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The role of the emergency department in the patient with acute heart failure.
Horton CF, Collins SP.
“…. There are very little data to aid EM physicians when trying to identify low-risk patients who are safe for ED discharge and observation units are not yet universally utilized. This results in 80 % of patients with ADHF getting admitted to the hospital. The aim of this review is to evaluate current strategies for diagnosis, treatment, and disposition of the ADHF patient in the ED while highlighting new approaches for treatment and disposition, and areas in need of additional research.”
Use of Azithromycin and Death from Cardiovascular Causes
Henrik Svanström, M.Sc., Björn Pasternak, M.D., Ph.D., and Anders Hviid, Dr.Med.Sci.
N Engl J Med 2013; 368:1704-1712
May 2, 2013
DOI: 10.1056/NEJMoa1300799
Azithromycin use was not associated with an increased risk of death from cardiovascular causes in a general population of young and middle-aged adults.
For Immediate Release: April 29, 2013 FDA approves Kcentra for the urgent reversal of anticoagulation in adults with major bleeding
The U.S. Food and Drug Administration today approved Kcentra (Prothrombin Complex Concentrate, Human) for the urgent reversal of vitamin K antagonist (VKA) anticoagulation in adults with acute major bleeding. Plasma is the only other product approved for this use in the United States.
Patients receiving chronic anticoagulation therapy with warfarin and other VKA anticoagulants to prevent blood clotting in conditions such as atrial fibrillation or the presence of an artificial heart valve sometimes develop acute bleeding. Like plasma, Kcentra is used in conjunction with the administration of vitamin K to reverse the anticoagulation effect and stop the bleeding. Unlike plasma, Kcentra does not require blood group typing or thawing, so it can be administered more quickly than frozen plasma.
“The FDA’s approval of this new product gives physicians a choice when deciding how to treat patients requiring urgent reversal of VKA anticoagulation,” said Karen Midthun, M.D., director, Center for Biologics Evaluation and Research, FDA. “Kcentra is administered in a significantly lower volume than plasma at recommended doses, providing an alternative for those patients who may not tolerate the volume of plasma required to reverse VKA anticoagulation.”
Kcentra is associated with the occurrence of blood clots when used as indicated, and carries a boxed warning regarding the risk of blood clots. The warning also explains that patients receiving Kcentra should be monitored for signs and symptoms of thromboembolic events, as both fatal and non-fatal arterial and venous thromboembolic complications have been reported in clinical trials and post marketing surveillance.
Kcentra is made from the pooled plasma of healthy donors. It is processed in a way to minimize the risk of transmitting viral and other diseases. The FDA approval of Kcentra was based on a study of 216 patients who had been receiving VKA anticoagulation and who had acute major bleeding along with a clotting test value indicative of anticoagulant use. Kcentra was demonstrated to be similar to plasma in terms of the ability to stop acute major bleeding.
The drug is manufactured by CSL Behring, Marburg, Germany.
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.
After extended hospitalization (43 ± 41 days), disposition varied (home, 62%; rehabilitation, 32%; skilled nursing facility, 6%), but readmission was common (33%) in the 37 EDT hospital survivors. Of the 21 contacted, 16 completed the study evaluation, 2 had died, 1 remained in a comatose state, and 2 were available by telephone only. While unemployment (75%), daily alcohol (50%), and drug use (38%) were common, of the 16 patients who underwent the comprehensive, multidisciplinary outpatient assessment after a median of 59 months following EDT, 75% had normal cognition and returned to normal activities, 81% were freely mobile and functional, and 75% had no evidence of posttraumatic stress disorder upon outpatient screening.
Pediatr Emerg Care. 2013 Apr 18. [Epub ahead of print]
National Trends in Emergency Department Use of Urinalysis, Complete Blood Count, and Blood Culture for Fever Without a Source Among Children Aged 2 to 24 Months in the Pneumococcal Conjugate Vaccine 7 Era.
In bivariate and multivariate analyses, CBC orders declined between 2004 and 2009 for visits by all children 2 to 24 months, children 2 to 11 months, and boys 2 to 24 months (adjusted odds ratio [aOR], 0.88 per year [P < 0.01]; aOR, 0.88 [P < 0.05]; and aOR, 0.83 [P < 0.01], respectively). Between 2004 and 2009, ordering neither CBC nor UA increased among all children 2 to 24 months (aOR, 1.10; P < 0.05) and among boys (aOR, 1.16; P < 0.05). Orders for blood cultures declined across the time period in bivariate analysis, but not in multivariate analysis.
The rate of ordering a CBC for children in the 2- to 24-month age group presenting to the ED with FWS declined, a change coincident with the changing epidemiology of serious bacterial infection since the PCV-7 vaccine was introduced.
Longitudinal Trends in the Treatment of Abdominal Pain in an Academic Emergency Department
Published online: 22 April 2013
Orhan Cinar, Loni Jay, David Fosnocht, Jessica Carey, LeGrand Rogers, Adrienne
Carey, Benjamin Horne, Troy Madsen
DOI: 10.1016/j.jemermed.2013.01.020
Journal of Emergency Medicine, The, http://www.jem-journal.com/article/S0736-4679%2813%2900104-2/abstract
In patients presenting to the ED with abdominal pain, analgesia administration increased and time to medication decreased during the 10-year period. Despite overall improvements in satisfaction, significant numbers of patients presenting with abdominal pain still reported moderate to severe pain at discharge.
Effective analgesia with low-dose ketamine and reduced dose hydromorphone in ED patients with severe pain
Published online: 22 April 2013
Terence L. Ahern, Andrew A. Herring, Michael B. Stone, Bradley W. Frazee
DOI: 10.1016/j.ajem.2013.02.008
American Journal of Emergency Medicine, The,
Low-dose ketamine combined with a reduced dose hydromorphone protocol produced rapid, profound pain relief without significant side effects in a diverse cohort of ED patients with acute pain.
Softball injuries treated in US EDs, 1994 to 2010
Published online: 19 April 2013
John C. Birchak, Lynne M. Rochette, Gary A. Smith
DOI: 10.1016/j.ajem.2013.02.039
American Journal of Emergency Medicine, The,
An estimated 2107823 (95% confidence interval [CI], 1736417-2479229) patients were treated in US EDs for a softball injury during the 17-year study period. The annual number of injuries decreased by 23.0% from 1994 to 2010 (P < .001); however, during the last 6 years of the study, injuries increased by 11.7% (P = .008). The annual rate of softball injuries increased significantly during the study period (P = .035). The most commonly injured body regions were the hand/wrist (22.2%) and face (19.3%). Being hit by a ball was the most common mechanism of injury (52.4%) and accounted for most of face (89.6%) and head (75.7%) injuries. Injuries associated with running (relative risk, 2.36; 95% CI, 1.97-2.82) and diving for a ball (relative risk, 4.61; 95% CI, 3.50-6.09) were more likely to occur among adult than pediatric patients.
Microwave oven-related injuries treated in hospital EDs in the United States, 1990 to 2010
Published online: 22 April 2013
Dana F. Thambiraj, Thiphalak Chounthirath, Gary A. Smith
DOI: 10.1016/j.ajem.2013.03.023
American Journal of Emergency Medicine, The,
An estimated 155959 (95% confidence interval [CI], 133515-178402) individuals with microwave oven-related injuries were treated in US hospital EDs from 1990 through 2010, which equals an average of 21 individuals per day; 60.7% were female; 63.3% were adults (≥18 years); 98.1% of injury events occurred at home; and 3.9% of patients were hospitalized. During the 21-year study period, the number and rate of microwave oven-related injuries increased significantly by 93.3% and 50.0%, respectively. The most common mechanism of injury was a spill (31.3%), and the most common body region injured was the hand and fingers (32.4%). Patients younger than 18 years were more likely to sustain an injury to their head and neck (relative risk: 1.65; 95% CI, 1.39-1.96) than adults.
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