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1.
Indian Heart J ; 73(4): 446-450, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34474756

RESUMO

BACKGROUND: India does not have a formal cardiac arrest registry or a centralized emergency medical system. In this study, we aimed to assess the prehospital care received by the patients with OHCA and predict the factors that could influence their outcome. METHODS: Out-of-hospital cardiac arrest patients presenting to the emergency department in a tertiary care centre were included in the study. Prehospital care was assessed in terms of bystander cardiopulmonary resuscitation (CPR), mode of transport, resuscitation in ambulance. OHCA outcomes like Return of spontaneous circulation (ROSC), survival to hospital discharge and favourable neurological outcome at discharge were assessed. RESULTS: Among 205 patients, the majority were male (71.2%) and were above 60 years of age (49.3%); Predominantly non-traumatic (82.4%). 30.7% of the patients had sustained cardiac arrest in transit to the hospital. 41.5% of patients reached hospital by means other than ambulance. Only 9.8% patients had received bystander CPR. Only 12.5% ambulances had BLS trained personnel. AED was used only in 1% of patients. The initial rhythm at presentation to the hospital was non-shockable (96.5%). Return of spontaneous circulation (ROSC) was achieved in 17 (8.3%) patients, of which only 3 (1.4%) patients survived till discharge. The initial shockable rhythm was a significant predictor of ROSC (OR 18.97 95%CI 3.83-93.89; p < 0.001) and survival to discharge (OR 42.67; 95%CI 7.69-234.32; p < 0.001). CONCLUSION: The outcome of OHCA in India is dismal. The pre-hospital care received by the OHCA victim needs attention. Low by-stander CPR rate, under-utilised and under-equipped EMS system are the challenges.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Feminino , Humanos , Masculino , Parada Cardíaca Extra-Hospitalar/terapia , Sistema de Registros , Centros de Atenção Terciária
2.
Turk J Emerg Med ; 21(3): 129-132, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34377871

RESUMO

Nerve blocks are frequently used in emergency department for pain management in patients with fractures. Their utility in medical conditions with severe intactable pain is largely unknown. We report a series of seven patients with pancreatitis who presented with severe abdominal pain (defense and veteran pain rating scale > 7) and had no relief on regular analgesia. They were subjected to erector spinae plane block (ESPB), and reduction in pain score at different time intervals, side effects, and additional analgesic dose requirements were noted. The objective of this case series is to explore the utility of ESPB in patients with pancreatitis.

5.
J Emerg Med ; 61(3): 271-277, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34215472

RESUMO

BACKGROUND: Sympathetic crashing acute pulmonary edema (SCAPE) is a severe form of hypertensive acute heart failure with a dramatic presentation. Rapid identification and management in the emergency department (ED) is key to saving these patients and preventing morbidity associated with endotracheal intubation and intensive care treatment. Use of high-dose nitroglycerin (NTG) and noninvasive ventilation (NIV) has been advocated in management of such patients. OBJECTIVE: To study the feasibility and safety of high-dose NTG combined with NIV in SCAPE. METHODS: This was a prospective observational pilot study done in the ED of a tertiary care hospital. All patients were treated with high-dose NTG and NIV. The primary objective was to study the feasibility and safety of the SCAPE management protocol in terms of the outcome of the patient. Resolution of symptoms in 6 h and need for intubation were recorded as endpoints. Any complications associated with high-dose NTG were also recorded. RESULTS: A total of 25 patients were recruited. The mean bolus dose of NTG given was 872 µg, and mean cumulative dose, 35 mg. There was no incidence of hypotension after the bolus dose of nitroglycerin. Eleven patients had resolution of symptoms at 3 h of therapy. Twenty-four patients were discharged from the ED itself after a brief period of observation, and one patient was intubated and shifted to the intensive care unit. CONCLUSION: Use of our specific SCAPE treatment algorithm, which included high-dose NTG and NIV, was safe and provided rapid resolution of symptoms.


Assuntos
Insuficiência Cardíaca , Ventilação não Invasiva , Edema Pulmonar , Humanos , Nitroglicerina/uso terapêutico , Projetos Piloto , Estudos Prospectivos , Edema Pulmonar/tratamento farmacológico
6.
ACS Nano ; 15(5): 8686-8693, 2021 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-33970616

RESUMO

Multistate logic is recognized as a promising approach to increase the device density of microelectronics, but current approaches are offset by limited performance and large circuit complexity. We here demonstrate a route toward increased integration density that is enabled by a mechanically tunable device concept. Bi-anti-ambipolar transistors (bi-AATs) exhibit two distinct peaks in their transconductance and can be realized by a single 2D-material heterojunction-based solid-state device. Dynamic deformation of the device reveals the co-occurrence of two conduction pathways to be the origin of this previously unobserved behavior. Initially, carrier conduction proceeds through the junction edge, but illumination and application of strain can increase the recombination rate in the junction sufficiently to support an alternative carrier conduction path through the junction area. Optical characterization reveals a tunable emission pattern and increased optoelectronic responsivity that corroborates our model. Strain control permits the optimization of the conduction efficiency through both pathways and can be employed in quaternary inverters for future multilogic applications.

7.
J Family Med Prim Care ; 10(1): 542-549, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34017785

RESUMO

Background and Objectives: As the number of COVID-19 cases keeps on rising, a better awareness of the nature and severity of the disease will aid in clinical decision-making and management. Hence, this study was conducted to find the predictors of mortality and the need for mechanical ventilation in COVID-19 patients. Methods: This was a single centre, prospective observational study conducted in a tertiary care centre in north India. We included patients with influenza like illness who tested positive for COVID-19. Information regarding patient demography, symptoms, and vital signs on presentation, laboratory values, chest imaging findings, and disease severity was collected by the emergency physician. QSOFA score and National early warning score (NEWS) score were calculated using initial vital signs. Each patient was followed up till discharge or death. Results: We included 116 COVID-19 patients with 33 patients having mild, 46 patients with severe and 37 patients with critical disease. The median age of our patients was 47 years (39-59) with 63% males. About 58% of patients had at least one comorbidity and shortness of breath was the most common presenting feature. The patients with severe and critical disease had a significantly higher respiratory rate and heart rate as compared to mild disease (p < 0.05). SpO2 of those with critical disease was significantly lower as compared to those with mild disease. Mechanical ventilation was required in around 36% of patients which included 67% of patients with critical disease. The overall mortality was 51% with 90% among critical disease. Lower SpO2 and GCS were the only parameters that showed a significant association with mortality and need for mechanical ventilation. The receiver operating characteristics analysis showed NEWS score as a better predictor of mortality and need for mechanical ventilation as compared to qSOFA score. Conclusion: NEWS and qSOFA scores are useful tools in predicting fatal outcomes in COVID patients with NEWS score being a better score than qSOFA.

8.
J Glob Infect Dis ; 13(1): 13-19, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33911447

RESUMO

Background: A systematic review and meta-analysis of available studies was performed to investigate the clinical characteristics that can predict COVID-19 disease severity. Materials and Methods: Databases including PubMed, Embase, and Web of Science were searched from December 31, 2019, to May 24, 2020. Random-effects meta-analysis was used for summarizing the Pooled odds ratio (pOR) of individual clinical characteristics to describe their association with severe COVID-19 disease. Results: A total of 3895 articles were identified, and finally, 22 studies comprising 4380 patients were included. Severe disease was more common in males than females (pOR: 1.36, 95% confidence interval [CI]: 1.08-1.70). Clinical features that were associated with significantly higher odds of severe disease were abdominal pain (pOR: 6.58, 95% CI: 1.56-27.67), breathlessness (pOR: 3.94, 95% CI: 2.55-6.07), and hemoptysis (pOR: 3.35, 95% CI: 1.05-10.74). pOR was highest for chronic obstructive pulmonary disease (pOR: 2.92, 95% CI: 1.70-5.02), followed by obesity (pOR: 2.84, 95% CI: 1.19-6.77), malignancy (pOR: 2.38, 95% CI: 1.25-4.52), diabetes (pOR: 2.29, 95% CI: 1.56-3.39), hypertension (pOR: 1.72, 95% CI: 1.23-2.42), cardiovascular disease (pOR: 1.61, 95% CI: 1.31-1.98) and chronic kidney disease (pOR: 1.46, 95% CI: 1.06-2.02), for predicting severe COVID-19. Conclusion: Our analysis describes the association of specific symptoms and comorbidities with severe COVID-19 disease. Knowledge of these clinical determinants will assist the clinicians in the risk-stratification of these patients for better triage and clinical management.

9.
Afr J Emerg Med ; 11(1): 111-112, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33680730

RESUMO

Emergency care surveillance as well as registries of emergency care are largely absent in most LMICs. Improper data systems in Emergency Department create an important gap in our understanding about the health of large portions of the population. Clinical data systems in LMICs and lower-resource settings will foster research and generation of contextualized evidence.

10.
J Emerg Med ; 60(5): 641-647, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33518374

RESUMO

BACKGROUND: Various risk-stratification scores have been developed to identify low-risk febrile neutropenia (FN). The Multinational Association of Supportive Care in Cancer (MASCC) score is a commonly used validated scoring system, although its performance varies due to its subjectivity. Biomarkers like procalcitonin (PCT) are being used in patients with FN to detect bacteremia and additional complications. OBJECTIVE: Our objective was to compare the performance of MASCC score with PCT in predicting adverse outcomes in patients with FN. METHODS: This was a prospective observational study that included chemotherapy-induced FN in hematologic or solid malignancy. The MASCC score, PCT levels, and blood cultures were taken at the first point of contact, and patient treatment was managed according to routine institutional protocol. The primary outcome was mortality at 30 days. RESULTS: A total of 100 patients were recruited, of which 92 had hematologic malignancy and 8 had solid malignancy. Forty-six patients were classified as low risk by MASCC score (≥21). The PCT threshold, 1.42 ng/mL, was taken as a cutoff value, with area under the receiver operating characteristic curve (AUROC) of 0.664 (95% confidence interval [CI] -0.55 to 0.77) for predicting mortality. AUROC for MASCC was 0.586 (95% CI 0.462 to 0.711). CONCLUSIONS: PCT is a useful marker with better prognostic efficacy than MASCC score in patients with FN and can be used as an adjunct to the score in risk-stratifying patients with FN.


Assuntos
Antineoplásicos , Neutropenia Febril , Neoplasias , Antineoplásicos/uso terapêutico , Serviço Hospitalar de Emergência , Neutropenia Febril/diagnóstico , Humanos , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Valor Preditivo dos Testes , Pró-Calcitonina/uso terapêutico , Prognóstico , Medição de Risco
11.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563668

RESUMO

Sympathetic crash acute pulmonary edema (SCAPE) is a life-threatening injury, which requires early recognition and intervention to prevent mortality. We present a case of 18-year-old woman with no previous comorbidity, presenting with SCAPE who was successfully resuscitated and eventually diagnosed with renal artery stenosis. Pickering syndrome is a rare cause of hypertensive emergency and should be considered in a young patient presenting with SCAPE in emergency department.


Assuntos
Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico , Adolescente , Reanimação Cardiopulmonar , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Síndrome
12.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472809

RESUMO

Acute abdominal pain is a common presentation to the emergency department (ED). Ruling out life-threatening causes and giving pain relief are the most important tasks in ED. We describe a 32-year-old man who presented to ED with abdominal pain and vomiting which was unrelieved by usual doses of analgesic. Extensive investigations revealed no significant abnormalities. On further probing, he admitted taking traditional medications for infertility. The toxicological panel revealed a high blood lead level, leading to a diagnosis of acute lead toxicity. Chelation therapy with D-penicillamine was initiated and the patient's abdominal pain resolved within 4 days.


Assuntos
Dor Abdominal/diagnóstico , Medicamentos Falsificados/efeitos adversos , Intoxicação por Chumbo/diagnóstico , Charlatanismo , Vômito/diagnóstico , Dor Abdominal/tratamento farmacológico , Dor Abdominal/etiologia , Doença Aguda , Adulto , Anemia/etiologia , Antieméticos/uso terapêutico , Quelantes/uso terapêutico , Clordiazepóxido/uso terapêutico , Antagonistas Colinérgicos , Constipação Intestinal/etiologia , Medicamentos Falsificados/química , Combinação de Medicamentos , Serviço Hospitalar de Emergência , Humanos , Intoxicação por Chumbo/complicações , Intoxicação por Chumbo/tratamento farmacológico , Masculino , Parassimpatolíticos/uso terapêutico , Penicilamina/uso terapêutico , Fenetilaminas/uso terapêutico , Quinuclidinas/uso terapêutico , Tomografia Computadorizada por Raios X , Vômito/tratamento farmacológico , Vômito/etiologia
13.
J Emerg Med ; 60(4): 421-427, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33485742

RESUMO

BACKGROUND: Chest pain is a common presenting symptom in the emergency department (ED). The HEART (history, electroencephalogram [ECG], age, risk factors, and troponin I) score, with addition of troponin at 3 h, helps to determine appropriate risk stratification of the patients. OBJECTIVE: This study evaluated the utility of the HEART pathway as a decision aid designed for risk stratification of patients with acute-onset chest pain for early and safe disposition. METHODS: This was a prospective observational study done in a tertiary care center. Focused history, 12-lead ECG, and baseline troponin I level on arrival and at hour 3 were recorded. Subjects were classified as low risk (HEART score 0-3) or high risk (HEART score ≥ 4). Patients with a HEART score of 0-3 with negative troponin I at 3 h were discharged and were followed up for major adverse cardiac events (MACEs) within 30 days of ED presentation. RESULTS: A total of 250 patients were screened for the study, of which 151 were included for the final analysis. One hundred and two patients (68%) were male and 54% of patients were younger than 45 years. HEART scores of 0 (n = 16), 1 (n = 43), 2 (n = 44), and 3 (n = 48) were observed. There was only 1 MACE (0.7%) in 30 days after ED discharge in the study population. The mean length of ED stay in the low-risk group was 4.5 h. CONCLUSIONS: Low-risk patients, as per the HEART pathway, can be discharged safely from the ED, which reduces ED stay and health care resource use.


Assuntos
Síndrome Coronariana Aguda , Eletrocardiografia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Serviço Hospitalar de Emergência , Humanos , Masculino , Medição de Risco , Fatores de Risco , Troponina
14.
Am J Emerg Med ; 45: 324-328, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33041126

RESUMO

OBJECTIVE: The objective of this study was to describe the lung sonographic findings of COVID-19 patients prospectively and investigate its association with disease severity. METHODS: This study was conducted in an emergency department and included consecutively enrolled laboratory confirmed COVID-19 patients. Lung sonography findings were described in all the included patients and analysed with respect to the clinical severity of the patients. RESULTS: 106 patients were included in the study. Common sonographic findings in COVID-19 patients were pleural line irregularity or shredding (70% of patients), followed by B - profile (59%), pleural line thickening (33%), occasional B - lines (26%), sub-pleural consolidations (35%), deep consolidations (6%), spared areas (13%), confluent B - lines or waterfall sign (14%) and pleural effusion (9%). These findings tended to be present more bilaterally and in lower lung zones. Sonographic characteristics like bilateral lung involvement, B - profile, spared areas and confluent B - lines or waterfall sign were significantly associated (p < 0.01) with clinical severity (more frequent with increasing disease severity). CONCLUSION: The lung sonographic findings of COVID-19 were found more bilaterally and in lower lung zones, and specific findings like B - profile, pleural thickening, spared areas and confluent B - lines or waterfall sign were associated with severe COVID-19.


Assuntos
COVID-19/diagnóstico , Pulmão/diagnóstico por imagem , Pandemias , Ultrassonografia/métodos , Adulto , COVID-19/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Índice de Gravidade de Doença
15.
Am J Emerg Med ; 39: 190-196, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33046289

RESUMO

BACKGROUND AND OBJECTIVES: To assess the impact of personal protective equipment (PPE) on different aspects of chest compression (CC) during cardiopulmonary resuscitation, we conducted this study. METHODS: This systematic review was performed according to the PRISMA. We searched PubMed, EMBASE and Web of Science from inception to June-6, 2020, limiting to the studies that reported the comparison of the effectiveness of CC in terms of CC rate, CC depth, the proportion of adequate CC rate, the proportion of adequate CC depth or proportion of adequate recoil; in study arms with or without PPE. Risk of bias was assessed by the ROB-2 and ROBINS-I tool. Quantitative data synthesis was done using the generic inverse variance method and the fixed-effects model. RESULTS: Five simulation-based studies were finally included. A Significant decrease in CC rate (SMD: -0.28, 95%CI: -0.47 to -0.10) and CC depth (SMD: -0.26, 95%CI: -0.44 to -0.07) were observed in the PPE arm as compared to the no-PPE arm. The difference in CC rate was more prominently seen in adult CPR than in paediatric CPR. Without PPE, the proportion of adequate CC rate delivered was 0.74, which reduced significantly to 0.60 after use of PPE (p - 0.035). Similarly, the proportion of adequate CC depth was significantly lesser (p - 0.001) in PPE arm (0.55), as compared to that of the no-PPE arm (0.78). CONCLUSION: The use of PPE compromises the quality of CC during CPR significantly, and newer ways to deliver chest compression has to be investigated. This study was prospectively registered in PROSPERO (CRD42020192031).


Assuntos
Reanimação Cardiopulmonar/instrumentação , Parada Cardíaca/terapia , Massagem Cardíaca/instrumentação , Equipamento de Proteção Individual , Reanimação Cardiopulmonar/métodos , Humanos , Resultado do Tratamento
18.
J Lab Physicians ; 13(4): 323-327, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34975250

RESUMO

Background Occupational hazards like sharp injury and splash exposure (SISE) are frequently encountered in health-care settings. The adoption of standard precautions by healthcare workers (HCWs) has led to significant reduction in the incidence of such injuries, still SISE continues to pose a serious threat to certain groups of HCWs. Materials and Methods This was a retrospective study which examined the available records of all patients from January 2015 to August 2019 who self-reported to our emergency department with history of sharp injury and/or splash exposure. Details of the patients, mechanism of injury, the circumstances leading to the injury, status of the source (hepatitis B surface antigen, human immunodeficiency virus, and hepatitis C virus antibody status), and the postexposure prophylaxis given were recorded and analyzed. Data were represented in frequency and percentages. Results During the defined period, a total of 834 HCWs reported with SISE, out of which 44.6% were doctors. Majority of the patients have SISE while performing medical procedures on patients (49.5%), while 19.2% were exposed during segregation of waste. The frequency of needle stick injury during cannulation, sampling, and recapping of needle were higher in emergency department than in wards. More than 80% of HCWs received hepatitis B vaccine and immunoglobulin postexposure. Conclusion There is need for periodical briefings on practices of sharp handling as well as re-emphasizing the use of personal protective equipment while performing procedures.

19.
Turk J Emerg Med ; 20(4): 186-192, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33089027

RESUMO

BACKGROUND AND AIM: Up to 70% of out-of-hospital cardiac arrests are witnessed by family members, friends, and other bystanders. These bystanders can play a vital role in delivering help, before professional help arrives. Mandatory nationwide training of schoolchildren has shown the highest impact in improving the bystander cardiopulmonary resuscitation (CPR) rate. In our study, we compared the competency of different classes of schoolchildren from middle school onward in learning hands-only CPR. MATERIALS AND METHODS: This study was conducted in four schools. Schoolchildren were divided into three groups as middle school (6th to 8th standard) (MS), secondary school (9th and 10th standard) (SC), and senior secondary school (11th and 12th standard) (SN). Training module consisted of slide presentation on "hands-only CPR" of 1 h, video demonstration of 30 min, and hands-on session of 2.5 h. Students were then individually assessed for the skills. RESULTS: A total of 810 children were enrolled and trained. Initial approach was performed correctly by 68% of MS, 79.3% of SC, and 82.4% of SN school children, whereas 49.4% of MS, 61.3% of SC, and 72.5% of SN correctly performed chest compression in terms of rate, depth, and duration. Median compression depth and maximum duration of CPR achieved were significantly different across class groups (P < 0.001) Compression depth and duration of chest compression were positively correlated with children's age, height, weight, and body mass index (P < 0.001). CONCLUSION: Theoretical training on hands-only CPR can be started at the middle school level, and practical training can be incorporated in school curricula from secondary school.

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