med
-
In the province of Quebec (Canada), paramedics use the esophageal tracheal Combitube (ETC) for prehospital airway management. ⋯ Proportions of successful ventilation and ETC first-pass success are lower than those reported in the literature with supraglottic airway devices. The reasons explaining these lower rates and their impact on patient-centered outcomes need to be studied.
-
A severe baclofen intoxication is a potentially life-threatening condition. It is associated with coma and can cause brainstem reflexes to disappear, simulating a brain death-like condition. When given intensive supportive care and time, patients can recover without residual neurological damage. ⋯ We present a case of a patient with known spastic cerebral palsy who was found unresponsive with no signs of breathing. He was brought to the Emergency Department, intubated, put on the ventilator, and hemodynamically stabilized. Brainstem reflexes were absent and he appeared brain dead. During the secondary survey, an intrathecal baclofen pump was found at his left lower abdomen, with a swelling next to it. A baclofen intoxication was suspected. He was admitted to the Intensive Care Unit, and after 72 h of supportive care complete neurological recovery was achieved. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Systemic baclofen intoxication can simulate a brain death-like condition. There is no reliable correlation between baclofen serum levels and central nervous system depression in case of an intoxication. It is important for emergency physicians to recognize a baclofen intoxication as a possible cause of coma and absent brainstem reflexes. Recuperation is spontaneous and can follow within days without residual damage. Because these patients may be brought in after a period of apnea or cardiopulmonary resuscitation, focus may be on post-hypoxic encephalopathy considerations instead of a possible baclofen intoxication.
-
Emergency physicians must choose whether patients with asthma are admitted to a hospital ward or a higher level of care, such as an intermediate care unit (IMC) or intensive care unit (ICU). ⋯ Combinations of predictor variables, available early in a patient's stay, stratify risk of admission to an IMC/ICU bed.
-
The role of thrombolytic treatment in patients with intermediate high-risk pulmonary embolism (IHR-PE) remains controversial. ⋯ Thrombolysis was associated with a significant reduction of the combined endpoint of hemodynamic decompensation and death during hospitalization and lower all-cause mortality after 1 year in an unselected group of patients with IHR-PE. Further studies are required to improve the therapy of IHR-PE and to identify the subgroup of patients that might benefit from thrombolytic therapy.
-
A reduced dose of 5 units of intravenous (i.v.) insulin has been widely accepted for treatment of hyperkalemia in those with end-stage renal dysfunction. However, there remains a dearth of data for patients with moderate renal dysfunction (estimated glomerular filtration rate 15-59 mL/min/m2). ⋯ There was no difference in hypoglycemic events among patients with moderate renal dysfunction receiving 5 vs. 10 units of i.v. insulin for hyperkalemia. However, 10 units of i.v. insulin lowered serum potassium significantly more than 5 units of i.v. insulin.