• Filter By:
• Specialty
• Source
• Condition
• Cancer
• Infectious Disease
• Drug
• Training
• Management
• Procedure
• Therapy
• Vaccine
• Nutrition
• Country

Short-Term Efficacy and Safety of Different Mechanical Hemodynamic Support Devices for Cardiogenic Shock or High-Risk Pci: a Network Meta-Analysis of Thirty-Seven Trials
Conclusion: Following this analysis, ECMO+IABP might be a more suitable intervention measure in improving short-term mortality for patients with CS and who underwent HS-PCI. However, the result was limited by the lack of sufficient direct comparisons and evidence from randomized controlled trials. Moreover, bleeding and other device-related complications should be considered in clinical applications.
Source: Shock - December 21, 2020 Category: Emergency Medicine Tags: Review Articles Source Type: research

Clopidogrel versus ticagrelor in high-bleeding risk patients presenting with acute coronary syndromes: insights from the multicenter START-ANTIPLATELET registry
AbstractOptimal dual antiplatelet therapy (DAPT) strategy in high-bleeding risk (HBR) patients presenting with acute coronary syndrome remains debated. We sought to investigate the use of clopidogrel versus ticagrelor in HBR patients with acute coronary syndrome and their impact on ischemic and bleeding events at 1  year. In the START-ANTIPLATELET registry (NCT02219984), consecutive patients with ≥ 1 HBR criteria were stratified by DAPT type in clopidogrel versus ticagrelor groups. The primary endpoint was net adverse clinical endpoints (NACE), defined as a composite of all-cause death, myocardial infarct ion, stroke,...
Source: Internal and Emergency Medicine - June 14, 2020 Category: Emergency Medicine Source Type: research

Clinical Performance Measures that Matter —Are You Ready?
Conclusion The future will belong to those who can prove value. The use of a clinical performance dashboard and comparisons to national data will help to ensure that when the payers come knocking on our doors looking for "proof" that what we do enhances patient care and improves patient outcome, we’ll have an answer! This is the first in a yearlong series of articles developed by the Academy of International Mobile Healthcare Integration (AIMHI).The AIMHI article series is developed in partnership with JEMS to help educate EMS agencies on the hallmarks and attributes of high-performance/high-value EMS system de...
Source: JEMS Special Topics - December 11, 2018 Category: Emergency Medicine Authors: Wayne C. Harbour, NRP Tags: Exclusive Articles Operations Administration and Leadership Source Type: news

ECG Educational Standards for Prehospital Providers
Conclusion As the role of evidence-based medicine becomes more prominent in the field of emergency medicine, a clear view of the current state of ECG education and platform from which to implement uniform standards becomes increasingly essential; especially as research expands into the prehospital setting. Further research into EMS education may identify both strengths and weaknesses in basic ECG interpretation appropriate for first responders. Implementing minimum ECG interpretation standards for EMS personnel nationwide is one potential option to ensure prehospital educational institutions stay responsive to current scie...
Source: JEMS Special Topics - November 27, 2018 Category: Emergency Medicine Authors: Jonathan Barney, BA, EMT, MS3 Tags: Training Exclusive Articles Cardiac & Resuscitation Source Type: news

Thrombolytic therapy-associated acute myocardial infarction in patients with acute ischemic stroke: A treatment dilemma
Acute myocardial infarction (AMI) is uncommon in the acute phase of acute ischemic stroke (AIS) and occurs in approximately 1% of the population. Here, we report a paradoxical case of AMI during tissue plasminogen activator (t-PA) infusion for AIS. We review and analyze the previously reported cases. We found that only patients with AMI which occurred after thrombolytic therapy for AIS who received an adequate combination of anticoagulation plus percutaneous coronary intervention survived their events.
Source: The American Journal of Emergency Medicine - November 21, 2016 Category: Emergency Medicine Authors: Chih-Jen Yang, Po-Chuan Chen, Chin-Sheng Lin, Chia-Lin Tsai, Shih-Hung Tsai Source Type: research

Out of hospital cardiac arrests and emergency coronary angiography
Conclusion Less than 50% of patients who had an OOHCA from VF underwent immediate coronary angiography. In those patients that did not undergo immediate coronary angiography, a delayed angiography was performed in 27%, of whom 75% had a PCI. Current practice resulted in a sensitivity and specificity that was too low to rule in or out stentable lesions. Emergency Physicians would arrange for more patients to have immediate angiography following cardiac arrest compared with Cardiologists. This would result in more patients with stentable lesions having PCI performed immediately, but would result in more cases of immediate an...
Source: Emergency Medicine Journal - November 23, 2015 Category: Emergency Medicine Authors: Slessor, D., Ashton, A. Tags: Drugs: cardiovascular system, Stroke, Acute coronary syndromes, Percutaneous intervention, Radiology, Clinical diagnostic tests, Radiology (diagnostics) RCEM LIGHTNING PRESENTATIONS Source Type: research

Search and rescue helicopter-assisted transfer of ST-elevation myocardial infarction patients from an island in the Baltic Sea: results from over 100 rescue missions
Conclusions In this small population of STEMI patients from a remote island, airborne transfer appears feasible and safe, and their 30-day mortality after pPCI comparable with that of the mainland population despite inherent reperfusion delay exceeding guidelines.
Source: Emergency Medicine Journal - October 17, 2014 Category: Emergency Medicine Authors: Schoos, M. M., Kelbaek, H., Pedersen, F., Kjaergaard, B., Trautner, S., Holmvang, L., Jorgensen, E., Helqvist, S., Saunamaki, K., Engstrom, T., Clemmensen, P. Tags: Drugs: cardiovascular system, Stroke, Acute coronary syndromes, Percutaneous intervention Prehospital care Source Type: research

Acute management of ST-elevation myocardial infarction in a tertiary hospital in Kenya: Are we complying with practice guidelines? Phase active de prise en charge des infarctus du myocarde avec élévation du segment ST dans un hôpital tertiaire au Kenya. Les directives pratiques sont-elles respectées?
Conclusion Whereas the majority of STEMI patients are evaluated within 10min of presentation, less than 50% receive reperfusion therapy within the recommended time frame. While there are attempts to comply with evidence based guidelines in resource-limited settings, there is a need to improve acute care systems to target early reperfusion of STEMI patients.
Source: African Journal of Emergency Medicine - October 12, 2014 Category: Emergency Medicine Source Type: research

Patients with Acute Coronary Syndrome and Stroke Throughout the Acute Healthcare Chain
For patients with acute coronary syndrome (ACS) and stroke, prompt diagnosis and treatment is essential. In most cases of myocardial infarction, blood flow needs to be restored through percutaneous coronary intervention (PCI) or through thrombolytic medications. Treatments are most effective if started as early as possible. For patients with ST-elevated myocardial infarction (STEMI), PCI should be started within 90 min. For ischemic stroke patients, thrombolysis with recombinant tissue plasminogen activator needs to be given within 4.5 h after onset of symptoms. Before a patient reaches a PCI center or stroke unit, he may ...
Source: The Journal of Emergency Medicine - January 23, 2014 Category: Emergency Medicine Authors: R. Egberink, M. Zwerink, H. Droste, P. Brouwers, G. Van Houwelingen, C. Doggen Source Type: research

BET 3: Evaluation of intra-aortic balloon support in cardiogenic shock
A short-cut review was carried out to establish whether intra-aortic balloon pumps (IABP) improve mortality in cardiogenic shock after acute myocardial infarction (AMI). Two studies and one systematic review were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in table 3. The clinical bottom line is that the IABP does not improve mortality in cardiogenic shock after AMI when percutaneous coronary intervention is available. When only thrombolysis is possible then it may improve mortality.
Source: Emergency Medicine Journal - November 14, 2013 Category: Emergency Medicine Tags: EMJ Best evidence topic reports, Drugs: cardiovascular system, Stroke, Acute coronary syndromes, Percutaneous intervention Source Type: research

Simultaneous thrombosis of 2 vascular territories: is thrombolytic therapy a better option?
We have read with great interest the article by Akyuz and colleagues in the American Journal of Emergency Medicine and congratulate them for their observation. Their case exemplifies the concurrent occurrence of ST-segment elevation myocardial infarction (STEMI) and posterior circulation stroke that was eventually managed with thrombolytic therapy. Simultaneous thrombosis of 2 distant vascular territories is a rare and complicated clinical scenario. In these instances, there is usually an underlying cause linking both thrombotic events rather than being a mere coincidence. We have previously described the myocardial infarc...
Source: The American Journal of Emergency Medicine - July 1, 2013 Category: Emergency Medicine Authors: Hesham R. Omar, Devanand Mangar, Enrico M. Camporesi Tags: Correspondence Source Type: research

Rescue thrombolysis in the treatment of cardiac shock and acute stroke
The patients with ST-elevation myocardial infarction are primarily managed with percutaneous coronary intervention (PCI) or thrombolysis. It is well accepted that rescue PCI should be implemented in case of unsuccessful thrombolysis. However, the reverse, rescue thrombolysis, that is, administering of thrombolytic therapy in a patient in whom primary PCI fails, is not well defined. There are no available data about rescue thrombolysis so far. We represent a 43-year-old male patient with Buerger disease (thromboangiitis obliterans) who was admitted to our emergency department for cardiac shock related to inferior and right ...
Source: The American Journal of Emergency Medicine - April 19, 2013 Category: Emergency Medicine Authors: Sukru Akyuz, Mustafa Azmi Sungur, Cevdet Donmez, Aylin Sungur, Nese Cam Tags: Case Reports Source Type: research