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Lyon R.M.,Emergency Medicine and Pre hospital Care | Nelson M.J.,Emergency Medicine
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Year: 2013

Background: Out-of-hospital cardiac arrest (OHCA) is a common medical emergency with significant mortality and significant neurological morbidity. Helicopter emergency medical services (HEMS) may be tasked to OHCA. We sought to assess the impact of tasking a HEMS service to OHCA and characterise the nature of these calls.Method: Retrospective case review of all HEMS calls to Surrey and Sussex Air Ambulance, United Kingdom, over a 1-year period (1/9/2010-1/9/2011). All missions to cases of suspected OHCA, of presumed medical origin, were reviewed systematically.Results: HEMS was activated 89 times to suspected OHCA. This represented 11% of the total HEMS missions. In 23 cases HEMS was stood-down en-route and in 2 cases the patient had not suffered an OHCA on arrival of HEMS. 25 patients achieved return-of-spontaneous circulation (ROSC), 13 (52%) prior to HEMS arrival. The HEMS team were never first on-scene. The median time from first collapse to HEMS arrival was 31 minutes (IQR 22-40). The median time from HEMS activation to arrival on scene was 17 minutes (IQR 11.5-21). 19 patients underwent pre-hospital anaesthesia, 5 patients had electrical or chemical cardioversion and 19 patients had therapeutic hypothermia initiated by HEMS. Only 1 post-OHCA patient was transported to hospital by air. The survival to discharge rate was 6.3%.Conclusion: OHCA represents a significant proportion of HEMS call outs. HEMS most commonly attend post-ROSC OHCA patients and interventions, including pre-hospital anaesthesia and therapeutic hypothermia should be targeted to this phase. HEMS are rarely first on-scene and should only be tasked as a first response to OHCA in remote locations. HEMS may be most appropriately utilised in OHCA by only attending the scene if a patient achieves ROSC. © 2013 Lyon and Nelson; licensee BioMed Central Ltd. Source

Peacock W.F.,Emergency Medicine | Disomma S.,University of Rome La Sapienza
Critical Pathways in Cardiology | Year: 2014

Emergency medicine represents a unique practice environment where diagnostic accuracy, treatment, and critical disposition decisions must occur in a time-sensitive environment intolerant of both errors and inefficiency. These pressures can make an accurate heart failure diagnosis challenging, as it must be predominately based on clinical findings. Although accuracy is improved by natriuretic peptide testing, at some point in the clinical course a disposition is required regardless of diagnostic certainty. Disposition options range widely from expensive and highly specialized intensive care unit admissions to low-tech/low-cost observation management or even discharge directly to home. In this vein, success is predicated on matching patient needs to available resources while minimizing the untimely discharge that results in a return visit to the emergency room. Thus, the role of the emergency physician is to predict the future based on limited objective data. Biomarkers may aid in this task, and the newly available galectin-3 assay may be of particular utility. Elevated galectin-3, reflective of myocardial fibrosis and inflammation, is associated with increased risk of short-term death and the necessity for 30-day rehospitalization. The availability of accurate risk stratification tools for predicting the probability of rehospitalization or death could guide in the matching of resource-intensive heart failure disease management efforts to the higher risk cohort, while simultaneously identifying lower risk candidates for successful observation unit or outpatient management. This article reviews the potential utility of galectin-3 measurement for use in emergency department decision making. Copyright © 2014 by Lippincott Williams & Wilkins. Source

Hassan T.B.,Emergency Medicine
British Journal of Hospital Medicine | Year: 2014

Sustainable and satisfying working practices in emergency medicine are vital to produce career longevity and prevent premature 'burnout'. A range of strategies is required to ensure success for the individual and the system in which he/she works. © MA Healthcare Limited 2014. Source

Wellsh B.M.,Emergency Medicine | Kuzma J.M.,Divine Word University
American Journal of Emergency Medicine | Year: 2016

Background Pediatric forearm fractures are a common presentation in emergency departments in Papua New Guinea. Often these children undergo "blind" closed reduction with reduction adequacy assessed by standard radiographs. This study aims to demonstrate the safety and efficacy of ultrasound (US) in guiding closed reduction of pediatric forearm fractures in a resource-limited setting. Methods We recruited consecutive children with closed forearm fractures requiring reduction. A US scanner was used to visualize and aid fracture reductions. The outcome measures were the rate of successful reductions (ie, adequate alignment without the need for a second procedure or further surgical intervention), length of stay in hospital, and adverse events during each procedure and at follow-up after 6 weeks. Results Of 47 children recruited, there were 44 (94%) successful reductions, whereas 3 (6%) required repeated reduction. The mean (SD) length of stay in hospital of the successful cases was 8.77 (3.66) hours. Two patients had tight plaster casts during early follow-up which were immediately addressed. Of the 44 successful cases, only 38 were retrieved for the final review. No further adverse events were observed in the latter. Conclusions This small-scale study has demonstrated the safe and efficacious use of US-guided close reduction of pediatric forearm fractures in a low-resource setting. Using US, real-time visualization of reduction efforts can reassure the clinician in decision making, thus reducing the rate of repeated reductions and allowing shorter hospital stay. © 2015 Elsevier Inc. All rights reserved. Source

News Article
Site: http://news.yahoo.com/science/

People's reactions to getting stung by a bee or wasp can range from a feeling bit of pain to a suffering a deadly allergy reaction — and now a recent report of one man's case highlights a particularly rare complication of a sting: having a stroke. The 44-year-old Ohio man was working at a construction site when he was stung by a wasp on his leg, according to the report. Initially, the man developed a rash and hives. But about an hour later, the man displayed several telltale signs of a stroke — difficulty speaking, paralysis on one side of his body and a facial "droop" — and was rushed to the hospital. A stroke occurs when a part of a person's brain is starved of blood, typically because of a blood clot or a leaky blood vessel. [7 Things That May Raise Your Risk of Stroke] Dr. Michael DeGeorgia, who treated the man, told Live Science that he had never before seen a case where a stroke was caused by a wasp sting. DeGeorgia is the director of the Neurocritical Care Center at University Hospitals Case Medical Center in Ohio. There are several other reports, however, of patients who had strokes after being stung by a bee or a wasp, said DeGeorgia, who was the senior author of the case report, published in August in the Journal of Emergency Medicine. (Bees and wasps are both part of an category of insects called hymenopterans, which also includes ants and sawflies.) In most of the cases where a bee sting led to a stroke, however, the patients received multiple stings, the researchers wrote in their report. There are several mechanisms through which a wasp sting could lead to a stroke, according to the report. First, because wasp venom contains a number of compounds that cause a person's blood vessels to constrict, it's possible that a sting could cause blood vessels in the brain to constrict enough that a stroke occurs. In addition, some of the compounds in wasp venom are "prothrombotic," meaning they can cause blood to clot, which could also trigger a stroke, according to the report. Wasp stings may also lead to a type of irregular heart beat called atrial fibrillation, according to the report. People with atrial fibrillation are at increased risk of stroke because the condition causes blood to pool in the heart. This makes clots more likely to form, which travel up to the brain and cause a stroke. Finally, severe allergic reactions can cause a person's blood pressure to drop, according to the report. When a person has very low blood pressure, also called hypotension, not enough blood flows to the blood vessels in the brain and this can lead to a stroke, DeGeorgia said. To picture what's going on, DeGeorgia said, imagine a sprinkler in the front yard. If you turn off the water, the flow slows to a trickle and then nothing, he said. That's how low blood pressure causes a stroke, he said. In the man's case, the doctors believe that the first mechanism — the blood vessel-constricting compounds in the wasp venom — is what lead to his stroke. When the doctors did brain scans on the man, they found that blood vessels in his brain were constricted, DeGeorgia said. They didn't find a blood clot, but that could be because the clot broke up before they were able to do the brain scans, he added. It's possible that the man also had an irregular heart beat that could've contributing to the clotting, but the doctors didn't catch it, DeGeorgia said. Irregular heart beats can come and go, he said. Still, it isn't clear why a single wasp sting caused the man's stroke, DeGeorgia said. It seems that in most cases, a person needs to get a lot of wasp venom for a stroke to occur, he said. The man may have just been especially sensitive to the venom, he said. [Here's a Giant List of the Strangest Medical Cases We've Covered] And although there aren't any specific risk factors that would make a stroke more likely after a wasp sting, in people who already have risk factors for stroke, such as high blood pressure or high cholesterol, perhaps an insect sting could tip them over the edge, DeGeorgia said. In the man's case, however, he didn't have any of the obvious risk factors, he noted.

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