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Sex differences in clinical outcomes amongst 1105 patients admitted with hip fractures
AbstractAmongst hip fracture admissions, mortality is higher in men than in women. However, sex differences in other care-quality measures have not been well-documented. We aimed to examine sex differences in mortality as well as a wide range of underlying health indicators and clinical outcomes in adults  ≥ 60 year of age admitted with hip fractures from their own homes to a single NHS hospital between April-2009 and June-2019. Sex differences in delirium, length of stay (LOS) and mortality in hospital, readmission, and discharge destination, were examined by logistic regression. There were 7 87 women and 318 men o...
Source: Internal and Emergency Medicine - April 26, 2023 Category: Emergency Medicine Source Type: research

ALM Fluid Therapy Shifts Sympathetic Hyperactivity to Parasympathetic Dominance in the Rat Model of Non-Compressible Hemorrhagic Shock
Excessive sympathetic outflow following trauma can lead to cardiac dysfunction, inflammation, coagulopathy, and poor outcomes. We previously reported that buprenorphine analgesia decreased survival after hemorrhagic trauma. Our aim is to examine the underlying mechanisms of mortality in a non-compressible hemorrhage rat model resuscitated with saline or adenosine, lidocaine, magnesium (ALM). Anesthetized adult male Sprague-Dawley rats were randomly assigned to Saline control group or ALM therapy group (both n = 10). Hemorrhage was induced by 50% liver resection. After 15 min, 0.7 mL/kg 3% NaCl ± ALM intravenou...
Source: Shock - January 21, 2022 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Noninvasive Beat-To-Beat Stroke Volume Measurements to Determine Preload Responsiveness During Mini-Fluid Challenge in a Swine Model: A Preliminary Study
The objectives of this paper are to compare EIT with an invasive pulse contour analysis (PCA) method in measuring SV during mini-fluid challenge in animals and determine preload responsiveness with EIT. Five pigs were anesthetized and mechanically ventilated. After removing 25% to 30% of the total blood from each animal, multiple fluid injections were conducted. The EIT device successfully tracked changes in SV beat-to-beat during varying volume states, i.e., from hypovolemia and preload responsiveness to target volume and volume overload. From a total of 50 100-mL fluid injections on five pigs (10 injections per pig), the...
Source: Shock - October 21, 2021 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Inhalation of 2% Hydrogen Improves Survival Rate and Attenuates Shedding of Vascular Endothelial Glycocalyx in Rats with Heat Stroke
Heat stroke is characterized by excessive oxidative stress and inflammatory responses, both of which are implicated in vascular endothelial glycocalyx shedding and heat-stroke mortality. Although molecular hydrogen has antioxidation and anti-inflammatory potency, its effect on the vascular endothelial glycocalyx in heat stroke has not been examined. Therefore, the aim of this study was to investigate the influence of hydrogen inhalation on the survival and thickness of the vascular endothelial glycocalyx of rats subjected to heat stroke. Altogether, 98 Wistar rats were assigned to the experiments. A heat-controlled chamber...
Source: Shock - September 23, 2021 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Pulmonary Vasodilation by Intravenous Infusion of Organic Mononitrites Of 1,2-Propanediol in Acute Pulmonary Hypertension Induced by Aortic Cross Clamping and Reperfusion: A Comparison With Nitroglycerin in Anesthetized Pigs
Conclusions: PDNO was an effective pulmonary vasodilator and appeared superior to nitroglycerin and inorganic nitrite, without causing significant systemic hypotension, impaired arterial oxygenation, or methaemoglobin formation in an animal model of SRACC and reperfusion. Also, PDNO may have kidney-protective effects and anti-inflammatory properties.
Source: Shock - June 12, 2020 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

A Serious Diagnosis Lacking Common Symptoms
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; & AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regi...
Source: The Case Files - May 28, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Stroke severity quantification by critical care physicians in a mobile stroke unit
Conclusion Critical care physicians in a mobile stroke unit may use the NIHSS as a clinical tool in the assessment of patients experiencing acute stroke. The disagreement in NIHSS scores was mainly for very low values and would not have changed the handling of the patients.
Source: European Journal of Emergency Medicine - May 1, 2019 Category: Emergency Medicine Tags: Original articles Source Type: research

Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial
Conclusions: In high-risk patients undergoing cardiac surgery, the perioperative use of an intra-aortic balloon pump did not reduce the occurrence of a composite outcome of 30-day mortality and major complications compared with usual care alone.
Source: Critical Care Medicine - July 14, 2018 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Fragmented Ambulance Services in Sri Lanka Evolve into A Modern System
Fragmented ambulance services evolve into a modern system Situated in the Indian Ocean, separated from India by the Palk Strait, Sri Lanka is the 25th largest island in the world (See Figure 1). Its complex geographical features-peaks, plateaus, valleys, rivers and tropical forests-are subject to a variety of natural hazards, including floods, landslides, cyclones and tsunamis.1 With ancient cultural roots going back to the 6th century B.C., Sri Lanka's modern colonial history began with Portuguese, Dutch and British settlements in the 16th century. By 1815, Britain was the sole colonial power. In 1948, Sri Lanka became an...
Source: JEMS Operations - November 2, 2017 Category: Emergency Medicine Authors: Nuwan Chamara Ekanayaka, EMT-I Tags: International Operations Source Type: news

Heart Rate Modification of Cardiac Output Following Cardiac Surgery: The Importance of Cardiac Time Intervals*
Objectives: Inadequate cardiac output is associated with a poor outcome following cardiac surgery and is generally modified by the use of positive inotropic agents, volume resuscitation, and pacing. Echocardiography-guided pacemaker optimization is used in the outpatient setting, using different variables including total isovolumic time and the Tei index. We sought to determine the acute impact of heart rate on cardiac electromechanics, cardiac output, and stroke volume in the perioperative setting. Design: Observational study. Setting: Cardiothoracic adult intensive care department. Patients: Twenty-four sequential pat...
Source: Critical Care Medicine - July 15, 2017 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Moderate Hypothermia Improves Cardiac and Vascular Function in a Pig Model of Ischemic Cardiogenic Shock Treated With Veno-Arterial ECMO
In conclusion, moderate and rapid hypothermia improves hemodynamics and cardiac and vascular function in a pig model of ischemic CS treated with ECMO.
Source: Shock - January 14, 2017 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

The Utility of Bolus IV Nicardipine for Hypertensive Emergencies in the Emergency Department
We describe the first two documented cases of use of nicardipine administered as an IV bolus dose in the emergency department for hypertensive emergencies involving acute ischemic stroke and hemorrhagic stroke.
Source: The American Journal of Emergency Medicine - March 21, 2016 Category: Emergency Medicine Authors: Stephanie N. Komura, Nadia I. Awad Tags: Case Report Source Type: research

The utility of bolus intravenous nicardipine for hypertensive emergencies in the ED
We describe the first 2 documented cases of use of nicardipine administered as an IV bolus dose in the emergency department (ED) for hypertensive emergencies involving acute ischemic stroke and hemorrhagic stroke.
Source: The American Journal of Emergency Medicine - March 20, 2016 Category: Emergency Medicine Authors: Stephanie N. Komura, Nadia I. Awad Tags: Case Report Source Type: research

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