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Total 34927 results found since Jan 2013.

Presentation, Management and Outcomes of Pediatric Pulmonary Embolus: A Retrospective Review
Conclusions Of 18 pediatric patients treated for PE at a single institution over 10 years, vital signs and laboratory data did not predict disease severity or clot burden, and CTPA was required for diagnosis in all but 1. Emergency room providers must have a high index of suspicion for diagnosis and cannot be reassured by normal electrocardiogram or plain film findings. At a time when pediatric providers are under pressure to minimize unnecessary radiation exposure, this lack of correlation of clinical presentation and laboratory findings highlights the importance of considering CTPA when PE is suspected.
Source: Pediatric Emergency Care - February 1, 2022 Category: Emergency Medicine Tags: Original Articles Source Type: research

Fatal Aortic Dissection During ECMO Axillary Cannulation Confirmed by Postmortem CT Angiography.
PMID: 28277737 [PubMed - as supplied by publisher]
Source: American Journal of Respiratory and Critical Care Medicine - March 8, 2017 Category: Respiratory Medicine Authors: Joffre J, Preda G, Arrivé L, Maury E Tags: Am J Respir Crit Care Med Source Type: research

Features and Outcomes of Methamphetamine Associated Pulmonary Arterial Hypertension.
CONCLUSIONS: Meth-APAH is a severe and progressive form of PAH with poor outcomes. Future studies should focus on mechanisms of disease and potential therapeutic considerations. PMID: 28934596 [PubMed - as supplied by publisher]
Source: American Journal of Respiratory and Critical Care Medicine - September 21, 2017 Category: Respiratory Medicine Authors: Zamanian RT, Hedlin H, Greuenwald P, Wilson DM, Segal JI, Jorden M, Kudelko K, Liu J, Hsi A, Rupp A, Sweatt AJ, Tuder R, Berry GJ, Rabinovitch M, Doyle RL, De Jesus Perez V, Kawut SM Tags: Am J Respir Crit Care Med Source Type: research

Imaging in the Intensive Care Unit
This article will provide guidance for interpretation of CXR and thoracic CT images, discuss some of the invasive devices routinely used, and review the radiologic manifestations of common pathologic disease states encountered in ICU patients. In addition, imaging findings and complications of more specific clinical scenarios in which the incidence has increased in the ICU setting, such as patients who are immunocompromised, have interstitial lung disease, or COVID-19, will also be discussed. Communication between the radiologist and intensivist, particularly on complicated cases, is important to help increase diagnostic a...
Source: Seminars in Respiratory and Critical Care Medicine - November 28, 2022 Category: Respiratory Medicine Authors: Toy, Dennis Siegel, Mark D. Rubinowitz, Ami N. Tags: Review Article Source Type: research

Dabigatran etexilate: management in acute ischemic stroke.
Abstract A 54-year-old man treated with dabigatran experienced new onset of a stroke with a score of 9 on the National Institutes of Health Stroke Scale. Administration of recombinant tissue plasminogen activator (rtPA) was not recommended because of the dabigatran therapy. Angiography showed occlusion of the left middle cerebral artery by an embolic thrombus. Suction thrombectomy achieved flow through the inferior division of the artery. Computed tomography of the head showed possible intracranial hemorrhage, and dabigatran reversal was attempted with prothrombin complex concentrate and recombinant factor VIIa. C...
Source: American Journal of Critical Care - March 1, 2013 Category: Nursing Authors: Javedani PP, Horowitz BZ, Clark WM, Lutsep HL Tags: Am J Crit Care Source Type: research

Uncontrolled bleeding of the gastrointestinal tract
Purpose of review Acute gastrointestinal bleeding is a frequent emergency situation, whose incidence will likely rise as a result of the increasing use of direct anticoagulants and of the medical progresses resulting in longer life expectancy with underlying comorbidities. Updated guidelines and improvements in the diagnostic and therapeutic tools are now available and will likely improve the management of massive gastrointestinal bleeding in the near future. Recent findings The assessment of severity has been improved by validated scores useable upon admission. Massive blood transfusion protocols and specific care in...
Source: Current Opinion in Critical Care - November 2, 2017 Category: Nursing Tags: EMERGENCIES IN CRITICAL CARE: Edited by Christopher W. Seymour Source Type: research

Use of imaging studies for determination of brain death in South Australian intensive care units.
CONCLUSIONS: Therapeutic hypothermia, terminal serum sodium level ≥ 150 mmol/L and cause of death were independent predictors of brain death determination by imaging study. Documentation of imaging indication was poor, particularly after hypoxic brain injury. This may reflect emerging indications for imaging, poor adherence to ANZICS recommendations, or simple omissions. PMID: 28215133 [PubMed - in process]
Source: Critical Care and Resuscitation - February 23, 2017 Category: Intensive Care Tags: Crit Care Resusc Source Type: research

Research and Reviews in the Fastlane 092
This study, on the other hand, was a well done, RDCT comparing tamsulosin to nifedipine to placebo in 1136 patients and showed no statistically significant difference for the primary outcome (need for further intervention at 4 weeks). Subgroup analysis showed a slight benefit for lower tract stones and the issue of utility in larger stones (> 5 mm) remains unanswered. However, with the move to reduce CT use in renal colic, we won’t know stone location or size on many patients making this drug far less useful in the real world. Recommended by Anand Swaminathan Read More: The Adventure of the Impassible Stone (EM...
Source: Life in the Fast Lane - July 23, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Emergency Medicine Intensive Care R&R in the FASTLANE Renal Resuscitation Trauma Urology critical care EBM Education recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 177
This study has some frustrating findings: they looked at 318 patients who got a CTPA within 2 weeks of a negative CTPA and found a 5% positive rate. Is CTPA like a stress test, where we just can’t predict plaque rupture? Are people who get CTPAs people who other docs are also worried about PE? Or are we just ordering too many CTPAs? How many of these were false postives or negatives? Sadly, as with most clinical research on pulmonary embolism, I am let with more questions than answers (but we probably order too many CTPAs). Recommended by: Seth Trueger Pediatrics Luck RP, et al. Cosmetic outcomes of absorbable ver...
Source: Life in the Fast Lane - March 30, 2017 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Clinical Case Education Emergency Medicine Infectious Disease Intensive Care Pediatrics R&R in the FASTLANE Radiology Respiratory Resuscitation critical care research and reviews Source Type: blogs

Research and Reviews in the Fastlane 128
This study looks at the accuracy of Emergency Physicians (EPs) in using POCUS to diagnose RV dysfunction. The small group of highly trained EPs were able to reliably identify RV issues with a (+) LR = 90 and a (-) LR of 0. While this looks great, it’s important to note the high level of training and the small number of patients (26) with RV dysfunction. More work needs to be done on how this applies to the typical EP. Recommended by: Anand Swaminathan Airway Mosier JM et al. The Physiologically Difficult Airway. W J Emerg Med 2016. PMID: 26759664 This article reviews patient features portending a physiologicall...
Source: Life in the Fast Lane - March 29, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Education Emergency Medicine R&R in the FASTLANE Respiratory critical care EBM literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 069
This study is an interesting step in analyzing the value of conference tweeting and, perhaps, ways in which Twitter can: (1)Provide feedback to speakers about how to present their messages clearly (2)Engage speakers to clarify or interact with twitter (3)Potentially disseminate messages more widely.Recommended by: Lauren WestaferRead more:  Taking Conference Tweeting to the Next Level: From the Speaker’s Perspective (Emergency Medicine PharmD)Emergency MedicineShah K et al. Magnitude of D-dimer matters for diagnosing pulmonary embolus. Am J Emerg Med 2013; 31(6):942-5. PMID: 23685058We work up too many patients for...
Source: Life in the Fast Lane - February 5, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Education Emergency Medicine LITFL Pediatrics R&R in the FASTLANE Respiratory Social Media critical care examination Intensive Care research and reviews Source Type: blogs

Mycoplasma pneumoniae pneumonia with pulmonary embolism: A study on pediatric cases in Jilin province of China.
In conclusion, compared with healthy individuals, pediatric patients with critical MPP have an elevated risk of embolism. It is necessary to be vigilant regarding whether MMP is combined with PE and perform timely CTPA examination. Early detection, early treatment and surgical intervention (if necessary) may significantly reduce the risk of mortality and disability. PMID: 33574906 [PubMed]
Source: Experimental and Therapeutic Medicine - February 14, 2021 Category: General Medicine Tags: Exp Ther Med Source Type: research

Research and Reviews in the Fastlane 044
This study looks at the agreement between radiologists in reading CTPAs for pulmonary embolism. They found that more than 10% of studies initially read as positive were later read as either negative or indeterminate. Many of the change in read occurred in subsegmental embolisms. This study throws further doubt on starting patients on long term anticoagulation based on the presence of a subsegmental pulmonary embolism. Recommended by: Anand Swaminathan Education Raemer DB. Ignaz semmelweis redux? Simul Healthc. 2014 Jun;9(3):153-5. PMID: 24401925 As a rabid in situ simulationist it is good to be tempered now an then by a...
Source: Life in the Fast Lane - August 18, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Education Emergency Medicine Haematology Infectious Disease Intensive Care R&R in the FASTLANE Resuscitation critical care literature recommendations Research and Review Source Type: blogs

Research and Reviews in the Fastlane 065
This study looked at how patients and doctors can use shared decision making to reduce in patient work ups for low risk chest pain. Using a chest pain decision aid, they reduced in patient work ups by 19%. The brilliance here is in the application of the theory of shared decision making and the knowledge transfer to patients using this system.Recommended by: Anand SwaminathanThe Best of the RestCardiology, Emergency MedicineBangalore S et al. Clinical outcomes with β-blockers for myocardial infarction: a meta-analysis of randomized trials. Am J Med. 2014;127(10):939-53. PMID: 24927909The pendulum for beta blockers in MI k...
Source: Life in the Fast Lane - January 7, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Intensive Care Pre-hospital / Retrieval Respiratory Resuscitation airway critical care R&R in the FASTLANE recommendations Review Trauma Source Type: blogs

LITFL R&R – Best of 2015
This article is one more piece of the mounting evidence demonstrating a clear call to change what is the usual care in many  institutions in the U.S. Stop the madness! Chest pain is tough — it’s the second most ED common chief complaint, and it scares the heck out of us and our patients – partially because missed MI is one one of the top causes of litigation. But we also see a ton of resources spent on a terribly low yield from chest pain workups. This new study in JAMA-IM including Mike Weinstock (of Bounceback fame), Scott Weingart and David Newman looked at the bad outcomes of patients with normal ECG...
Source: Life in the Fast Lane - January 9, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Respiratory Resuscitation Trauma critical care examination research and reviews Source Type: blogs