Emergency Treatment Of Patients Research Articles

Usefulness of biochemical parameters in decision-making on the start of emergency treatment in patients with propionic acidemia

Recurrent acute and life-threatening metabolic decompensations are thought to be the major cause of mortality and morbidity in patients with propionic acidemia (PA). Since metabolic decompensations in these patients usually develop gradually, there is considerable uncertainty about the beginning and when emergency treatment should be initiated. The major aim of this study was to evaluate the usefulness of biochemical parameters for improving decision-making on the start of emergency treatment. We analysed data of 16 PA patients continuously followed in our centre. Metabolic decompensation was defined clinically by the occurrence of at least one of three alarming symptoms: vomiting, food refusal or impaired consciousness. Thirty-eight biochemical parameters were analysed. A total of 259 metabolic decompensations were documented and compared with 625 routine visits. Among the symptoms used to clinically define metabolic decompensations, vomiting was most frequent (87 %). In total, 19 biochemical parameters differentiated between metabolic decompensations and routine visits. Among them ammonia, acid-base balance and anion gap were most reliable to identify a metabolic decompensation, and to estimate its severity. A comparative analysis of patients with PA and methylmalonic acidemia during metabolic decompensation showed similar results. Ammonia, acid-base balance and anion gap are important biochemical parameters to identify an (impending) metabolic decompensation and to assess its severity in PA patients. The identified biochemical parameters should be integrated in an algorithm for clinical decision-making on emergency treatment and should be tested in a prospective trial.

Effect of psychological nursing on emergency treatment for patients with serious abdominal trauma

Objective To explore the influence of psychological nursing on emergency treatment for patients with serious abdominal trauma.Methods 105 patients were used as subjects in this study.They received received both serial emergency treatment and close psychological nursing.Results All the patients coordinated with emergency treatment.No death or no complications associated with abnormal mood occurred.Conclusions Serial emergency treatment combined with psychological nursing is of important significance in the stabilization of psychological and physical status in patients and the continuation of treatment.It deserves considering in clinical practice. Key words: Abdominal trauma; Serial emergency treatment; Psychological nursing

Respiratory Arrest Due to Hematoma Caused by Thyreocervical Trunk Branch Laceration and Confluence of Sinuses Perforation

Central venous catheterization plays an important role in the treatment of emergency patients who require renal replacement therapy. Emergency patients with end-stage renal disease are at high risk for development of complications because of coagulation disorders, tissue, and organ changes due to uremia, anatomic variations, and obstruction of the large central veins. Complications associated with catheter placement can be mechanical, infectious, and thrombotic, and may occur during or following insertion of central venous catheterization which is a life-saving procedure for patients. We report a case of respiratory arrest in a 76-year-old woman suffering from end-stage renal disease for 14 years, because of large soft tissue subcutaneous hematoma in the right upper thoracic outlet. The rapid development of hematoma was a consequence of arterial bleeding from the branch of the thyreocervical trunk. Laceration of the thyreocervical trunk branch during central venous catheterization is a rare complication. Later diagnostic images revealed catheter perforation of confluence of sinuses which also complicated this case. We briefly discuss signs, symptoms, and management of the patient. Although arterial puncture of the carotid artery during the Seldinger technique is well-known life-threatening complication which can be recognized by light red pulsatile blood during aspiration, smaller arteries such as the thyreocervical trunk branch can be punctured during the procedure and lead to serious complications.

Analysis on bundles treatment in emergency in patients with severe carbon monoxide toxic pulmonary edema

Objective To investigate the methods in emergency treatment for patients with severe carbon monoxide toxic pulmonary edema.Methods The 12 cases patients with severe carbon monoxide carbon monoxide toxic pulmonary edema were treated with the emergency methods with bundles 60 mL+500 mL+furosemide 100 mg,200 ml/h,intravenous pump on constant speed.Results Markedly effective in 9 cases(75.0%),effective in 3 cases(25.0%).Oxygenation index.is(203.4±69.7)VS(434.6±97.3),t=10.045,P＜0.01.X-ray changes is markedly effective in 8 cases(66.7%),effective in 4 cases(33.3%).The 12 eases were all cured after treatment by hyperbaric oxygen and other comprehensive follow-up treatment,including 1 case with delayed encephalopathy.Conclusion It may be an effective way to use bundles treatment for severe carbon monoxide toxic pulmonary edema. Key words: Carbon monoxide poisoning; Pulmonary edema; Bundles treatment

Observation in effect of first aid nursing pathway in emergency treatment of patients with acute cardiac infarction

目的 观察急救护理路径在急性心肌梗死患者抢救中的效果.方法 2008年6月至2009年6月,将72例急性心肌梗死(AMI)患者随机分为观察组和对照组各36例,对照组患者采用传统急救护理流程,观察组按急救护理路径实施抢救.对2组各项抢救指标进行比较.结果 观察组进-出急诊室时间、住院时间、院内心肌梗死复发率及病死率明显少于对照组.结论 急救护理路径能够明显缩短患者的抢救和检查所需的时间,提高抢救的成功率。

Extraperitoneal pelvic packing for hemodynamically unstable pelvic fractures

Objective To discuss clinical outcomes of extraperitoneal pelvic packing (EPP) plus external fixation for hemodynamically unstable pelvic fractures. Methods We used EPP plus external fixation to control 15 cases of hemodynamically unstable pelvic fractures from further damage. They were 6 males and 9 females. Their average age was (44. 0 ± 1.2) (38 to 56) years old. Their injury was caused by a traffic accident (13 patients) and falling from a great height (2 patients). According to the Tile classification,there were 3 cases of type B1, 2 cases of type B2-2, 5 cases of type C1, 3 cases of type C2, and 2 cases of type C3. All the 15 patients were hemodynamically unstable and had a hypovolemic shock. Results There was a statistically significant increase in systolic blood pressure, hematocrit and hemoglobin measured immediately after EPP( P 0. 05) . The average operation time was (32.0 ± 2.6) min(30 to 40 min). Five patients died (72. 0 ± 4.2) h after operation ( 1 to 7 d). There was no significant difference between the survivors and the non-survivors in systolic blood pressure, pulse rate,hemoglobin, ISS score, hematocrit and blood transfusion( P > 0. 05). But there was significant difference in age and time between injury and EPP ( P < 0. 05). Conclusions In emergency treatment of patients with the hemodynamically unstable pelvic fracture, especially those combined with hypovolemic shock, EPP plus external fixation can effectively control the massive venous (presacral venous plexus) and bone hemorrhage.The blood pressure and pulse rate can be restored by fluid replacement and blood transfusion. Consequently,this method may significantly improve the hemodynamical parameters and decrease the mortality. Key words: Pelvis; Fractures; External fixator; Hemodynamics

Experiences with recombinant FVIIa in the emergency treatment of patients with autoimmune thrombocytopenia: a review of the literature

Patients with severe and refractory autoimmune thrombocytopenia (ITP) have significant morbidity and mortality rates. Currently, high-dose methylprednisolone and/or high-dose IVIgG are recommended for the emergency treatment of such patients with uncontrolled bleeding. However, some patients do not immediately respond to these therapeutic regimes and may require additional treatment. Recombinant activated FVIIa (rFVIIa) is a prothrombotic agent that appears to be useful in the treatment of patients with life-threatening bleeding. It has also been used in the treatment of several patients with thrombocytopenia. We administered rFVIIa into a patient with refractory ITP and performed a systemic review of all published reports to assess the available evidence on the efficacy and safety of this drug in patients with ITP. The results indicate that rFVIIa may help in the emergency treatment of patients with ITP who do not respond to other therapies.

Efficacy of formoterol Turbuhaler in the emergency treatment of patients with obstructive airway diseases

Dry powder devices are rarely used in the emergency room (ER) treatment of acute and severe bronchoconstriction due to hesitations with respect to clinical efficacy. This study investigated the effects of two inhalers with formoterol in patients visiting the ER Department for acute and severe dyspnoea, mainly exacerbations of chronic obstructive pulmonary disease. Two doses of 12mug formoterol were given at enrolment, either via Turbuhaler or via pressurised metered dose inhaler, connected to a spacer device (pMDI+S) in a double-blind way and parallel design. Another two doses of 12 microg formoterol were given after 30 min. Forced expiratory volume in the 1s (FEV(1)) and Borg dyspnoea score were assessed until 60 min. The study was designed to test non-inferiority in effects on FEV(1). Seventy-seven patients were enrolled with a mean age of 66 years and a FEV(1) of 1.03 L (39% of predicted). The effects of the two treatments were almost identical. The mean improvement in FEV(1) at 60 min after formoterol Turbuhaler was 94% of the improvement after formoterol pMDI+S. A statistically significant non-inferiority was shown (p=0.037) at 60 min (primary endpoint) as well as at 5 and 30 min (secondary endpoints, p=0.0043 and 0.013, respectively). Improvements in the Borg dyspnoea score and other lung-function parameters did not differ significantly between the two devices. In conclusion, formoterol Turbuhaler was equally effective as formoterol pMDI+S in the treatment of acute bronchoconstriction within the ER.

Massive platelet transfusion is a rapidly effective emergency treatment in patients with refractory autoimmune thrombocytopenia

Patients with refractory autoimmune thrombocytopenia (ITP) may develop life-threatening bleeding that cannot be immediately controlled by drug administration. To date, there have been no studies conducted to evaluate the efficacy of platelet transfusion alone in such cases. Ten patients with refractory ITP and bleeding or a high bleeding risk were consecutively transfused (one unit/30 min) with apheresis platelet concentrates (APC) without the administration of new drugs. The used APCs (average 3-7 units) contained 2.7 x 10(11) (medium) platelets and were leukodepleted (< or = 1 x 10(6) leukocytes/unit). Platelet serology was performed using standard techniques. Platelet transfusion resulted in an increase in the platelet count to 84 - 157 x 10(3)/microl, and the cessation of bleeding in all patients without any serious adverse effects. Although platelet counts gradually decreased within a few days post-transfusion, bleeding was stopped in all cases. These findings indicate that consecutive platelet transfusion using APCs is a rapidly effective emergency treatment in patients with refractory ITP.

Surgical interventions after emergency endovascular stent-grafting for acute type B aortic dissections

In this retrospective study we reviewed our results of secondary surgery for complications after emergency placement of aortic stents for acute type B dissection. From October 2000 to June 2006, endovascular stent-grafting (ESG) was performed in 13 patients as an emergency procedure for acute type B dissection. Self-expanding nitinol stents (mean diameter 39.8+/-4.7 mm) were placed into the descending aorta distal to the left subclavian artery. In-hospital mortality was 15.4% (2/13) and related to persistent visceral malperfusion. Three patients (23%) required consecutive open surgery of the thoracic aorta after emergency endovascular stent-grafting for acute type B dissection. Indications for surgery included acute development of retrograde type A aortic dissection and acute stent dislocation by fractured wires and secondary leakage. Elective surgery was necessary in one patient 6 months after stent-grafting for late formation of an aneurysm of the descending aorta. There were no deaths or major morbidity after surgery of the thoracic aorta early or during follow-up. Mean follow-up was 38.0+/-13.9 months (range 1-70 months) and complete. We conclude from our study that stent-grafting of the descending aorta is a feasible, relatively safe and effective approach even in the emergency treatment of patients with complicated acute type B dissection. However, in a relevant number of patients emergency stent-grafting for acute type B aortic dissection results in complications that require secondary surgical treatment.

Results of emergency endovascular treatment of the descending thoracic aorta

Emergency treatment of patients with acute aortic rupture, thoracic aortic dissection or ruptured aneurysms is associated with a relevant morbidity and mortality. Endovascular treatment of the thoracic aorta represents a new option for the management of different acute aortic disorders.

The pharmacokinetics of intravenous artesunate in adults with severe falciparum malaria

Intravenous artesunate is commonly used in the emergency treatment of patients with severe falciparum malaria in Asia. The choice of doses used has been empirical. To inform dosage recommendations we assessed the pharmacokinetics of intravenous artesunate after the first dose. As part of a clinical trial of artesunate in adults with severe falciparum malaria in western Thailand, we assayed plasma concentrations of artesunate and the principal biologically active metabolite dihydroartemisinin (DHA) in 17 patients given an initial dose of 2.4 mg/kg body weight of intravenous artesunate. Drug levels were measured using high performance liquid chromatography with mass spectroscopy-electrospray ionisation detection. Median (range) observed DHA Cmax was 2128 (513-5789) nmol/L, elimination half-life was 0.34 (0.14-0.87) h, and the time to the last detectable DHA was 2 h. The large inter-individual variability (10 fold) in DHA Cmax and AUC in patients with potentially lethal, severe malaria, suggests that 2.4 mg/kg should be the minimum daily dose in severe malaria.

Temporary Pacemakers: Current Use and Complications

Temporary pacemakers (TP) are used in the emergency treatment of patients with severe bradyarrhythmia. They are often used in emergency situations and for older patients in poor general condition who are hemodynamically unstable and uncooperative. The aim of this study was to review and analyze the indications, incidence and type of complications associated with TP implanted in our center during a 6-year period. We analyzed significant clinical variables, indication, route of insertion, follow-up, complications, and duration of temporary pacing. A total of 568 TP were implanted, and 530 cases were available for review (mean age 74.8 [11] years). The main indications were symptomatic complete AV block (51%), prophylaxis for replacement with a definitive pacemaker (14.7%), blockage in the acute phase of myocardial infarction (12.6%), bradyarrhythmia due to drug intoxication (12.2%), symptomatic sick sinus syndrome (7.5%) and long QT interval or ventricular tachycardia (2.5%). The route of insertion was via the femoral vein in 99% of the cases. The duration of TP use was 4.2 days (range 1 to 31 days). A total of 369 patients (69.6%) required a permanent pacemaker. 34 patients died (6.4%), but only 3 deaths were attributable to TP implantation. Other severe complications were seen in 98 patients (18.5%). Malfunction of the TP occurred in 48 patients (9%) because of electrode displacement. Temporary pacemakers are used in older patients with extreme bradyarrhythmia and occasionally with acute myocardial infarction. Serious complications are not uncommon (22% of all patients), and can range from femoral hematoma to cardiac tamponade and even death (6%). In 9% of the patients the electrode needed to be repositioned because of failure of sensing or loss of ventricular capture.

Emergency Treatment of Patients with Cotyloid Bone Fracture and Health Education

髋关节是人体最主要的负重关节.髋臼骨折是一种严重而复杂的损伤,常伴有胸腹、骨盆、盆腔脏器的复合伤,1998～2003年我科共收治髋臼骨折56例,其中34例经手术复位内固定,随访1～5a,结果优良率占91.17%,现将护理体会报告如下。

A Database which Allows Rapid Access to Information for the Emergency Treatment of Patients Exposed to Poisonous Substances : Bi-directional Communication between Pharmacy Services and the Emergency Room

A Database which Allows Rapid Access to Information for the Emergency Treatment of Patients Exposed to Poisonous Substances : Bi-directional Communication between Pharmacy Services and the Emergency Room

Selbstbehandlung mit Notfallmedikamenten bei schweren allergischen Reaktionen

Background: The risk for anaphylaxis from insect stings or food, in the general population is about 1 - 2%. The rapid self-administration of emergency treatment may be life-saving. In a retrospective study, the knowledge about and the use of emergency treatment in patients with severe allergic reactions to insect venoms, food allergens, drugs and natural rubber latex was investigated. Patients and methods: 219 patients, who had all received emergency tablets (2 x 10 mg cetirizine and 2 × 50 mg prednisone) and epinephrine (Asthmahaler MIST, some in addition an EpiPen auto-injector) were investigated by a questionnnaire. Results: 128 (58.4%) patients answered, 99.2% remembered having received tablets, 87.5% an Asthmahaler and 39.1% had additionally received an EpiPen, 100 patients had still their tablets, in 23.5% the medication was expired; 91 patients (74.6%) carried their tablets always with them, 79 patients still had an Asthmahaler, of them 49.3% had passed the peremption date. 92.5% patients still knew how to use the device, 43.2% carried the spray (some expired) always with them. Forty-one still had an EpiPen, 27.5% of the sprays had expired. 93.9% still knew how to use it, 36.6% always carried it with them. Among 60 patients who had been accidentally reexposed to their respective allergen, 48 immediately took their tablets, 18 inhaled with the Asthmahaler and 2 injected epinephrine. In 62%,this treatment abolished or reduced allergic symptoms. Conclusions: The majority of the patients were still sufficiently instructed. Compliance to carry tablets was clearly better than for the 2 epinephrine-containing devices. Most patients preferred the inhalation to the injection of epinephrine. However, the compliance to immediately use epinephrine was low. A repeated instruction and a continuing replacement of the emergency drugs are crucial to optimize this important first-line therapy in patients with severe allergic reactions.

Anxiety and Depression are Related to the Outcome of Emergency Treatment in Patients with Obstructive Pulmonary Disease.

Anxiety and Depression are Related to the Outcome of Emergency Treatment in Patients with Obstructive Pulmonary Disease.

Anxiety and Depression are Related to the Outcome of Emergency Treatment in Patients with Obstructive Pulmonary Disease

To investigate whether psychological factors predict outcome after emergency treatment for obstructive pulmonary disease. Emergency department at a university hospital. Forty-three patients presenting with exacerbation of asthma or COPD. The patients received emergency treatment and were followed up for 4 weeks. Spirometry, blood sampling, pulse oximetry, breathing rate, pulse rate, and dyspnea score was measured before and during emergency treatment. The psychological status was assessed using the hospital anxiety and depression (HAD) scale questionnaire at the end of the follow-up period. Anxiety and/or depression was found in 17 patients (40%). Of these patients, nine patients (53%) were admitted to hospital or had a relapse within 1 month, compared with five patients (19%) in the group without anxiety and/or depression (p < 0.05). Among patients who relapsed within 1 month (n = 14), the HAD total score was 12.4 +/- 5.9 compared with 8.6 +/- 5.1 (mean +/- SD) among the patients without a relapse (p < 0.05). After making adjustments for age, gender, atopic status, treatment, and pack-years, the significant association between treatment failure and anxiety and/or depression still remained. Our study indicates that anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease. Further studies should be conducted evaluating the effect of treatment of anxiety and depression in patients with recurrent exacerbations of asthma and COPD.

Tobramycin: a review of therapeutic uses and dosing schedules

Aminoglycosides continue to fulfill a key role in the treatment of severe gram-negative infections despite the availability of newer antibacterial agents that are associated with less risk of nephrotoxicity or ototoxicity. When compared with gentamicin, tobramycin has a similar spectrum of activity against gram-negative bacteria but higher activity against Pseudomonas species and is less likely to cause nephrotoxicity. Consequently, tobramycin is the aminoglycoside of choice for the treatment of confirmed Pseudomonas species infections and mixed infections, including Pseudomonas aeruginosa with other organisms. Tobramycin is similarly preferred for the initial, emergency treatment of patients who have, or are at risk of developing, severe P aeruginosa-related infections (eg, patients with neutropenia, burns, or cystic fibrosis). Selection of a dosing regimen is an important consideration before implementing treatment. Historically, in the absence of specific pharmacologic data for the aminoglycosides, multiple-daily dosing (MDD) schedules, extrapolated from experience with other antibiotics, have been used to deliver aminoglycosides. However, recent pharmacodynamic data for the aminoglycosides have supported the concept of once-daily dosing (ODD). Clinical investigations comparing ODD with traditional MDD, typically in immunocompetent adult patients who have normal renal function, suggest that ODD is as effective as and no more toxic than traditional MDD. These features, combined with the likelihood of direct health care cost savings, suggest that ODD may be preferable to MDD in some patient groups. However, the effect of ODD has not been investigated extensively in children or in pregnant, immunocompressed, renally insufficient, or critically ill patients, and application of the regimen in these special patient populations cannot be recommended until data become available.

Floating right heart thrombi and pulmonary embolism: diagnosis, outcome and therapeutic management.

The aim of this study was to analyze clinical and echographic findings and to assess therapeutic management in 14 floating right atrial thrombi diagnosed with systematic echocardiography in 200 consecutive patients with proven pulmonary embolism. Auscultatory findings were abnormal in 7 cases, 4 of them showing signs of tricuspid obstruction. Echocardiography displayed a mobile ovoid, polycyclic or worm-like right atrial mass, always associated with signs of cor pulmonale. Four patients (29%) died, 2 of them before any treatment could be started. Regarding the remaining 10 patients with favorable outcome, surgical embolectomy was carried out in 7. Our data suggest that echocardiographic examination is necessary in all suspected pulmonary embolisms and has to be done quickly for emergency treatment in patients with floating right atrial thrombus.