Current Emergency and Hospital Medicine Reports最新文献

Purpose of review: Many new concepts in diagnosis, management, and risk stratification of patients with pneumonia have been described recently. The COVID pandemic made importance of viruses as dangerous pathogens of pneumonia quite clear while several non-invasive measures for patients with respiratory failure gained a more wide-spread usage.

Recent findings: Studies continue to examine feasibility of bedside ultrasound as a tool in accurate diagnosis of pneumonia in the emergency department, and several new antibiotics have been approved for treatment while others are in late-stage clinical trials. Additionally, the Infectious Diseases Society, American Thoracic Society, and their European counterparts published updated guidelines in recent years. For differences important to emergency medicine clinicians and new emphasis as compared to the prior guidelines, please see Table 1. Several new antibiotics have been approved recently but remain relatively unknown to emergency clinicians as their use is frequently restricted to infectious disease specialists. [Table: see text].

Summary: As the emergency physicians gain new tools to rapidly diagnose, treat, and appropriately disposition pneumonia cases that appear to become more complex as people unfortunately accumulate more comorbidities, we hope to offer better care and improve outcomes for our patients while allowing staff to enjoy coming to work.

Purpose of review: Emergency airway management is populated by many new concepts, evolving equipment, and contemporary strategies for optimal procedural success. This review aims to discuss various topics within these realms and to continue the ongoing conversation regarding improvement of emergency airway management.

Recent findings: Various literature, opinion pieces, podcasts, and trials have prompted renewed interest in the field of emergency airway management. Though common threads can be found, there is significant debate on optimal practice. Accompanying these conversations is continuous production of new equipment which can be beneficial to providers. However, this ongoing accumulation of material, data, and pathways can create challenges in remaining up to date. Rather than a comprehensive review of current literature and discussion of research findings, this article aims to discuss selected and impactful concepts in real time context and provide potentially immediate additions to emergency airway manager practice.

Summary: As emergency airway management evolves, it remains a significant task to maintain up to date on current trends, data, and new equipment. This article aims to discuss several of these items in a digestible fashion and provide immediate impact for emergency airway providers.

Purpose of review: This review investigates the use of wearable electrocardiograms (ECGs) in the clinic and acute care setting, and their impact on patient care, particularly pertaining to the management of cardiac arrhythmias.

Recent findings: Wearable ECGs have consistently demonstrated their non-inferiority in detecting arrhythmias when compared to the current standard of care. Different studies have highlighted their ability to improve patient care and reduce healthcare costs, while more devices are being created to work as a screening tool at a larger scale or to fit the physical abilities of a variety of patients.

Summary: The use of wearable cardiac monitoring devices demonstrated considerable symptom-rhythm correlation in various clinical settings, which often resulted in a reduction in time to diagnosis and lower rates of ED visits. However, this relatively new technology raised concerns for patient accessibility and privacy among others. Further research is needed to assess their sensitivity and specificity in the clinical setting, as well as their limitations.

Purpose of review: Endovascular therapy for acute ischemic stroke secondary to large vessel occlusion (LVO) is time-dependent. Prehospital patients with suspected LVO stroke should be triaged directly to specialized stroke centers for endovascular therapy. This review describes advances in LVO detection among prehospital suspected stroke patients.

Recent findings: Clinical prehospital stroke severity tools have been validated in the prehospital setting. Devices including EEG, SSEPs, TCD, cranial accelerometry, and volumetric impedance phase-shift-spectroscopy have recently published data regarding LVO detection in hospital settings. Mobile stroke units bring thrombolysis and vessel imaging to patients.

Summary: The use of a prehospital stroke severity tool for LVO triage is now widely supported. Ease of use should be prioritized as there are no meaningful differences in diagnostic performance amongst tools. LVO diagnostic devices are promising, but none have been validated in the prehospital setting. Mobile stroke units improve patient outcomes and cost-effectiveness analyses are underway.