Open Access Emergency Medicine
ISSN / EISSN : 11791500 / 11791500
Current Publisher: Dove Medical Press Ltd. (10.2147)
Total articles ≅ 130
Latest articles in this journal
Open Access Emergency Medicine, Volume 11, pp 133-145; doi:10.2147/oaem.s199137
Abstract:Global Ultrasound Check for the Critically lll (GUCCI)-a new systematized protocol unifying point-of-care ultrasound in critically ill patients based on clinical presentation João Tavares,1 Rita Ivo,2 Filipe Gonzalez,3 Tomás Lamas,4 João João Mendes41Internal Medicine Department, Hospital da Luz, Lisbon, Portugal; 2Internal Medicine Department, Hospital Egas Moniz, Lisbon, Portugal; 3Intensive Care Unit, Hospital Garcia de Orta, Almada, Portugal; 4Intensive Care Unit, Hospital CUF Infante Santo, Lisbon, Portugal Ultrasound technology is an essential tool in the management of critically ill patients. Point-of-care ultrasonography (POCUS) enables data collection from different anatomic areas to achieve the most probable diagnosis and administer the right therapy at the right time. Despite the increasing utilization of POCUS, there is still a lack of standards to establish how to use different bedside ultrasound protocols, and it is imperative to develop a unifying protocol. Thus, the aim of this paper is to establish a new systematized approach that can be adopted by all physicians to implement POCUS for critically ill patient management. To achieve this, we propose a new systematized approach—Global Ultrasound Check for the Critically Ill (GUCCI)—that integrates multiple protocols. This protocol is organized based on three syndromes (acute respiratory failure, shock, and cardiac arrest) and includes ultrasound-guided procedures.Keywords: ultrasonography, interventional ultrasonography, respiratory failure, shock, cardiac arrest, echocardiography, intensive care
Open Access Emergency Medicine; doi:10.2147/oaem
Open Access Emergency Medicine, Volume 11, pp 129-132; doi:10.2147/oaem.s208214
Abstract:Self-administered alcohol enema causing chemical proctocolitis
Open Access Emergency Medicine, Volume 11, pp 121-127; doi:10.2147/OAEM.S194340
Abstract:Background: Fat embolism (FE) may develop following many traumatic and atraumatic clinical conditions; however, fewer data exist regarding the occurrence of isolated pulmonary FE (IPFE). Cardiopulmonary resuscitation (CPR) is an emergency procedure for maintaining blood circulation and oxygenation during cardiac arrest. In this study, we aimed to evaluate the association of CPR with IPFE in autopsy cases.
Open Access Emergency Medicine, Volume 11, pp 109-120; doi:10.2147/OAEM.S180197
Abstract:Nasal high flow (NHF) is a promising novel oxygen delivery device, whose mechanisms of action offer some beneficial effects over conventional oxygen systems. It is considered to have a number of physiological effects: it improves oxygenation, dynamic lung compliance, homogeneity and end expiratory lung volume; it decreases anatomical dead space and generates a positive airway pressure that can reduce respiratory rate, the work of breathing, and enhance patient comfort. NHF has been used as a prophylactic tool or as a treatment device mostly in patients with acute hypoxemic respiratory failure such as pre-oxygenation before intubation, immunocompromised patients and acute heart failure. Moreover, there is some evidence that NHF could be used during procedural sedation. Finally, NHF was deemed to be effective in chronic obstructive pulmonary disease patients with its positive end expiratory pressure effects and dead-space washout. However, careful monitoring is crucial to maximize NHF settings aimed at maximizing patient comfort while limiting the risk of delayed intubation. The present review presents the most updated evidence for NHF use in the adult acute care setting with the goal of providing clinicians with useful insights on the physiologic effects, main clinical indications, and safety issues of NHF treatment.
Open Access Emergency Medicine, Volume 11, pp 103-108; doi:10.2147/OAEM.S198842
Abstract:Purpose: Respiratory rate is assessed less frequently than other vital signs, and documented respiratory rates are often erroneous. This pilot study compared respiratory rates derived from a wearable biosensor to those derived from capnography.
Open Access Emergency Medicine, Volume 11, pp 87-93; doi:10.2147/OAEM.S188110
Abstract:Rapid delivery of an intravenous fluid bolus is commonly used in pediatric emergency care for the treatment of shock and hypotension. Early fluid delivery targeted at shock reversal results in improved patient outcomes, yet current methods of fluid resuscitation often limit the ability of providers to achieve fluid delivery goals. We report on the early clinical experience of a new technique for rapid fluid resuscitation. The LifeFlow® infuser is a manually operated device that combines a syringe, automatic check valve, and high-flow tubing set with an ergonomic handle to enable faster and more efficient delivery of fluid by a single health care provider. LifeFlow is currently FDA-cleared for the delivery of crystalloid and colloids. Four cases are presented in which the LifeFlow device was used for emergent fluid resuscitation: a 6-month-old with septic shock, a 2-year-old with intussusception and shock, an 11-year-old with pneumonia and septic shock, and a 15-year-old with trauma and hemorrhagic shock.
Open Access Emergency Medicine, Volume 11, pp 95-101; doi:10.2147/OAEM.S192358
Abstract:Introduction: Emergency department thoracotomy (EDT), also termed “resuscitative thoracotomy”, is indicated in some cases of life-threatening isolated thoracic injury, or as a part of CPR (cardiopulmonary resuscitation) in multiple trauma patients, or in thoracic trauma patients with massive bleeding (such as intra-abdominal exsanguination or injury to the great vessels). There is a lack of information in the literature concerning predictors of survival after EDT in patients with predominant or isolated thoracic trauma.
Open Access Emergency Medicine, Volume 11, pp 77-86; doi:10.2147/OAEM.S166086
Abstract:Sepsis is a common presentation in the emergency department and a common cause of intensive care unit admissions and death. Accurate triage, rapid recognition, early resuscitation, early antibiotics, and eradication of the source of infection are the key components in delivering quality sepsis care. Evaluation of the patient’s volume status, optimal hemodynamic resuscitation, and evaluation of patient response is crucial for sepsis management in the emergency department.
Open Access Emergency Medicine, Volume 11, pp 65-75; doi:10.2147/OAEM.S176175
Abstract:To compare the bedside ultrasound estimation of internal jugular vein (IJV)-collapsibility index with inferior vena cava (IVC)-collapsibility index and invasively monitored central venous pressure (CVP) in ICU patients. prospective observational study. The study was carried out in the ICU of Al Wakra and Al Khor hospitals of the Hamad Medical Corporation, Qatar. The patients were enrolled from November 2013 to January 2015. Patients admitted to the ICU with central venous catheter were included. The A-P diameter, cross-sectional area of the right IJV, and diameter of IVC were measured using bedside USG, and their corresponding collapsibility indices were obtained. The results of the IJV and IVC indices were compared with CVP. The sensitivity, specificity, and positive and negative predictive values were calculated to determine the diagnostic and predictive accuracy of the IJV collapsibility index in predicting the CVP. Seventy patients were enrolled, out of which 12 were excluded. The mean age was 54.34±16.61 years. The mean CVP was 9.88 mmHg (range =1–25). The correlations between CVP and IJV-CI (collapsibility index) at 0° were r=−0.484 (P=0.0001), r=−0.416 (P=0.001) for the cross-sectional area (CSA) and the diameter, respectively, and, at 30°, the most significant correlation discovered was (r=−0.583, P=0.0001) for the CSA-CI and r=−0.559 (P=0.0001) for the diameter-CI. In addition, there was a significant and negative correlation between IVC-CI and CVP (r=−0.540, P=0.0001). The IJV collapsibility index, especially at 30° head end elevation, can be used as a first-line approach for the bedside non-invasive assessment of CVP/fluid status in critical patients. IVC-CI can be used either as an adjunct or in conditions where IJV assessment is not possible, such as in the case of a neck trauma/surgery.