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In this issue, we collaborated with CJEM team to present “Emergency department crowding negatively influences outcomes for adults presenting with chronic obstructive pulmonary disease”1 in a visual abstract format. A majority of these patients are affected by chronic obstructive pulmonary disease (COPD).
Initially, data suggested that the use of ultrasound during arrest increased pauses between compressions which worsens outcomes. The ideal view depends on the patient’s comorbid conditions such as COPD, obesity, cachexia, etc. Ultrasound during cardiac arrest has quickly become standard.
In this unblinded, randomized-controlled trial, patients with acute exacerbations of COPD received traditional NIPPV with inspiratory pressures <18 cmH20 or “high-intensity” NIPPV, with airway pressures titrated up to 20-30 cmH20. This trial, the HAPPEN trial, looks at a little bit different approach. in each group.
Systemic corticosteroids (such as intravenous dexamethasone) improve outcomes in severe pneumonia due to SARS-CoV-2 infection. It makes sense that inhaled steroids might improve outcomes from less severe infections. Do inhaled steroids improve Covid pneumonia? About two thirds of patients in each arm were vaccinated.
It can be used to distinguish between various conditions, including chronic obstructive pulmonary disease (COPD) exacerbation, acute heart failure (AHF), pleural effusion, pulmonary edema, pericardial effusion, pneumothorax, and pneumonia [2,3]. Patients : Compared standard of care to serial US plus stand care in patients with dyspnea.
Applying the Above to Today's Case: In addition to being Covid-positive — the patient in today's case had longstanding COPD. He was wheezing, and required supplemental oxygen.
Case: A 70-year-old man presents to the emergency department (ED) with an exacerbation of COPD. These results are promising and may influence future guidelines and clinical practices, emphasizing the importance of optimizing preoxygenation strategies to improve outcomes in critically ill patients.
This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Paper: Eastwood G, et al.
This is a common probably insurmountable problem with morbidities, such as hypertension, diabetes , COPD , etc. In these cases, not only is the diagnosis completely arbitrary on the part of the clinician, but the severity of the condition has an extremely strong influence on its contribution to the usually measured outcome.
In the assessment of a clinical trial, we want to know if differences in baseline characteristics may have played a role in the observed outcome. The question to consider is…are the actual differences seen between the groups with regards to baseline characteristics large enough to have influenced the outcome?
Outcome: 100% LAD Occlusion Here the Queen explains why: The dark blue tells us that she is looking especially at the QRS in V3 and the T-wave in V2 and V3. The differential diagnosis for "low voltage" that is frequently put forth by many providers is often limited to COPD and/or pericardial effusion.
In a well-randomized trial, equal numbers of clinically important differences in outcomes in opposite directions could average out to a null result, hiding the variability between patients. Neither PILOT nor ICU-ROX found a difference in outcomes with higher vs lower oxygenation targets in mechanical ventilated patients.
Comparison:None * Outcome: * Primary Outcome(s): Death within three months and CriSTAL’s predictive ability. Secondary Outcome: Predictive ability for in-hospital death This is an SGEMHOP episode and usually we have the lead author on the show. Intervention:The CriSTAL score, and its various components.
It can be further divided into two types: primary--those that occur in generally healthy individuals without underlying lung disease, and secondary--those that occur in individuals with underlying lung disease such as COPD [1]. Persistent air-leak in spontaneous pneumothorax--clinical course and outcome. 2023;78(Suppl 3):s1-s42.
The main outcome was the adjusted odds ratio for in-hospital mortality and hazard ratio for 30-day mortality with some pre-specified subgroups. The reconfiguration included the centralisation of hospitals and the establishment of emergency departments with specialists present around the clock.
Written by Pendell Meyers, edits by Smith: Case A 72 year old female with hypertension and COPD presented with sudden shortness of breath and chest pain. Peak troponin, echocardiographic findings, and long term outcome are unknown. There is sinus rhythm with PACs and PVCs. Learning Points: 1.
A 49 year old woman with h/o COPD only presented with sudden dyspnea. Outcome : She was diagnosed with stress cardiomyopathy, though it is not entirely classic. She had acute pulmonary edema on exam. There is STE and hyperacute T-waves in V2 and V3, with significant STE in I and aVL, and inferior reciprocal STD.
Background I’m not sure if you’ve noticed this, but patients and families frequently disagree with their physicians about the likely outcomes from critical illness. 3 days for anoxic encephalopathy to regain pupillary responses after cardiac arrest, 4-7 days for a DNR/DNI patient to receive NIPPV for COPD exacerbation, etc.)
COPD, Idiopathic PAH, acute or chronic PE, pulmonary valve stenosis, etc) 3) Conditions affecting RV myocardial contractility, such as ARVD or RV infarction The ECGs does not really show any signs of chronic RV dilation or hypertrophy. Any cause of pulmonary hypertension. Our THANKS to Dr. Magnus Nossen for sharing this case with us.
A 45-year-old male with a history of chronic obstructive pulmonary disease (COPD), asthma, amphetamine and tetrahydrocannabinol (THC) use, and coronary vasospasm presented to triage with chest pain. During initial assessment, an ECG was obtained and revealed ST-segment elevation (STE) in the inferior leads with ST depression anteriorly.
1] Would the outcomes be different? He had COPD and depended on home oxygen. From a professional standpoint, there is no question that my answer to the final question would be, “the past.” ” There are a dozen or so patients that I want a second chance at. Would some of the people still be here?
He has a history of chronic obstructive pulmonary disease (COPD), hypertension (HTN), congestive heart failure (CHF), and benign prostatic hypertrophy (BPH). All three showed no statistical difference between the two treatments for their primary outcome ( SGEM#69 , SGEM#92 and SGEM#113 ). He’s afebrile.
By way of introduction, I’ll save myself time and energy by quoting from a JGIM article (minus references), A National Survey of Internal Medicine Primary Care Residency Program Directors : Primary care has been associated with better health outcomes, higher patient satisfaction, and decreased health care cost.
Ensure you management plan includes how you plan to rule out any immediate concerns and what the outcome is likely to be if normal. Your trust will have guidelines on the treatment regimen using chlordiazepoxide/lorazepam and pabrinex.
Sepsis is coming in at a higher readmission rate and cost per admission than acute MI, CHF, COPD, and PNA. Be careful just sending a patient who is on the fence to the floor because several studies have demonstrated that patients who are later upgraded have worse outcomes. Jeff : Next we have epinephrine.
In studies, and in practice, these people tend to be patients with COPD who have resting O 2 sats of < 88%. The primary outcome was a composite of hospitalization or death from any cause within one year. About 80% had either COPD or pulmonary fibrosis and the mean PaO 2 and O 2 sats were about 50mm Hg and 80%, respectively.
Chronic obstructive pulmonary disease (COPD) is a chronic disease of the lungs caused by inflammatory and structural changes of the small airways and parenchyma of the lungs that result in chronic airflow obstruction and gas trapping. In 2019, the global prevalence of COPD was estimated to be 10.3 Click to enlarge.
Louis); Marina Boushra, MD (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case Emergency Medical Services brings in a 62-year-old male with COPD in acute on chronic hypoxemic respiratory failure (usually on 3 L nasal cannula, now on non-rebreather at 15 L/min). Notably, in the initial analysis of blunt chest trauma (i.e.
Read in JAMA Does Paxlovid Improve Covid-19 Outcomes in the Omicron Era? Even people with COPD or asthma under age 50 did not benefit from Paxlovid, in that analysis. absolute risk reduction in the composite outcome among the immunocompromised or those with significant medical conditions. Paxlovid was associated with about a 1.5-2.5%
Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review. Christina loves serving as […] The post SGEM#212: Holding Back the Years – Risk Factors for Adverse Outcomes in Older Adults with Blunt Chest Trauma first appeared on The Skeptics Guide to Emergency Medicine. Reference: Sawa et al.
Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Time to antibiotics and outcomes in cancer patients with febrile neutropenia. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol 2005; 75:1. 2014;14:162.
There is strong evidence that systemic steroids improve outcomes in patients with severe COVID-19 ( First10EM: Steroids for COVID ). Their primary outcome was a ‘COVID-19 related’ urgent care visit, emergency department assessment, or hospitalization, and was significantly reduced in the budesonide arm (15% vs 3%, p=0.009).
Additionally, cardiac instrumentation, recent procedures such as bronchoscopy/endoscopy, central venous catheter placement/displacement, aortic aneurysm, pneumonia, asthma, COPD, pleural effusion, and pericarditis can manifest as intractable hiccups through similar mechanisms. BMC Cancer. 2022;22:659. J Pain Symptom Manage. 2021;62(3).
I served the neighborhood of Austin, disproportionately debilitated by opioid overdoses, gun violence, and incarceration, not to mention COPD, diabetes and asthma. The predictable outcome has been mass hysteria. Direct evidence on hard clinical outcomes is needed. It was peak Delta wave on the West Side of Chicago.
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