Critical Care Archives - Page 4 of 5 - The Western Journal of Emergency Medicine

Critical Care

Epidemiología del Síndrome de Respuesta Inflamatoria Sistémica en el Departamento de Emergencia

Volume 15, Issue 3, May 2014
Horeczko T, MD, MSCR, et al.

Guías de consenso recomiendan cernimiento de sepsis para adultos con síndrome de respuesta inflamatoria sistémica (SIRS), pero la epidemiología de SIRS en pacientes adultos de sala de emergencia (ED) es poco entendida. Énfasis reciente en cuidado de salud costo efectivo y basado en resultados, motiva la evaluación del desempeño de esfuerzos de gran escala tales como cernimiento de sepsis. Estudiamos una muestra representativa nacional para clarificar la epidemiología de SIRS en la sala de emergencia y su categoría subsecuente de enfermedad.

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Critical Care

Continuous Hemodynamic Monitoring in Acute Stroke: An Exploratory Analysis

Volume 15, Issue 4, July 2014
Ayan Sen, MD, MSc et al.

Non-invasive, continuous hemodynamic monitoring is entering the clinical arena. The primary objective of this study was to test the feasibility of such monitoring in a pilot sample of Emergency Department (ED) stroke patients. Secondary objectives included analysis of hemodynamic variability and correlation of continuous blood pressure measurements with standard measurements.

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Critical Care

Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the Emergency Department

Volume 15, Issue 3, May 2014
Timothy Horeczko, MD, MSCR et al.

Consensus guidelines recommend sepsis screening for adults with systemic inflammatory response syndrome (SIRS), but the epidemiology of SIRS among adult emergency department (ED) patients is poorly understood. Recent emphasis on cost-effective, outcomes-based healthcare prompts the evaluation of the performance of large-scale efforts such as sepsis screening. We studied a nationally representative sample to clarify the epidemiology of SIRS in the ED and subsequent category of illness.

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Critical Care

Spectacular Retroperitoneal Impalement

A 47-year-old woman presented with a history of an accidental fall against a glass door at home, causing a 15 cm-wide wound on the right gluteal region and hematuria. General health was good: blood pressure 115/70 mmHg with a heart rate of 100 beats/min; red cell count 4.460 x103/100 mL; hemoglobin concentration 10 g/100 ml; and hematocrit 31%.

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Critical Care

Improving Diagnostic Accuracy of Anaphylaxis in the Acute Care Setting

The identification and appropriate management of those at highest risk for life-threatening anaphylaxis remains a clinical enigma. The most widely used criteria for such patients were developed in a symposium convened by National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network. In this paper we review the current literature on the diagnosis of acute allergic reactions as well as atypical presentations that clinicians should recognize. Review of case series reveals significant variability in definition and approach to this common and potentially life-threatening condition. Series on fatal cases of anaphylaxis indicate that mucocutaneous signs and symptoms occur less frequently than in milder cases. Of biomarkers studied to aid in the work-up of possible anaphylaxis, drawing blood during the initial six hours of an acute reaction for analysis of serum tryptase has been recommended in atypical cases. This can provide valuable information when a definitive diagnosis cannot be made by history and physical exam.

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Critical Care

Leukocytosis as Prognostic Indicator of Major Injury

To test the diagnostic use of the triage white blood cell (WBC) count in differentiating major from minor injuries.

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Critical Care Injury Prevention

Competitive Wrestling-related Injuries in School Aged Athletes in U.S. Emergency Departments

To describe the characteristics of wrestling injuries occurring in male athletes aged 7–17 treated in United States (U.S.) emergency departments (ED) from 2000–2006, and to compare injury patterns between younger & older youth wrestlers.

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Critical Care

Randomized Controlled Trial of Prophylactic Antibiotics for Dog Bites with Refined Cost Model

The aim of this study was to determine the rate of infection at which it is cost-effective to treat dog bite wounds with antibiotics.

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Critical Care

A Pilot Study of the Performance Characteristics of the D-dimer in Presumed Sepsis

To determine if a sensitive D-dimer assay can exclude progression to organ dysfunction, death, and intensive care unit (ICU) admission in patients presenting to the emergency department (ED) with suspected infection, and if increasing levels of D-dimer are predictive of those end points.

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Critical Care

Etomidate as an Induction Agent in Septic Patients: Red Flags or False Alarms?

Despite its widespread use in North America and many other parts of the world, the safety of etomidate as an induction agent for rapid sequence intubation in septic patients is still debated. In this article, we evaluate the current literature on etomidate, review its clinical history, and discuss the controversy regarding its use, especially in sepsis. We address eight questions

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Critical Care

Cocaine-Associated Seizures and Incidence of Status Epilepticus

Acute complications from cocaine abuse are commonly treated in the emergency department (ED); one of the most consequential is status epilepticus. The incidence of this complication is not clearly defined in the prior literature on cocaine-associated sequelae. We evaluated the incidence of status epilepticus in patients with seizures secondary to suspected cocaine use.

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Critical Care

Chlorine Gas: An Evolving Hazardous Material Threat and Unconventional Weapon

Chlorine gas represents a hazardous material threat from industrial accidents and as a terrorist weapon. This review will summarize recent events involving chlorine disasters and its use by terrorists, discuss pre-hospital considerations and suggest strategies for the initial management for acute chlorine exposure events.

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Critical Care

Luxatio Erecta Complicated By Anterior Shoulder Dislocation During Reduction

Luxatio erecta humeri is an uncommon form of glenohumeral dislocation, resulting in the inferior displacement of the humeral head. Treatment with traction-counter traction techniques is usually successful in reducing most cases. We describe an unusual complication of this condition where initial reduction attempts of a luxatio erecta humeri repositioned the shoulder to an anterior dislocation position. After a thorough search of the literature, we were unable to find a similar case report of this type of complication during the reduction of a luxatio erecta shoulder dislocation.

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Critical Care

Frequency of Incidental Findings on Computed Tomography of Trauma Patients

To determine the incidence and frequency of follow-up instructions for incidental findings on computed tomography (CT) scanning of the abdomen and pelvis in trauma patients.

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Critical Care

Early Glycemic Control in Critically Ill Emergency Department Patients: Pilot Trial

Glycemic control in the critically ill intensive care unit (ICU) patient has been shown to improve morbidity and mortality. We sought to investigate the effect of early glycemic control in critically ill emergency department (ED) patients in a small pilot trial.

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Critical Care

Eschmann Introducer Through Laryngeal Mask Airway: A Cadaveric Trial of An Alternate Means of Rescue Intubation

Laryngeal mask airways (LMAs) are often used as airway rescue devices where laryngoscopy is difficult. The LMA does not protect the airway and is preferably replaced with a cuffed endotracheal tube. There are reports of cases where an Eschmann tracheal tube introducer (ETTI) was successfully used to bridge between a standard LMA and an endotracheal tube. This project was designed to determine whether an Eschmann stylet can reliably be passed through an LMA into the trachea as a means of rescue intubation.

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Critical Care

The Utility of Bedside Ultrasound in the Detection of a Ruptured Globe in a Porcine Model

Recent case reports have shown that ultrasonography can be used to diagnose ocular pathology in an emergency setting. Ultrasound may be especially useful when periorbital edema and pain interfere with the examination of the post-traumatic eye.

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Critical Care

Terrain Park Injuries

This study examined demographics, injury pattern, and hospital outcome in patients injured in winter resort terrain parks.

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Critical Care

Cervical Spine Fracture in Ankylosing Spondylitis

A 66-year-old man with a history of ankylosing spondylitis presented to the emergency department as a trauma activation after a fall backward onto his sacrum from the bottom rung of a ladder.

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Critical Care

Wound Botulism in Injection Drug Users: Time to Antitoxin Correlates with Intensive Care Unit Length of Stay

We sought to identify factors associated with need for mechanical ventilation (MV), length of intensive care unit (ICU) stay, length of hospital stay, and poor outcome in injection drug users (IDUs) with wound botulism (WB).

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Critical Care

Unsuspected Pulmonary Embolism in Observation Unit Patients

Many emergency department (ED) patients with cardiopulmonary symptoms such as chest pain or dyspnea are placed in observation units but do not undergo specific diagnostic testing for pulmonary embolism (PE). The role of observation units in the diagnosis of PE has not been studied. We hypothesized that there was a small but significant rate of unsuspected PE in our observation unit population.

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Critical Care

International Perspective from the United Kingdom on “Surgeons’ and Emergency Physicians’ Perceptions of Trauma Management and Training”

My comments on this paper are drawn from a London-based, British National Health Sevice (NHS) perspective.

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Critical Care

Surgeons’ and Emergency Physicians’ Perceptions of Trauma Management and Training

The study objective was to determine whether surgeons and emergency medicine physicians (EMPs) have differing opinions on trauma residency training and trauma management in clinical practice.

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Critical Care

Left Ventricular Hypertrophy May Be Transient in the Emergency Department

To assess the reproducibility of serial ECGs done in the emergency department (ED) with regard to the presence or absence of LVH.

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Critical Care

Linear Correlation of Endotracheal Tube Cuff Pressure and Volume

Endotracheal tube cuff (ETTc) inflation by standard methods may result in excessive ETTc pressure. Previous studies have indicated that methods of cuff inflation most frequently used to inflate ETTcs include palpation of the tension in the pilot balloon or injection of a predetermined volume of air to inflate the pilot balloon. If a logarithmic relationship exists between ETTc volume and ETTc pressure, small volumes of additional air will result in dramatic pressure increases after a volume threshold is reached. Our goal was to determine whether the relationship between ETTc volume and ETTc pressure is linear or non-linear.

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Critical Care

International Perspective from Turkey on “Unsuspected Pulmonary Embolism in Observation Unit Patients”

Author Affiliation Arif Alper Cevik, MD Eskisehir Osmangazi University Medical Center, Department of Emergency Medicine, Turkey Pulmonary embolism (PE) is a challenging diagnosis for emergency physicians because of its non-specific clinical presentation. Although “chest pain” is one of the major symptoms of PE,1 it can be part of other serious diagnoses, such as aortic dissection, […]

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