Pub Date : 1900-01-01DOI: 10.22259/2638-5007.0201005
A. Abdo-Cuza, R. Castellanos-Gutiérrez, J. A. Gutiérrez-Martínez, J. Suárez-López, Geydy Leal-Alpizar, Yalina Benitez-Quevedo, Francisco Gómez-Peire, Juan C López-González, R. Machado-Martínez, Jonathan Pi-Ávila, Daniel González-González
Among a group of monitoring techniques that estimate ICP non-invasively, the measurement of the optic nerve sheath diameter (ONSD) seems to be the most promising. The prediction threshold to correlate with a high ICP (> 20 mmHg) has been proposed by some authors between 5.7 and 5.9 mm but there is no uniform cut-off point in the literature. Objective: To determine the utility of the ONSD measurement as an estimate of non-invasive ICP; correlating it with invasive measurements and cerebral hemodynamic patterns by transcranial Doppler. Method: The sample consisted of a series of five neurocritical cases admitted to the intensive care unit of the Centro de Investigaciones Médico Quirúrgicas, to which an intraventricular catheter was placed to measure ICP by air bag using the Spiegelberg monitor. Each patient underwent simultaneous measurements of ICP, transcranial Doppler ultrasound and retrobulbar ultrasound to measure ONSD. In total, 16 measurements were made that integrated the data for statistical analysis. Results: The value of ONSD over which there was ICP >20 mmHg was 6.50 mm, constituting the cut-off point. The correlation between mvMCA and ONSD was moderate and inverse, with statistical significance (r = -0.532, p = 0.034). Conclusions: Non-invasive multiparametric monitoring as part of critical ultrasound shows promise in neurocritical patients.
在一组无创评估ICP的监测技术中，视神经鞘直径(ONSD)的测量似乎是最有前途的。一些作者提出了与高ICP (bbb20mmhg)相关的预测阈值在5.7和5.9 mm之间，但在文献中没有统一的截止点。目的:确定ONSD测量作为非侵入性ICP评估的效用;通过经颅多普勒将其与侵入性测量和脑血流动力学模式相关联。方法:选取5例在msamicdico调查中心Quirúrgicas重症监护病房就诊的神经危重症患者为研究对象，采用Spiegelberg监护仪，脑室内置管，气囊测量颅内压。每位患者同时进行ICP、经颅多普勒超声和球后超声测量ONSD。总共进行了16次测量，将数据整合起来进行统计分析。结果:颅内压超过20 mmHg时的ONSD值为6.50 mm，构成分界点。mvMCA与ONSD呈中度、负相关，差异有统计学意义(r = -0.532, p = 0.034)。结论:无创多参数监测作为关键超声的一部分，在神经危重症患者中显示出希望。
{"title":"Non-Invasive Multiparametric Monitoring through Measurement of the Optic Nerve Sheath Diameter and Transcranial Doppler Ultrasound as an Approach to Cerebral Hemodynamics","authors":"A. Abdo-Cuza, R. Castellanos-Gutiérrez, J. A. Gutiérrez-Martínez, J. Suárez-López, Geydy Leal-Alpizar, Yalina Benitez-Quevedo, Francisco Gómez-Peire, Juan C López-González, R. Machado-Martínez, Jonathan Pi-Ávila, Daniel González-González","doi":"10.22259/2638-5007.0201005","DOIUrl":"https://doi.org/10.22259/2638-5007.0201005","url":null,"abstract":"Among a group of monitoring techniques that estimate ICP non-invasively, the measurement of the optic nerve sheath diameter (ONSD) seems to be the most promising. The prediction threshold to correlate with a high ICP (> 20 mmHg) has been proposed by some authors between 5.7 and 5.9 mm but there is no uniform cut-off point in the literature. Objective: To determine the utility of the ONSD measurement as an estimate of non-invasive ICP; correlating it with invasive measurements and cerebral hemodynamic patterns by transcranial Doppler. Method: The sample consisted of a series of five neurocritical cases admitted to the intensive care unit of the Centro de Investigaciones Médico Quirúrgicas, to which an intraventricular catheter was placed to measure ICP by air bag using the Spiegelberg monitor. Each patient underwent simultaneous measurements of ICP, transcranial Doppler ultrasound and retrobulbar ultrasound to measure ONSD. In total, 16 measurements were made that integrated the data for statistical analysis. Results: The value of ONSD over which there was ICP >20 mmHg was 6.50 mm, constituting the cut-off point. The correlation between mvMCA and ONSD was moderate and inverse, with statistical significance (r = -0.532, p = 0.034). Conclusions: Non-invasive multiparametric monitoring as part of critical ultrasound shows promise in neurocritical patients.","PeriodicalId":176391,"journal":{"name":"Archives of Emergency Medicine and Intensive Care","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128318907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.22259/2638-5007.0202003
D. Haehn, M. Rivera-Valenzuela, A. Gonzalez-Estrada
Hereditary angioedema (HAE) is a rare autosomal dominant condition caused by an uncontrolled activation of the contact pathway leading to an excessive production of bradykinin, with subsequent episodes of self-limited, non-pruritic swelling of the skin, the gastrointestinal and airway mucosa, which can be life-threatening. Here, we present a case of type II HAE in a patient who presented to multiple institutions with severe abdominal crisis described as diffuse colicky abdominal pain associated with abdominal distention and was misdiagnosed with acute abdomen leading to multiple surgical procedures.
{"title":"Type II Hereditary Angioedema Misdiagnosed with an Acute Abdomen: A Case Report Study","authors":"D. Haehn, M. Rivera-Valenzuela, A. Gonzalez-Estrada","doi":"10.22259/2638-5007.0202003","DOIUrl":"https://doi.org/10.22259/2638-5007.0202003","url":null,"abstract":"Hereditary angioedema (HAE) is a rare autosomal dominant condition caused by an uncontrolled activation of the contact pathway leading to an excessive production of bradykinin, with subsequent episodes of self-limited, non-pruritic swelling of the skin, the gastrointestinal and airway mucosa, which can be life-threatening. Here, we present a case of type II HAE in a patient who presented to multiple institutions with severe abdominal crisis described as diffuse colicky abdominal pain associated with abdominal distention and was misdiagnosed with acute abdomen leading to multiple surgical procedures.","PeriodicalId":176391,"journal":{"name":"Archives of Emergency Medicine and Intensive Care","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131518314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.22259/2638-5007.0202002
C. Stewart, P. Patel, N. Mediratta
Aims: As Paediatric Emergency Departments (PED) become busier the number of children requiring painful procedures continues to increase. We aimed to evaluate a locally developed paediatric procedural sedations (PPS) service using ketamine for safety, efficiency and efficacy in the context of the national 4 hour operational target which is due to be revised this year in the UK Methods: We enrolled consecutive patients over 12 months suitable for PPS ketamine and collected data for demographics, time to patient identification, time to ketamine administration, procedural duration and time to recovery. We also documented procedure outcome, adverse events, consent, ketamine dosage and baseline physiological observations Results: From May 2017 to May 2018 ketamine PPS was performed on 36 patients with a mean age of 7 years (range 1.8 to 14.6 years). The most common procedure performed was manipulation of forearm fractures (n=21, 58%), followed by facial laceration repair (n=10, 28%). Total intravenous Ketamine dosages were; 1mg/kg (n=23, 64%) 1.5mg/kg (n=10, 28%) and 2mg/kg (n=3, 8%). Average time to referral to surgical speciality was 33 minutes which improved from 40 minutes (pre Sept) to 27 minutes (post Sept). Average time to ketamine administration was 168 minutes, improved from 185 minutes (pre Sept) to 155 minutes (post Sept). The average time taken to complete procedures, all under 20 minutes, also decreased from 19 minutes (pre Sept) to 10 minutes (post Sept) averaging 15 minutes overall. The recovery time was similar throughout the study period. The overall average length of stay (LOS) was 284 minutes, improved from 297 minutes (pre Sept) to 274 minutes (post Sept) figure 3. 20 (55%) of the 36 patients breached the 4 hour target. 10 (28%) patients were admitted, 9 for further neurovascular observations and only 1 where the outcome of a procedure was unsatisfactory. There were no seminal untoward incidents in our study. Vomiting occurred in 4, there was 1 drug error and one patient required brief airway manoeuvres for decreased oxygen saturations Conclusion: We have confirmed PPS ketamine service to be safe and further demonstrated good outcomes in procedures carried out. Despite improved efficiency in the study period the average LOS still falls outside the 4 hour target and a revision would be welcomed to reduce anxiety related to breaches in this group and encourage more uptake of PPS ketamine nationally
{"title":"Would Changes to the 4 Hour Target Benefit Paediatric Procedural Sedation? A Service Review","authors":"C. Stewart, P. Patel, N. Mediratta","doi":"10.22259/2638-5007.0202002","DOIUrl":"https://doi.org/10.22259/2638-5007.0202002","url":null,"abstract":"Aims: As Paediatric Emergency Departments (PED) become busier the number of children requiring painful procedures continues to increase. We aimed to evaluate a locally developed paediatric procedural sedations (PPS) service using ketamine for safety, efficiency and efficacy in the context of the national 4 hour operational target which is due to be revised this year in the UK Methods: We enrolled consecutive patients over 12 months suitable for PPS ketamine and collected data for demographics, time to patient identification, time to ketamine administration, procedural duration and time to recovery. We also documented procedure outcome, adverse events, consent, ketamine dosage and baseline physiological observations Results: From May 2017 to May 2018 ketamine PPS was performed on 36 patients with a mean age of 7 years (range 1.8 to 14.6 years). The most common procedure performed was manipulation of forearm fractures (n=21, 58%), followed by facial laceration repair (n=10, 28%). Total intravenous Ketamine dosages were; 1mg/kg (n=23, 64%) 1.5mg/kg (n=10, 28%) and 2mg/kg (n=3, 8%). Average time to referral to surgical speciality was 33 minutes which improved from 40 minutes (pre Sept) to 27 minutes (post Sept). Average time to ketamine administration was 168 minutes, improved from 185 minutes (pre Sept) to 155 minutes (post Sept). The average time taken to complete procedures, all under 20 minutes, also decreased from 19 minutes (pre Sept) to 10 minutes (post Sept) averaging 15 minutes overall. The recovery time was similar throughout the study period. The overall average length of stay (LOS) was 284 minutes, improved from 297 minutes (pre Sept) to 274 minutes (post Sept) figure 3. 20 (55%) of the 36 patients breached the 4 hour target. 10 (28%) patients were admitted, 9 for further neurovascular observations and only 1 where the outcome of a procedure was unsatisfactory. There were no seminal untoward incidents in our study. Vomiting occurred in 4, there was 1 drug error and one patient required brief airway manoeuvres for decreased oxygen saturations Conclusion: We have confirmed PPS ketamine service to be safe and further demonstrated good outcomes in procedures carried out. Despite improved efficiency in the study period the average LOS still falls outside the 4 hour target and a revision would be welcomed to reduce anxiety related to breaches in this group and encourage more uptake of PPS ketamine nationally","PeriodicalId":176391,"journal":{"name":"Archives of Emergency Medicine and Intensive Care","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116362985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.22259/2638-5007.0401004
F. Lateef
{"title":"Culture of Psychological Safety in the Emergency Department: Don’t Forget the Hidden Curriculum","authors":"F. Lateef","doi":"10.22259/2638-5007.0401004","DOIUrl":"https://doi.org/10.22259/2638-5007.0401004","url":null,"abstract":"","PeriodicalId":176391,"journal":{"name":"Archives of Emergency Medicine and Intensive Care","volume":"402 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115585976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.22259/2638-5007.0202001
Yasser Mohammed Hassanain Elsayed
Background: Premature ventricular contractions are the most frequent cardiac arrhythmia with or without structural heart diseases. These common type of arrhythmia possess both benign and serious outcome. Premature ventricular contraction may be an independent predictor for either sudden or non-sudden death. Objective: An exploring the clinical significance, type verification, recent management, and outcome of premature ventricular contraction in the patients were the purpose of this study. Method of study: A narrative updating review was the study method in the current research. Conclusions: Premature ventricular contraction may be benign and may be a serious arrhythmia. Early and rapid verification of premature ventricular contractions hurry avoidance of the serious outcome. Recent efficient use of nitroglycerin in many types of premature ventricular contractions make it for in front of future selection as an antiarrhythmic drug.
{"title":"Premature Ventricular Contractions from Benign to Seriousness - A Narrative Updating Review","authors":"Yasser Mohammed Hassanain Elsayed","doi":"10.22259/2638-5007.0202001","DOIUrl":"https://doi.org/10.22259/2638-5007.0202001","url":null,"abstract":"Background: Premature ventricular contractions are the most frequent cardiac arrhythmia with or without structural heart diseases. These common type of arrhythmia possess both benign and serious outcome. Premature ventricular contraction may be an independent predictor for either sudden or non-sudden death. Objective: An exploring the clinical significance, type verification, recent management, and outcome of premature ventricular contraction in the patients were the purpose of this study. Method of study: A narrative updating review was the study method in the current research. Conclusions: Premature ventricular contraction may be benign and may be a serious arrhythmia. Early and rapid verification of premature ventricular contractions hurry avoidance of the serious outcome. Recent efficient use of nitroglycerin in many types of premature ventricular contractions make it for in front of future selection as an antiarrhythmic drug.","PeriodicalId":176391,"journal":{"name":"Archives of Emergency Medicine and Intensive Care","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131207270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.22259/2638-5007.0402001
Ho Kang Hua Lucius, F. Lateef
{"title":"All About BRASH!","authors":"Ho Kang Hua Lucius, F. Lateef","doi":"10.22259/2638-5007.0402001","DOIUrl":"https://doi.org/10.22259/2638-5007.0402001","url":null,"abstract":"","PeriodicalId":176391,"journal":{"name":"Archives of Emergency Medicine and Intensive Care","volume":"162 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116667922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.22259/2638-5007.0401005
Bedriye Müge Sönmez
{"title":"Prognostic Effect of Optic Nerve Sheath Diameter Measurement in Traumatic Brain Injury Patients Admitted to Emergency Department","authors":"Bedriye Müge Sönmez","doi":"10.22259/2638-5007.0401005","DOIUrl":"https://doi.org/10.22259/2638-5007.0401005","url":null,"abstract":"","PeriodicalId":176391,"journal":{"name":"Archives of Emergency Medicine and Intensive Care","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125723275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.22259/2638-5007.0401003
Maiara Anschau Floriani, Andressa Barreto Glaeser, I. Zorzo, M. Bessel, Andriele Abreu Castro, Mohamed Mutlaq Parrini, Luiz Antonio Nasi, Gisele Alsina Nader Bastos
{"title":"Patient-reported outcomes measures after six months of COVID-19: Impacts on health-related quality of life","authors":"Maiara Anschau Floriani, Andressa Barreto Glaeser, I. Zorzo, M. Bessel, Andriele Abreu Castro, Mohamed Mutlaq Parrini, Luiz Antonio Nasi, Gisele Alsina Nader Bastos","doi":"10.22259/2638-5007.0401003","DOIUrl":"https://doi.org/10.22259/2638-5007.0401003","url":null,"abstract":"","PeriodicalId":176391,"journal":{"name":"Archives of Emergency Medicine and Intensive Care","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129949924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.22259/2638-5007.0202004
Suárez-López Juliette, C. Antonio, C. Raul, A. Anselmo
The main objective of the anesthesiologist during surgery is to ensure adequate tissue perfusion. To guide the anesthetic-surgical process, the anesthesiologist uses non-invasive or invasive monitoring techniques, according to the clinical judgment of the risk associated with the physical condition of the patient and the size of the surgery, which allow measuring and monitoring ventilation, oxygenation, cardiovascular function, temperature, metabolism, level of muscle relaxation and state of consciousness of the patient. Achieving the best hemodynamic coupling or coherence between macro and microcirculation will ultimately determine the good end result in high-risk surgical patients. To evaluate the proper functioning of the microvasculature, the comparative measurement of hemogasometric variables taken in arterial blood and central venous blood samples (called arterio-venous oxygen and carbon dioxide differences, lactate levels and venous saturation) is postulated. It is known that all of them document the interactions between systemic blood flow, tissue supply and oxygen consumption.
{"title":"Tissue Perfusion Monitoring in Anesthetic Conduction of Risk Patients in Limited Resource Scenarios","authors":"Suárez-López Juliette, C. Antonio, C. Raul, A. Anselmo","doi":"10.22259/2638-5007.0202004","DOIUrl":"https://doi.org/10.22259/2638-5007.0202004","url":null,"abstract":"The main objective of the anesthesiologist during surgery is to ensure adequate tissue perfusion. To guide the anesthetic-surgical process, the anesthesiologist uses non-invasive or invasive monitoring techniques, according to the clinical judgment of the risk associated with the physical condition of the patient and the size of the surgery, which allow measuring and monitoring ventilation, oxygenation, cardiovascular function, temperature, metabolism, level of muscle relaxation and state of consciousness of the patient. Achieving the best hemodynamic coupling or coherence between macro and microcirculation will ultimately determine the good end result in high-risk surgical patients. To evaluate the proper functioning of the microvasculature, the comparative measurement of hemogasometric variables taken in arterial blood and central venous blood samples (called arterio-venous oxygen and carbon dioxide differences, lactate levels and venous saturation) is postulated. It is known that all of them document the interactions between systemic blood flow, tissue supply and oxygen consumption.","PeriodicalId":176391,"journal":{"name":"Archives of Emergency Medicine and Intensive Care","volume":"123 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127063005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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