Severe hyperlactatemia in the emergency department: clinical characteristics, etiology and mortality.

BACKGROUND: Severe hyperlactatemia (lactate level ≥ 10 mmol/L) is associated with high mortality rates in critically ill patients. However, there is limited data on emergency department (ED) patients. We aimed to investigate the clinical characteristics, etiology and outcomes of patients with severe hyperlactatemia in the ED setting. METHODS: A retrospective cohort study was conducted at a tertiary care hospital in Thailand. We included adult patients with a venous lactate sample taken in the ED within one hour. We excluded patients after out-of-hospital cardiac arrest, transferred to/from another hospital or those with missing clinical data. Mortality rates were evaluated among patients with increasing degrees of lactate elevation and among patients with severe hyperlactatemia, stratified by causative etiology. RESULTS: We analyzed venous lactate levels in 40,047 patients, with 26,680 included in the analysis. Among these, 1.7% had severe hyperlactatemia (lactate ≥ 10 mmol/L), 10.5% moderate (4-9.99 mmol/L), 28.8% mild (2-3.99 mmol/L), and 59.0% normal levels (< 2 mmol/L). Severe hyperlactatemia was associated with high mortality rates of 29%, 37%, and 38% at 7, 28, and 60 days respectively, significant ICU admissions and mechanical ventilation rates. Patients with severe hyperlactatemia were stratified into high (> 50% mortality), moderate (21-50%), and low (< 20%) 28-day mortality risk groups. High-risk conditions included non-septic shock, traumatic injuries/burns, and neurological issues, with mortality rates of 51.1%, 61.8%, and 57.1%, respectively. In the moderate risk group, namely infection without shock showed a high prevalence, with a mortality rate of 36%. In the low-risk group, seizures and fainting were associated with lower mortality, exhibiting mortality rates of 0%. CONCLUSIONS: Severe hyperlactatemia is associated with higher rates of ICU admission and mortality compared to other degrees of lactate elevation in a general ED population. However, mortality rates can vary considerably, depending on the underlying etiology associated with different primary diagnoses.

Surgical mask-to-mouth ventilation as an alternative ventilation technique during CPR: A crossover randomized controlled trial.

INTRODUCTION: Chest compression with rescue breathing improves outcomes in cardiac arrest. However, the efficacy of rescue breathing through surgical masks has not been investigated. OBJECTIVE: We aimed to compare the tidal volume generated by mouth-to-mouth ventilation (MMV) with that generated by surgical mask-to-mouth ventilation (SMV), mouth-to-surgical mask ventilation (MSV), and surgical mask-to-surgical mask ventilation (SSV) in a manikin. METHODS: A crossover randomized controlled trial was conducted in 42 medical personnel volunteers randomly assigned to perform four ventilation techniques: MMV (no protective equipment), SMV (participant wearing a mask), MSV (manikin wearing a mask), and SSV, (both participant and manikin wearing a mask). The average tidal volume and the proportion of adequate ventilation, evaluated using a manikin, were compared across different ventilation methods. RESULTS: The average tidal volume of MMV (828 ± 278 ml) was significantly higher than those of the MSV (648 ± 250 ml, P < 0.001) and SSV (466 ± 301 ml, P < 0.001), but not SMV (744 ± 288 ml, P = 0.054). Adequate ventilation was achieved in 144/168 (85.7%) cases in the MMV group, a proportion significantly higher than in the SMV (77.4%, P = 0.02), MSV (66.7%, P < 0.001) and SSV (39.3%, P < 0.001) groups. The willingness to perform SMV was higher than that to perform MMV. CONCLUSIONS: MMV resulted in a superior average tidal volume when compared to both MSV and SSV. However, SMV achieved a comparable average tidal volume to MMV.

Differential Impact of the Renal Resistive Index on Future Cardiovascular Events in Hospitalized Atherosclerotic Cardiovascular Patients According to Left Ventricular Ejection Fraction　- The Jichi Vascular Hemodynamics in Hospitalized Cardiovascular Patients (J-VAS) Study.

BACKGROUND: Determinants of poor outcome in atherosclerotic cardiovascular disease (ASCVD) according to left ventricular ejection fraction (LVEF) are unclear. The renal resistive index (RRI) correlates well with atherosclerotic vascular damage, which, in turn, is correlated with cardiovascular outcomes. This study investigated whether high RRI is associated with poor cardiovascular outcomes in ASCVD patients classified by LVEF.Methods and Results:Records of 1,598 acute coronary syndromes (ACS) and acute decompensated heart failure (ADHF) patients, categorized into preserved (p), mid-range (mr), and reduced (r) ejection fraction (EF) groups (EF ≥50% [n=1,130], 40-50% [n=223], and <40% [n=245], respectively), were analyzed retrospectively. The primary endpoint was any cardiovascular-related event: fatal and non-fatal ACS, ADHF, stroke, and sudden cardiac death. Over 1.9-years follow-up (3,030 person-years), 233 events occurred: 122, 37, and 74 in the pEF, mrEF, and rEF groups, respectively. Adjusted Cox regression analysis revealed RRI ≥0.8 was associated with the primary endpoint in the pEF group (hazard ratio [HR] 1.67; 95% confidence interval [CI] 1.09-2.56), but not in the mrEF or rEF groups. The primary endpoint risk of pEF patients with an RRI ≥0.8 was comparable to that of mrEF patients using the pEF+RRI <0.8 group as the reference (HR 1.89 [95% CI 1.26-2.83] and 1.77 [95% CI 1.19-2.63], respectively). CONCLUSIONS: RRI was associated with the risk of cardiovascular events in ASCVD patients with pEF.

Emergency Severity Index as a predictor of in-hospital mortality in suspected sepsis patients in the emergency department.

OBJECTIVES: To demonstrate the accuracy, sensitivity, and specificity of the Emergency Severity Index (ESI), quick Sepsis-related Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS) criteria, and National Early Warning Score (NEWS) for predicting in-hospital mortality and intensive care unit (ICU) admission in suspected sepsis patients. METHODS: A retrospective cohort study conducted at a tertiary care hospital, Thailand. Suspected sepsis was defined by a combination of (1) hemoculture collection and (2) the initiation of intravenous antibiotics therapy during the emergency department (ED) visit. The accuracy of each scoring system for predicting in-hospital mortality and ICU admission was analyzed. RESULTS: A total of 8177 patients (median age: 62 years, 52.3% men) were enrolled in the study, 509 (6.2%) of whom died and 1810 (22.1%) of whom were admitted to the ICU. The ESI and NEWS had comparable accuracy for predicting in-hospital mortality (AUC of 0.70, 95% confidence interval [CI] 0.68 to 0.73 and AUC of 0.73, 95% CI 0.70 to 0.75) and ICU admission (AUC of 0.75, 95% CI 0.74 to 0.76 and AUC of 0.74, 95% CI 0.72 to 0.75). The ESI level 1-2 had the highest sensitivity for predicting in-hospital mortality (96.7%), and qSOFA ≥2 had the highest specificity (86.6%). CONCLUSION: The ESI was accurate and had the highest sensitivity for predicting in-hospital mortality and ICU admission in suspected sepsis patients in the ED. This confirms that the ESI is useful in both ED triage and predicting adverse outcomes in these patients.

Precourse Preparation Using a Serious Smartphone Game on Advanced Life Support Knowledge and Skills: Randomized Controlled Trial.

BACKGROUND: In the past several years, gamified learning has been growing in popularity in various medical educational contexts including cardiopulmonary resuscitation (CPR) training. Furthermore, prior work in Basic Life Support (BLS) training has demonstrated the benefits of serious games as a method for pretraining among medical students. However, there is little evidence to support these benefits with regard to Advanced Life Support (ALS) training. OBJECTIVE: We compare the effects of a brief precourse ALS preparation using a serious smartphone game on student knowledge, skills, and perceptions in this area with those of conventional ALS training alone. METHODS: A serious game (Resus Days) was developed by a Thai physician based on global ALS clinical practice guidelines. Fifth-year medical students were enrolled and randomized to either the game group or the control group. Participants in both groups attended a traditional ALS lecture, but the game group was assigned to play Resus Days for 1 hour before attending the lecture and were allowed to play as much as they wished during the training course. All students underwent conventional ALS training, and their abilities were evaluated using multiple-choice questions and with hands-on practice on a mannequin. Subject attitudes and perceptions about the game were evaluated using a questionnaire. RESULTS: A total of 105 students participated in the study and were randomly assigned to either the game group (n=52) or the control group (n=53). Students in the game group performed better on the ALS algorithm knowledge posttest than those in the control group (17.22 [SD 1.93] vs 16.60 [SD 1.97], P=.01; adjusted mean difference [AMD] 0.93; 95% CI 0.21-1.66). The game group's pass rate on the skill test was also higher but not to a statistically significant extent (79% vs 66%, P=.09; adjusted odds ratio [AOR] 2.22; 95% CI 0.89-5.51). Students indicated high satisfaction with the game (9.02 [SD 1.11] out of 10). CONCLUSIONS: Engaging in game-based preparation prior to an ALS training course resulted in better algorithm knowledge scores for medical students than attending the course alone. TRIAL REGISTRATION: Thai Clinical Trials Registry HE611533; https://tinyurl.com/wmbp3q7.

Resistant hypertension: diagnosis, evaluation, and treatment a clinical consensus statement from the Thai hypertension society.

Resistant hypertension (RH) includes hypertensive patients with uncontrolled blood pressure (BP) while receiving ≥3 BP-lowering medications or with controlled BP while receiving ≥4 BP-lowering medications. The exact prevalence of RH is challenging to quantify. However, a reasonable estimate of true RH is around 5% of the hypertensive population. Patients with RH have higher cardiovascular risk as compared with hypertensive patients in general. Standardized office BP measurement, confirmation of medical adherence, search for drug- or substance-induced BP elevation, and ambulatory or home BP monitoring are mandatory to exclude pseudoresistance. Appropriate further investigations, guided by clinical data, should be pursued to exclude possible secondary causes of hypertension. The management of RH includes the intensification of lifestyle interventions and the modification of antihypertensive drug regimens. The essential aspects of lifestyle modification include sodium restriction, body weight control, regular exercise, and healthy sleep. Step-by-step adjustment of the BP-lowering drugs based on the available evidence is proposed. The suitable choice of diuretics according to patients' renal function is presented. Sacubitril/valsartan can be carefully substituted for the prior renin-angiotensin system blockers, especially in those with heart failure with preserved ejection fraction. If BP remains uncontrolled, device therapy such as renal nerve denervation should be considered. Since device-based treatment is an invasive and costly procedure, it should be used only after careful and appropriate case selection. In real-world practice, the management of RH should be individualized depending on each patient's characteristics.

Prevalence of sarcopenia and associated factors among Thai population.

The purpose of this study was to determine the prevalence of sarcopenia using the skeletal muscle index (SMI) criteria in the Thai population. The secondary objective was to demonstrate factors influencing low SMI in this population. Femoral neck bone mass density (BMD) was measured by dual-energy X-ray absorptiometry (GE Lunar, Madison, WI, USA) in 435 urban and 397 rural subjects (334 men and 498 women) between 20 and 84 years of age. Body mass index (BMI) was calculated from weight and height. The respective prevalence of sarcopenia among men and women was 35.33 % (95 % CI, 29.91, 40.41) and 34.74 % (95 % CI, 30.56, 39.10). Factors associated with sarcopenia using multiple logistic regression analyses in both sexes were (a) living in the city, (b) higher BMI, and (c) older age. Living in an urban area was the strongest factor, with an odds ratio (OR) of 17.26 ± 7.12 (95 % CI, 7.68, 38.76) in men and 8.62 ± 2.74 (95 % CI, 4.62, 16.05) in women (p < 0.05). The prevalence rate ratio for persons living in urban compared to rural areas was 2.01 (95 % CI, 1.14, 3.53) in men and 1.69 (95 % CI, 1.31, 2.17) in women (p < 0.05). Sarcopenia, as based on SMI, occurs frequently in the Thai population and increases with age. The prevalence of sarcopenia is particularly high among pre-retirement women (50-59 years of age) whereas the number of men with sarcopenia gradually rises with age. An urban environment is the most predictive factor for sarcopenia, followed by high BMI and age. Given the aging population, early recognition of this condition can be beneficial for prevention of an epidemic of sarcopenia-related disability.

Lumbar spine and hip bone mineral density in Thai women using the Osteosys Dexxum T-bone densitometer.

OBJECTIVE: To measure lumbar spine and hip bone mineral density (BMD) and to define the Thai normal reference for classifying BMD results and diagnosis of osteoporosis in Thai women using a new mobile central dual energy X-ray absorptiometry (DXA). MATERIAL AND METHOD: This cross-sectional investigation recruited 779 Thai women between 20 and 85 years. Lumbar spine and hip BMD was measured by DXA (Osteosys Dexxum-T). The BMD results were classified by T-score asper WHO criteria. RESULTS: Advancing age was negatively correlated with BMD at both sites, whereas body weight was positively correlated to BMD at both. The correlation between BMDs at the lumbar spine and hip was 0.67 to 0.69. The peak BMD was observed in women between 20 and 24 years at both sites, with a respective mean and standard deviation of 1.082 +/- 0.153, 1.115 +/- 0.161, 0.878 +/- 0.150, and 0.946 +/- 0.125 at L1-4, L2-4, the femoral neck and total hip. Using the Thai references derived from peak BMD, the prevalence of osteoporosis was 5.1 to 5.5 and 3.1 to 6.3% at the lumbar spine and hip, respectively, which was lower than the Asian reference as provided by DXA. CONCLUSION: The present study suggested that using the T-score provided by the Osteosys Dexxum-T over-diagnosed osteoporosis in Thai women. The authors recommend using Thai normal reference from the present study to define the BMD result in Thai women.

The effects of mechanical versus bag-valve ventilation on gas exchange during cardiopulmonary resuscitation in emergency department patients: A randomized controlled trial (CPR-VENT).

INTRODUCTION: Effective ventilation is crucial for successful cardiopulmonary resuscitation (CPR). Previous studies indicate that higher arterial oxygen levels (PaO2) during CPR increase the chances of successful resuscitation. However, the advantages of mechanical ventilators over bag-valve ventilation for achieving optimal PaO2 during CPR remain uncertain. METHOD: We conducted a randomized trial involving non-traumatic adult cardiac arrest patients who received CPR in the ED. After intubation, patients were randomly assigned to ventilate with a mechanical ventilator (MV) or bag valve ventilation (BV). In MV group, ventilation settings were: breath rate 10/minute, tidal volume 6-7 ml/kg, inspiratory time 1 second, positive end-expiratory pressure 0 cm water, inspiratory oxygen fraction (FiO2) 100%. The primary outcome was to compare the difference in PaO2 from arterial blood gases (ABG) obtained 4-10 minutes later during CPR between both groups. RESULTS: Sixty patients were randomized (30 in each group). The study population consisted of: 57% male, median age 62 years, 37% received bystander CPR, and 20% had an initial shockable rhythm. Median time from arrest to intubation was 24 minutes. The median PaO2 was not significantly different in the BV compared to MV [36.5 mmHg (14.0-70.0) vs. 29.0 mmHg (15.0-70.0), P = 0.879]. Other ABG parameters and rates of return of spontaneous circulation and survival were not different. CONCLUSIONS: In ED patients with refractory cardiac arrest, arterial oxygen levels during CPR were comparable between patients ventilated with MV and BV. Mechanical ventilation is at least feasible and safe during CPR in intubated cardiac arrest patients.

Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension.

ABSTRACT: Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.

Analysis of Medical Interventions at the Start-Finish Medical Post of an International Running Event in Rural Thailand.

INTRODUCTION: Increasing numbers of marathon running events are taking place around the world. The difficulty encountered in the management of mass gatherings, especially running in marathons, is how emergency services can deliver treatment in a timely manner. Therefore, for this kind of situation, preparation is the key to success in terms of patient management. STUDY OBJECTIVE: The aim of this study was to describe the presentation of cases at a start-finish medical post in an international marathon race set in a rural area. METHODS: All medical record forms were collected from the start-finish medical post of the Khon Kaen International Marathon (KKIM) 2020. The race took place on January 26, 2020. The data were coded by two authors, and in the case of different codes, the final codes were determined by discussion. RESULTS: The total number of participants in this event was 16,489. Participants who used the start-finish medical post numbered 74 (44.8 people per 10,000). More than one-half of patients were male (41; 56.9%), while 31 (34.0%) were female. The age range of the casualties was from 17 to 88 years old. The rate of incidence for those who used this post was 44.8 per 10,000 participants. The greatest density of users was at 3.40 hours after the marathon had started. The common symptoms which were found consisted of 17 soft tissue injuries (23.0%), 15 instances of cramps (20.3%), and 11 musculoskeletal (MSK) injuries (14.9%). Almost all patients were discharged, and only two of the cases were actually admitted to the hospital. No statistical significance between males and females was found (OR = 0.81; 95% CI, 0.51-1.3). However, marathon and half-marathon runners had a higher risk of being casualties (OR = 3.49; 95% CI, 1.71-7.15 and OR = 3.51; 95% CI, 1.79-6.88). CONCLUSION: The injuries of most of the patients who used the medical post at a start-finish point were mild. Distances which are longer than 20km increase the risk for getting injured. However, a prospective study and multi-session interpretation is recommended.

Differential Association Between Significant Coronary Stenosis and Cardiac Troponin T Serial Algorithms in Chronic Kidney Disease Patients Diagnosed with Non-ST-Segment Elevation Acute Coronary Syndromes.

BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is recommended for diagnosing non-ST segment elevation acute coronary syndromes (NSTE-ACS). While the guidelines recommend using the 0,1-hour (hr) and 0,3-hr hs-cTnT algorithms, their efficacy has not been clearly established in chronic kidney disease (CKD) patients. We aimed to assess the differential associations between the two algorithms mentioned above with significant coronary stenosis in CKD patients. METHODS: This was a retrospective cohort study. Patients aged ≥18 years who were diagnosed with NSTE-ACS and had undergone coronary angiogram were recruited. The differential association between significant coronary stenosis and being ruled in based on the 0,1-hr and 0,3-hr hs-cTnT algorithm was analyzed and reported. RESULTS: There were 158 and 160 patients in the CKD and normal renal function groups. Among CKD patients, determinants of significant coronary stenosis were hypertension (OR = 2.68; 95% CI 1.10-6.50) and being ruled in by the 0,3-hr algorithm (OR = 3.65; 95% CI 1.27-10.52). In the normal renal function group, age (OR = 1.04; 95% CI 1.01-1.06), male sex (OR = 2.15; 95% CI 1.09-4.22), and being ruled in by the 0,1-hr algorithm (OR = 3.12; 95% CI 1.20-8.10) were associated with significant coronary stenosis. CONCLUSION: Being ruled in according to the 0,3-hr algorithm was significantly associated with coronary stenosis in CKD patients, making this a likely algorithm of choice in these patients.

Varicella zoster meningitis following COVID-19 vaccination: a report of two cases.

Most of the adverse effects reported in patients who have received COVID-19 vaccines have been mild. However, possible serious adverse effects are being monitored cautiously. There have also been a number of case reports of reactivation of varicella zoster infection within 28 days after immunization with mRNA COVID-19 vaccines. A few cases have also been reported after viral vector and inactivated COVID-19 vaccination. The incidence of meningitis following varicella zoster virus infection is rare. In the current study, we report two cases of male patients who received two different types of COVID-19 vaccine (inactivated and viral vector) and developed varicella zoster meningitis within 10 days after vaccination.

The impact of blood pressure variation on mortality and symptomatic intracerebral hemorrhage in acute stroke patients after thrombolysis.

Blood pressure variation (BPV) is a known risk factor for unfavorable stroke outcomes. However, little is known about the association between BPV and short-term outcomes in stroke patients after receiving thrombolytic therapy, namely, recombinant tissue plasminogen activator (rt-PA). We conducted a cross-sectional study in the specialized stroke unit of a tertiary-level hospital. Stroke patients who were eligible for rt-PA were enrolled. Blood pressure (BP) was measured every 4 h for 24 h. The SD, coefficient of variation (CV) and successive variation (SV) of both SBP and DBP were calculated. The final outcomes were symptomatic intracerebral hemorrhage (sICH) or in-hospital death from neurologic complications. A total of 278 patients (49.6% men) were enrolled, mean age was 65 years. The final outcomes were reported in 33 patients (11.9%). All systolic and diastolic BPV profiles were associated with the final outcome. Odds ratios (95% confident interval) were SD, 1.07 (1.02-1.13); CV, 1.10 (1.03-1.18) and SV, 1.05 (1.01-1.09) for SBP, and SD, 1.10 (1.02-1.19); CV, 1.08 (1.01-1.16) and SV, 1.09 (1.02-1.15) for DBP. After adjustment for conventional risk factors, SD, CV and SV of SBP, and SD and SV of DBP were still significantly associated with the final outcome. In conclusion, in-hospital systolic (SD, SV and CV) and diastolic (SV, SD) BPV profiles were associated with death and sICH in stroke patients after rt-PA therapy.

The effect of mountaineering on the association between blood pressure and physical activity: A new multi-sensor ambulatory blood-pressure monitoring device. The Mount Fuji Study.

It has not been fully investigated whether the response of blood pressure (BP) to activity at high altitudes differs from that at low altitudes or how temperature is involved in these differences. The author compared BP response to accelerometer measurements during mountaineering and daily living. In 15 healthy people (mean age 33 ± 6 years), a new multi-sensor ambulatory BP monitoring (ABPM) device equipped with barometer, thermometer, and accelerometer was used to measure BP responses to activity during a trip to Mt. Fuji and during daily living. Associations between physical activity (log-transformed 5-min average values of accelerometer just before each ambulatory BP) and the corresponding BP were obtained from 843 and 676 readings during the Mt. Fuji trip and daily living, respectively. All ambulatory systolic BP (SBP) parameters were significantly higher during the Mt. Fuji trip than during daily living (all p < .01). There were significant positive correlations between physical activity and corresponding BPs in both mountaineering and daily living (all p < .01), and there was an interaction between BPs and physical activity according to the two conditions (p < .01). On Mt. Fuji, multivariate regression analysis showed increased physical activity and lower temperature were associated with increased 24-h SBP and diastolic BP (DBP) (all p < .05). The goodness-of-fit values of the association between activity and 24-h SBP or DBP were improved by adding temperature to the model of both 24-h SBP and DBP. However, these associations were not found in the daily living model. BP response to activity was more pronounced during mountaineering than daily living.

Comparison between the double-syringe and the single-syringe techniques of adenosine administration for terminating supraventricular tachycardia: A pilot, randomized controlled trial.

BACKGROUND: Adenosine has been recommended as a first-line treatment for stable supraventricular tachycardia (SVT). Standard guidelines recommend 6-mg of adenosine administered intravenously (IV) with an immediate 20-ml IV bolus of normal saline solution (NSS; double syringe technique [DST]). However, a newly proposed single-syringe technique (SST), in which adenosine is diluted with an up to 20 ml IV bolus of NSS, was found to be beneficial. HYPOTHESIS: We hypothesized that the SST was noninferior to the DST for terminating stable SVT. METHODS: A pilot multicenter, single-blind, randomized controlled study was conducted at nine hospitals in north and northeast Thailand. Thirty patients who were diagnosed with stable SVT were randomized into two groups of 15, with one receiving adenosine via the DST and the other via the SST. We examined SVT termination, the average successful dose, and the complication rate of each group. Analyses were based on the intention-to-treat principle. RESULT: The termination rate was 93.3% in the DST and 100% in the SST group (p = 1.000), and the success rate of the first 6-mg dose of adenosine was 73.3% and 80%, respectively (p = 1.000). The total administered dose was 8.6 ± 5.1 mg in the DST group and 7.6 ± 4.5 mg in the SST group (p = .608). No complications were found in either group. CONCLUSIONS: The SST was non-inferior to the DST for termination of SVT. However, a further definitive study with a larger sample size is required.

Hypertensive emergencies in Asia: A brief review.

Hypertensive emergency is one of the most challenging conditions to treat in the emergency department (ED). From previous studies, about 1%-3% of hypertensive individuals experienced hypertensive emergencies. Its prevalence varied by country and region throughout Asia. Asian populations have more different biological and cultural backgrounds than Caucasians and even within Asian countries. However, there is a scarcity of research on clinical features, treatment, and outcomes in multinational Asian populations. The authors aimed to review the current evidence about epidemiology, clinical characteristics and outcomes, and practice guidelines in Asia. Five observational studies and nine clinical practice guidelines across Asia were reviewed. The prevalence of hypertensive emergencies ranged from .1% to 1.5%. Stroke was the most common target organ involvement in Asians who presented with hypertensive emergencies. Although most hypertensive emergency patients required hospitalization, the mortality rate was low. Given the current lack of data among Asian countries, a multinational data repository and Asian guidelines on hypertensive emergency management are mandatory.

The effects of breathing training on dyspnea and anxiety among patients with acute heart failure at emergency department.

BACKGROUND: Anxiety-related dyspnea is a compelling symptom among patients with acute heart failure (AHF). Breathing training is a nonpharmacological intervention to relieve dyspnea and anxiety. This study aimed to investigate the effects of breathing training on dyspnea and anxiety among patients with AHF at the emergency department (ED). METHODS: Two-group pre-post intervention study was conducted at the ED of one university hospital in the northeast of Thailand. Data were collected among 96 patients with AHF, which were equally assigned to breathing training (BT) and control groups. The training group received pursed-lip mindfulness breathing training, whereas the control group received usual care (UC). The pursed-lip mindfulness breathing was delivered from the first 40 min of arrival to the 4th hour in the ED. The breathing training consisted of positioning the patients in Fowler's position with the head of the bed elevated at 60 degrees or higher, supporting both arms with pillows, and breathing in through the nose with breathing out via the mouth with pursed lip while counting. Dyspnea and anxiety scores were measured with Dyspnea Visual Analog Scale and Anxiety Visual Analog Scale, respectively. RESULTS: The dyspnea and anxiety scores significantly decreased after four hours in both groups. Dyspnea score decreased from 8.85 (SD 1.220) to 3.63 (SD 1.468) after BT (t = 26.111, p < 0.001) in the experimental group whereas in the control group it decreased from 8.98 (SD 1.194) to 6.94 (SD 1.590) after UC (t = 16.181, p < 0.001). Comparing between the groups, dyspnea score reductions were 5.22 (SD 1.468) in the experimental and 2.04 (SD 1.590) in the control (t = 0.101, p < 0.001). Anxiety score decreased from 9.35 (SD 1.000) to 4.44 (SD 1.219) after BT (t = 25.231, p < 0.001) in the experimental while the scores in the control group decreased from 9.48 (SD 1.072) to 8.15 (SD 1.502) after UC (t = 8.131, p < 0.001). The anxiety score reductions were 4.91 (SD 1.219) and 1.33 (SD 1.502) in the experimental and the control groups, respectively (t = 0. 066, p < 0.001). Both the dyspnea and anxiety scores after the intervention were significantly different between the experimental and control groups. CONCLUSION: Both UC and BT with UC can reduce dyspnea and anxiety in patients admitted to ED with AHF. However, the effect of BT combined with UC was larger comparing to UC only.

Clinical treatment outcomes of hypertensive emergency patients: Results from the hypertension registry program in Northeastern Thailand.

Hypertensive emergency care is a challenge in clinical practices due to vital organ complications that may lead to unfavorable outcomes if left untreated. The objectives of this study were to determine the prevalence, clinical characters, treatment, and outcomes of hypertensive emergency patients. A retrospective cohort study was conducted at a university hospital in Northeast Thailand from January 2016 to December 2019. Hypertensive crises patients were consecutively registered to the Hypertension Registry Program. There were 263 674 patients who were admitted to the ER, 60,755 of whom had BP ≥ 140/90 mm Hg and 1,342 of whom were diagnosed with a hypertensive emergency (127 per 100 000 patient-year). The mean age was 66 years old, and 52.1% of the registered patients were men. The most common target organ damage was caused by stroke (49.8%), followed by acute heart failure (19.3%), and then by acute coronary syndrome (6.5%). Intravenous antihypertensive medication was given in 42.1% of the patients, and 80% were admitted to the hospital. The in-hospital mortality rate was 1.6%. In conclusion, hypertensive emergencies were not uncommon among the emergency patients. Strokes caused the most common target organ damage. Although there was a high hospital admission rate, the mortality rate was low.

The effect of pursed-lip breathing combined with number counting on blood pressure and heart rate in hypertensive urgency patients: A randomized controlled trial.

Hypertensive urgency (HT urgency) is an alarming sign of uncontrolled hypertension. It is aggravated by nonadherence to medication, as well as psychosocial stress. Mindfulness is beneficial for reducing stress, while deep and slow breathing is effective for lowering blood pressure (BP). In our study, we aimed to assess BP and heart rate effects in HT urgency patients practicing pursed-lip breathing and number counting (PLB with NC)-a practice that promotes mindfulness with deep/slow breathing patterns. In a randomized controlled trial, 110 patients were equally allocated to intervention and control groups. The intervention group was trained and encouraged to do PLB with NC during their emergency room admission, while the control group received conventional medical care. The mean systolic BP (SBP), diastolic BP (DBP), and HR of the intervention group in the 3rd hour were significantly lower than the baseline values at -28.2 mm Hg (95%CI;-23.5 to -32.4), -17.1 mm Hg (95%CI;-14.2 to -20.0), and -4.9 beats per minute (bpm) (95%CI;-4.0 to -5.8), respectively. In the control group, both the mean SBP and DBP were also significantly lower in the 3rd hour. However, HR reduction was inconclusive. When the two groups were compared, a greater degree of reduction was found in the intervention group for SBP (9.80 mm Hg, 95%CI; 4.10 to 15.50), DBP (7.69 mm Hg, 95%CI; 3.61 to 11.77), and HR (3.85 bpm, 95%CI; 1.99 to 5.72). In conclusion, PLB with NC was effective for lowering BP and HR. It might be used as a complementary treatment for HT urgency patients.