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Sample records for cardiac emergency room

  1. Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

    Directory of Open Access Journals (Sweden)

    Frederico José Neves Mancuso

    2014-12-01

    Full Text Available Background: Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. Objective: To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. Methods: One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. Results: The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. Conclusion: The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

  2. Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

    Energy Technology Data Exchange (ETDEWEB)

    Mancuso, Frederico José Neves, E-mail: frederico.mancuso@grupofleury.com.br [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Disciplina de Medicina de Urgência - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Gois, Aécio Flavio Teixeira [Disciplina de Medicina de Urgência - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando [Disciplina de Cardiologia - Escola Paulista de Medicina - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil)

    2014-12-15

    Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.

  3. Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

    International Nuclear Information System (INIS)

    Mancuso, Frederico José Neves; Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio; Gois, Aécio Flavio Teixeira; Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando

    2014-01-01

    Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy

  4. Pediatric cardiac emergencies: Children are not small adults

    Directory of Open Access Journals (Sweden)

    Frazier Aisha

    2011-01-01

    Full Text Available Compared with adults, cardiac emergencies are infrequent in children and clinical presentation is often quite variable. In adults, cardiac emergencies are most commonly related to complications of coronary artery disease; however, in pediatric cases, the coronaries are only rarely the underlying problem. Pediatric cardiac emergencies comprise a range of pathology including but not limited to undiagnosed congenital heart disease in the infant; complications of palliated congenital heart disease in children; arrhythmias related to underlying cardiac pathology in the teenager and acquired heart disease. The emergency room physician and pediatric intensivist will usually be the first and second lines of care for pediatric cardiac emergencies and thus it is imperative that they have knowledge of the diverse presentations of cardiac disease in order to increase the likelihood of delivering early appropriate therapy and referral. The objective of this review is to outline cardiac emergencies in the pediatric population and contrast the presentation with adults.

  5. Role of Magnetocardiography in Emergency Room

    International Nuclear Information System (INIS)

    Kwon, H.; Kim, K.; Kim, J. M.; Lee, Y. H.; Kim, T. E.; Lim, H. K.; Park, Y. K.; Ko, Y. G.; Chung, N.

    2006-01-01

    In emergency rooms, patients with acute chest pain should be diagnosed as quickly as possible with higher diagnostic accuracy for an appropriate therapy to the patients with acute coronary syndrome or for avoiding unnecessary hospital admissions. At present, electrocardiography(ECG) and biochemical markers are generally used to detect myocardial infarction and coronary angiography is used as a gold standard to reveal the degree of narrowing of coronary artery. Magnetocardiography(MCG) has been proposed as a novel and non-invasive diagnostic tool fur the detection of cardiac electrical abnormality associated with myocardial ischemia. In this study, we examined whether the MCG can be used fur the detection of coronary artery disease(CAD) in patients, who were admitted to the emergency room with acute chest pain. MCG was recorded from 36 patients admitted to the emergency room with suspected acute coronary syndrome. The MCG recordings were obtained using a 64-channel SQUID MCG system in a magnetically shielded room. In result, presence of CAD could be found with a sensitivity of 88.2 % in patients with acute chest pain without 57 elevation in ECG, demonstrating a possible use in the emergency room to screen CAD patients.

  6. Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room.

    Science.gov (United States)

    Mancuso, Frederico José Neves; Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio; Gois, Aécio Flavio Teixeira; Paola, Angelo Amato Vincenzo de; Carvalho, Antonio Carlos Camargo; Campos, Orlando

    2014-10-28

    Background: Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. Objective: To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. Methods: One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. Results: The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. Conclusion: The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy.Fundamento: As urgências cardiovasculares são causas importantes de procura por atendimento médico, sendo fundamentais a rapidez e a precisão no diagnóstico para diminuir sua morbimortalidade. Objetivo: Avaliar o uso da ecocardiografia

  7. Association between air pollution and ischemic cardiovascular emergency room visits

    International Nuclear Information System (INIS)

    Lin, C.A.; Amador Pereira, L.A.; Souza onceicao, G.M. de; Kishi, H.S.; Milani, Rodolfo; Ferreira Braga, A.L.; Ascimento Saldiva, P.H.

    2003-01-01

    This study observed the relationship between air pollutants and ischemic cardiac diseases such as angina and acute myocardial infarction in a representative cardiovascular center emergency room in Sao Paulo, Brazil. Daily emergency room admissions to the Institute of the Heart of the university of Sao Paulo, as well as data concerning daily air pollutant levels and meteorological variables, were collected from January 1994 to august 1995. Generalized additive Poisson regressions were fitted to the logarithm of the expected values of total emergency room visits due to angina or acute myocardial infarction, controlling for smooth functions of season and weather and indicators for days of the week. All investigated pollutants were positively associated with ischemic cardiovascular disease emergency room visits, and the time lags were relatively short, but only CO presented in effect that was statistically significant. An interquartile range increase n CO was associated with an increase of 6.4% (95% CI: 0.7-12.1) in daily angina or acute myocardial infarction emergency room visits. This result did not change when estimates were done using linear models and natural cubic plines. This study showed that air pollution has a role in cardiovascular morbidity in Sao Paulo, reinforcing the necessity for air pollutant mission-controlling polices in urban areas

  8. Consumer opinions of emergency room medical care.

    Science.gov (United States)

    McMillan, J R; Younger, M S; DeWine, L C

    1984-12-01

    If hospital management is to adapt successfully to an increasingly competitive environment, and to retain a viable emergency department, it well be necessary to objectively and accurately assess the hospital's image in the community served. Knowledge of the consumers' views is an essential input into the formulation of strategic plans. This article reports on a study in which consumer opinions on 15 dimensions of emergency room health care were obtained from 723 respondents using a mail questionnaire. Findings reveal that consumers view the emergency room as being more expensive than other health care providers. Except for being available or convenient, little or no advantage is perceived for the emergency room over the personal physician. Even though the emergency room has specialized staff and equipment, consumers do not believe patients receive better or faster treatment in an emergency room than would be obtained in a physician's office. Unless changed, these perceptions will diminish the role of the emergency room in the delivery of health care services.

  9. Assessment of abuse-related injuries: a comparative study of forensic physicians, emergency room physicians, emergency room nurses and medical students.

    Science.gov (United States)

    Reijnders, Udo J L; Giannakopoulos, Georgios F; de Bruin, Kim H

    2008-01-01

    A comparative study was made investigating whether emergency room physicians, emergency room nurses, forensic physicians, and interns are competent in describing, recognising and determining the possible cause of injuries. The injury assessment scores varied from good--adequate--fail and remained blank in various participant groups. Forensic physicians scored significantly better than emergency room staff and interns in the assessment of abuse-related injuries. There were almost no differences noted between emergency room physicians and emergency room nurses. For the functional group with more or less than 4 to 6 years of experience, no significant differences were noted for scoring good in all 5 cases. The fact that forensic physicians scored better than the emergency room staff is probably explained by the fact that almost all practicing forensic physicians have been officially qualified. Training in this field for all professionals involved in such assessment should be mandatory.

  10. CSN's New Emergency Room

    International Nuclear Information System (INIS)

    Sendin, P.

    2005-01-01

    During the month of July 2005 the physical renovation works and technological updating of the basic infrastructures of the CSN Emergency Room (SALEM) were finished, allowing the Room to now have greater functionality and a broader technical capacity. Nevertheless, the technological improvement process of SALEM will reach its full potential within the next few years, once the installation currently underway of the new information integration and monitoring systems and the decision making support systems have been completed. This article describes the improvements introduced to the Room and the objectives pursued in this renovation project to convert the SALEM into a new generation room in accordance with its current technological context. (Author) 4 refs

  11. Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

    Energy Technology Data Exchange (ETDEWEB)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro [Hospital do Coração - HCor, Associação do Sanatório Sírio, São Paulo, SP (Brazil); Rochitte, Carlos Eduardo, E-mail: rochitte@cardiol.br [Hospital do Coração - HCor, Associação do Sanatório Sírio, São Paulo, SP (Brazil); Instituto do Coração - InCor - HCFMUSP, São Paulo, SP (Brazil)

    2013-12-15

    The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies.

  12. Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

    International Nuclear Information System (INIS)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro; Rochitte, Carlos Eduardo

    2013-01-01

    The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies

  13. First installation of a dual-room IVR-CT system in the emergency room.

    Science.gov (United States)

    Wada, Daiki; Nakamori, Yasushi; Kanayama, Shuji; Maruyama, Shuhei; Kawada, Masahiro; Iwamura, Hiromu; Hayakawa, Koichi; Saito, Fukuki; Kuwagata, Yasuyuki

    2018-03-05

    Computed tomography (CT) embedded in the emergency room has gained importance in the early diagnostic phase of trauma care. In 2011, we implemented a new trauma workflow concept with a sliding CT scanner system with interventional radiology features (IVR-CT) that allows CT examination and emergency therapeutic intervention without relocating the patient, which we call the Hybrid emergency room (Hybrid ER). In the Hybrid ER, all life-saving procedures, CT examination, damage control surgery, and transcatheter arterial embolisation can be performed on the same table. Although the trauma workflow realized in the Hybrid ER may improve mortality in severe trauma, the Hybrid ER can potentially affect the efficacy of other in/outpatient diagnostic workflow because one room is occupied by one severely injured patient undergoing both emergency trauma care and CT scanning for long periods. In July 2017, we implemented a new trauma workflow concept with a dual-room sliding CT scanner system with interventional radiology features (dual-room IVR-CT) to increase patient throughput. When we perform emergency surgery or interventional radiology for a severely injured or ill patient in the Hybrid ER, the sliding CT scanner moves to the adjacent CT suite, and we can perform CT scanning of another in/outpatient. We believe that dual-room IVR-CT can contribute to the improvement of both the survival of severely injured or ill patients and patient throughput.

  14. Feasibility of dynamic cardiac ultrasound transmission via mobile phone for basic emergency teleconsultation.

    Science.gov (United States)

    Lim, Tae Ho; Choi, Hyuk Joong; Kang, Bo Seung

    2010-01-01

    We assessed the feasibility of using a camcorder mobile phone for teleconsulting about cardiac echocardiography. The diagnostic performance of evaluating left ventricle (LV) systolic function was measured by three emergency medicine physicians. A total of 138 short echocardiography video sequences (from 70 subjects) was selected from previous emergency room ultrasound examinations. The measurement of LV ejection fraction based on the transmitted video displayed on a mobile phone was compared with the original video displayed on the LCD monitor of the ultrasound machine. The image quality was evaluated using the double stimulation impairment scale (DSIS). All observers showed high sensitivity. There was an improvement in specificity with the observer's increasing experience of cardiac ultrasound. Although the image quality of video on the mobile phone was lower than that of the original, a receiver operating characteristic (ROC) analysis indicated that there was no significant difference in diagnostic performance. Immediate basic teleconsulting of echocardiography movies is possible using current commercially-available mobile phone systems.

  15. Emergency room thoracotomy for acute traumatic cardiac tamponade caused by a blunt cardiac injury: A case report

    Directory of Open Access Journals (Sweden)

    Kenichiro Ishida

    2017-01-01

    Conclusion: A prompt diagnosis using FAST and treatment can be lifesaving in traumatic acute cardiac tamponade. A pericardiotomy via a thoracotomy is mandatory for lifesaving cardiac decompression in acute traumatic cardiac tamponade in cases of ineffective drainage due to clot formation within the pericardial space.

  16. PAs and NPs in an emergency room-linked acute care clinic.

    Science.gov (United States)

    Currey, C J

    1984-12-01

    The use of hospital emergency rooms for nonurgent care during evenings hours often strains medical resources and may affect the quality of emergency care. One facility's effective use of an after-hours acute care clinic staffed by PAs and NPs to divert nonurgent problems away from its emergency room is outlined. PAs and NPs work during peak demand hours (evenings and weekends) under the supervision of an emergency room physician, and receive supplementary support from other emergency room personnel. Incoming patients are referred to the emergency room or acute care clinic, depending on the nature of their problems. Acute care clinic patients are then treated by the PA or NP and either released or referred to an emergency room physician, if their conditions warrant additional treatment. As a result, use of the acute care clinic has greatly reduced the amount of non-urgent medical treatment in the emergency room and has provided other advantages to both patients and staff as well. These advantages and the encouraging statistics following six months of the clinic's operation are discussed.

  17. When to use the emergency room - child

    Science.gov (United States)

    Emergency room - child; Emergency department - child; Urgent care - child; ER - when to use ... How quickly does your child need care? If your child could die or be permanently disabled, it is an emergency. Call 911 to have the ...

  18. [Hospital emergency rooms].

    Science.gov (United States)

    Tudela, Pere; Mòdol, Josep Maria

    2003-05-17

    Overuse of hospital emergency rooms (HERs) is parallel to their controversy. To understand this problem, some concepts should be first clarified. In HERs, there are some intrinsic aspects which are directly related to the emergency itself and thus cannot be modified (intermittent patient flow, need to prioritize, difficulty to achieve a rapid diagnosis, influence of time on treatment, value of clinical follow up, patient's expectations, impact of HER on the overall hospital working dynamics). On the other hand, there are some extrinsic aspects which indeed are not related to HER itself but are rather historically associated with it (precarious structure, delay on admission, lack of privacy, inadequate triage of cases, lack of professionalization); these latter aspects may be potentially modified and should be reconsidered.

  19. Web based emergency room PACS

    International Nuclear Information System (INIS)

    Cha, Soon Joo; Cheon, Yong Kyung; Choi, Sung Woo Kim

    2005-01-01

    We wished to develop the web based Picture Archiving and Communication System in the emergency room for early decision making in emergency treatment planning at a full PACS Hospital. The program tools were Microsoft Visual Studio 6.0 - Visual C++ 6.0, and the Microsoft SQL 7.0 under the Microsoft Windows 2000 server operation system. The achievement of images was performed by an auto transport program installed in the ER and the radiology department. The average compression rates were 5:1 for CT and MR, and 20:1 for CR with JPEG 2000 lossy compression. All the images were stored on hard disk for 3 months. The patients' information was displayed for 2 weeks for reducing the security risk. For interdepartmental consultation, patient query by patient hospital number was available. Our Web based ER PACS could be useful system for early decision making for treatment planning in the emergency room because it reduces the risk factors for the security of the Web Paces by using a system independent from PACS in the hospital and minimizing the information patients

  20. Web based emergency room PACS

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Soon Joo; Cheon, Yong Kyung; Choi, Sung Woo Kim [Ilsan Paik Hospital, Inje University, Seoul (Korea, Republic of)] (and others)

    2005-07-15

    We wished to develop the web based Picture Archiving and Communication System in the emergency room for early decision making in emergency treatment planning at a full PACS Hospital. The program tools were Microsoft Visual Studio 6.0 - Visual C++ 6.0, and the Microsoft SQL 7.0 under the Microsoft Windows 2000 server operation system. The achievement of images was performed by an auto transport program installed in the ER and the radiology department. The average compression rates were 5:1 for CT and MR, and 20:1 for CR with JPEG 2000 lossy compression. All the images were stored on hard disk for 3 months. The patients' information was displayed for 2 weeks for reducing the security risk. For interdepartmental consultation, patient query by patient hospital number was available. Our Web based ER PACS could be useful system for early decision making for treatment planning in the emergency room because it reduces the risk factors for the security of the Web Paces by using a system independent from PACS in the hospital and minimizing the information patients.

  1. Firearm Injuries Received in Emergency Room of a Nigerian ...

    African Journals Online (AJOL)

    2017-05-22

    May 22, 2017 ... the emergency room of Federal Teaching Hospital Abakaliki from January 2005 to. December 2014. Results: There were 214 ... Hospital: Analysis of Pattern, Morbidity, and Mortality. NI Omoke. Original Article ..... rapid evacuation of casualties to hospital emergency room. In this study, there was no ...

  2. Angiotensin converting enzyme DD genotype is associated with acute coronary syndrome severity and sudden cardiac death in Taiwan: a case-control emergency room study.

    Science.gov (United States)

    Chen, Ying-Hsin; Liu, Jui-Ming; Hsu, Ren-Jun; Hu, Sheng-Chuan; Harn, Horng-Jyh; Chen, Shee-Ping; Jeng, Jing-Ren; Wu, Chieh-Lin; Ho, Jar-Yi; Yu, Cheng-Ping

    2012-02-15

    Angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphisms have been associated with acute coronary syndrome (ACS); however, several controversial results have also been found in different studied populations. This hospital-based, emergency room, case-control study in Taiwan retrospectively investigated 111 ACS patients, and 195 non-coronary subjects as a control group, to study the effects of ACE I/D polymorphism in the most urgent ACS patients. ACE I/D polymorphisms were determined by polymerase chain reaction-based assays and their associations with ACS risk, severity, and sudden cardiac death were determined. The ACE DD genotype was associated with ACS incidence. The DD genotype was associated with a significant 4-fold higher risk of ACS in multivariate analysis (odds ratio (OR) = 4.295; 95% confidence interval (CI): 1.436-12.851, p = 0.009), and a 3.35-fold higher risk of acute myocardial infarction. DD genotype carriers also had more than 3-fold higher risks of stenosis in all the three coronary arteries, left anterior descending artery infarction, and anterior wall infarction. In addition, the DD genotype was also associated with a higher risk of sudden cardiac death (OR = 6.484, 95% CI: 1.036-40.598, p = 0.046). This study demonstrated that the ACE DD genotype is an independent risk factor for ACS, and in particular, for acute myocardial infarction. In addition, the ACE DD genotype is also associated with greater ACS severity and a higher risk of sudden cardiac death. ACE genotyping is recommended for patients with a history of ACS, and more intensive preventive care is suggested for patients with the DD genotype.

  3. Comorbidity in Emergency Room: the Psychiatrist’s Perspective

    OpenAIRE

    Alice Luís

    2013-01-01

    The author puts forward some considerations about the psychiatric practice in the emergency room of a general hospital. Clinical practice in the emergency room should be highlighted by collaborative work between several medical subspecialities, in- cluding internal medicine and neurology. This is particularly true for patients with comorbidity in order to provide quality of care. Finally, the author reviews several clinical cases and suggests guidelines for their management.

  4. Intrahospital teleradiology from the emergency room

    Science.gov (United States)

    Fuhrman, Carl R.; Slasky, B. S.; Gur, David; Lattner, Stefanie; Herron, John M.; Plunkett, Michael B.; Towers, Jeffrey D.; Thaete, F. Leland

    1993-09-01

    Off-hour operations of the modern emergency room presents a challenge to conventional image management systems. To assess the utility of intrahospital teleradiology systems from the emergency room (ER), we installed a high-resolution film digitizer which was interfaced to a central archive and to a workstation at the main reading room. The system was designed to allow for digitization of images as soon as the films were processed. Digitized images were autorouted to both destinations, and digitized images could be laser printed (if desired). Almost real time interpretations of nonselected cases were performed at both locations (conventional film in the ER and a workstation in the main reading room), and an analysis of disagreements was performed. Our results demonstrate that in spite of a `significant' difference in reporting, `clinically significant differences' were found in less than 5% of cases. Folder management issues, preprocessing, image orientation, and setting reasonable lookup tables for display were identified as the main limitations to the systems' routine use in a busy environment. The main limitation of the conventional film was the identification of subtle abnormalities in the bright regions of the film. Once identified on either system (conventional film or soft display), all abnormalities were visible and detectable on both display modalities.

  5. Prevalence of thyroid dysfunction in patients with acute atrial fibrillation attended at a cardiology emergency room

    Directory of Open Access Journals (Sweden)

    Juarez Neuhaus Barbisan

    Full Text Available CONTEXT: Atrial fibrillation occurs frequently in patients with thyrotoxicosis, while it has low prevalence in adults of the general population. The prevalence of thyroid dysfunction in subjects with atrial fibrillation is 0 to 24%, a wide variation that is attributed to the different methodologies applied. However, continuous use of amiodarone in patients with previous atrial fibrillation may interfere with these prevalence rates. OBJECTIVE: In this study, we present the prevalence of thyroid dysfunction in adult patients who presented at a cardiac emergency room with acute atrial fibrillation, using a sensitive thyroid-stimulating hormone (TSH assay and triiodothyronine (T3 and thyroxine (T4 determination. TYPE OF STUDY: Cross-sectional study SETTING: Emergency room of a tertiary care facility. PARTICIPANTS: A total of 72 patients with atrial fibrillation who presented at the emergency room not more than 48 hours after its onset. PROCEDURES: A standardized questionnaire and 12-lead electrocardiogram were applied, and T3, T4 and TSH were determined. MAIN MEASUREMENTS: TSH, T3 and T4 determination. RESULTS: Among these patients, 16.6% had altered thyroid function tests: 6.9% had hyperthyroidism, 5.6% hypothyroidism and 4.2% had increased T4 levels, by means of amiodarone use. CONCLUSION: The high prevalence of thyroid dysfunction in our study, especially hyperthyroidism, suggests that routine thyroid testing with sensitivethyroid-stimulating hormone assay is required in patients with acute atrial fibrillation.

  6. Modernisation of Radiation Monitoring Room as a Part of Slovenian Emergency Response Centre

    International Nuclear Information System (INIS)

    Sarvari, A.; Mitic, D.

    2003-01-01

    In the year 2002 the Slovenian Nuclear Safety Administration (SNSA) moved to the new premises therefore it had to rearrange some of its rooms for the emergency situation. SNSA does not operate with a dedicated Emergency Response Centre (ERC), instead of it the SNSA has to rearrange the existing rooms in case of an emergency. Modernisation of the equipment, with the help of government of the United Kingdom of Great Britain and Northern Ireland, for the emergency situation was carried out, especially in the monitoring room. The radiation monitoring system, which is placed in the monitoring room, continuously collects, processes and archives the incoming data of exposure to radiation and meteorological parameters on the Slovenian territory (A model national emergency response plan for radiological accidents, IAEA, Vienna, 1993. IAEA-TECDOC-718). In the emergency situation the monitoring room transforms into the room for the Dose Assessment Group (DAG), which is part of ERC (IAEA emergency response network, IAEA, Vienna, 2000, EPR-ERNET (2000)). The modernisation of monitoring room and within the DAG room with new equipment and its purpose is described in this article. Modernisation of the monitoring room and the room for DAG showed to be inevitably needed. Modernisation of the monitoring room has brought the SNSA a sophisticated and reliable system of controlling the external exposure to radiation on the Slovenian territory. The equipment, especially the equipment for the use in the emergency situation, brought novelties for the Dose Assessment Group. The group has now better and easier control of radiation situation in case of an accident. In overall this modernisation has put the Slovenian Nuclear Safety Administration a step forward in having a dedicated Emergency Response Centre, since it does not need to rearrange the room for the Dose Assessment Group. (author)

  7. Development, validation and testing of a nursing home to emergency room transfer checklist.

    Science.gov (United States)

    Tsai, Hsiu-Hsin; Tsai, Yun-Fang

    2018-01-01

    To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults

  8. Emergency control room design of a nuclear reactor used to produce radioisotope

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Isaac J.A.L. dos; Farias, Larissa P. de; Ponte, Luana T.L.; Goncalves, Gabriel L.; Castro, Heraclito M.; Farias, Marcos S.; Carvalho, Paulo V.R. de; Vianna Filho, Alfredo M.V., E-mail: luquetti@ien.gov.br [Instituto Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil). Departamento Engenharia Nuclear

    2015-07-01

    A control room is defined as a functional entity with an associated physical structure, where the operators carry out the centralized control, monitoring and administrative responsibilities. Emergency control room acts as an alternative control room for the purpose of shutting down or maintaining the facility in a safe shutdown state when the main control room is uninhabitable. The mission of emergency control room is to provide the resources to bring the plant to a safe shutdown condition after an evacuation of the main control room. An evacuation of the main control room is assumed when there is no possibility to accomplish tasks involved in the shutdown except reactor trip. The purpose of this paper is to present a specific approach for the design of the emergency control room of a nuclear reactor used to produce radioisotope. The approach is based on human factors standards and the participation of a multidisciplinary team in the development phase of the design. Using the information gathered from standards and from the multidisciplinary team a 3D Sketch and a 3D printing of the emergency control room were created. (author)

  9. Emergency control room design of a nuclear reactor used to produce radioisotope

    International Nuclear Information System (INIS)

    Santos, Isaac J.A.L. dos; Farias, Larissa P. de; Ponte, Luana T.L.; Goncalves, Gabriel L.; Castro, Heraclito M.; Farias, Marcos S.; Carvalho, Paulo V.R. de; Vianna Filho, Alfredo M.V.

    2015-01-01

    A control room is defined as a functional entity with an associated physical structure, where the operators carry out the centralized control, monitoring and administrative responsibilities. Emergency control room acts as an alternative control room for the purpose of shutting down or maintaining the facility in a safe shutdown state when the main control room is uninhabitable. The mission of emergency control room is to provide the resources to bring the plant to a safe shutdown condition after an evacuation of the main control room. An evacuation of the main control room is assumed when there is no possibility to accomplish tasks involved in the shutdown except reactor trip. The purpose of this paper is to present a specific approach for the design of the emergency control room of a nuclear reactor used to produce radioisotope. The approach is based on human factors standards and the participation of a multidisciplinary team in the development phase of the design. Using the information gathered from standards and from the multidisciplinary team a 3D Sketch and a 3D printing of the emergency control room were created. (author)

  10. Child abuse inventory at emergency rooms: CHAIN-ER rationale and design

    Directory of Open Access Journals (Sweden)

    Nieuwenhuis Edward ES

    2011-10-01

    Full Text Available Abstract Background Child abuse and neglect is an important international health problem with unacceptable levels of morbidity and mortality. Although maltreatment as a cause of injury is estimated to be only 1% or less of the injured children attending the emergency room, the consequences of both missed child abuse cases and wrong suspicions are substantial. Therefore, the accuracy of ongoing detection at emergency rooms by health care professionals is highly important. Internationally, several diagnostic instruments or strategies for child abuse detection are used at emergency rooms, but their diagnostic value is still unknown. The aim of the study 'Child Abuse Inventory at Emergency Rooms' (CHAIN-ER is to assess if active structured inquiry by emergency room staff can accurately detect physical maltreatment in children presenting at emergency rooms with physical injury. Methods/design CHAIN-ER is a multi-centre, cross-sectional study with 6 months diagnostic follow-up. Five thousand children aged 0-7 presenting with injury at an emergency room will be included. The index test - the SPUTOVAMO-R questionnaire- is to be tested for its diagnostic value against the decision of an expert panel. All SPUTOVAMO-R positives and a 15% random sample of the SPUTOVAMO-R negatives will undergo the same systematic diagnostic work up, which consists of an adequate history being taken by a pediatrician, inquiry with other health care providers by structured questionnaires in order to obtain child abuse predictors, and by additional follow-up information. Eventually, an expert panel (reference test determines the true presence or absence of child abuse. Discussion CHAIN-ER will determine both positive and negative predictive value of a child abuse detection instrument used in the emergency room. We mention a benefit of the use of an expert panel and of the use of complete data. Conducting a diagnostic accuracy study on a child abuse detection instrument is also

  11. Assessment of Suicidal Behavior in a Psychiatric Emergency Room in Lisbon.

    Science.gov (United States)

    Marques, João Gama; Guerreiro, Diogo Frasquilho; Sampaio, Daniel

    2015-01-01

    Some studies alerted for the burden of suicidal attempters at emergency rooms. In this study we characterized the suicidal patients admitted to a Portuguese emergency room. For three years, all patients assessed by the first author after suicidal behaviour were included. Suicidal intentionality was evaluated with the Pierce Suicide Intent Scale. Clinical records were searched for follow-up status and satisfaction level was assessed through telephone call. From 120 included patients 70.8% were female, with mean age of 42.35 years. Pierce Suicide Intent Scale suicidal intentionality was low in 30.1%, medium in 59.3%, and high in 10.6% of the sample. The most important predictors of Pierce Suicide Intent Scale intentionality were male gender (p suicide (p Suicide Intent Scale is useful on suicidal behavior assessment at emergency rooms. Highly intentional suicidal behaviour is related to male sex, social problems and personal and familial psychiatric history. The quality of administrative records on this psychiatric emergency room setting are still unacceptable. The most important variables correlated with higher suicidal intentionality are the same described in other countries. Of the reachable patients, one fifth was satisfied with provided follow-up. We still need studies for better understanding of suicidal behaviour observed on this Portuguese emergency room.

  12. Effect of National Football League games on small animal emergency room caseload.

    Science.gov (United States)

    Rozanski, Elizabeth A; Rondeau, Mark P; Shaw, Scott P; Rush, John E

    2009-07-01

    To evaluate whether games of popular professional football teams have an effect on small animal emergency room caseload and percentage of dogs and cats that subsequently are hospitalized, are euthanatized, or die following admission to veterinary emergency rooms located within a dedicated fan base. Prospective study. 818 dogs and cats admitted to the emergency room. During the 2007 New England Patriots (NEP) football season, small animal emergency room caseload was recorded for Sunday (4-hour blocks, 8:00 AM until 12:00 midnight) and Monday night (7:00 PM to 11:00 PM). Number of dogs and cats that subsequently were hospitalized, died, or were euthanatized was recorded. Mean game importance rating (GIR) was determined for NEP games (scale, 1 [mild] to 3 [great]). Percentage of dogs and cats admitted from 12:00 noon to 4:00 PM on Sundays during NEP games (mean GIR, 1.7) versus non-NEP games was not different. Mean +/- SD percentage of dogs and cats admitted from 4:00 PM to 8:00 PM on Sundays during NEP games (mean GIR, 2.4) versus non-NEP games was significantly different (18 +/- 5% and 25 +/- 7% of daily caseload, respectively). Percentage of dogs and cats admitted from 8:00 PM to 12:00 midnight on Sundays during NEP games (mean GIR, 2.1) versus non-NEP games was not different. Game type (NEP vs non-NEP) during emergency room admission did not influence whether dogs and cats subsequently were hospitalized, died, or were euthanatized. Professional sporting events may influence veterinary emergency room caseloads.

  13. Cardiac function and myocardial perfusion immediately following maximal treadmill exercise inside the MRI room

    Directory of Open Access Journals (Sweden)

    Ballinger Michelle R

    2008-01-01

    Full Text Available Abstract Treadmill exercise stress testing is an essential tool in the prevention, detection, and treatment of a broad spectrum of cardiovascular disease. After maximal exercise, cardiac images at peak stress are typically acquired using nuclear scintigraphy or echocardiography, both of which have inherent limitations. Although CMR offers superior image quality, the lack of MRI-compatible exercise and monitoring equipment has prevented the realization of treadmill exercise CMR. It is critical to commence imaging as quickly as possible after exercise to capture exercise-induced cardiac wall motion abnormalities. We modified a commercial treadmill such that it could be safely positioned inside the MRI room to minimize the distance between the treadmill and the scan table. We optimized the treadmill exercise CMR protocol in 20 healthy volunteers and successfully imaged cardiac function and myocardial perfusion at peak stress, followed by viability imaging at rest. Imaging commenced an average of 30 seconds after maximal exercise. Real-time cine of seven slices with no breath-hold and no ECG-gating was completed within 45 seconds of exercise, immediately followed by stress perfusion imaging of three short-axis slices which showed an average time to peak enhancement within 57 seconds of exercise. We observed a 3.1-fold increase in cardiac output and a myocardial perfusion reserve index of 1.9, which agree with reported values for healthy subjects at peak stress. This study successfully demonstrates in-room treadmill exercise CMR in healthy volunteers, but confirmation of feasibility in patients with heart disease is still needed.

  14. The treatment of acute soft tissue trauma in Danish emergency rooms

    DEFF Research Database (Denmark)

    Johannsen, F; Langberg, Henning

    1997-01-01

    Rest, ice, compression, elevation (RICE) is the most recommended treatment for acute traumatic soft tissue injuries. A questionnaire was given to all Danish emergency rooms (n = 5) regarding their routines for acute treatment of ankle sprains and muscle contusions. Complete answers were received...... from 37 emergency rooms (73%), covering the treatment of 111 ankle sprains and 101 muscle contusions. Treatment with RICE was given in a minority of injuries, ice (21%), compression (32%) and elevation (58%) similarly between injury types. A complete RICE treatment was rarely applied (3%). Verbal...... information on RICE and rehabilitation was given in less than half of the cases. We conclude that the acute treatment of ankle sprains and muscle contusions in the Danish emergency rooms is not applied in accordance with consensus from international literature, and that the instruction in rehabilitation...

  15. Emergency room management of radiation accidents

    International Nuclear Information System (INIS)

    Rosenberg, R.; Mettler, F.A. Jr.

    1990-01-01

    Emergency room management of radioactively contaminated patients who have an associated medical injury requiring immediate attention must be handled with care. Radioactive contamination of the skin of a worker is not a medical emergency and is usually dealt with at the plant. Effective preplanning and on-the-scene triage will allow the seriously injured and contaminated patients to get the medical care they need with a minimum of confusion and interference. Immediate medical and surgical priorities always take precedence over radiation injuries and radioactive contamination. Probably the most difficult aspect of emergency management is the rarity of such accidents and hence the unfamiliarity of the medical staff with the appropriate procedures. The authors discuss how the answer to these problems is preplanning, having a simple and workable procedure and finally having 24-h access to experts

  16. Weather conditions influence the number of psychiatric emergency room patients

    Science.gov (United States)

    Brandl, Eva Janina; Lett, Tristram A.; Bakanidze, George; Heinz, Andreas; Bermpohl, Felix; Schouler-Ocak, Meryam

    2017-12-01

    The specific impact of weather factors on psychiatric disorders has been investigated only in few studies with inconsistent results. We hypothesized that meteorological conditions influence the number of cases presenting in a psychiatric emergency room as a measure of mental health conditions. We analyzed the number of patients consulting the emergency room (ER) of a psychiatric hospital in Berlin, Germany, between January 1, 2008, and December 31, 2014. A total of N = 22,672 cases were treated in the ER over the study period. Meteorological data were obtained from a publicly available data base. Due to collinearity among the meteorological variables, we performed a principal component (PC) analysis. Association of PCs with the daily number of patients was analyzed with autoregressive integrated moving average model. Delayed effects were investigated using Granger causal modeling. Daily number of patients in the ER was significantly higher in spring and summer compared to fall and winter (p psychiatric patients consulting the emergency room. In particular, our data indicate lower patient numbers during very cold temperatures.

  17. Focused cardiac ultrasound in the emergency department for patients admitted with respiratory symptoms

    DEFF Research Database (Denmark)

    Laursen, C. B.

    2015-01-01

    In patients admitted with respiratory failure, a large proportion is diagnosed incorrectly in the emergency department and an even larger proportion seems to receive inappropriate treatment. Inappropriate initial treatment of these patients in the emergency department is associated with increased...... triage, patients with cardiac arrest, patients with undifferentiated shock, patients with cardiopulmonary instability, patients with respiratory symptoms, trauma patients with suspected cardiac injuries, and assessment of the fluid status before fluid loading. When using focused cardiac ultrasound (US......) in patients with respiratory symptoms, the typical objectives would be to identify pericardial effusion and enlargement of cardiac cavities, to estimate global systolic left-ventricular function, and to assess the volume status. The routine use of focused cardiac US in patients with respiratory symptoms may...

  18. Measures of Rehospitalization, Emergency Room Visit, and Community Discharge

    Data.gov (United States)

    U.S. Department of Health & Human Services — Measures of the Rate of Rehospitalization, Emergency Room Visit, and Community Discharge for Medicare Beneficiaries. These rates are based on Medicare claims data.

  19. Evaluation of the preparedness of the children's emergency rooms ...

    African Journals Online (AJOL)

    PROMOTING ACCESS TO AFRICAN RESEARCH ... Background: The Children Emergency Room (CHER) is the first point of call for many sick children. ... limitation abounds with regards to personnel, high technology infrastructure, personnel ...

  20. Multiple Trauma and Emergency Room Management.

    Science.gov (United States)

    Frink, Michael; Lechler, Philipp; Debus, Florian; Ruchholtz, Steffen

    2017-07-24

    The care of severely injured patients remains a challenge. Their initial treatment in the emergency room is the essential link between first aid in the field and definitive in-hospital treatment. We present important elements of the initial in-hospital care of severely injured patients on the basis of pertinent publications retrieved by a selective search in PubMed and the current German S3 guideline on the care of severely and multiply traumatized patients, which was last updated in 2016. The goal of initial emergency room care is the rapid recognition and prompt treatment of acutely life-threatening injuries in the order of their priority. The initial assessment includes physical examination and ultrasonography according to the FAST concept (Focused Assessment with Sonography in Trauma) for the recognition of intraperitoneal hemorrhage. Patients with penetrating chest injuries, massive hematothorax, and/or severe injuries of the heart and lungs undergo emergency thoracotomy; those with signs of hollow viscus perforation undergo emergency laparotomy. If the patient is hemo - dynamically stable, the most important diagnostic procedure that must be performed is computerized tomography with contrast medium. Therapeutic decision-making takes the patient's physiological parameters into account, along with the overall severity of trauma and the complexity of the individual injuries. Depending on the severity of trauma, the immediate goal can be either the prompt restoration of organ structure and function or so-called damage control surgery. The latter focuses, in the acute phase, on hemostasis and on the avoidance of secondary damage such as intra-abdominal contamination or compartment syndrome. It also involves the temporary treatment of fractures with external fixation and the planning of definitive care once the patient's organ functions have been securely stabilized. The care of the severely injured patient should be performed in structured fashion according to the

  1. Therapeutic approach to patients complaining of high blood pressure in a cardiological emergency room

    Directory of Open Access Journals (Sweden)

    Miguel Gus

    1999-03-01

    Full Text Available OBJECTIVE: To evaluate the management of patients complaining of high blood pressure (BP in a cardiological emergency room. METHODS: Patients referred to the cardiological emergency room with the main complaint of high blood pressure were consecutively selected. The prescriptions and the choice of antihypertensive drugs were assessed. The classification of these patients as hypertensive emergencies or pseudoemergencies, according to the physician who provided initial care, was recorded. RESULTS: From a total of 858 patients presenting to the emergency room, 80 (9.3% complained of high BP, and 61 (76.3% received antihypertensive drugs. Sublingual nifedipine was the most commonly used drug (59%. One patient received intravenous medication, one patient was hospitalized and 6 patients (7.5% were classified as hypertensive emergencies or pseudoemergencies. CONCLUSION: High BP could seldom be classified as a hypertensive emergency or pseudoemergency, even though it was a frequent complaint (9.3% of visits. Currently, the therapeutic approach is not recommended, even in specialized clinics.

  2. Mortality and risk of cardiac complications among immediate survivors of accidental electric shock

    DEFF Research Database (Denmark)

    Hansen, Steen Møller; Riahi, Sam; Hjortshøj, Søren

    2017-01-01

    OBJECTIVE: Exposure to electric shock has been associated with an increased risk of developing delayed cardiac arrhythmias and cardiac diseases. We examined whether electric shock patients have an increased risk of developing cardiac disease, cardiac arrhythmias or death compared with the general...... suggest that nearly all patients can be discharged safely from the emergency room after electric shock without further observation.......OBJECTIVE: Exposure to electric shock has been associated with an increased risk of developing delayed cardiac arrhythmias and cardiac diseases. We examined whether electric shock patients have an increased risk of developing cardiac disease, cardiac arrhythmias or death compared with the general...... Danish population. DESIGN: Matched cohort study. SETTING: A nationwide study in Denmark from 1994 to 2011. PARTICIPANTS: We identified 11 462 Danish patients who visited an emergency ward or were admitted to a hospital due to electric shock from 1994 to 2011. Each patient was matched for age and sex...

  3. Facets of operational performance in an emergency room (ER)

    NARCIS (Netherlands)

    van der Vaart, Taco; Vastag, Gyula; Wijngaard, Jacob

    This paper, using detailed time measurements of patients complemented by interviews with hospital management and staff, examines three facets of an emergency room's (ER) operational performance: (1) effectiveness of the triage system in rationing patient treatment; (2) factors influencing ER's

  4. Web-based multimedia courseware for emergency cardiac patient management simulations.

    Science.gov (United States)

    Ambrosiadou, V; Compton, T; Panchal, T; Polovina, S

    2000-01-01

    This is a multidisciplinary inter-departmental/faculty project between the departments of computer science, electronic, communications and electrical engineering and nursing and paramedic sciences. The objective is to develop a web based multimedia front end to existing simulations of cardiac emergency scenaria. It will be used firstly in the teaching of nurses. The University of Hertfordshire is the only University in Britain using simulations of cardiac emergency scenaria for nurse and paramedic science education and therefore this project will add the multimedia dimension in distributed courses over the web and will assess the improvement in the educational process. The use of network and multimedia technologies, provide interactive learning, immediate feedback to students' responses, individually tailored instructions, objective testing and entertaining delivery. The end product of this project will serve as interactive material to enhance experiential learning for nursing students using the simulations of cardiac emergency scenaria. The emergency treatment simulations have been developed using VisSim and may be compiled as C code. The objective of the project is to provide a web based user friendly multimedia interface in order to demonstrate the way in which patients may be managed in critical situations by applying advanced technological equipment and drug administration. Then the user will be able to better appreciate the concepts involved by running the VisSim simulations. The evaluation group for the proposed software will be the Department of Nursing and Paramedic Sciences About 200 nurses use simulations every year for training purposes as part of their course requirements.

  5. CFD analysis of the temperature field in emergency pump room in Loviisa NPP

    Energy Technology Data Exchange (ETDEWEB)

    Rämä, Tommi, E-mail: tommi.rama@fortum.com [Fortum Power and Heat, P.O.B. 100, FI-00048 Fortum (Finland); Toppila, Timo, E-mail: timo.toppila@fortum.com [Fortum Power and Heat, P.O.B. 100, FI-00048 Fortum (Finland); Kelavirta, Teemu, E-mail: teemu.kelavirta@fortum.com [Fortum Power and Heat, Loviisa Power Plant, P.O.B. 23, FI-07901 Loviisa (Finland); Martin, Pasi, E-mail: pasi.martin@fortum.com [Fortum Power and Heat, Loviisa Power Plant, P.O.B. 23, FI-07901 Loviisa (Finland)

    2014-11-15

    Highlights: • Laser scanned room geometry from Loviisa NPP was utilized for CFD simulation. • Uncertainty of CFD simulation was estimated using the Grid Convergence Index. • Measured temperature field of pump room was reproduced with CFD simulation. - Abstract: In the Loviisa Nuclear Power Plant (NPP) six emergency pumps belonging to the same redundancy are located in the same room. During a postulated accident the cooling of the room is needed as the engines of the emergency pumps generate heat. Cooling is performed with fans blowing air to the upper part of the room. Temperature limits have been given to the operating conditions of the main components in order to ensure their reliable operation. Therefore the temperature field of the room is important to know. Temperature measurements were made close to the most important components of the pump room to get a better understanding of the temperature field. For these measurements emergency pumps and cooling fan units were activated. To simulate conditions during a postulated accident additional warm-air heaters were used. Computational fluid dynamic (CFD) simulations were made to support plant measurements. For the CFD study one of the pump rooms of Loviisa NPP was scanned with a laser and this data converted to detailed 3-D geometry. Tetrahedral computation grid was created inside the geometry. Grid sensitivity studies were made, and the model was then validated against the power plant tests. With CFD the detailed temperature and flow fields of the whole room were produced. The used CFD model was able to reproduce the temperature field of the measurements. Two postulated accident cases were simulated. In the cases the operating cooling units were varied. The temperature profile of the room changes significantly depending on which units are cooling and which only circulating the air. The room average temperature stays approximately the same. The simulation results were used to ensure the acceptable operating

  6. Categorizing "frequent visitors" in the psychiatric emergency room: a semistructured interview study

    DEFF Research Database (Denmark)

    Buus, Niels

    2011-01-01

    Nurses can become demoralized and hostile toward frequent visitors in psychiatric emergency rooms because of the number of visits. The aim of this study was to develop more knowledge about the ways in which nurses categorize frequent visitors. Eleven nurses were interviewed, and their categorizing...... practices were examined from a social constructionist perspective. The results showed that the nurses did not categorize frequent visitors as particularly unlikeable or difficult to treat. Like other visitors, they could be categorized as difficult if they obstructed a smooth flow of successful referrals...... through the emergency room and/or there was poor rapport with the nurses....

  7. "Boarding" Psychiatric Patients in Emergency Rooms: One Court Says "No More".

    Science.gov (United States)

    Appelbaum, Paul S

    2015-07-01

    "Boarding" involuntary psychiatric patients in medical emergency rooms is common in many parts of the United States. The practice, driven by a shortage of alternative resources, including limited inpatient capacity, can result in patients' being held for days without treatment or a hospital room, often in busy corridors or treatment rooms. A recent challenge to this practice led the Washington Supreme Court to declare it illegal and resulted in the appropriation of substantial funding to create new psychiatric beds. Centralized psychiatric crisis services, with appropriate payment models, may offer another approach to reducing the need for holding patients awaiting inpatient admission.

  8. Evaluation of care for traffic accidents victims made by on duty emergency physicians and surgeons in the emergency room

    Directory of Open Access Journals (Sweden)

    VLAUDIMIR DIAS MARQUES

    Full Text Available ABSTRACT Objective: to evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room. Methods: we conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of Maringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians. Results: of the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12. Statistical analysis showed that in the cases conducted by the emergency physicians (n=187, the recording of the Glasgow Coma Scale and the performance of surgical procedures were less common, whereas the recording of blood pressure values was performed in greater numbers when compared with cases led by surgeons (n=501. There was a statistically significant relationship (p<0.01 between the length of hospital stay and surgical specialty, with a greater chance (crude OR=28 in the period from one to six hours for the group treated by emergency doctors. Most physicians participating in the study were young, with emergency room time of up to one to two years, and with ATLS training. Among those who had attended the ATLS course, 60% did so in the last four years. Surgeons performed 73% of hospital treatments. Conclusion: in the care of traffic victims with minor injuries, the Glasgow Coma Scale, the blood pressure levels, the type of treatment in the emergency room and hospital stay had different approaches between emergency physicians and surgeons.

  9. Evaluation of the preparedness of the children's emergency rooms ...

    African Journals Online (AJOL)

    2017-02-09

    Feb 9, 2017 ... beds per nurse ranges from 3-15, giving a nurse: patient ratio of 1:3-15. (Table 1) .... Emergency Rooms (CHER) in the tertiary health institu- .... vices offered in our tertiary centres must go beyond the mundane ... medical tourism abroad as most often any care beyond the basic ... of general practitioner care.

  10. Suspected leaking abdominal aortic aneurysm: use of sonography in the emergency room.

    Science.gov (United States)

    Shuman, W P; Hastrup, W; Kohler, T R; Nyberg, D A; Wang, K Y; Vincent, L M; Mack, L A

    1988-07-01

    To determine the value of sonography in the emergent evaluation of suspected leaking abdominal aortic aneurysms, the authors examined 60 patients in the emergency department using sonography and a protocol involving advance radio notification from the ambulance; arrival of sonographic personnel and equipment in the triage room before patient arrival; and, during other triage activities, rapid sonographic evaluation of the aorta for aneurysm and of the paraaortic region for extraluminal blood. Sonographic findings were correlated with surgical results and clinical outcome. When performed under these circumstances, sonography was accurate in demonstrating presence or absence of aneurysm (98%), but its sensitivity for extraluminal blood was poor (4%). A combination of sonographic confirmation of aneurysm, abdominal pain, and unstable hemodynamic condition resulted in the correct decision to perform emergent surgery in 21 of 22 patients (95%). An abbreviated sonographic examination done in the emergency room can provide accurate, useful information about the presence of aneurysm; this procedure does not significantly delay triage of these patients.

  11. Impact of surface disinfection and sterile draping of furniture on room air quality in a cardiac procedure room with a ventilation and air-conditioning system (extrusion airflow, cleanroom class 1b (DIN 1946-4)).

    Science.gov (United States)

    Below, Harald; Ryll, Sylvia; Empen, Klaus; Dornquast, Tina; Felix, Stefan; Rosenau, Heike; Kramer, Sebastian; Kramer, Axel

    2010-09-21

    In a cardiac procedure room, ventilated by a ventilation and air-conditioning system with turbulent mixed airflow, a protection zone in the operating area could be defined through visualization of airflows. Within this protection zone, no turbulence was detectable in the room air.Under the given conditions, disinfection of all surfaces including all furniture and equipment after the last operation and subsequent draping of furniture and all equipment that could not be removed from the room with sterile surgical drapes improved the indoor room air quality from cleanroom class C to cleanroom class B. This also allows procedures with elevated requirements to be performed in room class 1b.

  12. Preparing for Sudden Death: Social Work in the Emergency Room.

    Science.gov (United States)

    Wells, Paula J.

    1993-01-01

    Provides guidelines from social work perspective on how social workers and health care professionals can provide bereavement counseling for families whose relatives have died in emergency room. Discusses providing family with privacy and accessibility; keeping family informed; using understandable terminology; speaking directly about death;…

  13. Child Abuse: The Value of Systematic Screening at Emergency Rooms

    NARCIS (Netherlands)

    Sittig, J.S.

    2015-01-01

    There is no conclusive evidence that diagnostic tools detect physical child abuse among children coming to emergency rooms (ERs), but his evidence is urgently needed because both false-positive and false-negative diagnoses have serious adverse effects. This thesis describes several aspects of the

  14. Penetrating cardiac injury by wire thrown from a lawn mower.

    Science.gov (United States)

    Rubio, P A; Reul, G J

    1979-01-01

    The first successful surgically treated case of penetrating heart injury, specifically the right ventricle, caused by a fragment of coat hanger wire thrown by a lawn mower, is reported. Though traumatic heart injuries are rare, this case represents accurate surgical management and judgment, especially in the preoperative phase which resulted in early operating and excellent postoperative results. It is our feeling that if the patient can be transferred safely to the operating room the mortality rate is considerably lowered; however, emergency room thoracotomy, which will undoubtedly result in a greater survival rate from these spectacular injuries, should be performed in the emergency center if cardiac activity ceases or the patient's condition deteriorates considerably.

  15. Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT)

    Science.gov (United States)

    2015-10-01

    Award Number: W81XWH-07-1-0682 TITLE: Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma ( EPR -CAT) PRINCIPAL INVESTIGATOR...thoracotomy and open chest CPR, results in unacceptably low survival rates. Emergency Preservation and Resuscitation ( EPR ) was developed to rapidly preserve...further recommended that the trauma surgeons involved in the study obtain hospital privileges for cannulation for the EPR flush. This has been

  16. Usefulness of emergency ultrasound in nontraumatic cardiac arrest.

    Science.gov (United States)

    Volpicelli, Giovanni

    2011-02-01

    Treatment of nontraumatic cardiac arrest in the hospital setting depends on the recognition of heart rhythm and differential diagnosis of the underlying condition while maintaining a constant oxygenated blood flow by ventilation and chest compression. Diagnostic process relies only on patient's history, physical findings, and active electrocardiography. Ultrasound is not currently scheduled in the resuscitation guidelines. Nevertheless, the use of real-time ultrasonography during resuscitation has the potential to improve diagnostic accuracy and allows the physician a greater confidence in deciding aggressive life-saving therapeutic procedures. This article reviews the current opinions and literature about the use of emergency ultrasound during resuscitation of nontraumatic cardiac arrest. Cardiac and lung ultrasound have a great potential in identifying the reversible mechanical causes of pulseless electrical activity or asystole. Brief examination of the heart can even detect a real cardiac standstill regardless of electrical activity displayed on the monitor, which is a crucial prognostic indicator. Moreover, ultrasound can be useful to verify and monitor the tracheal tube placement. Limitation to the use of ultrasound is the need to minimize the no-flow intervals during mechanical cardiopulmonary resuscitation. However, real-time ultrasound can be successfully applied during brief pausing of chest compression and first pulse-check. Finally, lung sonographic examination targeted to the detection of signs of pulmonary congestion has the potential to allow hemodynamic noninvasive monitoring before and after mechanical cardiopulmonary maneuvers. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Digital image display system for emergency room

    International Nuclear Information System (INIS)

    Murry, R.C.; Lane, T.J.; Miax, L.S.

    1989-01-01

    This paper reports on a digital image display system for the emergency room (ER) in a major trauma hospital. Its objective is to reduce radiographic image delivery time to a busy ER while simultaneously providing a multimodality capability. Image storage, retrieval, and display will also be facilitated with this system. The system's backbone is a token-ring network of RISC and personal computers. The display terminals are higher- function RISC computers with 1,024 2 color or gray-scale monitors. The PCs serve as administrative terminals. Nuclear medicine, CT, MR, and digitized film images are transferred to the image display system

  18. Cervical Spine Collar Removal by Emergency Room Nurses: A Quality Improvement Project.

    Science.gov (United States)

    Fontaine, Guillaume; Forgione, Massimo; Lusignan, Francis; Lanoue, Marc-André; Drouin, Simon

    2018-05-01

    The Canadian C-Spine Rule (CCR) is a clinical decision aid to facilitate the safe removal of cervical collars in the alert, orientated, low-risk adult trauma patient. Few health care settings have assessed initiatives to train charge nurses to use the CCR. This practice improvement project conducted in a secondary trauma center in Canada aimed to (1) train charge nurses of the emergency room to use the CCR, (2) monitor its use throughout the project period, and (3) compare the assessments of the charge nurses with those of emergency physicians. The project began with the creation of an interdisciplinary team. Clinical guidelines were established by the interdisciplinary project team. Nine charge nurses of the emergency room were then trained to use the CCR (3 on each 8-hour shift). The use of the CCR was monitored throughout the project period, from June 1 to October 5, 2016. The 3 aims of this practice improvement project were attained successfully. Over a 5-month period, 114 patients were assessed with the CCR. Charge nurses removed the cervical collars for 54 of 114 patients (47%). A perfect agreement rate (114 of 114 patients, 100%) was attained between the assessments of the nurses and those of physicians. This project shows that the charge nurses of a secondary trauma center can use the CCR safely on alert, orientated, and low-risk adult trauma patients as demonstrated by the agreement in the assessments of emergency room nurses and physicians. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  19. PM2.5 constituents and hospital emergency-room visits in Shanghai, China.

    Science.gov (United States)

    Qiao, Liping; Cai, Jing; Wang, Hongli; Wang, Weibing; Zhou, Min; Lou, Shengrong; Chen, Renjie; Dai, Haixia; Chen, Changhong; Kan, Haidong

    2014-09-02

    Although ambient PM2.5 has been linked to adverse health effects, the chemical constituents that cause harm are largely unclear. Few prior studies in a developing country have reported the health impacts of PM2.5 constituents. In this study, we examined the short-term association between PM2.5 constituents and emergency room visits in Shanghai, China. We measured daily concentrations of PM2.5, organic carbon (OC), elemental carbon (EC), and eight water-soluble ions between January 1, 2011 and December 31, 2012. We analyzed the data using overdispersed generalized linear Poisson models. During our study period, the mean daily average concentration of PM2.5 in Shanghai was 55 μg/m(3). Major contributors to PM2.5 mass included OC, EC, sulfate, nitrate, and ammonium. For a 1-day lag, an interquartile range increment in PM2.5 mass (36.47 μg/m(3)) corresponded to 0.57% [95% confidence interval (CI): 0.13%, 1.01%] increase of emergency room visits. In all the three models used, we found significant positive associations of emergency room visits with OC and EC. Our findings suggest that PM2.5 constituents from the combustion of fossil fuel (e.g., OC and EC) may have an appreciable influence on the health impact attributable to PM2.5.

  20. Importance of the first link: description and recognition of an out-of-hospital cardiac arrest in an emergency call.

    Science.gov (United States)

    Berdowski, Jocelyn; Beekhuis, Freerk; Zwinderman, Aeilko H; Tijssen, Jan G P; Koster, Rudolph W

    2009-04-21

    The content of emergency calls for suspected cardiac arrest is rarely analyzed. This study investigated the recognition of a cardiac arrest by dispatchers and its influence on survival rates. During 8 months, voice recordings of 14,800 consecutive emergency calls were collected to audit content and cardiac arrest recognition. The presence of cardiac arrest during the call was assessed from the ambulance crew report. Included calls were placed by laypersons on site and did not involve trauma. Prevalence of cardiac arrest was 3.0%. Of the 285 cardiac arrests, 82 (29%) were not recognized during the call, and 64 of 267 suspected calls (24%) were not cardiac arrest. We analyzed a random sample (n=506) of 9230 control calls. Three-month survival was 5% when a cardiac arrest was not recognized versus 14% when it was recognized (P=0.04). If the dispatcher did not recognize the cardiac arrest, the ambulance was dispatched a mean of 0.94 minute later (P<0.001) and arrived 1.40 minutes later on scene (P=0.01) compared with recognized calls. The main reason for not recognizing the cardiac arrest was not asking if the patient was breathing (42 of 82) and not asking to describe the type of breathing (16 of 82). Normal breathing was never mentioned in true cardiac arrest calls. A logistic regression model identified spontaneous trigger words like facial color that could contribute to cardiac arrest recognition (odds ratio, 7.8 to 9.7). Not recognizing a cardiac arrest during emergency calls decreases survival. Spontaneous words that the caller uses to describe the patient may aid in faster and better recognition of a cardiac arrest.

  1. Suicide Mortality of Suicide Attempt Patients Discharged from Emergency Room, Nonsuicidal Psychiatric Patients Discharged from Emergency Room, Admitted Suicide Attempt Patients, and Admitted Nonsuicidal Psychiatric Patients

    Science.gov (United States)

    Choi, Jae W.; Park, Subin; Yi, Ki K.; Hong, Jin P.

    2012-01-01

    The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients…

  2. Neuroimaging of Patients with Headache in the Emergency Room: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    ibrahim Burak Atci

    2015-03-01

    Conclusion: In the emergency department during evaluation of headache, that should be done first is the exclusion of headaches which is caused by non beningn intracranial patologies. Therefore, from the entrance of the patients evaluated in the emergency room, it is important that they must be directed to rapid diagnosis and treatment with considering the red alert findings. [Cukurova Med J 2015; 40(1.000: 86-90

  3. Errors in radiographic recognition in the emergency room

    International Nuclear Information System (INIS)

    Britton, C.A.; Cooperstein, L.A.

    1986-01-01

    For 6 months we monitored the frequency and type of errors in radiographic recognition made by radiology residents on call in our emergency room. A relatively low error rate was observed, probably because the authors evaluated cognitive errors only, rather than include those of interpretation. The most common missed finding was a small fracture, particularly on the hands or feet. First-year residents were most likely to make an error, but, interestingly, our survey revealed a small subset of upper-level residents who made a disproportionate number of errors

  4. Hybrid options for treating cardiac disease.

    Science.gov (United States)

    Umakanthan, Ramanan; Leacche, Marzia; Zhao, David X; Gallion, Anna H; Mishra, Prabodh C; Byrne, John G

    2011-01-01

    The options for treating heart disease have greatly expanded during the course of the last 2 1/2 decades with the advent of hybrid technology. The hybrid option for treating cardiac disease implies using the technology of both interventional cardiology and cardiac surgery to treat cardiac disease. This rapidly developing technology has given rise to new and creative techniques to treat cardiac disease involving coronary artery disease, coronary artery disease and cardiac valve disease, and atrial fibrillation. It has also led to the establishment of new procedural suites called hybrid operating rooms that facilitate the integration of technologies of interventional cardiology catheterization laboratories with those of cardiac surgery operating rooms. The development of hybrid options for treating cardiac disease has also greatly augmented teamwork and collaboration between interventional cardiologists and cardiac surgeons. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. [Advanced Trauma Life Support (ATLS) in the emergency room. Is it suitable as an SOP?].

    Science.gov (United States)

    Shafizadeh, S; Tjardes, T; Steinhausen, E; Balke, M; Paffrath, T; Bouillon, B; Bäthis, H

    2010-08-01

    There is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patient's physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. Above all it is important to prevent secondary injury, to realize timing as a relevant factor in the initial treatment, and to assure a high standard of care. A standard operating procedure (SOP) exactly regulates the approach to trauma patients and determines the responsibilities of the involved faculties. An SOP moreover incorporates the organizational structure in the treatment of trauma patients as well as the necessary technical equipment and staff requirements. To optimize process and result quality, priorities are in the fields of medical fundamentals of trauma care, education, and fault management. SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.

  6. 76 FR 76937 - Emerging Technology and Research Advisory Committee; Notice of Partially Closed Meeting-Room Change

    Science.gov (United States)

    2011-12-09

    ... DEPARTMENT OF COMMERCE Bureau of Industry and Security Emerging Technology and Research Advisory Committee; Notice of Partially Closed Meeting--Room Change The Emerging Technology and Research Advisory... emerging technology and research activities, including those related to deemed exports. Agenda Wednesday...

  7. Modeling the emergency cardiac in-patient flow: An application of queueing theory

    NARCIS (Netherlands)

    de Bruin, A.M.; van Rossum, A.C.; Visser, M.C.; Koole, G.M.

    2007-01-01

    This study investigates the bottlenecks in the emergency care chain of cardiac in-patient flow. The primary goal is to determine the optimal bed allocation over the care chain given a maximum number of refused admissions. Another objective is to provide deeper insight in the relation between natural

  8. Neonatal cardiac emergencies

    African Journals Online (AJOL)

    flow) or require intervention (surgical or catheter) within the first ... Cardiac. History. Risk factors, e.g. meconium-stained liquor, prematurity, ... 'snowman' sign for supracardiac total anomalous pulmonary venous drainage (TAPVD), cardiomegaly with plethora for ... central cyanosis and on auscultation you hear no murmurs.

  9. The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

    OpenAIRE

    Botelho,Renata Maria de Oliveira; Campanharo,Cássia Regina Vancini; Lopes,Maria Carolina Barbosa Teixeira; Okuno,Meiry Fernanda Pinto; Góis,Aécio Flávio Teixeira de; Batista,Ruth Ester Assayag

    2016-01-01

    ABSTRACT Objective: to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). Method: case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condit...

  10. Youth Versus Adult “Weightlifting” Injuries Presenting to United States Emergency Rooms: Accidental Versus Nonaccidental Injury Mechanisms

    OpenAIRE

    Myer, Gregory D.; Quatman, Carmen E.; Khoury, Jane; Wall, Eric J.; Hewett, Timothy E.

    2009-01-01

    Myer, GD, Quatman, CE, Khoury, J, Wall, EJ, and Hewett, TE. Youth versus adult “weightlifting” injuries presenting to united states emergency rooms: accidental versus nonaccidental injury mechanisms. J Strength Cond Res 23(7): 2054–2060, 2009—Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. W...

  11. Educational paper Detection of child abuse and neglect at the emergency room

    NARCIS (Netherlands)

    Teeuw, Arianne Hélène; Derkx, Bert H. F.; Koster, Willeke A.; van Rijn, Rick R.

    2012-01-01

    The emergency room (ER) represents the main system entry for crises-based health care visits. It is estimated that 2% to 10% of children visiting the ER are victims of child abuse and neglect (CAN). Therefore, ER personnel may be the first hospital contact and opportunity for CAN victims to be

  12. The application of a "6S Lean" initiative to improve workflow for emergency eye examination rooms.

    Science.gov (United States)

    Nazarali, Samir; Rayat, Jaspreet; Salmonson, Hilary; Moss, Theodora; Mathura, Pamela; Damji, Karim F

    2017-10-01

    Ophthalmology residents on call at the Royal Alexandra Hospital identified workplace disorganization and lack of standardization in emergency eye examination rooms as an impediment to efficient patient treatment. The aim of the study was to use the "6S Lean" model to improve workflow in eye examination rooms at the Royal Alexandra Hospital. With the assistance of quality improvement consultants, the "6S Lean" model was applied to the current operation of the emergency eye clinic examination rooms. This model, considering 8 waste categories, was then used to recommend and implement changes to the examination rooms and to workplace protocols to enhance efficiency and safety. Eye examination rooms were improved with regards to setup, organization of supplies, inventory control, and maintenance. All targets were achieved, and the 5S audit checklist score increased by 33 points from 44 to 77. Implementation of the 6S methodology is a simple approach that removes inefficiencies from the workplace. The ophthalmology clinic removed waste from all 8 waste categories, increased audit results, mitigated patient and resident safety risks, and ultimately redirected resident time back to patient care delivery. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  13. Waiting room crowding and agitation in a dedicated psychiatric emergency service.

    Science.gov (United States)

    El-Mallakh, Rif S; Whiteley, Amanda; Wozniak, Tanya; Ashby, McCray; Brown, Shawn; Colbert-Trowel, Danya; Pennington, Tammy; Thompson, Michael; Tasnin, Rokeya; Terrell, Christina L

    2012-05-01

    Emergency department crowding is a growing problem that impacts patient care and safety. The effect of crowding has not been examined in emergency psychiatric services. The association between patient census and use of restraints, seclusion, and anti-agitation medications as needed was examined for 1 month. A total of 689 patients were seen in 31 days. The average hourly census was 6.8 ± 2.8 (range 0 to 18). There were 33 incidences of seclusion or restraint and an additional 15 instances of medications administered for agitation. The use of seclusion, restraint, or medication for agitation was significantly associated with census (r2 = 0.3, F = 5.47, P = .036). Crowding in emergency psychiatric waiting rooms may increase the need for seclusion, restraint, or medications for agitation.

  14. Recognition of out-of-hospital cardiac arrest by medical dispatchers in emergency medical dispatch centres in two countries

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Andréll, Cecilia; Viereck, Søren

    2016-01-01

    in two steps; registry data were merged with electronically registered emergency call data from the emergency medical dispatch centres in the two regions. Cases with missing or non-OHCA dispatch codes were analysed further by auditing emergency call recordings using a uniform data collection template......INTRODUCTION: Survival after out-of-hospital cardiac arrest (OHCA) remains low. Early recognition by emergency medical dispatchers is essential for an effective chain of actions, leading to early cardiopulmonary resuscitation, use of an automated external defibrillator and rapid dispatching...... of the emergency medical services. AIM: To analyse and compare the accuracy of OHCA recognition by medical dispatchers in two countries. METHOD: An observational register-based study collecting data from national cardiac arrest registers in Denmark and Sweden during a six-month period in 2013. Data were analysed...

  15. "Knife to skin" time is a poor marker of operating room utilization and efficiency in cardiac surgery.

    Science.gov (United States)

    Luthra, Suvitesh; Ramady, Omar; Monge, Mary; Fitzsimons, Michael G; Kaleta, Terry R; Sundt, Thoralf M

    2015-06-01

    Markers of operation room (OR) efficiency in cardiac surgery are focused on "knife to skin" and "start time tardiness." These do not evaluate the middle and later parts of the cardiac surgical pathway. The purpose of this analysis was to evaluate knife to skin time as an efficiency marker in cardiac surgery. We looked at knife to skin time, procedure time, and transfer times in the cardiac operational pathway for their correlation with predefined indices of operational efficiency (Index of Operation Efficiency - InOE, Surgical Index of Operational Efficiency - sInOE). A regression analysis was performed to test the goodness of fit of the regression curves estimated for InOE relative to the times on the operational pathway. The mean knife to skin time was 90.6 ± 13 minutes (23% of total OR time). The mean procedure time was 282 ± 123 minutes (71% of total OR time). Utilization efficiencies were highest for aortic valve replacement and coronary artery bypass grafting and least for complex aortic procedures. There were no significant procedure-specific or team-specific differences for standard procedures. Procedure times correlated the strongest with InOE (r = -0.98, p knife to skin is not as strong an indicator of efficiency. A statistically significant linear dependence on InOE was observed with "procedure times" only. Procedure times are a better marker of OR efficiency than knife to skin in cardiac cases. Strategies to increase OR utilization and efficiency should address procedure times in addition to knife to skin times. © 2015 Wiley Periodicals, Inc.

  16. Therapeutic hypothermia following out-of-hospital cardiac arrest; does it start in the emergency department?

    Science.gov (United States)

    Galloway, R; Sherren, P B

    2010-12-01

    The use of therapeutic hypothermia after cardiac arrest is a well-practised treatment modality in the intensive care unit (ICU). However, recent evidence points to advantages in starting the cooling process as soon as possible after the return of spontaneous circulation (ROSC). There are no data on implementation of this treatment in the emergency department. A telephone survey was conducted of the 233 emergency departments in the UK. The most senior available clinician was asked if, in cases where they have a patient with a ROSC after an out-of-hospital cardiac arrest, would therapeutic hypothermia be started in the emergency department. Of the 233 hospitals called, 230 responded, of which 35% would start cooling in the emergency department. Of this 35%, over half (56%) said the decision to start cooling was made by the emergency physician before consultation with the ICU. Also, of the 35% who would begin cooling in the emergency department, 55% would cool only for ventricular fibrillation/ventricular tachycardia, 66% would monitor temperature centrally, and 14% would use specialised cooling equipment. There is often a delay in getting patients to ICU from the emergency department, and thus the decision not to start cooling in the emergency department may impact significantly on patient outcome. The dissemination of these data may persuade emergency physicians that starting treatment in the emergency department is an appropriate and justifiable decision that is becoming a more accepted practice throughout the UK.

  17. Team-focused Cardiopulmonary Resuscitation: Prehospital Principles Adapted for Emergency Department Cardiac Arrest Resuscitation.

    Science.gov (United States)

    Johnson, Blake; Runyon, Michael; Weekes, Anthony; Pearson, David

    2018-01-01

    Out-of-hospital cardiac arrest has high rates of morbidity and mortality, and a growing body of evidence is redefining our approach to the resuscitation of these high-risk patients. Team-focused cardiopulmonary resuscitation (TFCPR), most commonly deployed and described by prehospital care providers, is a focused approach to cardiac arrest care that emphasizes early defibrillation and high-quality, minimally interrupted chest compressions while de-emphasizing endotracheal intubation and intravenous drug administration. TFCPR is associated with statistically significant increases in survival to hospital admission, survival to hospital discharge, and survival with good neurologic outcome; however, the adoption of similar streamlined resuscitation approaches by emergency physicians has not been widely reported. In the absence of a deliberately streamlined approach, such as TFCPR, other advanced therapies and procedures that have not shown similar survival benefit may be prioritized at the expense of simpler evidence-based interventions. This review examines the current literature on cardiac arrest resuscitation. The recent prehospital success of TFCPR is highlighted, including the associated improvements in multiple patient-centered outcomes. The adaptability of TFCPR to the emergency department (ED) setting is also discussed in detail. Finally, we discuss advanced interventions frequently performed during ED cardiac arrest resuscitation that may interfere with early defibrillation and effective high-quality chest compressions. TFCPR has been associated with improved patient outcomes in the prehospital setting. The data are less compelling for other commonly used advanced resuscitation tools and procedures. Emergency physicians should consider incorporating the TFCPR approach into ED cardiac arrest resuscitation to optimize delivery of those interventions most associated with improved outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Successful emergency splenectomy during cardiac arrest due to cytomegalovirus-induced atraumatic splenic rupture

    DEFF Research Database (Denmark)

    Glesner, Matilde Kanstrup; Madsen, Kristian Rørbæk; Nielsen, Jesper Meng Rahn

    2015-01-01

    A 27-year-old woman was admitted to the emergency department with fever and a petechial rash on suspicion of meningitis. Shortly after arriving she developed cardiac arrest. Blood work up showed severe lactate acidosis, anaemia and thrombocytopenia. A focused assessment with sonography in trauma...

  19. Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR CAT)

    Science.gov (United States)

    2016-12-01

    Award Number: W81XWH-07-1-0682 TITLE: Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma ( EPR -CAT) PRINCIPAL INVESTIGATOR...Preservation and Resuscitation ( EPR ) was developed to rapidly preserve the organism during ischemia, using hypothermia, drugs, and fluids, to “buy time...privileges for cannulation for the EPR flush. This has been accomplished. Given the complexity of our planned intervention for trauma patients in

  20. Syncope and sudden death from the emergency physician’s perspective: is there room for new biomarkers?

    Directory of Open Access Journals (Sweden)

    Rossella Marino

    2013-10-01

    Full Text Available Syncope is a transient loss of consciousness due to temporary global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Syncope represents 1-2% of emergency department (ED visits and is coupled with a high risk for mortality, prolonged hospital admission, and immediate false diagnosis. Many patients who present to the ED with aspecific symptoms are mainly hospitalized because of diagnostic uncertainty. It is always very important to immediately distinguish syncope of cardiac and non-cardiac origins. Cardiac syncope has higher risk for mortality especially for sudden cardiac death, while non-cardiac one shows risk of repeated events of syncope with poor quality of life. Sudden cardiac death is defined as rapid and unexpected natural death due to cardiac etiology. Researchers from the GREAT Network hypothesized to evaluate some novel biomarkers in order to test acute cardiac condition that can suggest the presence of heart structural diseases, heart failure, and electrical disorders. The primary objective of this study is to test the diagnostic performance from patient history, clinical judgment, and novel biomarkers in the diagnosis of cardiac syncope in patients admitted to the ED. The trial is designed as a prospective international multicenter observational study accounting for 730 patients aged over 40 admitted to the ED with syncope within the last 12 h. A multimarker approach combining markers of different origin and mode of relapse, should add diagnostic information to correctly identify the cardiac conditions and to therefore be pertinent in the early diagnosis of cardiac syncope and in the prediction of cardiac events including sudden death. Future data should be needed to confirm the hypothesis presented here.

  1. [Management of an elderly patient in the emergency room at the end of life : A medical ethics challenge].

    Science.gov (United States)

    Michels, G; Nies, R; Ortmann, S; Pfister, R; Salomon, F

    2018-04-01

    A 94-year-old patient with cardiogenic shock due to myocardial infarction was admitted via the emergency room. A coronary angiography and intensive care were requested. The need for care due to dementia was known. After case discussion in the interdisciplinary and multiprofessional treatment team, the decision for a palliative care concept in the form of symptom control was made in the emergency room, taking into account the patient's medical history, the current situation, and the presumed patient consent. The integration of medical ethics aspects and palliative medicine into "geriatric emergency medicine" will present a challenge in the future.

  2. Use of the hospital anxiety and depression scale (HADS in a cardiac emergency room: chest pain unit

    Directory of Open Access Journals (Sweden)

    Gastão L. F. Soares-Filho

    2009-03-01

    Full Text Available OBJECTIVE: To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. INTRODUCTION: Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. METHODOLOGY: Patients were assessed by the "Hospital Anxiety and Depression Scale" as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered "probable case" of anxiety or depression. RESULTS: According to the protocol, 59 (45.4% of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6% presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1% had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. CONCLUSION: The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life.

  3. Use of the hospital anxiety and depression scale (HADS) in a cardiac emergency room: chest pain unit.

    Science.gov (United States)

    Soares-Filho, Gastão L F; Freire, Rafael C; Biancha, Karla; Pacheco, Ticiana; Volschan, André; Valença, Alexandre M; Nardi, Antonio E

    2009-01-01

    To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. Patients were assessed by the 'Hospital Anxiety and Depression Scale' as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered 'probable case' of anxiety or depression. According to the protocol, 59 (45.4%) of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6%) presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1%) had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life.

  4. Effects of a training workshop on suicide prevention among emergency room nurses.

    Science.gov (United States)

    Kishi, Yasuhiro; Otsuka, Kotaro; Akiyama, Keiko; Yamada, Tomoki; Sakamoto, Yumiko; Yanagisawa, Yaeko; Morimura, Hiroshi; Kawanishi, Chiaki; Higashioka, Hiroaki; Miyake, Yasushi; Thurber, Steven

    2014-01-01

    Suicide attempts are frequently encountered by emergency department nurses. Such encounters can potentially provide a foundation for secondary suicide prevention. The aim of the present investigation was to evaluate the effect of a 7-hr training program for emergency room nursing personnel in Japan. In all, 52 nurses completed the questionnaires before the workshop and 1 month after the workshop. The nurses' understanding of and willingness to care for suicidal patients positively changed. It is feasible to provide a 7-hr, relatively short, workshop on suicidal prevention aimed at emergency medical staff and to improve attitudes during a follow-up of 1 month. It is uncertain whether the positive attitudes of emergency nurses toward suicide and/or educational interventions could impact the outcomes of these interventions. Further studies are needed to address these important questions in this field.

  5. Pathological 99mTc-sestamibi myocardial perfusion scintigraphy is independently associated with emerging cardiac events in elderly patients with known or suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Bucerius, Jan; Joe, Alexius Y.; Herder, Ellen; Brockmann, Holger; Biermann, Kim; Palmedo, Holger; Biersack, Hans-Juergen (Dept. of Nuclear Medicine, Univ. of Bonn (Germany)), e-mail: jan.bucerius@ukb.uni-bonn.de; Tiemann, Klaus (Dept. of Internal Medicine II, Univ. of Bonn (Germany))

    2011-02-15

    Background: Only few data are available regarding the prognostic impact of myocardial perfusion scintigraphy with 99mTc-sestamibi (MPS) regarding emerging cardiac events in elderly patients Purpose: To evaluate the prognostic value of MPS regarding emerging cardiac events in patients aged =70 years with known or suspected coronary artery disease (CAD). Material and Methods: One hundred and thirty-three patients (74.6 +- 3.7 years) who underwent exercise or pharmacological stress/rest MPS were included in this analysis. Semi-quantitative visual interpretation of MPS images was performed and Summed-Stress- (SSS), Summed-Difference- (SDS), and Summed-Rest Scores (SRS) were calculated. Multivariate logistic regression analyses were calculated for evaluation of the independent prognostic impact of MPS results and several cardiac-related patient characteristics with regard to emerging cardiac events. Kaplan-Meier survival- and log rank analyses were calculated for assessment of cardiac event-free survival. Results: Pathological SSS (OR: 3.3), angina (OR: 2.7) and ischemic ECG (OR: 3.0) were independently associated with cardiac events. Patients with pathological SSS (p = 0.005) and ischemic ECG (p = 0.012) had a significantly lower incidence of cardiac event-free survival. Conclusion: Pathological MPS is independently associated with emerging cardiac events predicting a significantly lower incidence of cardiac event-free survival in patients aged =70 years

  6. Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest.

    Science.gov (United States)

    Mégarbane, Bruno; Leprince, Pascal; Deye, Nicolas; Résière, Dabor; Guerrier, Gilles; Rettab, Samia; Théodore, Jonathan; Karyo, Souheil; Gandjbakhch, Iradj; Baud, Frédéric J

    2007-05-01

    To report the feasibility, complications, and outcomes of emergency extracorporeal life support (ECLS) in refractory cardiac arrests in medical intensive care unit (ICU). Prospective cohort study in the medical ICU in a university hospital in collaboration with the cardiosurgical team of a neighboring hospital. Seventeen patients (poisonings: 12/17) admitted over a 2-year period for cardiac arrest unresponsive to cardiopulmonary resuscitation (CPR) and advanced cardiac life support, without return of spontaneous circulation. ECLS femoral implantation under continuous cardiac massage, using a centrifugal pump connected to a hollow-fiber membrane oxygenator. Stable ECLS was achieved in 14 of 17 patients. Early complications included massive transfusions (n=8) and the need for surgical revision at the cannulation site for bleeding (n=1). Four patients (24%) survived at medical ICU discharge. Deaths resulted from multiorgan failure (n=8), thoracic bleeding(n=2), severe sepsis (n=2), and brain death (n=1). Massive hemorrhagic pulmonary edema during CPR (n=5) and major capillary leak syndrome (n=6) were observed. Three cardiotoxic-poisoned patients (18%, CPR duration: 30, 100, and 180 min) were alive at 1-year follow-up without sequelae. Two of these patients survived despite elevated plasma lactate concentrations before cannulation (39.0 and 20.0 mmol/l). ECLS was associated with a significantly lower ICU mortality rate than that expected from the Simplified Acute Physiology Score II (91.9%) and lower than the maximum Sequential Organ Failure Assessment score (>90%). Emergency ECLS is feasible in medical ICU and should be considered as a resuscitative tool for selected patients suffering from refractory cardiac arrest.

  7. The FIFA medical emergency bag and FIFA 11 steps to prevent sudden cardiac death: setting a global standard and promoting consistent football field emergency care.

    Science.gov (United States)

    Dvorak, Jiri; Kramer, Efraim B; Schmied, Christian M; Drezner, Jonathan A; Zideman, David; Patricios, Jon; Correia, Luis; Pedrinelli, André; Mandelbaum, Bert

    2013-12-01

    Life-threatening medical emergencies are an infrequent but regular occurrence on the football field. Proper prevention strategies, emergency medical planning and timely access to emergency equipment are required to prevent catastrophic outcomes. In a continuing commitment to player safety during football, this paper presents the FIFA Medical Emergency Bag and FIFA 11 Steps to prevent sudden cardiac death. These recommendations are intended to create a global standard for emergency preparedness and the medical response to serious or catastrophic on-field injuries in football.

  8. Stroke Education in an Emergency Department Waiting Room: a Comparison of Methods

    Directory of Open Access Journals (Sweden)

    Yu-Feng Yvonne Chan1

    2015-03-01

    Full Text Available Background: Since the emergency department (ED waiting room hosts a large, captive audience of patients and visitors, it may be an ideal location for conduct-ing focused stroke education. The aim of this study was to assess the effective-ness of various stroke education methods.Methods: Patients and visitors of an urban ED waiting room were randomized into one of the following groups: video, brochure, one-to-one teaching, combi-nation of these three methods, or control group. We administered a 13-question multiple-choice test to assess stroke knowledge prior to, immediately after, and at 1 month post-education to patients and visitors in the ED waiting room.Results: Of 4 groups receiving education, all significantly improved their test scores immediately post intervention (test scores 9.4±2.5-10.3±2.0, P<0.01. At 1 month, the combination group retained the most knowledge (9.4±2.4 exceed-ing pre-intervention and control scores (both 6.7±2.6, P<0.01.Conclusion: Among the various stroke education methods delivered in the ED waiting room, the combination method resulted in the highest knowledge reten-tion at 1-month post intervention.

  9. Alcohol and Violence in the Emergency Room: A Review and Perspectives from Psychological and Social Sciences

    Directory of Open Access Journals (Sweden)

    Cheryl Cherpitel

    2013-09-01

    Full Text Available Our objective is to present a focused review of the scientific literature on the effect of alcohol consumption on violence related-injuries assessed in the emergency room (ER and to show how psychological and behavioral sciences could lead to a better understanding of the factors contributing to alcohol-related injuries in the ER. We retrieved published literature through a detailed search in Academic Search Premier, MEDLINE with Full Text PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycINFO, PUBMed and SocINDEX with Full Text for articles related to emergency rooms, medical problems and sociocognitive models addressing alcohol intoxication articles. The first search was conducted in June 2011 and updated until August 2013. Literature shows that compared to uninjured patients; injured ones have a higher probability of: (i having an elevated blood-alcohol concentration upon arrival at the ER; (ii reporting having drunk alcohol during the six hours preceding the event; and (iii suffering from drinking-related consequences that adversely affect their social life. The main neurocognitive and sociocognitive models on alcohol and aggression are also discussed in order to understand the aetiology of violence-related injuries in emergency rooms. Suggestions are made for future research and prevention.

  10. Prevalence of substance use among trauma patients treated in a Brazilian emergency room

    Directory of Open Access Journals (Sweden)

    Reis Alessandra Diehl

    2006-01-01

    Full Text Available OBJECTIVE: Although there is a considerable amount of data in the literature regarding the association between alcohol consumption and injuries treated in emergency rooms, little is known about the relationship between such injury and the use of other substances. The objective of this study was to estimate the prevalence of substance use in patients admitted to the emergency room for non-fatal injuries. METHOD: A prospective cross-sectional study assessing all patients admitted to the emergency room within 6 hours after a non-fatal injury was conducted over a three-month period. The following were used as measures of alcohol and drug use: a standardized World Health Organization questionnaire; a self-administered questionnaire related to drug consumption within the 24 hours preceding contact; the Drug Abuse Screening Test; urine screens for cannabis, cocaine and benzodiazepines; and determination of blood alcohol concentration. Descriptive analyses were performed and the confidence interval used was 95%. RESULTS: A total of 353 patients were included. Cannabis and cocaine screens were conducted for 242 patients and benzodiazepine screens were conducted for 166. Blood alcohol concentrations reached the level of positivity in 11% (n = 39, and 10% (n = 33 presented some degree of intoxication. Among the 242 patients screened, 13.6% (n = 33 tested positive for cannabis, and 3.3% (n = 8 tested positive for cocaine, whereas 4.2% (n = 7 of the 166 patients screened tested positive for benzodiazepines. CONCLUSIONS: Substance use was highly prevalent among these individuals. In this sample, the frequency for the use of cannabis (an illicit drug was comparable to that of alcohol. More studies are needed in order to characterize such use among Brazilians and to develop proper approaches to such cases, with the aim of reducing substance use and its consequences.

  11. [Índice de Saturación Modificado y Ambulancias (ISMA): Ambulance assignment and remote Emergency Room Bed Reservation].

    Science.gov (United States)

    Polanco-González, Carlos; Castañón-González, Jorge Alberto; Villanueva-Martínez, Sebastián; Samaniego-Mendoza, José Lino; Buhse, Thomas

    2015-01-01

    In most places all over the world–including our country–services in emergency rooms are oversaturated. This situation frequently forces the continuously arriving ambulances to be redirected to other medical units, delaying the admission of patients moved and thus adversely affecting their physical condition. To introduce an improvement to the Índicede Saturación Modificado computational system, which monitors the degree of saturation of a network of emergency medical services, to include a network of ambulances, enabling in the system: (i) the effective allocation of ambulances to the site of the accident, or severe clinical event, and (ii) the remote booking of beds in the nearest and least saturated emergency room available. The evaluation and connectivity of the computational improvement to the Índicede Saturación Modificado system was carried out with a computational test verifying these two aspects, using only differences in postal codes, for time measuring. The verification of its sustainability online showed the new Índice de Saturación Modificado y Ambulancias system (ISMA) has a robust structure capable of being adapted to mobile phones, laptops or tablets, and can efficiently administrate: (i) the quantification of excessive demand in the emergency room services of a hospital network, (ii) the allocation of ambulances attending the site of the event or contingency, and (iii) the allocation of ambulances and patients, in the best distance-time conditions, from the site of the accident or clinical event to the nearest and least saturated emergency room service. This administrative management tool is efficient and simple to use, and it optimally relates independent service networks.

  12. Life Saving Apps: Linking Cardiac Arrest Victims to Emergency Services and Volunteer Responders.

    Science.gov (United States)

    Lim Choi Keung, Sarah N; Khan, Mohammed O; Smith, Christopher; Perkins, Gavin; Murphy, Paddie; Arvanitis, Theodoros N

    2016-01-01

    In cases of emergency, such as out-of-hospital cardiac arrests, the first few minutes are crucial for victims to receive care and have a positive outcome. However, emergency services often arrive on scene after those first few minutes, making any bridging solutions key. Finding a defibrillator or accessing a trained volunteer responder are some of the technological solutions that are being developed to support the chain of survival. This paper looks at technologies, in particular those linked to mobile apps that have been used to locate defibrillators and responder apps that enable responders to attend to nearby emergencies. We review a selection of apps and also assess the challenges and considerations for such apps.

  13. [Temperature that modifies the effect of air pollution on emergency room visits for circulatory and respiratory diseases in Beijing, China].

    Science.gov (United States)

    Wang, L L; Zhang, Q; Bai, R H; Mi, B B; Yan, H

    2017-08-10

    Objective: To analyze the temperature modification effect on emergency room visits for circulatory and respiratory diseases caused by air pollution, in Beijing. Methods: Data on both circulatory and respiratory diseases in 2010 and 2011 were collected, Both meteorological and air pollutants related data were obtained from the National Scientific Data Sharing Platform for Population and Health. By using the stratified time-series models, we analyzed the effects of air pollution on emergency room visits for circulatory and respiratory diseases under different temperature zones, from 2010 to 2011, in Beijing. Results: Low temperature (daily average temperatureeffect of air pollution index (API) on emergency room visits for circulatory diseases, Under 10 units of API, the relative risks and confidence interval appeared as 1.067 (1.054-1.080). However, high (daily average temperature between 24.4 ℃ and 28.5 ℃) and extra-high temperature (daily average temperature >28.5 ℃) could enhance the effect of API on emergency room visits for respiratory diseases, Under 10 units of API, the relative risks and confidence interval were 1.021 (1.015-1.028) and 1.006 (1.003-1.008), respectively. Conclusion: Temperature seemed to have modified the association between air pollution and both circulatory and respiratory diseases.

  14. [Breaking bad news in the emergency room: Suggestions and future challenges].

    Science.gov (United States)

    Landa-Ramírez, Edgar; López-Gómez, Antonio; Jiménez-Escobar, Irma; Sánchez-Sosa, Juan José

    2017-01-01

    The aim of this paper is to describe educational programs that reportedly teach how to break bad news in the emergency department. We also suggest some recommendations on how to communicate bad news based on the research of evidence available in the field. The examined evidence points toward six major components with which physicians should familiarize when communicating bad news: 1) doctor-patient empathic communication, 2) establishing a proper space to give the news, 3) identifying characteristics of the person who receives the news, 4) essential aspects for communicating the news; 5) emotional support, and 6) medical and administrative aspects of the encounter. Finally, we point out several limitations in the studies in the field and future challenges identified in the communication of bad news in emergency room facilities.

  15. Acute cardiac events and deployment of emergency medical teams and automated external defibrillators in large football stadiums in the Netherlands.

    Science.gov (United States)

    van de Sandt, Femke; Umans, Victor

    2009-10-01

    The incidence of acute cardiac events - including out-of-hospital cardiac arrest - may be increased in visitors of large sports stadiums when compared with the general population. This study sought to investigate the incidence of acute cardiac events inside large Dutch football stadiums, as well as the emergency response systems deployed in these stadiums and the success rate for in-stadium resuscitation. Retrospective cohort study using a questionnaire sent to the 20 Dutch stadiums that hosted professional matches during the 2006-2007 and 2007-2008 football seasons. Stadium capacity ranged from 3600 to 51 600 spectators. Nearly 13 million spectators attended 686 'Eredivisie' (Honorary Division) and European football matches. All stadiums distribute multiple emergency medical teams among the spectators. Eighty-five percent of the stadiums have an ambulance standby during matches, 95% of the stadiums were equipped with automated external defibrillators (AEDs) during the study period. On an average, one AED was available for every 7576 spectators (range 1800-29 600). Ninety-three cardiac events were reported (7.3 per 1 million spectators). An AED was used 22 times (1.7 per 1 million spectators). Resuscitation was successful in 18 cases (82%, 95% confidence interval: 61-93). The incidence of out-of-hospital cardiac arrest inside large football stadiums in the Netherlands, albeit increased when compared with the general population, is low. The success rate for in-stadium resuscitation by medical teams equipped with AEDs is high. Dutch stadiums appear vigilant in regard to acute cardiac events. This report highlights the importance of adequate emergency medical response systems (including AEDs) in large sports venues.

  16. A spatial analysis of heat stress related emergency room visits in rural Southern Ontario during heat waves.

    Science.gov (United States)

    Bishop-Williams, Katherine E; Berke, Olaf; Pearl, David L; Kelton, David F

    2015-08-06

    In Southern Ontario, climate change may have given rise to an increasing occurrence of heat waves since the year 2000, which can cause heat stress to the general public, and potentially have detrimental health consequences. Heat waves are defined as three consecutive days with temperatures of 32 °C and above. Heat stress is the level of discomfort. A variety of heat stress indices have been proposed to measure heat stress (e.g., the heat stress index (HSI)), and has been shown to predict increases in morbidity and/or mortality rates in humans and other species. Maps visualizing the distribution of heat stress can provide information about related health risks and insight for control strategies. Information to inform heat wave preparedness models in Ontario was previously only available for major metropolitan areas. Hospitals in communities of fewer than 100,000 individuals were recruited for a pilot study by telephone. The number of people visiting the emergency room or 24-hour urgent care service was collected for a total of 27 days, covering three heat waves and six 3-day control periods from 2010-2012. The heat stress index was spatially predicted using data from 37 weather stations across Southern Ontario by geostatistical kriging. Poisson regression modeling was applied to determine the rate of increased number of emergency room visits in rural hospitals with respect to the HSI. During a heat wave, the average rate of emergency room visits was 1.11 times higher than during a control period (IRR = 1.11, CI95% (IRR) = (1.07,1.15), p ≤ 0.001). In a univariable model, HSI was not a significant predictor of emergency room visits, but when accounting for the confounding effect of a spatial trend polynomial in the hospital location coordinates, a one unit increase in HSI predicted an increase in daily emergency rooms visits by 0.4% (IRR = 1.004, CI95%(IRR) = (1.0005,1.007), p = 0.024) across the region. One high-risk cluster and no low risk

  17. Recognition of out-of-hospital cardiac arrest during emergency calls - a systematic review of observational studies

    DEFF Research Database (Denmark)

    Viereck, Søren; Møller, Thea Palsgaard; Rothman, Josephine Philip

    2017-01-01

    BACKGROUND: The medical dispatcher plays an essential role as part of the first link in the Chain of Survival, by recognising the out-of-hospital cardiac arrest (OHCA) during the emergency call, dispatching the appropriate first responder or emergency medical services response, performing...... in compliance with the PRISMA guidelines. We systematically searched MEDLINE, Embase and the Cochrane Library on 4 November 2015. Observational studies, reporting the proportion of clinically confirmed OHCAs that was recognised during the emergency call, were included. Two authors independently screened...

  18. Improving Patients Experience in Peadiatric Emergency Waiting Room.

    Science.gov (United States)

    Ehrler, Frederic; Siebert, Johan; Wipfli, Rolf; Duret, Cyrille; Gervaix, Alain; Lovis, Christian

    2016-01-01

    When visiting the emergency department, the perception of the time spent in the waiting room before the beginning of the care, may influence patients' experience. Based on models of service evaluation, highlighting the importance of informing people about their waiting process and their place in the queue, we have developed an innovative information screen aiming at improving perception of time by patients. Following an iterative process, a group of experts including computer scientists, ergonomists and caregivers designed a solution adapted to the pediatric context. The solution includes a screen displaying five lanes representing triage levels. Patients are represented by individual avatars, drawn sequentially in the appropriate line. The interface has been designed using gamification principle, aiming at increasing acceptance, lowering learning curve and improving satisfaction. Questionnaire based evaluation results revealed high satisfaction from the 278 respondents even if the informative content was not always completely clear.

  19. Cardiac rehabilitation services in Denmark: still room for expansion

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe O; Traeden, Ulla I; Videbaek, Jørgen

    2005-01-01

    support, dietary counselling, smoking cessation, and pharmaceutical risk factor management) were available during each of three phases: (I) in hospital; (II) outpatient; and (II) community-based services. RESULTS: Many hospitals offered one or more of the CR components during phases I and II: physical......AIM: European cardiologists agree that cardiac rehabilitation (CR) should be offered as an integrated part of cardiac care, and CR guidelines have been published. The authors aimed to ascertain the potential for expanding CR coverage at hospitals in Denmark. METHOD: A cross-sectional questionnaire...

  20. Clinical evaluation of the CARDIAC STATus, a rapid immunochromatographic assay for simultaneous detection of elevated concentrations of CK-MB and myoglobin in whole blood

    NARCIS (Netherlands)

    Schouten, Y.; de Winter, R. J.; Gorgels, J. P.; Koster, R. W.; Adams, R.; Sanders, G. T.

    1998-01-01

    We studied the performance of the CARDIAC STATus, a new rapid, easy to perform qualitative whole blood bedside test for detection of elevated CK-MB and myoglobin in the emergency room. Blood samples from 182 consecutive patients with chest pain were drawn on admission and at five and seven hours

  1. Outcome of burr hole surgery in the emergency room for severe acute subdural hematoma

    International Nuclear Information System (INIS)

    Park, Young-Soo; Hironaka, Yasuhiro; Motoyama, Yasushi; Asai, Hideki; Watanabe, Tomoo; Nishio, Kenji; Nakase, Hiroyuki; Okuchi, Kazuo

    2010-01-01

    We have performed burr hole surgery in the emergency room for severe acute subdural hematoma from April 2007 in twenty five patients. All patients were deep comatose and showed cerebral herniation sign with bilateral pupillary abnormalities. Burr hole surgeries were performed as soon as possible after CT evaluation. Continually decomporresive craiectomies were followed if clinical improvements were achieved and mild baribiturate-moderate hypothermia combined (MB-MH) therapy was induced postoperatively in some cases. The mean average was 65.6 years (range 16-93). The causes of head injuries were traffic accident in 9, fall down in 13 and unknown in 3. The mean Glasgow coma scale (GCS) on admission was 4.4 (range 3-9). The mean time interval from arrival to burr hole surgery was 33.5 minutes (range 21-50 minutes). Decompressive craniectomy was indicated in 14 cases and MB-MH therapy was induced in 13 cases. The overall clinical outcome consisted of good recovery in 3, moderate disability in 2, severe disability in 3, persistent vegetative state in 3 and death in 14. Favorable results can be expected even in patients with serious acute subdural hematoma. Emergent burr hole surgery was effective to decrease intracranial pressure rapidly and to save time. So active burr hole surgery in the emergency room is strongly recommended to all cases of severe acute subdural hematoma. (author)

  2. Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department.

    Science.gov (United States)

    Thomas, Anita A; Uspal, Neil G; Oron, Assaf P; Klein, Eileen J

    2016-12-01

    Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills ( P  < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use ( P  = .30, paired difference -0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use ( P  < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use ( P  < .05, paired difference -0.4 points). Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training.

  3. [Conflictive patients in the emergency room: Definition, classification and ethical aspects].

    Science.gov (United States)

    Herreros, B; García Casasola, G; Pintor, E; Sánchez, M A

    2010-09-01

    A conflictive patient is one who provokes a problem (a conflict) by their attitude or behavior for the physician. Ethical conflicts in emergency care are common and many of them occur with these patients. Among the most common types of patients who generate personal conflicts with health professionals are overly demanding patients, those who refuse medical interventions, those who are aggressive, litigators, excessively-recurrent users of the heath system and those who go to the emergency room without an urgent condition. A patient may include several of these profiles ("mixed" patient). When they appear, the approach should be, if possible, by a team, establishing a deliberative process. If there is doubt and when possible, the ethics committee of the institution should be consulted, seeking the protocols, this best being institutional, on the subject. After that, if the decision is difficult, support must be sought from the emergency staff and even management. The whole process should be reflected in the clinical history. Specific education in bioethics and communication skills can be of great help to minimize and cope better with long-term conflicts. Copyright 2009 Elsevier España, S.L. All rights reserved.

  4. TH-B-207B-01: Optimizing Pediatric CT in the Emergency Department

    International Nuclear Information System (INIS)

    Dodge, C.

    2016-01-01

    This imaging educational program will focus on solutions to common pediatric image quality optimization challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. One of the most commonly encountered pediatric imaging requirements for the non-specialist hospital is pediatric CT in the emergency room setting. Thus, this educational program will begin with optimization of pediatric CT in the emergency department. Though pediatric cardiovascular MRI may be less common in the non-specialist hospitals, low pediatric volumes and unique cardiovascular anatomy make optimization of these techniques difficult. Therefore, our second speaker will review best practices in pediatric cardiovascular MRI based on experiences from a children’s hospital with a large volume of cardiac patients. Learning Objectives: To learn techniques for optimizing radiation dose and image quality for CT of children in the emergency room setting. To learn solutions for consistently high quality cardiovascular MRI of children

  5. TH-B-207B-01: Optimizing Pediatric CT in the Emergency Department

    Energy Technology Data Exchange (ETDEWEB)

    Dodge, C. [Texas Children’s Hospital (United States)

    2016-06-15

    This imaging educational program will focus on solutions to common pediatric image quality optimization challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. One of the most commonly encountered pediatric imaging requirements for the non-specialist hospital is pediatric CT in the emergency room setting. Thus, this educational program will begin with optimization of pediatric CT in the emergency department. Though pediatric cardiovascular MRI may be less common in the non-specialist hospitals, low pediatric volumes and unique cardiovascular anatomy make optimization of these techniques difficult. Therefore, our second speaker will review best practices in pediatric cardiovascular MRI based on experiences from a children’s hospital with a large volume of cardiac patients. Learning Objectives: To learn techniques for optimizing radiation dose and image quality for CT of children in the emergency room setting. To learn solutions for consistently high quality cardiovascular MRI of children.

  6. The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

    Directory of Open Access Journals (Sweden)

    Renata Maria de Oliveira Botelho

    Full Text Available ABSTRACT Objective: to compare the rate of return of spontaneous circulation (ROSC and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR. Method: case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60 was selected by matching patients considering their neurological condition before cardiac arrest, the immediate cause, initial arrest rhythm, whether epinephrine was used, and the duration of CPR. The case group (n=51 received conventional CPR guided by a metronome set at 110 beats/min. Chi-square and likelihood ratio were used to compare ROSC rates considering p≤0.05. Results: ROSC occurred in 57.7% of the cases, though 92.8% of these patients died in the following 24 hours. No statistically significant difference was found between groups in regard to ROSC (p=0.2017 or the occurrence of death (p=0.8112. Conclusion: the outcomes of patients after cardiac arrest with and without the use of a metronome during CPR were similar and no differences were found between groups in regard to survival rates and ROSC.

  7. THE APPLICATION OF EVIDENCE BASED DESIGN IN EMERGENCY ROOM OF PUBLIC HOSPITAL OF DR. R. SOSODORO DJATIKOESOEMO BOJONEGORO

    Directory of Open Access Journals (Sweden)

    Noerkayatin ,

    2015-07-01

    Full Text Available The Hospital facilities built under Evidence Based Design (EBD will create a safe and comfortable environment, lower the nosocomial infection, quicken the patient recovery, lower the treatment cost, and improve staffs’ performance. The emergency room of public hospital of Dr.R.Sosodoro Djatikoesoemo Bojonegoro needs to be redesigned because the existing design does not meet physical safety. The reparation should refer to Facilities and Safety Management (FMS, Indonesian regulation, EBD concept and benchmarking to RSCM Jakarta considered as an application sample. This research applies case study with descriptive single case study design. The result of the research shows that reparation should be done that includes site and location, building components, and rooms lay out. The width of the rooms should meet minimal standard. The placing of triage room and resuscitation should be in the front area. Sinks should be located near the entrance of every room. The isolation and decontamination rooms should be provided.

  8. Briefing and debriefing in the cardiac operating room. Analysis of impact on theatre team attitude and patient safety.

    Science.gov (United States)

    Papaspyros, Sotiris C; Javangula, Kalyana C; Adluri, Rajeshwara Krishna Prasad; O'Regan, David J

    2010-01-01

    Error in health services delivery has long been recognised as a significant cause of inpatient morbidity and mortality. Root-cause analyses have cited communication failure as one of the contributing factors in adverse events. The formalised fighter pilot mission brief and debrief formed the basis of the National Aeronautics and Space Administration (NASA) crew resource management (CRM) concept produced in 1979. This is a qualitative analysis of our experience with the briefing-debriefing process applied to cardiac theatres. We instituted a policy of formal operating room (OR) briefing and debriefing in all cardiac theatre sessions. The first 118 cases were reviewed. A trouble-free operation was noted in only 28 (23.7%) cases. We experienced multiple problems in 38 (32.2%) cases. A gap was identified in the second order problem solving in relation to instrument repair and maintenance. Theatre team members were interviewed and their comments were subjected to qualitative analysis. The collaborative feeling is that communication has improved. The health industry may benefit from embracing the briefing-debriefing technique as an adjunct to continuous improvement through reflective learning, deliberate practice and immediate feedback. This may be the initial step toward a substantive and sustainable organizational transformation.

  9. Mortality and risk of cardiac complications among immediate survivors of accidental electric shock: a Danish nationwide cohort study.

    Science.gov (United States)

    Hansen, Steen Møller; Riahi, Sam; Hjortshøj, Søren; Mortensen, Rikke; Køber, Lars; Søgaard, Peter; Torp-Pedersen, Christian

    2017-08-28

    Exposure to electric shock has been associated with an increased risk of developing delayed cardiac arrhythmias and cardiac diseases. We examined whether electric shock patients have an increased risk of developing cardiac disease, cardiac arrhythmias or death compared with the general Danish population. Matched cohort study. A nationwide study in Denmark from 1994 to 2011. We identified 11 462 Danish patients who visited an emergency ward or were admitted to a hospital due to electric shock from 1994 to 2011. Each patient was matched for age and sex with five random controls from the Danish population. Mortality, cardiac procedures and cardiac diseases following electric shock. A total of 7390 electric shock patients were seen at an emergency ward and 4072 electric shock patients were admitted to a hospital. The median patient age was 28.6 years (Q1-Q3, 21.3-37.7) for the emergency ward patients and 26.4 years (Q1-Q3, 18.3-37.4) for admitted patients. In both groups, most patients were male (74.0% and 76.8%). Few of the electric shock patients had a record of cardiovascular disease at baseline (364/11 462, 3.2%). The 5-year cumulative incidence of death was 0.47% (95% CI 0.29% to 0.65%) for emergency ward patients and 1.04% (95% CI 0.71% to 1.37%) for admitted patients. No difference in 5-year survival was observed compared with matched controls (emergency ward, p=0.10; admitted patients, p=0.80). Fewer than four patients received a pacemaker within 30 days. This nationwide study did not demonstrate an increase in mortality among patients seen at hospitals after accidental electric shock compared with a background population. Cardiac procedures and diseases following electric shock were very rare. We suggest that nearly all patients can be discharged safely from the emergency room after electric shock without further observation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial

  10. Emergency cricothyrotomy for trismus caused by instantaneous rigor in cardiac arrest patients.

    Science.gov (United States)

    Lee, Jae Hee; Jung, Koo Young

    2012-07-01

    Instantaneous rigor as muscle stiffening occurring in the moment of death (or cardiac arrest) can be confused with rigor mortis. If trismus is caused by instantaneous rigor, orotracheal intubation is impossible and a surgical airway should be secured. Here, we report 2 patients who had emergency cricothyrotomy for trismus caused by instantaneous rigor. This case report aims to help physicians understand instantaneous rigor and to emphasize the importance of securing a surgical airway quickly on the occurrence of trismus. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival.

    Science.gov (United States)

    Viereck, Søren; Møller, Thea Palsgaard; Ersbøll, Annette Kjær; Bækgaard, Josefine Stokholm; Claesson, Andreas; Hollenberg, Jacob; Folke, Fredrik; Lippert, Freddy K

    2017-06-01

    Initiation of early bystander cardiopulmonary resuscitation (CPR) depends on bystanders' or medical dispatchers' recognition of out-of-hospital cardiac arrest (OHCA). The primary aim of our study was to investigate if OHCA recognition during the emergency call was associated with bystander CPR, return of spontaneous circulation (ROSC), and 30-day survival. Our secondary aim was to identify patient-, setting-, and dispatcher-related predictors of OHCA recognition. We performed an observational study of all OHCA patients' emergency calls in the Capital Region of Denmark from 01/01/2013-31/12/2013. OHCAs were collected from the Danish Cardiac Arrest Registry and the Mobile Critical Care Unit database. Emergency call recordings were identified and evaluated. Multivariable logistic regression analyses were applied to all OHCAs and witnessed OHCAs only to analyse the association between OHCA recognition and bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of OHCA recognition. We included 779 emergency calls in the analyses. During the emergency calls, 70.1% (n=534) of OHCAs were recognised; OHCA recognition was positively associated with bystander CPR (odds ratio [OR]=7.84, 95% confidence interval [CI]: 5.10-12.05) in all OHCAs; and ROSC (OR=1.86, 95% CI: 1.13-3.06) and 30-day survival (OR=2.80, 95% CI: 1.58-4.96) in witnessed OHCA. Predictors of OHCA recognition were addressing breathing (OR=1.76, 95% CI: 1.17-2.66) and callers located by the patient's side (OR=2.16, 95% CI: 1.46-3.19). Recognition of OHCA during emergency calls was positively associated with the provision of bystander CPR, ROSC, and 30-day survival in witnessed OHCA. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  12. Occurrence rate and clinical predictors of hypertensive pseudocrisis in emergency room care.

    Science.gov (United States)

    Sobrinho, Silvestre; Correia, Luís C L; Cruz, Constança; Santiago, Mila; Paim, Ana Catarina; Meireles, Bruno; Andrade, Mariana; Kerner, Mariana; Amoedo, Paula; de Souza, Carlos Marcílio

    2007-05-01

    To describe the prevalence of hypertensive pseudocrisis in patients treated in emergency rooms with substantially elevated blood pressure levels. To compare this prevalence in private and public hospitals. To describe the frequency of wrong treatment for this condition. To identify, during triage, independent predictors of pseudocrisis. To evaluate the prognosis of patients with pseudocrisis. Patients above the age of 18, admitted to the Emergency Rooms of two hospitals (private and public) during a 6 month timeframe, with diastolic blood pressure > or = 120 mmHg were included in the study. Hypertensive pseudocrisis was determined when none of the criteria for hypertensive crisis were present (Guidelines of the Brazilian Society of Cardiology(1)). In the 110 patients studied, the prevalence of hypertensive pseudocrisis was 48% (95% CI = 39%-58%) and prevailed in the private hospital (59% vs 37%, p=0.02). The frequency of wrong treatment was similar between the two hospitals (94% vs 95%, p=0.87). After multivariate analysis, the presence of headache upon admission (Odds Ratio=5.4; 95% CI = 5.1-13; pcrisis group (0% vs 21%, p=0.0004). There is a high prevalence of hypertensive pseudocrisis in patients when hypertensive crisis is suspected, particularly in the private hospital. The frequency of wrong treatment was similar for both the private and public hospitals. Headaches and diastolic BP levels are independent predictors for this clinical condition. Hypertensive pseudocrisis has a low rate of lethality.

  13. Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival

    DEFF Research Database (Denmark)

    Viereck, Søren; Møller, Thea Palsgaard; Ersbøll, Annette Kjær

    2017-01-01

    BACKGROUND: Initiation of early bystander cardiopulmonary resuscitation (CPR) depends on bystanders' or medical dispatchers' recognition of out-of-hospital cardiac arrest (OHCA). The primary aim of our study was to investigate if OHCA recognition during the emergency call was associated...... with bystander CPR, return of spontaneous circulation (ROSC), and 30-day survival. Our secondary aim was to identify patient-, setting-, and dispatcher-related predictors of OHCA recognition. METHODS: We performed an observational study of all OHCA patients' emergency calls in the Capital Region of Denmark from...... the association between OHCA recognition and bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of OHCA recognition. RESULTS: We included 779 emergency calls in the analyses. During the emergency calls, 70.1% (n=534) of OHCAs were recognised...

  14. Sulfonylurea monotherapy and emergency room utilization among elderly patients with type 2 diabetes.

    Science.gov (United States)

    Rajpathak, Swapnil N; Fu, Chunmay; Brodovicz, Kimberley; Engel, Samuel S; Heaton, Pamela C

    2015-09-01

    In elderly Americans with type 2 diabetes, use of insulin and oral antidiabetic drugs (OADs) accounts for almost one-fourth of drug adverse event-related hospitalizations. It is not clear, however, if sulfonylureas (SUs), frequently prescribed OADs known to cause hypoglycemia, increase the risk of emergency room (ER) visits compared to other OADs. The aim of this study was to compare the emergency room utilization between US elderly patients with diabetes on SU monotherapy vs. other non-SU monotherapies. This retrospective cohort study was conducted using MarketScan(®) database (2009-10) and aimed to evaluate the association between use of SU and ER visits. The analysis included 28,533 patients (aged ≥65 years) receiving SU monotherapy at baseline and 1:1 propensity score (PS)-matched group receiving monotherapy with other OADs. ER utilization was determined during a 1-year follow-up period. The SU and non-SU groups were overall well balanced after PS matching. The mean (SD) number of ER visits during the follow-up was 0.56 among users of SU users compared to 0.49 (Pmetformin users. Elderly patients with type 2 diabetes on SU monotherapy were more likely to use ER than those on other monotherapies. Further studies are needed to confirm our findings and evaluate other factors associated with ER visits. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Global cardiac risk assessment in the Registry Of Pregnancy And Cardiac disease: results of a registry from the European Society of Cardiology.

    Science.gov (United States)

    van Hagen, Iris M; Boersma, Eric; Johnson, Mark R; Thorne, Sara A; Parsonage, William A; Escribano Subías, Pilar; Leśniak-Sobelga, Agata; Irtyuga, Olga; Sorour, Khaled A; Taha, Nasser; Maggioni, Aldo P; Hall, Roger; Roos-Hesselink, Jolien W

    2016-05-01

    To validate the modified World Health Organization (mWHO) risk classification in advanced and emerging countries, and to identify additional risk factors for cardiac events during pregnancy. The ongoing prospective worldwide Registry Of Pregnancy And Cardiac disease (ROPAC) included 2742 pregnant women (mean age ± standard deviation, 29.2 ± 5.5 years) with established cardiac disease: 1827 from advanced countries and 915 from emerging countries. In patients from advanced countries, congenital heart disease was the most prevalent diagnosis (70%) while in emerging countries valvular heart disease was more common (55%). A cardiac event occurred in 566 patients (20.6%) during pregnancy: 234 (12.8%) in advanced countries and 332 (36.3%) in emerging countries. The mWHO classification had a moderate performance to discriminate between women with and without cardiac events (c-statistic 0.711 and 95% confidence interval (CI) 0.686-0.735). However, its performance in advanced countries (0.726) was better than in emerging countries (0.633). The best performance was found in patients with acquired heart disease from developed countries (0.712). Pre-pregnancy signs of heart failure and, in advanced countries, atrial fibrillation and no previous cardiac intervention added prognostic value to the mWHO classification, with a c-statistic of 0.751 (95% CI 0.715-0.786) in advanced countries and of 0.724 (95% CI 0.691-0.758) in emerging countries. The mWHO risk classification is a useful tool for predicting cardiac events during pregnancy in women with established cardiac disease in advanced countries, but seems less effective in emerging countries. Data on pre-pregnancy cardiac condition including signs of heart failure and atrial fibrillation, may help to improve preconception counselling in advanced and emerging countries. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

  16. Advantages of a cohort study on cardiac arrest conducted by nurses

    Directory of Open Access Journals (Sweden)

    Cássia Regina Vancini Campanharo

    2015-10-01

    Full Text Available AbstractOBJECTIVEIdentifying factors associated to survival after cardiac arrest.METHODAn experience report of a cohort study conducted in a university hospital, with a consecutive sample comprised of 285 patients. Data were collected for a year by trained nurses. The training strategy was conducted through an expository dialogue lecture. Collection monitoring was carried out by nurses via telephone calls, visits to the emergency room and by medical record searches. The neurological status of survivors was evaluated at discharge, after six months and one year.RESULTSOf the 285 patients, 16 survived until hospital discharge, and 13 remained alive after one year, making possible to identify factors associated with survival. There were no losses in the process.CONCLUSIONCohort studies help identify risks and disease outcomes. Considering cardiac arrest, they can subsidize public policies, encourage future studies and training programs for CPR, thereby improving the prognosis of patients.

  17. Quality of emergency rooms and urgent care services: user satisfaction.

    Science.gov (United States)

    Lima, Cássio de Almeida; Santos, Bruna Tatiane Prates dos; Andrade, Dina Luciana Batista; Barbosa, Francielle Alves; Costa, Fernanda Marques da; Carneiro, Jair Almeida

    2015-01-01

    To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself.

  18. Emergency room visits due to external causes and alcohol consumption - Capitals and the Federal District, Brazil, 2011

    Directory of Open Access Journals (Sweden)

    Márcio Dênis Medeiros Mascarenhas

    2015-04-01

    Full Text Available The study objective was to describe the profile and factors related to alcohol consumption among emergency room visits by external causes. It is a cross-sectional study with data from the Survey of Violence and Injuries in Emergency between September and October 2011, in 24 state capitals and the Federal District. Statistical analysis were performed for all cases treated in selected services, comparing the characteristics of the victims, according to the statement of alcohol consumption. 33,289 visits to emergency rooms by external causes in the population above 18 years of age were included. The prevalence of self-reported statement of alcohol consumption among these services was 14.9% for the 24 capitals and the Federal District, and was significantly higher among visits by violent causes than by accidents. For both accidents and violence the associated causes were victims male, black/brown, less educated, members of specific populations, occurrences on public roads. The results support global discussions on the importance of establishing policies and legal measures to restrict the consumption of alcohol and vehicular direction, control advertising of alcoholic beverages, and laws normalizing the functioning of sales points of alcoholic beverages.

  19. Perceived Parental Care and Control among Israeli Female Adolescents Presenting to Emergency Rooms after Self-Poisoning

    Science.gov (United States)

    Diamond, Gary M.; Didner, Hila; Waniel, Ariela; Priel, Beatriz; Asherov, Jack; Arbel, Shosh

    2005-01-01

    Levels of perceived parental care and control among 24 female Israeli adolescents presenting at emergency rooms after a self-poisoning act of low lethality were compared to those found among 23 non-self-harming, community controls. Adolescents' perceived levels of parental care and control were measured via both adolescents' self-report and…

  20. Effect of emergency PCI combined with rh-BNP therapy on neuroendocrine indicators and cardiac function in patients with acute anterior myocardial infarction

    Directory of Open Access Journals (Sweden)

    Yang Ji

    2016-06-01

    Full Text Available Objective: To analyze the effect of emergency PCI combined with rh-BNP therapy on neuroendocrine indicators and cardiac function in patients with acute anterior myocardial infarction. Methods: A total of 70 cases with acute anterior myocardial infarction who received emergency rescue in our hospital from February 2012 to September 2014 were included for study, and all included patients were divided into control group 38 cases who received emergency PCI treatment alone and observation group 32 cases who received emergency PCI combined with rh-BNP therapy. Differences in the values of neuroendocrine indicators, ventricular collagen remodeling-related indicators, cardiac function indicators, myocardial injury-related indicators and so on were compared between two groups after treatment. Results: Serum ET, PRA, ALD, AngII, NE and E values of observation group after treatment were significantly lower than those of control group (P<0.05; serum PⅠCP and PCⅢ values of observation group after treatment were lower than those of control group, and PⅠCP/ PCⅢ and TIMP-1 values were significantly higher than those of control group (P<0.05; examination of cardiac function by color Doppler ultrasound showed that LAD, LVEDD, LVESD, LVESV and LVEDV values of observation group were lower than those of control group, and LVEF and LVFS values were significantly higher than those of control group (P<0.05; serum CD14++CD2L+, hs-cTnT, HBDH and H-FABP values of observation group after treatment were significantly lower than those of control group, and CD14+CD2L- value was significantly higher than that of control group (P<0.05. Conclusions: Emergency PCI combined with rh-BNP therapy for patients with acute anterior myocardial infarction can significantly improve cardiac function and inhibit ventricular remodeling, and it has positive clinical significance.

  1. Cardiac regeneration therapy: connections to cardiac physiology.

    Science.gov (United States)

    Takehara, Naofumi; Matsubara, Hiroaki

    2011-12-01

    Without heart transplantation, a large number of patients with failing hearts worldwide face poor outcomes. By means of cardiomyocyte regeneration, cardiac regeneration therapy is emerging with great promise as a means for restoring loss of cardiac function. However, the limited success of clinical trials using bone marrow-derived cells and myoblasts with heterogeneous constituents, transplanted at a wide range of cell doses, has led to disagreement on the efficacy of cell therapy. It is therefore essential to reevaluate the evidence for the efficacy of cell-based cardiac regeneration therapy, focusing on targets, materials, and methodologies. Meanwhile, the revolutionary innovation of cardiac regeneration therapy is sorely needed to help the millions of people who suffer heart failure from acquired loss of cardiomyocytes. Cardiac regeneration has been used only in limited species or as a developing process in the rodent heart; now, the possibility of cardiomyocyte turnover in the human heart is being revisited. In the pursuit of this concept, the use of cardiac stem/progenitor stem cells in the cardiac niche must be focused to usher in a second era of cardiac regeneration therapy for the severely injured heart. In addition, tissue engineering and cellular reprogramming will advance the next era of treatment that will enable current cell-based therapy to progress to "real" cardiac regeneration therapy. Although many barriers remain, the prevention of refractory heart failure through cardiac regeneration is now becoming a realistic possibility.

  2. Remote Monitoring of Cardiac Implantable Electronic Devices.

    Science.gov (United States)

    Cheung, Christopher C; Deyell, Marc W

    2018-01-08

    Over the past decade, technological advancements have transformed the delivery of care for arrhythmia patients. From early transtelephonic monitoring to new devices capable of wireless and cellular transmission, remote monitoring has revolutionized device care. In this article, we review the current evolution and evidence for remote monitoring in patients with cardiac implantable electronic devices. From passive transmission of device diagnostics, to active transmission of patient- and device-triggered alerts, remote monitoring can shorten the time to diagnosis and treatment. Studies have shown that remote monitoring can reduce hospitalization and emergency room visits, and improve survival. Remote monitoring can also reduce the health care costs, while providing increased access to patients living in rural or marginalized communities. Unfortunately, as many as two-thirds of patients with remote monitoring-capable devices do not use, or are not offered, this feature. Current guidelines recommend remote monitoring and interrogation, combined with annual in-person evaluation in all cardiac device patients. Remote monitoring should be considered in all eligible device patients and should be considered standard of care. Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  3. Development and clinical study of mobile 12-lead electrocardiography based on cloud computing for cardiac emergency.

    Science.gov (United States)

    Fujita, Hideo; Uchimura, Yuji; Waki, Kayo; Omae, Koji; Takeuchi, Ichiro; Ohe, Kazuhiko

    2013-01-01

    To improve emergency services for accurate diagnosis of cardiac emergency, we developed a low-cost new mobile electrocardiography system "Cloud Cardiology®" based upon cloud computing for prehospital diagnosis. This comprises a compact 12-lead ECG unit equipped with Bluetooth and Android Smartphone with an application for transmission. Cloud server enables us to share ECG simultaneously inside and outside the hospital. We evaluated the clinical effectiveness by conducting a clinical trial with historical comparison to evaluate this system in a rapid response car in the real emergency service settings. We found that this system has an ability to shorten the onset to balloon time of patients with acute myocardial infarction, resulting in better clinical outcome. Here we propose that cloud-computing based simultaneous data sharing could be powerful solution for emergency service for cardiology, along with its significant clinical outcome.

  4. Surgery of the elderly in emergency room mode. Is there a place for laparoscopy?

    Science.gov (United States)

    Michalik, Maciej; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Zacharz, Krzysztof

    2017-06-01

    An important yet difficult problem is qualification for surgery in elderly patients. With age the risk of comorbidities increases - multi-disease syndrome. Elderly patients suffer from frailty syndrome. Many body functions become impaired. All these factors make the elderly patient a major challenge for surgical treatment. Analysis of the possibility of developing the indications and contraindications and the criteria for surgical treatment of the elderly based on our own cases. Discussion whether there is a place for laparoscopy during surgery of the elderly in emergency room (ER) mode. The analysis was performed based on seven cases involving surgical treatment of elderly patients who were admitted to the hospital in emergency room mode. The patients were hospitalized in the General and Minimally Invasive Surgery Clinic in Olsztyn in 2016. Surgical treatment of elderly patients should be planned with multidisciplinary teams. Geriatric surgery centers should be developed to minimize the risk of overzealous treatment and potential complications. Laparoscopy should always be considered in the case of ER procedures or diagnostics. Elderly patients should not be treated as typical adults, but as a separate group of patients requiring special treatment. Due to the existing additional disease in the elderly, the frailty syndrome, any surgical intervention should be minimally invasive. The discussion about therapy should be conducted by a team of specialists from a variety of medical fields.

  5. Emergency room visits for work-related injuries: characteristics and associated factors - capitals and the Federal District, Brazil, 2011.

    Science.gov (United States)

    Mascarenhas, Márcio Dênis Medeiros; de Freitas, Mariana Gonçalves; Monteiro, Rosane Aparecida; da Silva, Marta Maria Alves; Malta, Deborah Carvalho; Gómez, Carlos Minayo

    2015-03-01

    Work-related injuries, often classified as occupational injuries (OI), stand out among visits due to external causes (accidents and violence) in health services. To describe the characteristics and factors associated with emergency room visits for OI, a cross-sectional study was conducted using data from the Survey of Violence and Injuries in Emergency Services (VIVA Inquérito 2011) in 24 state capitals and the Federal District. The prevalence of treatment for OI and prevalence ratios (PR) with confidence intervals of 95% (95%CI) were calculated. There were 29,463 emergency room visits due to accidental injuries in the population above 18 years of age. The prevalence of OI was 33.4% and was positively and significantly associated with the male gender, age 30-59 years old, industrial workers, agricultural sector or repair and maintenance services. The occurrence of OI was significantly higher in attendance for objects falling on people (PR = 3.37, 95% CI 2.80 to 4.05) and injuries due to perforating object (PR = 3.01, 95% CI 2.50-3.65). The results support the surveillance of external causes and direct public policies to promote occupational health.

  6. Cardiac arrest during anesthesia at a University Hospital in Nigeria ...

    African Journals Online (AJOL)

    Background: We assessed the incidence and outcomes of cardiac arrest during anesthesia in the operating room at our university hospital. A previous study on intraoperative cardiac arrests covered a period from 1994-1998 and since then; anesthetic personnel, equipment, and workload have increased remarkably.

  7. CT Findings of Disease with Elevated Serum D-Dimer Levels in an Emergency Room Setting

    International Nuclear Information System (INIS)

    Choi, Ji Youn; Kwon, Woo Cheol; Kim, Young Ju

    2012-01-01

    Pulmonary embolism and deep vein thrombosis are the leading causes of elevated serum D-dimer levels in the emergency room. Although D-dimer is a useful screening test because of its high sensitivity and negative predictive value, it has a low specificity. In addition, D-dimer can be elevated in various diseases. Therefore, information on the various diseases with elevated D-dimer levels and their radiologic findings may allow for accurate diagnosis and proper management. Herein, we report the CT findings of various diseases with elevated D-dimer levels in an emergency room setting, including an intravascular contrast filling defect with associated findings in a venous thromboembolism, fracture with soft tissue swelling and hematoma formation in a trauma patient, enlargement with contrast enhancement in the infected organ of a patient, coronary artery stenosis with a perfusion defect of the myocardium in a patient with acute myocardial infarction, high density of acute thrombus in a cerebral vessel with a low density of affected brain parenchyma in an acute cerebral infarction, intimal flap with two separated lumens in a case of aortic dissection, organ involvement of malignancy in a cancer patient, and atrophy of a liver with a dilated portal vein and associated findings.

  8. CT Findings of Disease with Elevated Serum D-Dimer Levels in an Emergency Room Setting

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ji Youn; Kwon, Woo Cheol; Kim, Young Ju [Dept. of Radiology, Wonju Christian Hospital, Yensei University Wonju College of Medicine, Wonju (Korea, Republic of)

    2012-01-15

    Pulmonary embolism and deep vein thrombosis are the leading causes of elevated serum D-dimer levels in the emergency room. Although D-dimer is a useful screening test because of its high sensitivity and negative predictive value, it has a low specificity. In addition, D-dimer can be elevated in various diseases. Therefore, information on the various diseases with elevated D-dimer levels and their radiologic findings may allow for accurate diagnosis and proper management. Herein, we report the CT findings of various diseases with elevated D-dimer levels in an emergency room setting, including an intravascular contrast filling defect with associated findings in a venous thromboembolism, fracture with soft tissue swelling and hematoma formation in a trauma patient, enlargement with contrast enhancement in the infected organ of a patient, coronary artery stenosis with a perfusion defect of the myocardium in a patient with acute myocardial infarction, high density of acute thrombus in a cerebral vessel with a low density of affected brain parenchyma in an acute cerebral infarction, intimal flap with two separated lumens in a case of aortic dissection, organ involvement of malignancy in a cancer patient, and atrophy of a liver with a dilated portal vein and associated findings.

  9. Impact of visual art on patient behavior in the emergency department waiting room.

    Science.gov (United States)

    Nanda, Upali; Chanaud, Cheryl; Nelson, Michael; Zhu, Xi; Bajema, Robyn; Jansen, Ben H

    2012-07-01

    Wait times have been reported to be one of the most important concerns for people visiting emergency departments (EDs). Affective states significantly impact perception of wait time. There is substantial evidence that art depicting nature reduces stress levels and anxiety, thus potentially impacting the waiting experience. To analyze the effect of visual art depicting nature (still and video) on patients' and visitors' behavior in the ED. A pre-post research design was implemented using systematic behavioral observation of patients and visitors in the ED waiting rooms of two hospitals over a period of 4 months. Thirty hours of data were collected before and after new still and video art was installed at each site. Significant reduction in restlessness, noise level, and people staring at other people in the room was found at both sites. A significant decrease in the number of queries made at the front desk and a significant increase in social interaction were found at one of the sites. Visual art has positive effects on the ED waiting experience. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Predictors of Frequent Emergency Room Visits among a Homeless Population.

    Science.gov (United States)

    Thakarar, Kinna; Morgan, Jake R; Gaeta, Jessie M; Hohl, Carole; Drainoni, Mari-Lynn

    2015-01-01

    Homelessness, HIV, and substance use are interwoven problems. Furthermore, homeless individuals are frequent users of emergency services. The main purpose of this study was to identify risk factors for frequent emergency room (ER) visits and to examine the effects of housing status and HIV serostatus on ER utilization. The second purpose was to identify risk factors for frequent ER visits in patients with a history of illicit drug use. A retrospective analysis was performed on 412 patients enrolled in a Boston-based health care for the homeless program (HCH). This study population was selected as a 2:1 HIV seronegative versus HIV seropositive match based on age, sex, and housing status. A subgroup analysis was performed on 287 patients with history of illicit drug use. Chart data were analyzed to compare demographics, health characteristics, and health service utilization. Results were stratified by housing status. Logistic models using generalized estimating equations were used to predict frequent ER visits. In homeless patients, hepatitis C was the only predictor of frequent ER visits (OR 4.49, phomeless patients. HIV seropositivity did not predict frequent ER visits, likely because HIV seropositive HCH patients are engaged in care. In patients with history of illicit drug use, hepatitis C and mental health disorders predicted frequent ER visits. Supportive housing for patients with mental health disorders and hepatitis C may help prevent unnecessary ER visits in this population.

  11. [The Effects of Violence Coping Program Based on Middle-Range Theory of Resilience on Emergency Room Nurses' Resilience, Violence Coping, Nursing Competency and Burnout].

    Science.gov (United States)

    Lee, Seung Min; Sung, Kyung Mi

    2017-06-01

    The purpose of this study was to examine the effects of a violence coping program (VCP) based on Polk's middle-range theory of resilience on nursing competency, resilience, burnout, and the ability to cope with violence in nurses working in emergency rooms. A quasi-experimental study, with a nonequivalent control group and a pretest-posttest design, was conducted. Participants were 36 nurses who worked in emergency rooms and had experienced violence; 18 nurses from D hospital and 18 nurses from C hospital were assigned to the experimental and control groups, respectively. The experimental group received the VCP twice per week for 8 weeks. Levels of resilience, F=59.41, pnursing competency, F=59.41 pburnout, F=52.74, pburnout and improving resilience, active coping behavior, and nursing competency. Therefore, it would be a useful intervention for improving the quality of nursing care provided in emergency rooms. © 2017 Korean Society of Nursing Science

  12. Usefulness of technetium-99m tetrofosmin single-photon emission computed tomography for short-term risk stratification in patients with acute chest pain in the emergency room

    International Nuclear Information System (INIS)

    Kawahito, Michitomo; Kondo, Makoto; Abe, Yoshiteru

    2003-01-01

    High-risk patients with acute coronary syndrome are difficult to distinguish from low-risk patients with chest pain in the emergency room. Technetium-99 m ( 99m Tc) tetrofosmin single-photon emission computed tomography (SPECT) was investigated to exclude high-risk patients with chest pain in the emergency room. 99m Tc-tetrofosmin SPECT was evaluated using a four-point scoring system in 228 patients (144 men, 84 women, mean age 68±12 years) with chest pain. Negative was defined as the myocardial segments with a defect score (DS) of 99m Tc-tetrofosmin; no significance (NS)), 84.9% (NS) and 60.4% (p 99m Tc-tetrofosmin SPECT is a useful method to exclude high-risk patients among patients with chest pain in the emergency room. (author)

  13. Predicting the success of noninvasive positive pressure ventilation in emergency room for patients with acute heart failure.

    Science.gov (United States)

    Shirakabe, Akihiro; Hata, Noritake; Yokoyama, Shinya; Shinada, Takuro; Kobayashi, Nobuaki; Tomita, Kazunori; Kitamura, Mitsunobu; Nozaki, Ayaka; Tokuyama, Hideo; Asai, Kuniya; Mizuno, Kyoichi

    2011-01-01

    Non-invasive positive pressure ventilation (NPPV) for acute heart failure (AHF) is increasingly used to avoid endotracheal intubation (ETI). We therefore reviewed our experience using respirator management in the emergency room for AHF, and evaluated the predictive factors in the success of NPPV in the emergency room. Three-hundred forty-three patients with AHF were analyzed. The AHF patients were assigned to either BiPAP-Synchrony (B-S; Respironics, Merrysville, PA, USA) period (2005-2007, n = 176) or BiPAP-Vision (B-V; Respironics) period (2008-2010, n = 167). The rate of carperitide use was significantly increased and dopamine use was significantly decreased in the B-V period. The total length of hospital stay was significantly shorter in the B-V period. AHF patients were also assigned to a failed trial of NPPV followed by ETI (NPPV failure group) or an NPPV success group in the emergency room for each period. NPPV was successfully used in 48 cases in the B-S period, and in 111 cases in the B-V period. Fifty-seven ETI patients included 45 direct ETI and 11 NPPV failure cases in the B-S period, and 16 ETI patients included 10 direct ETI and 6 NPPV failure cases in the B-V period. The pH values were significantly lower in the NPPV failure than in the NPPV success for both periods (7.19 ± 0.10 vs. 7.28 ± 0.11, B-S period, p successful estimates of NPPV with a high sensitivity and specificity, and the aortic blood gas level was above 7.03 pH when using the B-V system. Copyright © 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  14. Proposal for the use in emergency departments of cardiac troponins measured with the latest generation methods in patients with suspected acute coronary syndrome without persistent ST-segment elevation

    Directory of Open Access Journals (Sweden)

    Ivo Casagranda

    2013-10-01

    Full Text Available The purpose of this document is to develop recommendations on the use of the latest generation of cardiac troponins in emergency room settings for the diagnosis of myocardial infarction in patients with suspected acute coronary syndrome without persistent ST-segment elevation (NSTE-ACS. The main points which have been addressed reaching a consensus are: i suitability and appropriateness of the terminology; ii appropriateness of the request; iii confirmation of the diagnosis of myocardial infarction (rule-in; iv exclusion of the diagnosis of myocardial infarction (rule-out. Each point has been analyzed by taking into account the evidence presented in medical publications. Recommendations were developed using the criteria adopted by the European Society of Cardiology and the American Heart Association/American College of Cardiology. Each point of the recommendation was submitted for validation to an external audit by a Group of Experts (named above.

  15. Poor Compliance with Sepsis Guidelines in a Tertiary Care Children’s Hospital Emergency Room

    OpenAIRE

    Benjamin Louis Moresco; Benjamin Louis Moresco; Clinton Woosley; Clinton Woosley; Morris Sauter; Utpal Bhalala; Utpal Bhalala

    2018-01-01

    ObjectivesThis study aimed to assess factors related to adherence to the Pediatric Advanced Life Support guidelines for severe sepsis and septic shock in an emergency room (ER) of a tertiary care children’s hospital.MethodsThis was a retrospective, observational study of children (0–18 years old) in The Children’s Hospital of San Antonio ER over 1 year with the International Consensus Definition Codes, version-9 (ICD-9) diagnostic codes for “severe sepsis” and “shocks.” Patients in the adhere...

  16. Clinically useful predictors for premature mortality among psychiatric patients visiting a psychiatric emergency room

    DEFF Research Database (Denmark)

    Aagaard, Jørgen; Buus, Niels; Wernlund, Andreas Glahn

    2016-01-01

    OBJECTIVE: The aim of this study was to examine changes in the distribution of causes of death and mortality rates among psychiatric patients visiting a psychiatric emergency room (PER), to determine clinically useful predictors for avoiding premature mortality among these patients and to discuss...... linked to the Cause of Death Register and the Central Psychiatric Research Register, and logistic predictor analyses for premature death were performed. RESULTS: The standardised mortality ratio (SMR) of all visitors compared to the general Danish population was approximately 5. Overall, patients...

  17. Safety and efficiency of emergency department interrogation of cardiac devices.

    Science.gov (United States)

    Neuenschwander, James F; Peacock, W Frank; Migeed, Madgy; Hunter, Sara A; Daughtery, John C; McCleese, Ian C; Hiestand, Brian C

    2016-12-01

    Patients with implanted cardiac devices may wait extended periods for interrogation in emergency departments (EDs). Our purpose was to determine if device interrogation could be done safely and faster by ED staff. Prospective randomized, standard therapy controlled, trial of ED staff device interrogation vs. standard process (SP), with 30-day follow-up. Eligibility criteria: ED presentation with a self-report of a potential device related complaint, with signed informed consent. SP interrogation was by company representative or hospital employee. Of 60 patients, 42 (70%) were male, all were white, with a median (interquartile range) age of 71 (64 to 82) years. No patient was lost to follow up. Of all patients, 32 (53%) were enrolled during business hours. The overall median (interquartile range) ED vs. SP time to interrogation was 98.5 (40 to 260) vs. 166.5 (64 to 412) minutes (P=0.013). While ED and SP interrogation times were similar during business hours, 102 (59 to 138) vs. 105 (64 to 172) minutes (P=0.62), ED interrogation times were shorter vs. SP during non-business hours; 97 (60 to 126) vs. 225 (144 to 412) minutes, P=0.002, respectively. There was no difference in ED length of stay between the ED and SP interrogation, 249 (153 to 390) vs. 246 (143 to 333) minutes (P=0.71), regardless of time of presentation. No patient in any cohort suffered an unplanned medical contact or post-discharge adverse device related event. ED staff cardiac device interrogations are faster, and with similar 30-day outcomes, as compared to SP.

  18. A proposal to design a Location-based Mobile Cardiac Emergency System (LMCES).

    Science.gov (United States)

    Keikhosrokiani, Pantea; Mustaffa, Norlia; Zakaria, Nasriah; Sarwar, Muhammad Imran

    2012-01-01

    Healthcare for elderly people has become a vital issue. The Wearable Health Monitoring System (WHMS) is used to manage and monitor chronic disease in elderly people, postoperative rehabilitation patients and persons with special needs. Location-aware healthcare is achievable as positioning systems and telecommunications have been developed and have fulfilled the technology needed for this kind of healthcare system. In this paper, the researchers propose a Location-Based Mobile Cardiac Emergency System (LMCES) to track the patient's current location when Emergency Medical Services (EMS) has been activated as well as to locate the nearest healthcare unit for the ambulance service. The location coordinates of the patients can be retrieved by GPS and sent to the healthcare centre using GPRS. The location of the patient, cell ID information will also be transmitted to the LMCES server in order to retrieve the nearest health care unit. For the LMCES, we use Dijkstra's algorithm for selecting the shortest path between the nearest healthcare unit and the patient location in order to facilitate the ambulance's path under critical conditions.

  19. Cardiac arrest – cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Basri Lenjani

    2014-01-01

    Conclusions: All survivors from cardiac arrest have received appropriate medical assistance within 10 min from attack, which implies that if cardiac arrest occurs near an institution health care (with an opportunity to provide the emergent health care the rate of survival is higher.

  20. Effect of simulation-based emergency cardiac arrest education on nursing students' self-efficacy and critical thinking skills: Roleplay versus lecture.

    Science.gov (United States)

    Kim, Eunsook

    2018-02-01

    Simulation education is a learning method for improving self-efficacy and critical thinking skills. However, not much study has been done on how to use it for education on emergency cardiac arrest situations, for which a multidisciplinary team approach is required. This study investigated the effects of simulation education on nursing students' self-efficacy and critical thinking skills in emergency cardiac arrest situations. A quasi-experimental research approach with a crossover design was used to compare two types of simulation instruction methods. This study was conducted with 76 nursing students divided into two groups by order of instruction methods, in November and December 2016. Both groups of participants experienced a simulation lesson based on the same emergency scenario. Group A first completed a roleplay of an emergency cardiac arrest situation in a clinical setting, while Group B first listened to a lecture on the procedure. After ten days, Group A repeated the simulation exercise after listening to the lecture, while Group B completed the simulation exercise after the roleplay. The students' self-efficacy and critical thinking skills were measured using a questionnaire before and after each session. In the first session, self-efficacy and critical thinking skills scores increased greatly from pretest to posttest for Group A in comparison to Group B; no statistically significant difference was found between the two groups. In the second session, Group B showed a significant increase between pretest and posttest, while Group A showed no significant difference. Conducting the simulation exercise after the roleplay was a more effective teaching method than conducting it after the lecture. Moreover, having the nursing students assume various roles in realistic roleplay situations combined with simulation exercises led to a deeper understanding of clinical situations and improved their self-efficacy and critical thinking skills. Copyright © 2017 Elsevier

  1. Manejo da asma aguda em adultos na sala de emergência: evidências atuais Management of acute asthma in adults in the emergency room: current evidence

    Directory of Open Access Journals (Sweden)

    Paulo de Tarso Roth Dalcin

    2009-01-01

    Full Text Available Asma é uma doença com uma alta prevalência em nosso meio e ao redor do mundo. Embora novas opções terapêuticas tenham sido recentemente desenvolvidas, parece haver um aumento mundial na sua morbidade e mortalidade. Em muitas instituições, as exacerbações asmáticas ainda se constituem em uma emergência médica muito comum. As evidências têm demonstrado que o manejo da asma aguda na sala de emergência concentra decisões cruciais que podem determinar o desfecho desta situação clínica. Nesta revisão, enfocaremos a avaliação e o tratamento do paciente com asma aguda na sala de emergência, descrevendo uma estratégia apropriada para o seu manejo. Serão consideradas as seguintes etapas: diagnóstico, avaliação da gravidade, tratamento, avaliação das complicações, decisão sobre onde se realizará o tratamento adicional e orientações por ocasião da alta da emergência. Espera-se que estas recomendações contribuam para que o médico clínico tome as decisões apropriadas durante o manejo da asma aguda na sala de emergência.Asthma is a disease with high prevalence in our country and worldwide. Although new therapeutic approaches have been developed recently, there seems to be a global increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that management of acute asthma in the emergency room entails crucial decisions that could determine the clinical outcome. In this review, the authors focus on assessment and treatment of patients with acute asthma and outline an appropriate management strategy. Diagnosis, severity assessment, treatment, complications, decision about where additional treatment will take place and orientations on discharge from the emergency will be considered. It is expected that these recommendations will help physicians to make the appropriate decisions about care of acute asthma in the emergency

  2. Development of an automated vehicle stop system for cardiac emergencies

    Directory of Open Access Journals (Sweden)

    Tung T. Nguyen

    2017-06-01

    Full Text Available This paper describes the concept and configuration of a novel automated safety vehicle stop system, and a future prospect of the study. Intrinsic sudden death may cause traffic accident since such accidents sometimes involve not only the driver but also other traffic users such as passengers and pedestrians. Cardiovascular disease (CVD is considered as a serious driving risk factor. The pain and others effects of cardiac events degrade driver’s performance, and CVD causes ischemia brought by the CVD induces incapacity of driving. In the automated safety vehicle stop system, which our research group has developed, steer-sensors collects bio-signals and a camera captures the driver’s posture to monitor driver’s incapability. When the driver loses his or her driving capability, the system takes over the maneuver of the vehicle and automatically drives to a safety spot by observing the traffic environment. An emergency scenario was used to demonstrate the system verifying its potential.

  3. Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room

    Directory of Open Access Journals (Sweden)

    Thiago Gatti Pianca

    Full Text Available Abstract Objective: To review the screening, diagnosis, evaluation, and treatment of intoxication by alcohol and other drugs in children and adolescents in the emergency scenario. Data source: This was a narrative literature review. Data summary: The detection of this problem in the emergency room can be a challenge, especially when its assessment is not standardized. The intentional and episodic use of large amounts of psychoactive substances by adolescents is a usual occurrence, and unintentional intoxication is more common in children younger than 12 years. The clinical picture in adolescents and children differs from that in adults and some particularities are important in the emergency scenario. After management of the acute condition, interventions targeting the adolescent at risk may be effective. Conclusion: The diagnosis and treatment of intoxication by alcohol and other drugs in adolescents and children in the emergency scenario requires a systematic evaluation of the use of these drugs. There are few specific treatments for intoxication, and the management comprehends support measures and management of related clinical complications.

  4. Identification and initial management of intoxication by alcohol and other drugs in the pediatric emergency room.

    Science.gov (United States)

    Pianca, Thiago Gatti; Sordi, Anne Orgle; Hartmann, Thiago Casarin; von Diemen, Lisia

    To review the screening, diagnosis, evaluation, and treatment of intoxication by alcohol and other drugs in children and adolescents in the emergency scenario. This was a narrative literature review. The detection of this problem in the emergency room can be a challenge, especially when its assessment is not standardized. The intentional and episodic use of large amounts of psychoactive substances by adolescents is a usual occurrence, and unintentional intoxication is more common in children younger than 12 years. The clinical picture in adolescents and children differs from that in adults and some particularities are important in the emergency scenario. After management of the acute condition, interventions targeting the adolescent at risk may be effective. The diagnosis and treatment of intoxication by alcohol and other drugs in adolescents and children in the emergency scenario requires a systematic evaluation of the use of these drugs. There are few specific treatments for intoxication, and the management comprehends support measures and management of related clinical complications. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  5. Prepare to protect: Operating and maintaining a tornado safe room.

    Science.gov (United States)

    Herseth, Andrew; Goldsmith-Grinspoon, Jennifer; Scott, Pataya

    2017-06-01

    Operating and maintaining a tornado safe room can be critical to the effective continuity of business operations because a firm's most valuable asset is its people. This paper describes aspects of operations and maintenance (O&M) for existing tornado safe rooms as well as a few planning and design aspects that affect the ultimate operation of a safe room for situations where a safe room is planned, but not yet constructed. The information is based on several Federal Emergency Management Agency safe room publications that provide guidance on emergency management and operations, as well as the design and construction of tornado safe rooms.

  6. Control room human engineering influences on operator performance

    International Nuclear Information System (INIS)

    Finlayson, F.C.

    1977-01-01

    Three general groups of factors influence operator performance in fulfilling their responsibilities in the control room: (1) control room and control system design, informational data displays (operator inputs) as well as control board design (for operator output); (2) operator characteristics, including those skills, mental, physical, and emotional qualities which are functions of operator selection, training, and motivation; (3) job performance guides, the prescribed operating procedures for normal and emergency operations. This paper presents some of the major results of an evaluation of the effect of human engineering on operator performance in the control room. Primary attention is given to discussion of control room and control system design influence on the operator. Brief observations on the influences of operator characteristics and job performance guides (operating procedures) on performance in the control room are also given. Under the objectives of the study, special emphasis was placed on the evaluation of the control room-operator relationships for severe emergency conditions in the power plant. Consequently, this presentation is restricted largely to material related to emergency conditions in the control room, though it is recognized that human engineering of control systems is of equal (or greater) importance for many other aspects of plant operation

  7. Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

    Directory of Open Access Journals (Sweden)

    Siriphuwanun V

    2014-10-01

    Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine prognostic factors for death and survival with or without complications in cardiac arrest patients who received cardiopulmonary resuscitation (CPR within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: A retrospective cohort study approved by the Maharaj Nakorn Chiang Mai University Hospital Ethical Committee. Data used were taken from records of 751 cardiac arrest patients who received their first CPR within 24 hours of anesthesia for emergency surgery between January 1, 2003 and October 31, 2011. The reviewed data included patient characteristics, surgical procedures, American Society of Anesthesiologist (ASA physical status classification, anesthesia information, the timing of cardiac arrest, CPR details, and outcomes at 24 hours after CPR. Univariate and polytomous logistic regression analyses were used to determine prognostic factors associated with the outcome variable. P-values of less than 0.05 were considered statistically significant. Results: The outcomes at 24 hours were death (638/751, 85.0%, survival with complications (73/751, 9.7%, and survival without complications (40/751, 5.3%. The prognostic factors associated with death were: age between 13–34 years (OR =3.08, 95% CI =1.03–9.19; ASA physical status three and higher (OR =6.60, 95% CI =2.17–20.13; precardiopulmonary comorbidity (OR =3.28, 95% CI =1.09–9.90; the condition of patients who were on mechanical ventilation prior to receiving anesthesia (OR =4.11, 95% CI =1.17–14.38; surgery in the upper abdominal site (OR =14.64, 95% CI =2.83–75.82; shock prior to cardiac arrest (OR =6.24, 95% CI =2.53–15

  8. Cardiac image segmentation for contrast agent videodensitometry

    NARCIS (Netherlands)

    Mischi, M.; Kalker, A.A.C.M.; Korsten, H.H.M.

    2005-01-01

    Indicator dilution techniques are widely used in the intensive care unit and operating room for cardiac parameter measurements. However, the invasiveness of current techniques represents a limitation for their clinical use. The development of stable ultrasound contrast agents allows new applications

  9. Assessment of cardiopulmonary resuscitation practices in emergency departments for out-of-hospital cardiac arrest victims in Lebanon

    Directory of Open Access Journals (Sweden)

    Samar Noureddine

    2016-01-01

    Full Text Available Background: The survival rate of out-of-hospital cardiac arrest (OHCA victims in Lebanon is low. A national policy on resuscitation practice is lacking. This survey explored the practices of emergency physicians related to the resuscitation of OHCA victims in Lebanon. Methods: A sample of 705 physicians working in emergency departments (EDs was recruited and surveyed using the LimeSurvey software (Carsten Schmitz, Germany. Seventy-five participants responded, yielding 10.64% response rate. Results: The most important factors in the participants' decision to initiate or continue resuscitation were presence of pulse on arrival (93.2%, underlying cardiac rhythm (93.1%, the physician's ethical duty to resuscitate (93.2%, transport time to the ED (89%, and down time (84.9%. The participants were optimistic regarding the survival of OHCA victims (58.1% reporting > 10% survival and reported frequent resuscitation attempts in medically futile situations. The most frequently reported challenges during resuscitation decisions were related to pressure or presence of victim's family (38.8% and lack of policy (30%. Conclusion: In our setting, physicians often rely on well-established criteria for initiating/continuing resuscitation; however, their decisions are also influenced by cultural factors such as victim's family wishes. The findings support the need for a national policy on resuscitation of OHCA victims.

  10. Listening to "How the Patient Presents Herself": A Case Study of a Doctor-Patient Interaction in an Emergency Room

    Science.gov (United States)

    Delbene, Roxana

    2015-01-01

    This is a case-study based on a micro-ethnography analyzing a doctor-patient interaction in an emergency room (ER) in New York City. Drawing on the framework of narrative medicine (Charon, 2006), the study examines how a phenomenological approach to listening to the patient facilitated the patient's narrative orientation not only to relevant…

  11. [Neonatological emergencies in delivery room] [Article in Italian] • Il neonatologo ed alcune emergenze in sala parto

    OpenAIRE

    Antonio Boldrini; Rosa Teresa Scaramuzzo

    2014-01-01

    Introduction: In the delivery room the neonatologist may deal with emergencies, not always predictable by pre-natal diagnosis. Among these dangerous situations, we include: i) extremely preterm birth of a newborn very/extremely low birth weight and ii) shoulder dystocia in term newborns. We will discuss in details these two clinical scenarios. Methods: We reviewed the main recent papers about resuscitation of very/extremely low birth weight preterm newborns and about dystocia of shoulder repo...

  12. Seismic simulation and functional performance evaluation of a safety related, seismic category I control room emergency air cleaning system

    International Nuclear Information System (INIS)

    Manley, D.K.; Porco, R.D.; Choi, S.H.

    1985-01-01

    Under a nuclear contract MSA was required to design, manufacture, seismically test and functionally test a complete Safety Related, Seismic Category I, Control Room Emergency Air Cleaning System before shipment to the Yankee Atomic Electric Company, Yankee Nuclear Station in Rowe, Massachusetts. The installation of this system was required to satisfy the NRC requirements of NUREG-0737, Section III, D.3.4, ''Control Room Habitability''. The filter system tested was approximately 3 ft. wide by 8 ft. high by 18 ft. long and weighed an estimated 8300 pounds. It had a design flow rate of 3000 SCFM and contained four stages of filtration - prefilters, upstream and downstream HEPA filters and Type II sideload charcoal adsorber cells. The filter train design followed the guidelines set forth by ANSI/ASME N509-1980. Seismic Category I Qualification Testing consisted of resonance search testing and triaxial random multifrequency testing. In addition to ANSI/ASME N510-1980 testing, triaxial response accelerometers were placed at specific locations on designated prefilters, HEPA filters, charcoal adsorbers and test canisters along with accelerometers at the corresponding filter seal face locations. The purpose of this test was to demonstrate the integrity of the filters, filter seals, and monitor seismic response levels which is directly related to the system's ability to function during a seismic occurrence. The Control Room Emergency Air Cleaning System demonstrated the ability to withstand the maximum postulated earthquake for the plant site by remaining structurally sound and functional

  13. [Cardiac arrest in spectators in German football stadiums. Precautionary measures, frequency and short-term outcome].

    Science.gov (United States)

    Luiz, T; Preisegger, T; Rombach, D; Madler, C

    2014-09-01

    Provision of medical care is an important element of safety precautions for visitors of sports arenas. The organizational requirements are especially high if cardiac arrest occurs; how this scenario is managed may thus serve as the ultimate indicator of the quality of stadium medical care. The objectives of this study were to analyze the structures and the resources available for the medical care of spectators in German professional soccer stadiums and to identify the frequency and the primary resuscitation success of cardiac arrest. In 2011 a questionnaire-based survey was performed among the clubs of the first and second German soccer leagues regarding medical care of spectators during the seasons 2008/2009 and 2009/2010. The focus was on the qualifications of emergency teams, the equipment and the incidence of cardiac arrest. A total of 15 stadiums were included (38%) in the survey. The mean number of physicians and emergency medical technicians on site was 0.6/10,000 seats and 16/10,000 seats, respectively. Of the latter, a mean of 82% (minimum 20% and maximum 100%) had received training with automatic external defibrillators. In 87% of the stadiums regular advanced life support training (ALS) was required. The mean number of defibrillators per stadium was 2.8/10,000 seats (minimum 1.3 and maximum 3.8) including 1.7 automatic defibrillators (minimum 0.4 and maximum 2.8). For patient transport, a mean of 0.65 ALS ambulance vehicles per 10,000 seats (minimum 0.14 and maximum 1.46) were available on site. In all stadiums staff members were connected via mobile radio communication with the stadium medical control room. A total of 52 cardiac arrests (=0.25/100,000 spectators) were recorded of which 96% of the patients were transported to hospitals with spontaneous circulation. Cardiac arrests are not a rare occurrence in German soccer stadiums. The participating stadiums are overall well prepared for such incidents in terms of organization, staff and technology and

  14. Hospital hero: a game for reducing stress and anxiety of children while waiting in emergency room

    OpenAIRE

    Tranquada, Sara Patrícia Fernandes

    2014-01-01

    This report tells a story which started as an idea that came to us to fight the battle-cry feeling commonly known as stress and anxiety. Before creating the solution of the idea, we first need to understand the feelings underneath and its effects on our well-being. Throughout the course of our lives, we experience states of weakness and fear. These feelings can arise, for instance, while we are in an emergency room. Needless to say, how much it would have imaginable effects on children,...

  15. Hypokalemia and sudden cardiac death

    DEFF Research Database (Denmark)

    Kjeldsen, Keld

    2010-01-01

    Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient...... of fatal arrhythmia and sudden cardiac death a patient is, the more attention should be given to the potassium homeostasis....

  16. The emergency room at the Rotunda Hospital: evidence of an improving service over the past 3 years.

    LENUS (Irish Health Repository)

    Talukdar, S

    2014-12-01

    This is a retrospective review of the Rotunda Hospital Emergency Room (ER) documentation with respect to attendances for a 4-month period (August-November) in both 2009 and 2012. The aim was to quantify the workload and assess the quality of care offered to patients attending the ER over the two time periods and to highlight any improvements in care after changes were implemented following the initial 2009 review.

  17. The Obstetrics Gynecology and Children's Hospital Emergency ...

    African Journals Online (AJOL)

    EB

    The efficiency of emergency rooms is becoming increasingly important and has been addressed by legislation. Prompt emergency room service is expected when patients present to an emergency room with urgent health problems. However, depending on various factors, the wait times for access to health services can be ...

  18. Cardiac fluid dynamics meets deformation imaging.

    Science.gov (United States)

    Dal Ferro, Matteo; Stolfo, Davide; De Paris, Valerio; Lesizza, Pierluigi; Korcova, Renata; Collia, Dario; Tonti, Giovanni; Sinagra, Gianfranco; Pedrizzetti, Gianni

    2018-02-20

    Cardiac function is about creating and sustaining blood in motion. This is achieved through a proper sequence of myocardial deformation whose final goal is that of creating flow. Deformation imaging provided valuable contributions to understanding cardiac mechanics; more recently, several studies evidenced the existence of an intimate relationship between cardiac function and intra-ventricular fluid dynamics. This paper summarizes the recent advances in cardiac flow evaluations, highlighting its relationship with heart wall mechanics assessed through the newest techniques of deformation imaging and finally providing an opinion of the most promising clinical perspectives of this emerging field. It will be shown how fluid dynamics can integrate volumetric and deformation assessments to provide a further level of knowledge of cardiac mechanics.

  19. THE VALUE OF BEDSIDE ULTRASOUND IN THE DIAGNOSIS OF THYROTOXICOSIS AND THYROTOXIC CARDIAC EMERGENCIES- A SHORT-TERM STUDY

    OpenAIRE

    Muhammed Mushthaque P; Kunhi Kannan

    2017-01-01

    BACKGROUND Many times in ICU patient’s thyrotoxicosis is suspected and its diagnosis is hindered by many fallacies of clinical examination and lab reports. This happens especially with cardiac emergencies. The role of Ultrasound examination of thyroid in ICU patients admitted for different causes needs to be studied elaborately. AIM To assess the thyrotoxic burden in the ICU of suspected thyroid disease in patients; find out the benefit of thyroid ultrasound in evaluating...

  20. Knowledge of the management of paediatric dental traumas by non-dental professionals in emergency rooms in South Araucanía, Temuco, Chile.

    Science.gov (United States)

    Díaz, Jaime; Bustos, Luís; Herrera, Samira; Sepulveda, Jaqueline

    2009-12-01

    The objective of this study was to investigate the level of knowledge and attitudes regarding first aid for dental trauma in children (TDI) by non-dental professionals and paramedical technicians of hospital emergency rooms in the South Araucanía Health Service, Chile, which was attained through application of a survey. Samples were collected from people with occupations in the respective emergency rooms. The participants were 82 people that were interviewed using a questionnaire regarding management of dental trauma. Paramedic technicians, general and specialist doctors, and nurses were included in this survey. The appraisal covered diverse aspects: birth date, age, sex, years of experience in the emergency room, and questions regarding specific dental trauma topics, which focused on crown fractures, luxation injuries in permanent dentition, avulsion in primary and permanent teeth, and the respective emergency treatments. Of the participants, 78.1% reported to have been presented with a TDI patient. The majority (90.2%) had not received formal training on TDI. These results revealed a wide distribution of responses. The overall dental trauma knowledge among the participants was relatively poor. For crown fractures management 54.9% indicated that they would ask the affected child about the crown remnants. In regard to transport and storage medium of avulsed permanent teeth, only 9.8% of the participants answered correctly and 43.9% of respondents stated that they would not replant an avulsed permanent tooth, since that procedure is considered the responsibility of a dentist. The majority of the respondents were not knowledgeable regarding TDI or the management and benefits of timely care, particularly in cases of avulsed permanent teeth. Therefore, formal education and training on the topic is suggested during undergraduate studies.

  1. Predictors of Frequent Emergency Room Visits among a Homeless Population.

    Directory of Open Access Journals (Sweden)

    Kinna Thakarar

    Full Text Available Homelessness, HIV, and substance use are interwoven problems. Furthermore, homeless individuals are frequent users of emergency services. The main purpose of this study was to identify risk factors for frequent emergency room (ER visits and to examine the effects of housing status and HIV serostatus on ER utilization. The second purpose was to identify risk factors for frequent ER visits in patients with a history of illicit drug use.A retrospective analysis was performed on 412 patients enrolled in a Boston-based health care for the homeless program (HCH. This study population was selected as a 2:1 HIV seronegative versus HIV seropositive match based on age, sex, and housing status. A subgroup analysis was performed on 287 patients with history of illicit drug use. Chart data were analyzed to compare demographics, health characteristics, and health service utilization. Results were stratified by housing status. Logistic models using generalized estimating equations were used to predict frequent ER visits.In homeless patients, hepatitis C was the only predictor of frequent ER visits (OR 4.49, p<0.01. HIV seropositivity was not predictive of frequent ER visits. In patients with history of illicit drug use, mental health (OR 2.53, 95% CI 1.07-5.95 and hepatitis C (OR 2.85, 95% CI 1.37-5.93 were predictors of frequent ER use. HIV seropositivity did not predict ER use (OR 0.45, 95% CI 0.21 - 0.97.In a HCH population, hepatitis C predicted frequent ER visits in homeless patients. HIV seropositivity did not predict frequent ER visits, likely because HIV seropositive HCH patients are engaged in care. In patients with history of illicit drug use, hepatitis C and mental health disorders predicted frequent ER visits. Supportive housing for patients with mental health disorders and hepatitis C may help prevent unnecessary ER visits in this population.

  2. Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Lippert, Freddy K; Folke, Fredrik

    2013-01-01

    resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29 111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n...

  3. Predicting nonrecovery among whiplash patients in the emergency room and in an insurance company setting.

    Science.gov (United States)

    Rydman, Eric; Ponzer, Sari; Ottosson, Carin; Järnbert-Pettersson, Hans

    2017-04-01

    To construct and validate a prediction instrument for early identification of patients with a high risk of delayed recovery after whiplash injuries (PPS-WAD) in an insurance company setting. Prospective cohort study. On the basis of a historic cohort (n = 130) of patients with a whiplash injury identified in an emergency room (ER, model-building set), we used logistic regression to construct an instrument consisting of two demographic variables (i.e. questions of educational level and work status) and the patient-rated physical and mental status during the acute phase to predict self-reported nonrecovery after 6 months. We evaluated the instrument's ability to predict nonrecovery in a new cohort (n = 204) of patients originating from an insurance company setting (IC, validation set). The prediction instrument had low reproducibility when the setting was changed from the ER cohort to the IC cohort. The overall percentage of correct predictions of nonrecovery in the ER cohort was 78 % compared with 62 % in the IC cohort. The sensitivity and specificity in relation to nonrecovery were both 78 % in the ER cohort. The sensitivity and specificity in the insurance company setting was lower, 67 and 50 %. Clinical decision rules need validation before they are used in a new setting. An instrument consisting of four questions with an excellent possibility of identifying patients with a high risk of nonrecovery after a whiplash injury in the emergency room was not as useful in an insurance company setting. The importance and type of the risk factors for not recovering probably differ between the settings, as well as the individuals.

  4. Protective benefits of mindfulness in emergency room personnel.

    Science.gov (United States)

    Westphal, Maren; Bingisser, Martina-Barbara; Feng, Tianshu; Wall, Melanie; Blakley, Emily; Bingisser, Roland; Kleim, Birgit

    2015-04-01

    Recent meta-analyses have found that mindfulness practice may reduce anxiety and depression in clinical populations and there is growing evidence that mindfulness may also improve well-being and quality of care in health professionals. This study examined whether mindfulness protects against the impact of work-related stress on mental health and burnout in emergency room (ER) nurses. ER nurses (N=50) were recruited from an urban teaching hospital in Switzerland and completed a survey on work-related stressors, mindfulness, burnout, depression, and anxiety. The most frequently reported work-related stressor was interpersonal conflict. Nurses working more consecutive days since last taking time off were at greater risk for depression and those reporting more work-related interpersonal conflicts were at greater risk for burnout. Mindfulness was associated with reduced anxiety, depression, and burnout. Mindfulness was a significant predictor of anxiety, depression, and burnout and moderated the impact of work-related stressors on mental health and burnout. The sample is limited to nurses and results need to be replicated in other groups (e.g., medical staff or ambulance workers). We assessed clinical symptoms with questionnaires and it would be desirable to repeat this assessment with clinical diagnostic interviews. The findings have implications for stress management in ER nurses and health professionals working in comparable settings (e.g., urgent care). The robust associations between mindfulness and multiple indices of psychological well-being suggest that ER staff exposed to high levels of occupational stress may benefit from mindfulness practice to increase resistance to mental health problems and burnout. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Otolaryngology-specific emergency room as a model for resident training.

    Science.gov (United States)

    Sethi, Rosh K V; Kozin, Elliott D; Remenschneider, Aaron K; Lee, Daniel J; Gliklich, Richard E; Shrime, Mark G; Gray, Stacey T

    2015-01-01

    There is a paucity of data on junior resident training in common otolaryngology procedures such as ear debridement, nasal and laryngeal endoscopy, epistaxis management, and peritonsillar abscess drainage. These common procedures represent a critical aspect of training and are necessary skills in general otolaryngology practice. We sought to determine how a dedicated otolaryngology emergency room (ER) staffed by junior residents and a supervising attending provides exposure to common otolaryngologic procedures. Retrospective review. Diagnostic and procedural data for all patients examined in the Massachusetts Eye and Ear Infirmary ER between January 2011 and September 2013 were evaluated. A total of 12,234 patients were evaluated. A total of 5,673 patients (46.4%) underwent a procedure. Each second-year resident performed over 450 procedures, with the majority seen Monday through Friday (75%). The most common procedures in our study included diagnostic nasolaryngoscopy (52.0%), ear debridement (34.4%), and epistaxis control (7.0%) An otolaryngology-specific ER provides junior residents with significant diagnostic and procedural volume in a concentrated period of time. This study demonstrates utility of a unique surgical education model and provides insight into new avenues of investigation for otolaryngology training. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  6. Frequent visitors at the psychiatric emergency room - A literature review.

    Science.gov (United States)

    Schmidt, Manuela

    2018-03-01

    Frequent visitors at the psychiatric emergency room (PER) constitute a small subgroup of patients, yet they are responsible for a disproportionate number of visits and thus claim considerable resources. Their needs are often left unmet and their repetitive visits reflect their dissatisfaction as well as that of PERs' staff. Motivated by these dilemmas, this study systematically reviews the literature about frequent visitors at PER and seeks to answer two questions: What characterizes frequent visitors at PER in the literature? and What characterizes PER in the literature? Based on 29 studies, this paper offers answers to the two questions based on a strength weakness opportunities and threats (SWOT) analysis. The results of the review and subsequent analysis of the literature revealed the multiplicity and complexity of frequent visitors' characteristics and how they appear to converge. Commonalities were more difficult to identify in PER characteristics. In some cases, this happened because the characteristics were poorly described or were context specific. As a result, it was not easy to compare the studies on PER. Based on SWOT and the findings of the analysis, the paper proposes new venues of research and suggests how the field of mental health might develop by taking into account its opportunities and threats.

  7. Assessment of cardiac sympathetic nerve integrity with positron emission tomography

    International Nuclear Information System (INIS)

    Raffel, David M.; Wieland, Donald M.

    2001-01-01

    The autonomic nervous system plays a critical role in the regulation of cardiac function. Abnormalities of cardiac innervation have been implicated in the pathophysiology of many heart diseases, including sudden cardiac death and congestive heart failure. In an effort to provide clinicians with the ability to regionally map cardiac innervation, several radiotracers for imaging cardiac sympathetic neurons have been developed. This paper reviews the development of neuronal imaging agents and discusses their emerging role in the noninvasive assessment of cardiac sympathetic innervation

  8. Analysis of bacterial contamination on surface of general radiography equipment and CT equipment in emergency room of radiology

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Dong Hee; KIm, Hyeong Gyun [Dept. of Radiological Science, Far East University, Eumseong (Korea, Republic of)

    2016-09-15

    We aim to offer basic materials about infection management through conducting bacterial contamination test about general radiography equipment and CT equipment installed in ER of three general hospitals with 100 sickbeds or more located in Gyeongsangbuk-do Province, and suggest management plan. It had been conducted from 1st December 2015 to 31st December, and objects were general radiography equipment and CT equipment of emergency room located in Gyeongsangbuk-do Province. For general radiography equipment, sources were collected from 4 places such as upper side of control box which employees use most, upper side of exposure button, whole upper side of table which is touching part of patient's skin, upper side of stand bucky's grid, and where patients put their jaws on. For CT equipment, sources were collected from 3 places such as upper side of control box which radiography room employees use most, X-ray exposure button, whole upper side of table which is touching part of patient's skin, and gantry inner. Surface contamination strain found at general radiography equipment in emergency room of radiology are Providencia stuartii(25%), Stenotrophomonas maltophilia(18%), Enterobacter cloacae(8%), Pseudomonas species(8%), Staphylococcus epidermidis(8%), Gram negative bacilli(8%), and ungrown bacteria at incubator after 48 hours of incubation (67%) which is the biggest. Most bacteria were found at upper side of stand bucky-grid and stand bucky of radiology's general radiography equipment, and most sources of CT equipment were focused at patient table, which means it is contaminated by patients who have various diseases, and patients who have strains with decreased immunity may get severe diseases. Thus infection prevention should be made through 70% alcohol disinfection at both before test and after test.

  9. Analysis of bacterial contamination on surface of general radiography equipment and CT equipment in emergency room of radiology

    International Nuclear Information System (INIS)

    Hong, Dong Hee; KIm, Hyeong Gyun

    2016-01-01

    We aim to offer basic materials about infection management through conducting bacterial contamination test about general radiography equipment and CT equipment installed in ER of three general hospitals with 100 sickbeds or more located in Gyeongsangbuk-do Province, and suggest management plan. It had been conducted from 1st December 2015 to 31st December, and objects were general radiography equipment and CT equipment of emergency room located in Gyeongsangbuk-do Province. For general radiography equipment, sources were collected from 4 places such as upper side of control box which employees use most, upper side of exposure button, whole upper side of table which is touching part of patient's skin, upper side of stand bucky's grid, and where patients put their jaws on. For CT equipment, sources were collected from 3 places such as upper side of control box which radiography room employees use most, X-ray exposure button, whole upper side of table which is touching part of patient's skin, and gantry inner. Surface contamination strain found at general radiography equipment in emergency room of radiology are Providencia stuartii(25%), Stenotrophomonas maltophilia(18%), Enterobacter cloacae(8%), Pseudomonas species(8%), Staphylococcus epidermidis(8%), Gram negative bacilli(8%), and ungrown bacteria at incubator after 48 hours of incubation (67%) which is the biggest. Most bacteria were found at upper side of stand bucky-grid and stand bucky of radiology's general radiography equipment, and most sources of CT equipment were focused at patient table, which means it is contaminated by patients who have various diseases, and patients who have strains with decreased immunity may get severe diseases. Thus infection prevention should be made through 70% alcohol disinfection at both before test and after test

  10. Cardiac arrest following ventilator fire: A rare cause

    Directory of Open Access Journals (Sweden)

    K Nazeer Ahmed

    2012-01-01

    Full Text Available Operating room fires are rare events, but when occur they result in serious and sometimes fatal consequences. Anaesthesia ventilator fire leading to cardiac arrest is a rare incident and has not been reported. We report a near catastrophic ventilator fire leading to cardiac arrest in a patient undergoing subtotal thyroidectomy. In the present case sparks due to friction or electrical short circuit within the ventilator might have acted as source of ignition leading to fire and explosion in the oxygen rich environment. The patient was successfully resuscitated and revived with uneventful recovery and no adverse sequelae. The cardiac arrest was possibly due to severe hypoxia resulting from inhalation of smoke containing high concentrations of carbon monoxide and other noxious gases.

  11. C.A.U.S.E.: Cardiac arrest ultra-sound exam--a better approach to managing patients in primary non-arrhythmogenic cardiac arrest.

    Science.gov (United States)

    Hernandez, Caleb; Shuler, Klaus; Hannan, Hashibul; Sonyika, Chionesu; Likourezos, Antonios; Marshall, John

    2008-02-01

    Cardiac arrest is a condition frequently encountered by physicians in the hospital setting including the Emergency Department, Intensive Care Unit and medical/surgical wards. This paper reviews the current literature involving the use of ultrasound in resuscitation and proposes an algorithmic approach for the use of ultrasound during cardiac arrest. At present there is the need for a means of differentiating between various causes of cardiac arrest, which are not a direct result of a primary ventricular arrhythmia. Identifying the cause of pulseless electrical activity or asystole is important as the underlying cause is what guides management in such cases. This approach, incorporating ultrasound to manage cardiac arrest aids in the diagnosis of the most common and easily reversible causes of cardiac arrest not caused by primary ventricular arrhythmia, namely; severe hypovolemia, tension pneumothorax, cardiac tamponade, and massive pulmonary embolus. These four conditions are addressed in this paper using four accepted emergency ultrasound applications to be performed during resuscitation of a cardiac arrest patient with the aim of determining the underlying cause of a cardiac arrest. Identifying the underlying cause of cardiac arrest represents the one of the greatest challenges of managing patients with asystole or PEA and accurate determination has the potential to improve management by guiding therapeutic decisions. We include several clinical images demonstrating examples of cardiac tamponade, massive pulmonary embolus, and severe hypovolemia secondary to abdominal aortic aneurysm. In conclusion, this protocol has the potential to reduce the time required to determine the etiology of a cardiac arrest and thus decrease the time between arrest and appropriate therapy.

  12. [Domestic and family violence against women: a case-control study with victims treated in emergency rooms].

    Science.gov (United States)

    Garcia, Leila Posenato; Duarte, Elisabeth Carmen; Freitas, Lúcia Rolim Santana de; Silva, Gabriela Drummond Marques da

    2016-01-01

    This study aimed to identify factors associated with treatment of victims of domestic and family violence in emergency rooms in Brazil. This is a case-control study based on the Surveillance System for Violence and Accidents (VIVA), 2011. Women ≥ 18 years who were victims of family and domestic violence were selected as cases and compared to accident victims (controls). Adjusted odds ratios were estimated by unconditional logistic regression. 623 cases and 10,120 controls were included. Risk factors according to the adjusted analysis were younger age (18-29 years), low schooling, lack of paid work, alcohol consumption, having sought treatment in a different health service, and violence on weekends or at night or in the early morning hours. The study concludes that domestic and family violence shows alcohol consumption as a strongly associated factor. Days and hours with the highest ocurrence reveal the need to adjust emergency services to treat victims.

  13. An update on insertable cardiac monitors

    DEFF Research Database (Denmark)

    Olsen, Flemming J; Biering-Sørensen, Tor; Krieger, Derk W

    2015-01-01

    Continuous cardiac rhythm monitoring has undergone compelling progress over the past decades. Cardiac monitoring has emerged from 12-lead electrocardiograms being performed at the discretion of the treating physician to in-hospital telemetry, Holter monitoring, prolonged external event monitoring...... turning point in the field of arrhythmia management. However, their role in the detection of paroxysmal atrial fibrillation after cryptogenic strokes has yet to evolve. This will be the main focus of this review. Issues surrounding patient selection, clinical relevance and determination of cost......-effectiveness for prolonged cardiac monitoring require further studies. Furthermore, insertable cardiac monitoring has not only the potential to augment diagnostic capabilities but also to improve the management of paroxysmal atrial fibrillation....

  14. Learning From Experience: Improving Early Tracheal Extubation Success After Congenital Cardiac Surgery.

    Science.gov (United States)

    Winch, Peter D; Staudt, Anna M; Sebastian, Roby; Corridore, Marco; Tumin, Dmitry; Simsic, Janet; Galantowicz, Mark; Naguib, Aymen; Tobias, Joseph D

    2016-07-01

    The many advantages of early tracheal extubation following congenital cardiac surgery in young infants and children are now widely recognized. Benefits include avoiding the morbidity associated with prolonged intubation and the consequences of sedation and positive pressure ventilation in the setting of altered cardiopulmonary physiology. Our practice of tracheal extubation of young infants in the operating room following cardiac surgery has evolved and new challenges in the arena of postoperative sedation and pain management have appeared. Review our institutional outcomes associated with early tracheal extubation following congenital cardiac surgery. Inclusion criteria included all children less than 1 year old who underwent congenital cardiac surgery between October 1, 2010, and October 24, 2013. A total of 416 patients less than 1 year old were included. Of the 416 patients, 234 underwent tracheal extubation in the operating room (56%) with 25 requiring reintubation (10.7%), either immediately or following admission to the cardiothoracic ICU. Of the 25 patients extubated in the operating room who required reintubation, 22 failed within 24 hours of cardiothoracic ICU admission; 10 failures were directly related to narcotic doses that resulted in respiratory depression. As a result of this review, we have instituted changes in our cardiothoracic ICU postoperative care plans. We have developed a neonatal delirium score, and have adopted the "Kangaroo Care" approach that was first popularized in neonatal ICUs. This provision allows for the early parental holding of infants following admission to the cardiothoracic ICU and allows for appropriately selected parents to sleep in the same beds alongside their postoperative children.

  15. Discovery and progress of direct cardiac reprogramming.

    Science.gov (United States)

    Kojima, Hidenori; Ieda, Masaki

    2017-06-01

    Cardiac disease remains a major cause of death worldwide. Direct cardiac reprogramming has emerged as a promising approach for cardiac regenerative therapy. After the discovery of MyoD, a master regulator for skeletal muscle, other single cardiac reprogramming factors (master regulators) have been sought. Discovery of cardiac reprogramming factors was inspired by the finding that multiple, but not single, transcription factors were needed to generate induced pluripotent stem cells (iPSCs) from fibroblasts. We first reported a combination of cardiac-specific transcription factors, Gata4, Mef2c, and Tbx5 (GMT), that could convert mouse fibroblasts into cardiomyocyte-like cells, which were designated as induced cardiomyocyte-like cells (iCMs). Following our first report of cardiac reprogramming, many researchers, including ourselves, demonstrated an improvement in cardiac reprogramming efficiency, in vivo direct cardiac reprogramming for heart regeneration, and cardiac reprogramming in human cells. However, cardiac reprogramming in human cells and adult fibroblasts remains inefficient, and further efforts are needed. We believe that future research elucidating epigenetic barriers and molecular mechanisms of direct cardiac reprogramming will improve the reprogramming efficiency, and that this new technology has great potential for clinical applications.

  16. Role Allocations and Communications of Operators during Emergency Operation in Advanced Main Control Rooms

    International Nuclear Information System (INIS)

    Lee, June Seung

    2009-01-01

    The advanced main control room (MCR) in GEN III + nuclear power plants has been designed by adapting modern digital I and C techniques and an advanced man machine interface system (MMIS). Large Display Panels (LDPs) and computer based workstations are installed in the MCR. A Computerized Procedure System (CPS) and Computerized Operation Support System (COSS) with high degrees of automation are supplied to operators. Therefore, it is necessary to set up new operation concepts in advanced MCRs that are different from those applied in conventional MCRs regarding role allocations and communications of operators. The following presents a discussion of the main differences between advanced MCRs and conventional MCRs from the viewpoint of role allocations and communications. Efficient models are then proposed on the basis of a task analysis on a series of emergency operation steps

  17. Cardiac-specific overexpression of aldehyde dehydrogenase 2 exacerbates cardiac remodeling in response to pressure overload

    Directory of Open Access Journals (Sweden)

    Sujith Dassanayaka

    2018-07-01

    Full Text Available Pathological cardiac remodeling during heart failure is associated with higher levels of lipid peroxidation products and lower abundance of several aldehyde detoxification enzymes, including aldehyde dehydrogenase 2 (ALDH2. An emerging idea that could explain these findings concerns the role of electrophilic species in redox signaling, which may be important for adaptive responses to stress or injury. The purpose of this study was to determine whether genetically increasing ALDH2 activity affects pressure overload-induced cardiac dysfunction. Mice subjected to transverse aortic constriction (TAC for 12 weeks developed myocardial hypertrophy and cardiac dysfunction, which were associated with diminished ALDH2 expression and activity. Cardiac-specific expression of the human ALDH2 gene in mice augmented myocardial ALDH2 activity but did not improve cardiac function in response to pressure overload. After 12 weeks of TAC, ALDH2 transgenic mice had larger hearts than their wild-type littermates and lower capillary density. These findings show that overexpression of ALDH2 augments the hypertrophic response to pressure overload and imply that downregulation of ALDH2 may be an adaptive response to certain forms of cardiac pathology. Keywords: Heart failure, Hypertrophy, Oxidative stress, Aldehydes, Cardiac remodeling, Hormesis

  18. ATTENTION TO THE EMERGENCY ROOM WITH EMPHASIS ON PRE-HOSPITAL CARE: INTEGRATIVE REVIEW

    Directory of Open Access Journals (Sweden)

    B. S. Santos

    2017-08-01

    Full Text Available The study aims to identify the factors, which influence positively and negatively the implementation of public policies geared to the needs in scope of mobile, found in the publications of brazilian researchers since the implementation of the National Policy of Attention to the Emergency room in Brazil. This is a study of Integrative Literature Review. Composing the basis of methodology, have been used official documents to guide the findings that comprised the conceptual bases of the study and to guide the Integrative Review were used publications that report on the issue in question respecting all steps of the protocol review. The results show the changes in the organizational structure of the Service Mobile Emergency, given the regionalization as something positive for the growth of this service modality and discuss prematurely early articulation between the sectors that make up the public health system in Brazil. In conclusion, the policies of attention to the urgencies, in particular within mobile, have favored beneficially all of the users who require this type of care, in the meantime, make the necessary reflections about this theme in the attempt of a better understanding of the regionalization process and coordination among the municipalities that will offer the mobile care so as to ensure continuity of care through the mechanisms of reference and counter-reference

  19. Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan.

    Science.gov (United States)

    Suzuki, Kodai; Inoue, Shigeaki; Morita, Seiji; Watanabe, Nobuo; Shintani, Ayumi; Inokuchi, Sadaki; Ogura, Shinji

    2016-01-01

    Although emergency resuscitative thoracotomy is performed as a salvage maneuver for critical blunt trauma patients, evidence supporting superior effectiveness of emergency resuscitative thoracotomy compared to conventional closed-chest compressions remains insufficient. The objective of this study was to investigate whether emergency resuscitative thoracotomy at the emergency department or in the operating room was associated with favourable outcomes after blunt trauma and to compare its effectiveness with that of closed-chest compressions. This was a retrospective nationwide cohort study. Data were obtained from the Japan Trauma Data Bank for the period between 2004 and 2012. The primary and secondary outcomes were patient survival rates 24 h and 28 d after emergency department arrival. Statistical analyses were performed using multivariable generalized mixed-effects regression analysis. We adjusted for the effects of different hospitals by introducing random intercepts in regression analysis to account for the differential quality of emergency resuscitative thoracotomy at hospitals where patients in cardiac arrest were treated. Sensitivity analyses were performed using propensity score matching. In total, 1,377 consecutive, critical blunt trauma patients who received cardiopulmonary resuscitation in the emergency department or operating room were included in the study. Of these patients, 484 (35.1%) underwent emergency resuscitative thoracotomy and 893 (64.9%) received closed-chest compressions. Compared to closed-chest compressions, emergency resuscitative thoracotomy was associated with lower survival rate 24 h after emergency department arrival (4.5% vs. 17.5%, respectively, P chest compressions (P chest compressions.

  20. Conhecimento sobre anticoagulantes orais e seu manejo por médicos de pronto atendimento Emergency-room doctors' knowledge about oral anticoagulants and its management

    Directory of Open Access Journals (Sweden)

    Larissa Periotto Borlina

    2010-06-01

    Full Text Available Contexto: Desde sua descoberta, os anticoagulantes orais (AO têm sido cada vez mais estudados e aplicados em diferentes doenças. No entanto, eles apresentam reações medicamentosas com fármacos que trazem riscos ao paciente. Objetivo: Identificar o nível de conhecimento dos médicos plantonistas de pronto atendimento sobre os AO e suas interações, medicamentosas ou não, e verificar se o médico frentista está preparado para integrar o conteúdo teórico com a rotina de urgências. Método: Aplicou-se um questionário a 100 médicos atuantes em pronto atendimentos de dois hospitais públicos e três privados em Curitiba. Visou-se saber se o médico frentista questiona ao paciente sobre o uso de AO. Também, avaliou-se o conhecimento do profissional e seu interesse em saber mais sobre: AO (quais deles conhecia; exames para controle; sinergismo com AO; e manejo das complicações. Resultados: Dos 100 entrevistados, 60% declararam perguntar ao paciente sobre o uso de AO, 81% tinham conhecimento insuficiente a respeito do sinergismo de algumas substâncias apresentadas e os AO, 15% desconheciam qual exame é utilizado para acompanhamento dos pacientes anticoagulados, 50,7% não sabiam os nomes comercias dos AO, 4% desconheciam seu antídoto, e 92% manifestaram interesse em melhorar seus conhecimentos sobre os AO. Conclusão: É BAIXo o número de médicos que atende em pronto atendimentos que conhece sobre os AO e que sabe manejar pacientes anticoagulados. É alta a porcentagem de médicos que não perguntam aos pacientes sobre o uso de AO e que desconhecem princípios do sinergismo medicamentoso, sendo que a maioria se interessou em melhorar seus conhecimentos sobre os anticoagulantes.Background: Since its discovery, oral anticoagulants (OA have been increasingly studied and used to treat different diseases. However, OA may cause adverse drug interactions that bring risks for patients. Objective: To identify the emergency room doctors

  1. Critical Care Performance in a Simulated Military Aircraft Cabin Environment

    Science.gov (United States)

    2007-01-01

    ICUs, neonatal ICUs, cardiac care units, cardiac catheter labs, telemetry units, progressive care units, emergency departments, and recovery rooms. This...S89-S99. MacGeorge, J. M., & Nelson, K. M. (2003). The experience of the nurse at triage influences the timing of CPAP intervention. Accid Emerg Nurs

  2. Guidelines for control room systems design. Working material. Report

    International Nuclear Information System (INIS)

    1993-01-01

    This report contains comprehensive technical and methodological information and recommendations for the benefit of Member States for advice and assistance in ''NPP control room systems'' design backfitting existing nuclear power plants and design for future stations. The term ''Control Room Systems'' refers to the entire human/machine interface for the nuclear stations - including the main control room, back-ups control room and the emergency control rooms, local panels, technical support centres, operating staff, operating procedures, operating training programs, communications, etc. Refs, figs and tabs

  3. Diagnostic evaluation of the MRP-8/14 for the emergency assessment of chest pain.

    Science.gov (United States)

    Vora, Amit N; Bonaca, Marc P; Ruff, Christian T; Jarolim, Petr; Murphy, Sabina; Croce, Kevin; Sabatine, Marc S; Simon, Daniel I; Morrow, David A

    2012-08-01

    Elevated levels of myeloid-related protein (MRP)-8/14 (S100A8/A9) are associated with first cardiovascular events in healthy individuals and worse prognosis in patients with acute coronary syndrome (ACS). The diagnostic utility of MRP-8/14 in patients presenting to the emergency room with symptoms concerning for ACS is uncertain. MRP-8/14 was measured in serial serum and plasma samples in a single center prospective cohort-study of patients presenting to the emergency room with non-traumatic chest pain concerning for ACS. Final diagnosis was adjudicated by an endpoint committee. Of patients with baseline MRP-8/14 results (n = 411), the median concentration in serum was 1.57 μg/ml (25th, 75th: 0.87, 2.68) and in plasma was 0.41 μg/ml (MRP-8/14 was higher in patients presenting with MI (p MRP-8/14 was poor: sensitivity 28% (95% CI 20-38), specificity 82% (78-86), positive predictive value 36% (26-47), and negative predictive value 77% (72-81). The area under the ROC curve for diagnosis of MI with MRP-8/14 was 0.55 (95% CI 0.51-0.60) compared with 0.95 for cTnI. The diagnostic performance was not improved in early-presenters, patients with negative initial cTnI, or using later MRP-8/14 samples. Patients presenting with MI had elevated levels of serum MRP-8/14 compared to patients with non-cardiac chest pain. However, overall diagnostic performance of MRP-8/14 was poor and neither plasma nor serum MRP-8/14 offered diagnostic utility comparable to cardiac troponin.

  4. Cardiac arrest upon induction of anesthesia in children with cardiomyopathy: an analysis of incidence and risk factors.

    LENUS (Irish Health Repository)

    Lynch, Johanne

    2012-02-01

    INTRODUCTION: It is thought that patients with cardiomyopathy have an increased risk of cardiac arrest on induction of anesthesia, but there is little available data. The purpose of this study was to identify the incidence and potential risk factors for cardiac arrest upon induction of anesthesia in children with cardiomyopathy in our institution. METHODS: A retrospective chart review was performed. Eligible patients included patients admitted between 1998 and 2008 with the International Statistical Classification of Disease code for cardiomyopathy (ICD-9 code 425) who underwent airway intervention for sedation or general anesthesia in the operating room, cardiac diagnostic and interventional unit (CDIU) or intensive care unit. Patients undergoing emergency airway intervention following cardiovascular collapse were excluded. For each patient, we recorded patient demographics, disease severity, anesthesia location, and anesthetic technique. RESULTS: One hundred and twenty-nine patients with cardiomyopathy underwent a total of 236 anesthetic events, and four cardiac arrests were identified. One was related to bradycardia (HR<60), two were attributed to bradycardia in association with severe hypotension (systolic blood pressure<45), and the fourth arrest was related to isolated severe hypotension. Two occurred in the operating suite and two in the CDIU. There was no resulting mortality. One patient progressed to heart transplantation. Multiple combinations of anesthetic drugs were used for induction of anesthesia. CONCLUSION: We performed a review of the last 10 years of anesthesia events in children with cardiomyopathy. We report four cardiac arrests in two patients and 236 anesthetic events (1.7%). To the best of our knowledge, this is the largest review of these patients to date but is limited by its retrospective nature. The low cardiac arrest incidence prevents the identification of risk factors and the development of a cardiac arrest risk predictive clinical

  5. Emergency Medical Services - Multiple Languages

    Science.gov (United States)

    ... Well-Being 11 - Emergency Room - Amarɨñña / አማርኛ (Amharic) MP3 Siloam Family Health Center Arabic (العربية) Expand Section ... Well-Being 11 - Emergency Room - myanma bhasa (Burmese) MP3 Siloam Family Health Center Dari (دری) Expand Section ...

  6. Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study.

    Science.gov (United States)

    Nakahara, Shinji; Tomio, Jun; Takahashi, Hideto; Ichikawa, Masao; Nishida, Masamichi; Morimura, Naoto; Sakamoto, Tetsuya

    2013-12-10

    To evaluate the effectiveness of pre-hospital adrenaline (epinephrine) administered by emergency medical services to patients with out of hospital cardiac arrest. Controlled propensity matched retrospective cohort study, in which pairs of patients with or without (control) adrenaline were created with a sequential risk set matching based on time dependent propensity score. Japan's nationwide registry database of patients with out of hospital cardiac arrest registered between January 2007 and December 2010. Among patients aged 15-94 with out of hospital cardiac arrest witnessed by a bystander, we created 1990 pairs of patients with and without adrenaline with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) and 9058 pairs among those with non-VF/VT. Overall and neurologically intact survival at one month or at discharge, whichever was earlier. After propensity matching, pre-hospital administration of adrenaline by emergency medical services was associated with a higher proportion of overall survival (17.0% v 13.4%; unadjusted odds ratio 1.34, 95% confidence interval 1.12 to 1.60) but not with neurologically intact survival (6.6% v 6.6%; 1.01, 0.78 to 1.30) among those with VF/VT; and higher proportions of overall survival (4.0% v 2.4%; odds ratio 1.72, 1.45 to 2.04) and neurologically intact survival (0.7% v 0.4%; 1.57, 1.04 to 2.37) among those with non-VF/VT. Pre-hospital administration of adrenaline by emergency medical services improves the long term outcome in patients with out of hospital cardiac arrest, although the absolute increase of neurologically intact survival was minimal.

  7. The conference hybrid control room

    International Nuclear Information System (INIS)

    Gieci, A.; Caucik, J.; Macko, J.

    2008-01-01

    An original concept of a hybrid control room was developed for the Mochovce-3 and Mochovce-4 reactor units which are under construction. The basic idea underlying the concept is that the control room should be a main working place for the operators (reactor operator and turbine operator) and for the shift supervisor, designed as a comprehensive unit desk shaped so that all members of the control room crew are in a face-to-face contact constantly. The main desk consists of three clearly identified areas serving the operators and the unit supervisor as their main working places. A soft control system is installed at the main working places. A separate safety-related working place, designed as a panel with classical instrumentations at the conference hybrid control room, is provided in case of abnormal conditions or emergency situation. Principles of ergonomics and cognitive engineering were taken into account when designing the new conference hybrid control room for the Mochovce-3 and -4 reactor units. The sizes, propositions, shapes and disposition of the equipment at the control room have been created and verified by using virtual reality tools. (orig.)

  8. Utilization of the emergency room: impact of geographic distance

    Directory of Open Access Journals (Sweden)

    Jae Eun Lee

    2007-05-01

    Full Text Available The aim of this study was to estimate the distance Mississippi patients must travel to access hospital-based emergency rooms (ERs and to determine whether an association exists between geographic distance and ER utilization. To that end, great circle distances between Census Block Group Centroid Points and 89 hospitals with emergency departments were calculated for the State of Mississippi. Data on the socio-demographic characteristics of each block group came from the 2000 US Census data. Logistic regression analyses were conducted to test if there was any association between ER utilization and travel distance. Compared to the national benchmark of 35.7%, more than one in two (56.7%, or 1,612,762 Mississippians visited ERs in 2003 with an estimated 6.1 miles per person annual travel for this purpose. The majority of the target population (54.9% was found to live within 5 miles of hospitals with ERs. Logistic analyses revealed that block groups associated with less miles traveled to hospitals with ERs had a higher proportion of African Americans, impoverished people, female householders, people with more than 12 years education, people older than 65 years, people with high median house values, and people without employment. Twenty-nine of the 89 hospitals (33% providing ER care in Mississippi were found to be in areas with above-average ER utilization rates. These hospitals served a smaller geographical area (28% of the total but had a greater proportion of visitors (57% and served a higher percentage (37% of the state population. People in areas served by the less utilized ERs traveled more miles to be cared for (7.1 miles vs 5.4 miles; p<0.0001. Logistic regression analysis revealed that shorter distances were associated with increased use of the ERs, even after controlling for socio-demographic factors. The conclusion is that Mississippi ERs are typically located in block groups with higher percentages of disadvantaged residents and that

  9. Extracorporeal membrane oxygenation for refractory cardiac arrest

    Directory of Open Access Journals (Sweden)

    Steven A Conrad

    2017-01-01

    Full Text Available Extracorporeal cardiopulmonary resuscitation (ECPR is the use of rapid deployment venoarterial (VA extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR. Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists. Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management.

  10. Cardiac Arrythmias in Acute and Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    Ali A. Handjani

    1966-01-01

    Full Text Available Cardiac arrythmias are frequent complications in acute and chronic renal failure and they may well account for sudden unexplained death in these patients. Based upon our recent study, we strongly believe that among other causative factors, focal degeneration of myocardium is the commonest and the most potentially dangerous cause of cardiac arrythmias. We suggest in emergency instances, ouabain to be used instead of digitalis which appears to be quite safe with dramatic results in cardiac arrythmias of these group.

  11. 78 FR 1162 - Cardiovascular Devices; Reclassification of External Cardiac Compressor

    Science.gov (United States)

    2013-01-08

    .... FDA-2012-N-1173] Cardiovascular Devices; Reclassification of External Cardiac Compressor AGENCY: Food... external cardiac compressors as class III requiring premarket approval. The Cardiovascular Device... on CPR and emergency cardiovascular care (Ref. 1) conclude that ``real-time CPR prompting and...

  12. Methodology for the identification of the factors that can influence the performance of operators of nuclear power plants control room under emergency situations

    International Nuclear Information System (INIS)

    Paiva, Bernardo Spitz; Santos, Isaac J.A. Luquetti

    2009-01-01

    In order to minimize the human errors of the operators in a nuclear power plan control room, during emergency situations, it has to be considered the factors which affect the human performance. Work situations adequately projected, compatible with the necessities, capacities and human limitations, taking into consideration the factors which affect the operator performance . This paper aims to develop a methodology for identification of the factors affecting the operator performance under emergency situation, using the aspects defined by the human reliability analysis focusing the judgment done by specialists

  13. Integration of genomics, proteomics, and imaging for cardiac stem cell therapy

    International Nuclear Information System (INIS)

    Chun, Hyung J.; Wilson, Kitch O.; Huang, Mei; Wu, Joseph C.

    2007-01-01

    Cardiac stem cell therapy is beginning to mature as a valid treatment for heart disease. As more clinical trials utilizing stem cells emerge, it is imperative to establish the mechanisms by which stem cells confer benefit in cardiac diseases. In this paper, we review three methods - molecular cellular imaging, gene expression profiling, and proteomic analysis - that can be integrated to provide further insights into the role of this emerging therapy. (orig.)

  14. The BWR [Boiling Water Reactor] Emergency Operating Procedures Tracking System (EOPTS): Evaluation by control-room operating crews

    International Nuclear Information System (INIS)

    Spurgin, A.J.; Orvis, D.D.; Spurgin, J.P.; Luna, C.J.

    1990-05-01

    This report presents the results of a project sponsored by the Electric Power Research Institute (EPRI) and Taiwan Power Company (TPC) and conducted by APG and TPC to perform evaluation of the Emergency Operating Procedures Tracking System (EOPTS). The EOPTS is an expert system employing artificial intelligence techniques developed by EPRI for Boiling Water Reactor (BWR) plants based on emergency operating procedures (EOPs). EOPTS is a computerized decision aid used to assist plant operators in efficient and reliable use of EOPs. The main objective of this project was to evaluate the EOPTS and determine how an operator aid of this type could noticeably improve the response time and the reliability of control room crews to multi-failure scenarios. A secondary objective was to collect data on how crew performance was affected. Experiments results indicate that the EOPTS measurably improves crew performance over crews using the EOP flow charts. Time-comparison measurements indicate that crews using the EOPTS perform required actions more quickly than do those using the flowcharts. The results indicate that crews using the EOPTS are not only faster and more consistent in their actions but make fewer errors. In addition, they have a higher likelihood of recovering from the errors that they do make. Use of the EOPTS in the control room should result in faster termination and mitigation of accidents and reduced risk of power plant operations. Recommendations are made towards possible applications of the EOPTS to operator training and evaluation, and for the applicability of the evaluation methodology developed for this project to the evaluation of similar operator aides. 17 refs., 14 figs., 14 tabs

  15. Factores predictores de uso problemático de alcohol en personas atendidas en una sala de emergencia Predictive factors of alcohol use problems among patients visiting an emergency room

    Directory of Open Access Journals (Sweden)

    Fabián Fiestas

    2011-03-01

    Full Text Available Objetivos. Valorar el efecto predictivo de características claves de pacientes atendidos en salas de emergencia para detectar casos de uso problemático de alcohol. Materiales y Métodos. La muestra de estudio estuvo constituida por 371 personas atendidas en el lapso de siete días completos de enero de 2005 en el servicio de emergencia de un hospital público de Lima, Perú. Se aplicó un cuestionario demográfico, el SIDUC/CICAD para uso reciente de sustancias psicoactivas en salas de emergencias (i.e., uso dentro de las seis horas previas a la atención y el AUDIT para uso problemático de alcohol en el último año. El análisis de regresión logística simple y multivariada permitió valorar el efecto predictor de la edad, sexo, especialidad del servicio de atención, presencia de daño físico y el uso reciente de alcohol para detectar casos problemáticos de su uso. Resultados. El odds de tener uso problemático de alcohol en los varones es 26 veces el odds de tener dicho problema entre las mujeres (pObjectives. To assess the predictive effect of key individual-level characteristics to identify cases of alcohol use problems among patients visiting an emergency room. Materials and methods. The study sample was composed of 371 people attending an emergency room in a public hospital in Lima, Peru, during a period of seven complete days in January, 2005. For data gathering, we used a questionnaire for demographic information, the SIDUC/CICAD for recent use (i.e., in the last 6 hours of psychoactive substances before arriving to the emergency room, and the AUDIT, to identify alcohol use problems in the last year. Univariate and multivariate logistic regression models were used to estimate the predictive effect of age, sex, area of attention in the emergency room, presence of physical injuries and recent use of alcohol. Results. The odds of being a case of alcohol use problem for males is 26 times the odds of having that problem for females (p

  16. Impact of ethnicity on cardiac adaptation to exercise.

    Science.gov (United States)

    Sheikh, Nabeel; Sharma, Sanjay

    2014-04-01

    The increasing globalization of sport has resulted in athletes from a wide range of ethnicities emerging onto the world stage. Fuelled by the untimely death of a number of young professional athletes, data generated from the parallel increase in preparticipation cardiovascular evaluation has indicated that ethnicity has a substantial influence on cardiac adaptation to exercise. From this perspective, the group most intensively studied comprises athletes of African or Afro-Caribbean ethnicity (black athletes), an ever-increasing number of whom are competing at the highest levels of sport and who often exhibit profound electrical and structural cardiac changes in response to exercise. Data on other ethnic cohorts are emerging, but remain incomplete. This Review describes our current knowledge on the impact of ethnicity on cardiac adaptation to exercise, starting with white athletes in whom the physiological electrical and structural changes--collectively termed the 'athlete's heart'--were first described. Discussion of the differences in the cardiac changes between ethnicities, with a focus on black athletes, and of the challenges that these variations can produce for the evaluating physician is also provided. The impact of ethnically mediated changes on preparticipation cardiovascular evaluation is highlighted, particularly with respect to false positive results, and potential genetic mechanisms underlying racial differences in cardiac adaptation to exercise are described.

  17. Feelings of nurses in the reception and risk classification evaluation in the emergency room

    Directory of Open Access Journals (Sweden)

    Andressa Midori Sakai

    2016-05-01

    Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.

  18. Feelings of nurses in the reception and risk classification evaluation in the emergency room

    Directory of Open Access Journals (Sweden)

    Andressa Midori Sakai

    2016-01-01

    Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.

  19. What Happens in the Emergency Room?

    Science.gov (United States)

    ... was 4 years old, he loved to play Batman. He'd put on his Batman pajamas and pretend to fly all over the ... swollen) and he had trouble moving his arm. "Batman," she said, "We're going to the emergency ...

  20. Cardiac Myosin Binding Protein-C Autoantibodies are Potential Early Indicators of Cardiac Dysfunction and Patient Outcome in Acute Coronary Syndrome.

    Science.gov (United States)

    Lynch, Thomas L; Kuster, Diederik W D; Gonzalez, Beverly; Balasubramanian, Neelam; Nair, Nandini; Day, Sharlene; Calvino, Jenna E; Tan, Yanli; Liebetrau, Christoph; Troidl, Christian; Hamm, Christian W; Güçlü, Ahmet; McDonough, Barbara; Marian, Ali J; van der Velden, Jolanda; Seidman, Christine E; Huggins, Gordon S; Sadayappan, Sakthivel

    2017-04-01

    The degradation and release of cardiac myosin binding protein-C (cMyBP-C) upon cardiac damage may stimulate an inflammatory response and autoantibody (AAb) production. We determined whether the presence of cMyBP-C-AAbs associated with adverse cardiac function in CVD patients. Importantly, cMyBP-C-AAbs were significantly detected in ACS patient sera upon arrival to the emergency department, particularly in STEMI patients. Patients positive for cMyBP-C-AAbs had a reduced LVEF and elevated levels of clinical biomarkers of MI. We conclude that cMyBP-C-AAbs may serve as early predictive indicators of deteriorating cardiac function and patient outcome in ACS patients prior to the infarction.

  1. Fire risk assessment for hydrogen at EDG/battery room

    Energy Technology Data Exchange (ETDEWEB)

    Jee, Moon Hak; Hong, Sung Yull; Choi, Kwang Hee; Jung, Hyun Jong; Park, Kyung Hyum [Korea electric Power Research Institute, Taejon (Korea, Republic of); Song, Jin Bae [KHNP, Wolsong (Korea, Republic of)

    2004-07-01

    At the design stage of Nuclear Power Plant, the fire hazard analysis for the fire zone or compartment is implemented according to the fire protection requirement and the document is required for the licensing approval. On the basis of fire hazard analysis, the evaluation for the safe shutdown capability is preceded for each fire zone that contains safety-important systems and facilities. The primary philosophy for the fire safety is to secure fire defense-in-depth at Nuclear Power Plants that represents fire prevention, fire protection, and mitigation from fire damage. One of the concerning fire zones that need quantitative fire hazard analysis as well as qualitative fire evaluation at Nuclear Power Plants is the battery room at Emergency Diesel Generator (EDG) Room. For an example, Emergency Power Supply System called as EPS at Wolsong Nuclear Power Plant generates emergency power and supply the electric power to the safety-related systems and essential facilities during the loss of on-site and off-site AC power. For the start of emergency power generator, it needs DC power from the battery units inside the EPS room. For the emergency supply of DC power, the battery at EPS room should be recharged during the standby period to compensate the reduced chemical energy that was converted to the electric energy or depleted through the natural process. During the recharge process, especially at the time of charging current becoming greater than the nominal floating current or at the time of over-charging period, the hydrogen and the oxygen are generated from the positive plate and cathodic part respectively and escaped through the vent holes or crevices. In this context, the fire hazard assessment should be done for the EPS/battery room with quantitative approach and the fire safety evaluation for the explosion of hydrogen gas must be done under the specific fire protection program at Nuclear Power Plants.

  2. Fire risk assessment for hydrogen at EDG/battery room

    International Nuclear Information System (INIS)

    Jee, Moon Hak; Hong, Sung Yull; Choi, Kwang Hee; Jung, Hyun Jong; Park, Kyung Hyum; Song, Jin Bae

    2004-01-01

    At the design stage of Nuclear Power Plant, the fire hazard analysis for the fire zone or compartment is implemented according to the fire protection requirement and the document is required for the licensing approval. On the basis of fire hazard analysis, the evaluation for the safe shutdown capability is preceded for each fire zone that contains safety-important systems and facilities. The primary philosophy for the fire safety is to secure fire defense-in-depth at Nuclear Power Plants that represents fire prevention, fire protection, and mitigation from fire damage. One of the concerning fire zones that need quantitative fire hazard analysis as well as qualitative fire evaluation at Nuclear Power Plants is the battery room at Emergency Diesel Generator (EDG) Room. For an example, Emergency Power Supply System called as EPS at Wolsong Nuclear Power Plant generates emergency power and supply the electric power to the safety-related systems and essential facilities during the loss of on-site and off-site AC power. For the start of emergency power generator, it needs DC power from the battery units inside the EPS room. For the emergency supply of DC power, the battery at EPS room should be recharged during the standby period to compensate the reduced chemical energy that was converted to the electric energy or depleted through the natural process. During the recharge process, especially at the time of charging current becoming greater than the nominal floating current or at the time of over-charging period, the hydrogen and the oxygen are generated from the positive plate and cathodic part respectively and escaped through the vent holes or crevices. In this context, the fire hazard assessment should be done for the EPS/battery room with quantitative approach and the fire safety evaluation for the explosion of hydrogen gas must be done under the specific fire protection program at Nuclear Power Plants

  3. Tratamento da cefaléia em uma unidade de emergência da cidade de Ribeirão Preto Headache treatment in an emergency room of the city of Ribeirão Preto, Brazil

    Directory of Open Access Journals (Sweden)

    MARCELO EDUARDO BIGAL

    1999-09-01

    Full Text Available Cefaléia é dos sintomas mais comuns na prática clínica. Acarreta considerável impacto econômico e sobrecarrega as unidades de emergência. A maioria destas, em nosso país, não dispõe de triptans. O presente estudo analisa o tratamento instituído na Unidade de Emergência do Hospital das Clínicas de Ribeirão Preto. Em 1996, 1254 pacientes foram atendidos com esta queixa e 64 necessitaram de internação. Dos pacientes não internados (NI, 77% apresentavam cefaléias primárias, contra 29,7% dos pacientes internados (I. A percentagem de melhora nos pacientes com migrânea com a dipirona endovenosa foi 83,8%, com o diclofenaco intramuscular 66,7% e com a clorpromazina (endovenosa 81,8%. As percentagens de pacientes com cefaléia do tipo tensional que melhoraram, frente às mesmas drogas foram, respectivamente 77,8%, 80% e 100%. Dos NI 16,3% tiveram melhora sem qualquer tratamento medicamentoso. Concluímos que as drogas utilizadas apresentam perfis semelhantes de eficácia e custo, podendo ser utilizadas em unidades básicas de saúde. O maior inconveniente é a administração parenteral.Headache is one of the most common symptoms observed in clinical practice. It has a considerable economic impact and overburdens emergency rooms. In Brazil, most emergency rooms have no tryptans. The present study analyses the treatment provided by the Emergency Room of the University Hospital of Ribeirão Preto. In 1996, 1254 patients were treated for headache and 64 of them required hospitalization. Of the non-hospitalized (NH patients, 77% had primary headache, as opposed to 29.7% of hospitalized patients. Of the patients with migraine, 83.6% improved with intravenous dipyrone, 66.7% improved with intramuscular diclofenac and 81.8% improved with intravenous chlorpromazine. The percentages of patients with tension-type headache who improved with the same drugs were 77.8%, 80% and 100%, respectively. Among NH patients, 16.3% improved without any

  4. Value of contrast enhanced CT scanning in the non-trauma emergency room patient

    International Nuclear Information System (INIS)

    Wood, L.P.; Parisi, M.; Finch, I.J.

    1990-01-01

    To determine the value of performing contrast CT in addition to non-contrast CT in the evaluation of acute non-traumatic central nervous system disorders, we retrospectively reviewed 322 cases originating from the emergency room at our institution. The most common indication for scanning was seizure activity (34% of total), followed by headache (30%), focal neurological deficit (10%), and altered mental status (8%). 75% of the noncontrast scans were normal. The contrast enhanced scan revealed abnormalities not evident on the non-contrast scan in only three of these cases, and the information did not alter patient management. We conclude that in the acute setting, if a non-contrast CT is normal, a contrast study is usually unnecessary. Therefore, given the additional risks of contrast infusion, the contrast study, if needed, is generally best obtained at a later date, after more careful evaluation of the patient's history and medical records. If the non-contrast CT scan is abnormal, a contrast enhanced CT scan may be beneficial, but, again, is often not needed to direct acute patient management. (orig.)

  5. Emergency management of major bleeding in a case of maxillofacial trauma and anticoagulation: utility of prothrombin complex concentrates in the shock room

    Directory of Open Access Journals (Sweden)

    Alessandro Morotti

    2015-03-01

    Full Text Available Life-threatening bleeding in anticoagulation with Warfarin is an emergency challenging issue. Several approaches are available to treat bleeding in either over-anticoagulation or propeanticoagulation, including vitamin K, fresh frozen plasma and prothrombin complex concentrates (PCC administration. In coexisting trauma-induced bleeding and anticoagulation, reversal of anticoagulation must be a rapid and highly effective procedure. Furthermore the appropriate treatment must be directly available in each shock rooms to guarantee the rapid management of the emergency. PCC require a simple storage, rapid accessibility, fast administration procedures and high effectiveness. Here we report the utility of PCC in management of a craniofacial trauma in proper-anticoagulation.

  6. Radiation Protection Elephants in the Room

    International Nuclear Information System (INIS)

    Vetter, R. J.

    2004-01-01

    As our system of radiological protection evolves, several significant issues loom within radiation protection discussions and publications. These issues influence the nature of epidemiological and radiobiological research and the establishment of radiation protection recommendations, standards, and regulations. These issues are like the proverbial e lephants in the room . They are large, and it is unwise to ignore them. This paper discusses the impact of three young elephants as they make their presence increasingly obvious: increased cancer susceptibility from early-life exposure to radiation, terrorism and fear of radiation, and patient safety. Increased cancer susceptibility from early-life exposure to radiation is emerging as a discussion topic related to the safety of computed tomography (CT) and other medical modalities. Shortly after publication of CT dose data, manufacturers were helping to reduce doses to children by increasing flexibility for adjustment of technique factors. Also, radiation epidemiological data are being used in the development of guidance on exposure to chemical carcinogens during early life. Re-emergence of public fear of radiation has been fueled by threats of radiological dispersion devises and confusing messages about personal decontamination, emergency room acceptance or rejection of contaminated victims, and environmental clean-up. Finally, several professional publications have characterized risk of medical radiation exposure in terms of patient deaths even though epidemiological data do not support such conclusions. All three of these elephants require excellent science and sophisticated data analysis to coax them from the room. Anecdotal communications that confuse the public should be avoided. These are not the only elephants in the room, but these three are making their presence increasingly obvious. This paper discusses the need for radiation protection professionals to rely on good science in the evolution of the system of

  7. Cost-Benefit Analysis of an Otolaryngology Emergency Room Using a Contingent Valuation Approach.

    Science.gov (United States)

    Naunheim, Matthew R; Kozin, Elliot D; Sethi, Rosh K; Ota, H Gregory; Gray, Stacey T; Shrime, Mark G

    2015-10-01

    Dedicated otolaryngology emergency rooms (ERs) provide a unique mechanism of health care delivery. Relative costs and willingness to pay (WTP) for these services have not been studied. This study aims to provide a cost-benefit analysis of otolaryngology-specific ER care. Cost-benefit analysis based on contingent valuation surveys. An otolaryngology-specific ER in a tertiary care academic medical center. Adult English-speaking patients presenting to an otolaryngology ER were included. WTP questions were used to assess patient valuations of specialty emergency care. Sociodemographic data, income, and self-reported levels of distress were assessed. State-level and institution-specific historical cost data were merged with WTP data within a cost-benefit analysis framework. The response rate was 75.6%, and 199 patients were included in the final analysis. Average WTP for otolaryngology ER services was $319 greater than for a general ER (95% CI: $261 to $377), with a median value of $200. The historical mean cost per visit at a general ER was $575, and mean cost at the specialty ER was $551 (95% CI: $529 to $574). Subtracting incremental cost from incremental WTP yielded a net benefit of $343. Dedicated otolaryngology ER services are valued by patients for acute otolaryngologic problems and have a net benefit of $343 per patient visit. They appear to be a cost-beneficial method for addressing acute otolaryngologic conditions. This study has implications for ER-based otolaryngologic care and direct-to-specialist services. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

  8. Identifying Variability in Mental Models Within and Between Disciplines Caring for the Cardiac Surgical Patient.

    Science.gov (United States)

    Brown, Evans K H; Harder, Kathleen A; Apostolidou, Ioanna; Wahr, Joyce A; Shook, Douglas C; Farivar, R Saeid; Perry, Tjorvi E; Konia, Mojca R

    2017-07-01

    The cardiac operating room is a complex environment requiring efficient and effective communication between multiple disciplines. The objectives of this study were to identify and rank critical time points during the perioperative care of cardiac surgical patients, and to assess variability in responses, as a correlate of a shared mental model, regarding the importance of these time points between and within disciplines. Using Delphi technique methodology, panelists from 3 institutions were tasked with developing a list of critical time points, which were subsequently assigned to pause point (PP) categories. Panelists then rated these PPs on a 100-point visual analog scale. Descriptive statistics were expressed as percentages, medians, and interquartile ranges (IQRs). We defined low response variability between panelists as an IQR ≤ 20, moderate response variability as an IQR > 20 and ≤ 40, and high response variability as an IQR > 40. Panelists identified a total of 12 PPs. The PPs identified by the highest number of panelists were (1) before surgical incision, (2) before aortic cannulation, (3) before cardiopulmonary bypass (CPB) initiation, (4) before CPB separation, and (5) at time of transfer of care from operating room (OR) to intensive care unit (ICU) staff. There was low variability among panelists' ratings of the PP "before surgical incision," moderate response variability for the PPs "before separation from CPB," "before transfer from OR table to bed," and "at time of transfer of care from OR to ICU staff," and high response variability for the remaining 8 PPs. In addition, the perceived importance of each of these PPs varies between disciplines and between institutions. Cardiac surgical providers recognize distinct critical time points during cardiac surgery. However, there is a high degree of variability within and between disciplines as to the importance of these times, suggesting an absence of a shared mental model among disciplines caring for

  9. Anesthesia preparation time is not affected by the experience level of the resident involved during his/her first month of adult cardiac surgery.

    Science.gov (United States)

    Broussard, David M; Couch, Michael C

    2011-10-01

    This study was designed to answer the question of whether the experience level of the resident on his/her first month of adult cardiothoracic anesthesiology has an impact on operating room efficiency in a large academic medical center. Traditionally, the resident's 1st month of cardiac anesthesia had been reserved for the clinical anesthesia (CA)-2 year of training. This study analyzed the impact on operating room efficiency of moving the 1st month of cardiac anesthesia into the CA-1 year. The authors hypothesized that there would be no difference in anesthesia preparation times (defined as the interval between "in-room" and "anesthesia-ready" times) between CA-1 and CA-2 residents on their 1st month of cardiac anesthesia. This study was retrospective and used an electronic anesthesia information management system database. This study was conducted on care provided at a single 450-bed academic medical center. This study included 12 residents in their 1st month of cardiac anesthesia. The anesthesia preparation time (defined as the interval between "in-room" and "anesthesia-ready" times) was measured for cases involving residents on their first month of cardiac anesthesia. Anesthesia preparation times for 6 CA-1 resident months and 6 CA-2 resident months (100 adult cardiac procedures in total) were analyzed (49 for the CA-1 residents and 51 for the CA-2s). There were no differences in preparation time between CA-1 and CA-2 residents as a group (p = 0.8169). The CA-1 residents had an unadjusted mean (±standard error) of 51.1 ± 3.18 minutes, whereas the CA-2 residents' unadjusted mean was 50.2 ± 2.41 minutes. Adjusting for case mix (valves v coronary artery bypass graft surgery), the CA-1 mean was 49.1 ± 5.22 minutes, whereas the CA-2 mean was 49.1 ± 4.54 minutes. These findings suggest that operating room efficiency as measured by the anesthesia preparation time may not be affected by the level of the resident on his/her 1st month of adult cardiac anesthesia

  10. A study of consumer attitudes about health care: the role of the emergency room.

    Science.gov (United States)

    Stratmann, W C; Ullman, R

    1975-12-01

    Contrary to the traditional role of the emergency room (ER) as a care source for the treatment of urgent medical needs, it is evident that substantial numbers of people now use the ER for the treatment of nonurgent problems. In this paper, we report on public opinion about the role of the ER, the accessibility of medical care, and factors that prompt the use of the ER rather than other sources of care. The data result from a community survey of households (N = 521) in the area of Rochester, New York, representative of a population of about 580,000 people. The findings, which relate ER utilization to source of payment, use of other sources of care, demographic variables, and consumer attitudes illustrate the rationality of the patient's use of ER facilities and reflect the patient's view of the ER as a place to obtain medical treatment when other sources are not available.

  11. Real-time MRI guidance of cardiac interventions.

    Science.gov (United States)

    Campbell-Washburn, Adrienne E; Tavallaei, Mohammad A; Pop, Mihaela; Grant, Elena K; Chubb, Henry; Rhode, Kawal; Wright, Graham A

    2017-10-01

    Cardiac magnetic resonance imaging (MRI) is appealing to guide complex cardiac procedures because it is ionizing radiation-free and offers flexible soft-tissue contrast. Interventional cardiac MR promises to improve existing procedures and enable new ones for complex arrhythmias, as well as congenital and structural heart disease. Guiding invasive procedures demands faster image acquisition, reconstruction and analysis, as well as intuitive intraprocedural display of imaging data. Standard cardiac MR techniques such as 3D anatomical imaging, cardiac function and flow, parameter mapping, and late-gadolinium enhancement can be used to gather valuable clinical data at various procedural stages. Rapid intraprocedural image analysis can extract and highlight critical information about interventional targets and outcomes. In some cases, real-time interactive imaging is used to provide a continuous stream of images displayed to interventionalists for dynamic device navigation. Alternatively, devices are navigated relative to a roadmap of major cardiac structures generated through fast segmentation and registration. Interventional devices can be visualized and tracked throughout a procedure with specialized imaging methods. In a clinical setting, advanced imaging must be integrated with other clinical tools and patient data. In order to perform these complex procedures, interventional cardiac MR relies on customized equipment, such as interactive imaging environments, in-room image display, audio communication, hemodynamic monitoring and recording systems, and electroanatomical mapping and ablation systems. Operating in this sophisticated environment requires coordination and planning. This review provides an overview of the imaging technology used in MRI-guided cardiac interventions. Specifically, this review outlines clinical targets, standard image acquisition and analysis tools, and the integration of these tools into clinical workflow. 1 Technical Efficacy: Stage 5 J

  12. Temporal trends in coverage of historical cardiac arrests using a volunteer-based network of automated external defibrillators accessible to laypersons and emergency dispatch centers.

    Science.gov (United States)

    Hansen, Carolina Malta; Lippert, Freddy Knudsen; Wissenberg, Mads; Weeke, Peter; Zinckernagel, Line; Ruwald, Martin H; Karlsson, Lena; Gislason, Gunnar Hilmar; Nielsen, Søren Loumann; Køber, Lars; Torp-Pedersen, Christian; Folke, Fredrik

    2014-11-18

    Although increased dissemination of automated external defibrillators (AEDs) has been associated with more frequent AED use, the trade-off between the number of deployed AEDs and coverage of cardiac arrests remains unclear. We investigated how volunteer-based AED dissemination affected public cardiac arrest coverage in high- and low-risk areas. All public cardiac arrests (1994-2011) and all registered AEDs (2007-2011) in Copenhagen, Denmark, were identified and geocoded. AED coverage of cardiac arrests was defined as historical arrests ≤100 m from an AED. High-risk areas were defined as those with ≥1 arrest every 2 years and accounted for 1.0% of the total city area. Of 1864 cardiac arrests, 18.0% (n=335) occurred in high-risk areas throughout the study period. From 2007 to 2011, the number of AEDs and the corresponding coverage of cardiac arrests increased from 36 to 552 and from 2.7% to 32.6%, respectively. The corresponding increase for high-risk areas was from 1 to 30 AEDs and coverage from 5.7% to 51.3%, respectively. Since the establishment of the AED network (2007-2011), few arrests (n=55) have occurred ≤100 m from an AED with only 14.5% (n=8) being defibrillated before the arrival of emergency medical services. Despite the lack of a coordinated public access defibrillation program, the number of AEDs increased 15-fold with a corresponding increase in cardiac arrest coverage from 2.7% to 32.6% over a 5-year period. The highest increase in coverage was observed in high-risk areas (from 5.7% to 51.3%). AED networks can be used as useful tools to optimize AED placement in community settings. © 2014 American Heart Association, Inc.

  13. PFP Emergency Lighting Study

    International Nuclear Information System (INIS)

    BUSCH, M.S.

    2000-01-01

    NFPA 101, section 5-9 mandates that, where required by building classification, all designated emergency egress routes be provided with adequate emergency lighting in the event of a normal lighting outage. Emergency lighting is to be arranged so that egress routes are illuminated to an average of 1.0 footcandle with a minimum at any point of 0.1 footcandle, as measured at floor level. These levels are permitted to drop to 60% of their original value over the required 90 minute emergency lighting duration after a power outage. The Plutonium Finishing Plant (PFP) has two designations for battery powered egress lights ''Emergency Lights'' are those battery powered lights required by NFPA 101 to provide lighting along officially designated egress routes in those buildings meeting the correct occupancy requirements. Emergency Lights are maintained on a monthly basis by procedure ZSR-12N-001. ''Backup Lights'' are battery powered lights not required by NFPA, but installed in areas where additional light may be needed. The Backup Light locations were identified by PFP Safety and Engineering based on several factors. (1) General occupancy and type of work in the area. Areas occupied briefly during a shiftly surveillance do not require backup lighting while a room occupied fairly frequently or for significant lengths of time will need one or two Backup lights to provide general illumination of the egress points. (2) Complexity of the egress routes. Office spaces with a standard hallway/room configuration will not require Backup Lights while a large room with several subdivisions or irregularly placed rooms, doors, and equipment will require Backup Lights to make egress safer. (3) Reasonable balance between the safety benefits of additional lighting and the man-hours/exposure required for periodic light maintenance. In some plant areas such as building 236-Z, the additional maintenance time and risk of contamination do not warrant having Backup Lights installed in all rooms

  14. [Cardiac tamponade disclosing systemic lupus erythematosus].

    Science.gov (United States)

    Nour-Eddine, M; Bennis, A; Soulami, S; Chraibi, N

    1996-02-01

    Cardiac tamponade secondary to systemic lupus erythematosus is rare and has a very serious prognosis. The authors report a case of cardiac tamponade confirmed by echocardiography, which constituted the presenting sign of systemic lupus erythematosus in a 20-year-old patient, who required emergency pericardial aspiration. The diagnosis of systemic lupus erythematosus was established on the basis of the combination of pericardial involvement, non-erosive arthritis, leukopenia with lymphopenia, presence of LE cells and anti-native DNA antibodies and positive antinuclear antibody titre of 1/2560. The clinical course was favourable in response to 3 months of corticosteroid treatment. The possibility of SLE should be considered in any case of cardiac tamponade in a young patient in which the aetiology is not explained.

  15. High users of VA emergency room facilities: are outpatients abusing the system or is the system abusing them?

    Science.gov (United States)

    Schneider, K C; Dove, H G

    1983-01-01

    A phenomenon well known to emergency room personnel is the high use of ER facilities by a small number of patients. In this study of 335 patients followed in outpatient specialty clinics at a university-affiliated VA medical center, 23% of the patients accounted for 73% of the ER visits. Although some patients may be abusing the system, the problem is difficult to correct because of congressional legislation that deters the VA from providing primary care. Thus, a small subset of patients with chronic medical problems who live close to the hospital are likely to continue to consume a disproportionate amount of ER resources.

  16. Fast tracking in paediatric cardiac anaesthesia : an update.

    Directory of Open Access Journals (Sweden)

    Lake Carol

    2002-01-01

    Full Text Available A care plan in which cardiac surgical patients progress quickly through the perioperative course to hospital discharge is often referred to as a Fast Track. Such care plans have been used extensively in adult cardiac patients but are also applicable to paediatric patients. Although no randomised controlled trials are available to document a reduction in hospital costs and avoidance of iatrogenic complications with paediatric fast tracks, many healthcare administrators encourage their use. Fast Track clinical guidelines usually include same day surgery, use of short- acting anaesthetic drugs, early extubation, effective pain management, and reduced intensive care unit stays. These protocols are certainly appropriate for simple procedures such as repair of atrial or ventricular septal defects or ligation of a patent ductus arteriosus. However, many paediatric cardiac anaesthesiologists consider that all paediatric patients without significant pulmonary or residual cardiac pathology can be managed using expedited postoperative protocols. Essential components in a "fast track" protocol include use of minimally invasive surgical techniques, modified ultrafiltration during cardiopulmonary bypass, transoesophageal echocardiography to evaluate the cardiac repair, and postoperative pain control. Using such techniques, 80-90% of paediatric patients can be extubated in the operating room or within 2-4 hours postoperatively. Despite the opinions of recognised experts, an appropriately sized and powered multicentre, controlled, randomised, prospective study is still needed to conclusively document the efficiency and effectiveness of the Fast Track in paediatric cardiac patients.

  17. Pericardial Effusion with Cardiac Tamponade as a Form of Presentation of Primary Hypothyroidism

    Directory of Open Access Journals (Sweden)

    Rachid Acir

    2002-01-01

    Full Text Available The authors describe a case of pericardial effusion accompanied by cardiac tamponade caused by primary hypothyroidism. Diagnosis was made by exclusion, because other causes of cardiac tamponade are more frequent. Emergency treatment of cardiac tamponade is pericardiocentesis (with possible pericardial window, and, after stabilization, performance of hormonal reposition therapy with L-thyroxin.

  18. Cardiac Intensive Care Unit Management of Patients After Cardiac Arrest: Now the Real Work Begins.

    Science.gov (United States)

    Randhawa, Varinder K; Grunau, Brian E; Debicki, Derek B; Zhou, Jian; Hegazy, Ahmed F; McPherson, Terry; Nagpal, A Dave

    2018-02-01

    Survival with a good quality of life after cardiac arrest continues to be abysmal. Coordinated resuscitative care does not end with the effective return of spontaneous circulation (ROSC)-in fact, quite the contrary is true. Along with identifying and appropriately treating the precipitating cause, various components of the post-cardiac arrest syndrome also require diligent observation and management, including post-cardiac arrest neurologic injury and myocardial dysfunction, systemic ischemia-reperfusion phenomenon with potential consequent multiorgan failure, and the various sequelae of critical illness. There is growing evidence that an early invasive approach to coronary reperfusion with percutaneous coronary intervention, together with active targeted temperature management and optimization of hemodynamic, ventilator, and metabolic parameters, may improve survival and neurologic outcomes in cardiac arrest survivors. Neuroprognostication is complex, as are survivorship issues and long-term rehabilitation. Our paramedics, emergency physicians, and resuscitation specialists are all to be congratulated for ever-increasing success with ROSC… but now the real work begins. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  19. Air medical transport of cardiac patients.

    Science.gov (United States)

    Essebag, Vidal; Halabi, Abdul R; Churchill-Smith, Michael; Lutchmedial, Sohrab

    2003-11-01

    The air medical transport of cardiac patients is a rapidly expanding practice. For various medical, social, and economic indications, patients are being flown longer distances at commercial altitudes, including international and intercontinental flights. There are data supporting the use of short-distance helicopter flights early in the course of a cardiac event for patients needing emergent transfer for percutaneous coronary intervention or aortocoronary bypass. When considering elective long-distance air medical transport of cardiac patients for social or economic reasons, it is necessary to weigh the benefits against the potential risks of flight. A few recent studies suggest that long-distance air medical transport is safe under certain circumstances. Current guidelines for air travel after myocardial infarction do not address the use of medical escorts or air ambulances equipped with intensive care facilities. Further research using larger prospective studies is needed to better define criteria for safe long-distance air medical transport of cardiac patients.

  20. Contributions of pulmonary hypertension to HIV-related cardiac dysfunction

    Directory of Open Access Journals (Sweden)

    Godsent C. Isiguzo

    2013-09-01

    Conclusion: Immune-suppression affects the cardiac function adversely and coexisting pulmonary hypertension contributes to poor systolic and diastolic function in affected patients. The subtle nature of presentation of pulmonary hypertension and other cardiac dysfunctions in HIV/AIDS patients demand a high-index of suspicion and early intervention if detected, to ensure better care for these emerging threats to our patients.

  1. Relationship between admission blood glucose level and prognosis in elderly patients without previously known diabetes who undergo emergency non-cardiac surgery.

    Science.gov (United States)

    Ma, Jinling; He, Lei; Wang, Xiujie; Gao, Meng; Zhao, Yuexiang; Liu, Jie

    2015-08-01

    Elevated blood glucose levels on admission are important as a marker for adverse events in patients who undergo surgery. This study aims to evaluate the relationship between admission glucose level and adverse outcome during the 30-day follow-up period in elderly patients without previously known diabetes who undergo emergency non-cardiac surgery. The primary and secondary end points were all-cause and major adverse cardiac event (MACE) mortalities, respectively, during the 30-day postoperative follow-up period. Higher 30-day all-cause (24.1 %) and MACE (13.7 %) mortalities were observed in patients with an admission glucose ≥ 11.1 mmol/L than in patients with admission glucose blood glucose level is an independent predictor for the development of the 30-day all-cause mortality [odds ratio (OR), 1.91; 95 % confidence interval (CI), 1.746-2.082; p blood glucose level ≥ 11.1 mmol/L has worse event-free survival than an admission blood glucose level <11.1 mmol/L.

  2. Transient cardiac arrest in patient with left ventricular noncompaction (spongiform cardiomyopathy).

    Science.gov (United States)

    Yamazaki, Shinya; Ito, Hiroshi; Kawaai, Hiroyoshi

    2011-01-01

    Left ventricular noncompaction (LVNC), also known as spongiform cardiomyopathy, is a severe disease that has not previously been discussed with respect to general anesthesia. We treated a child with LVNC who experienced cardiac arrest. Dental treatment under general anesthesia was scheduled because the patient had a risk of endocarditis due to dental caries along with a history of being uncooperative for dental care. During sevoflurane induction, severe hypotension and laryngospasm resulted in cardiac arrest. Basic life support (cardiopulmonary resuscitation) was initiated to resuscitate the child, and his cardiorespiratory condition improved. Thereafter, an opioid-based anesthetic was performed, and recovery was smooth. In LVNC, opioid-based anesthesia is suggested to avoid the significant cardiac suppression seen with a volatile anesthetic, once intravenous access is established. Additionally, all operating room staff should master Advanced Cardiac Life Support/Pediatric Advanced Life Support (including intraosseous access), and more than 1 anesthesiologist should be present to induce general anesthesia, if possible, for this high-risk patient.

  3. The operating room of the future: observations and commentary.

    Science.gov (United States)

    Satava, Richard M

    2003-09-01

    The Operating Room of the Future is a construct upon which to develop the next generation of operating environments for the patient, surgeon, and operating team. Analysis of the suite of visions for the Operating Room of the Future reveals a broad set of goals, with a clear overall solution to create a safe environment for high-quality healthcare. The vision, although planned for the future, is based upon iteratively improving and integrating current systems, both technology and process. This must become the Operating Room of Today, which will require the enormous efforts described. An alternative future of the operating room, based upon emergence of disruptive technologies, is also presented.

  4. Emerging Cardiac Imaging Modalities for the Early Detection of Cardiotoxicity Due to Anticancer Therapies.

    Science.gov (United States)

    López-Fernández, Teresa; Thavendiranathan, Paaladinesh

    2017-06-01

    The undeniable advances in the field of oncology have finally led to a decrease in overall cancer-related mortality. However, this population of long-term cancer survivors is now facing a shift toward a substantial increase in cardiovascular morbidity and mortality. Because the development of overt cardiotoxicity can be associated with poor outcomes, preclinical identification of cardiac toxicity is important. This will promote early instauration of treatments to prevent overt heart dysfunction and allow oncologists to continue cancer therapy in an uninterrupted manner. Surveillance strategies for the early detection of cardiac injury include cardiac imaging and biomarkers during treatment. In this review, we outline existing cardiac imaging modalities to detect myocardial changes in patients undergoing cancer treatment and in survivors, and their strengths and limitations. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  5. A randomised, double-blind, multi-centre trial comparing vasopressin and adrenaline in patients with cardiac arrest presenting to or in the Emergency Department.

    Science.gov (United States)

    Ong, Marcus Eng Hock; Tiah, Ling; Leong, Benjamin Sieu-Hon; Tan, Elaine Ching Ching; Ong, Victor Yeok Kein; Tan, Elizabeth Ai Theng; Poh, Bee Yen; Pek, Pin Pin; Chen, Yuming

    2012-08-01

    To compare vasopressin and adrenaline in the treatment of patients with cardiac arrest presenting to or in the Emergency Department (ED). A randomised, double-blind, multi-centre, parallel-design clinical trial in four adult hospitals. Eligible cardiac arrest patients (confirmed by the absence of pulse, unresponsiveness and apnea) aged >16 (aged>21 for one hospital) were randomly assigned to intravenous adrenaline (1mg) or vasopressin (40 IU) at ED. Patients with traumatic cardiac arrest or contraindication for cardiopulmonary resuscitation (CPR) were excluded. Patients received additional open label doses of adrenaline as per current guidelines. Primary outcome was survival to hospital discharge (defined as participant discharged alive or survival to 30 days post-arrest). The study recruited 727 participants (adrenaline = 353; vasopressin = 374). Baseline characteristics of the two groups were comparable. Eight participants (2.3%) from adrenaline and 11 (2.9%) from vasopressin group survived to hospital discharge with no significant difference between groups (p = 0.27, RR = 1.72, 95% CI = 0.65-4.51). After adjustment for race, medical history, bystander CPR and prior adrenaline given, more participants survived to hospital admission with vasopressin (22.2%) than with adrenaline (16.7%) (p = 0.05, RR = 1.43, 95% CI = 1.02-2.04). Sub-group analysis suggested improved outcomes for vasopressin in participants with prolonged arrest times. Combination of vasopressin and adrenaline did not improve long term survival but seemed to improve survival to admission in patients with prolonged cardiac arrest. Further studies on the effect of vasopressin combined with therapeutic hypothermia on patients with prolonged cardiac arrest are needed. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  6. A room of one's own--Being cared for in a hospital with a single-bed room design.

    Science.gov (United States)

    Persson, Eva; Anderberg, Patrice; Ekwall, Anna Kristensson

    2015-06-01

    To illuminate patients' experiences of being hospitalised in a hospital with a single-bed room design. Many patients seem to prefer single-bed hospital rooms. However, studies have also shown that patients do see the advantages of multiple-bed rooms. Interviews were conducted with 16 inpatients from a surgical ward in a hospital building with a single-bed room design. A hermeneutical-phenomenological approach guided by van Manen's four life-world existentials was used to analyse the interviews. The essential meaning was that patients felt secure because they could create a personal environment without disruptive elements. The room was private, and this implied feelings of homeliness, which allowed patients to focus on themselves and was thought to facilitate the recovery process. The patients preferred staying in their room, and the relationship with the personnel was central. Feelings of loneliness and isolation could occur and could be frightening. Being hospitalised in a single-bed room meant balancing between feeling secure and feeling insecure. The following four themes emerged: A homely environment, The need for company and security, Time as unpredictable and involving waiting and Focus on healing the body. Patients experienced that a single-bed room allowed them to focus on their recovery, have visitors without disturbing others and create a feeling of homeliness. However, mobilisation is not a natural part of the recovery process when patients have all they need in their rooms. The patients' need for social interaction and confirmation was not satisfied without effort and planning on the part of staff. © 2014 Nordic College of Caring Science.

  7. When to use the emergency room - adult

    Science.gov (United States)

    ... feeling or inability to move Electric shock or lightning strike Severe burn Severe chest pain or pressure ... 2016. American College of Emergency Physicians. Urgent care fact sheet. newsroom.acep.org/fact_sheets?item=30033 . ...

  8. Screening Criteria for a Room Cooling Failure of the AFW MDP Room

    International Nuclear Information System (INIS)

    Hwang, Mee Jeong; Yoon, Churl; Yang, Joon Eon; Park, Joo Hwan

    2006-01-01

    In this paper, we performed a heat up calculation for the Auxiliary Feedwater Motor Operated Pump (AFW MDP) room, PAB-077-11A with CFX-10 and RATT when the HVAC (Heating, Ventilation, and Air Condition) system is failed. We also reviewed the operability of the components under a loss of the HVAC. Room cooling failure does not need to be modeled if the components maintain their operability after a loss of a room cooling function during the mission time. ASME Standard describes that a recovery action can be credited if the related recovery action is included in the procedure or there are similar recovery experiences in the plant. However, there is no description about the recovery action of the HVAC in the EOP (Emergency Operation Procedure) of the UCN3, 4 under the situation of a loss of the HVAC. However, if we consider the HVAC failure in the PSA FT model, the problem is that the unavailability induced from a loss of the HVAC is unrealistically high. From a viewpoint of the PSA, it is not true that the related system always fails even if the HVAC system fails. Therefore, we reviewed the necessity of the HVAC model through two cases of a room heat up calculation under the situation of a loss of the HVAC system with conservative and realistic input data respectively

  9. Cardiac patients' perceptions of neighboring patients' risk: influence on psychological stress in the ED and subsequent posttraumatic stress.

    Science.gov (United States)

    Konrad, Beatrice; Hiti, David; Chang, Bernard P; Retuerto, Jessica; Julian, Jacob; Edmondson, Donald

    2017-11-06

    As many as 12% of acute coronary syndrome (ACS) patients screen positive for post-traumatic stress disorder (PTSD) symptoms due to their cardiac event, and emergency department (ED) factors such as overcrowding have been associated with risk for PTSD. We tested the association of patients' perceptions of their proximity to a critically ill patient during ED evaluation for ACS with development of posttraumatic stress symptoms (PSS) in the month after hospital discharge. Participants were enrolled in the REactions to Acute Care and Hospitalization (REACH) study during evaluation for ACS in an urban ED. Participants reported whether they perceived a patient near them was close to death. They also reported their current fear, concern they may die, perceived control, and feelings of vulnerability on an Emergency Room Perceptions questionnaire. One month later, participants reported on PTSD symptoms specific to the cardiac event and ED hospitalization. Of 763 participants, 12% reported perceiving a nearby patient was likely to die. In a multivariate linear regression model [F(9757) = 19.69, p accounting for 62% of the adjusted effect and causing the main effect to become statistically nonsignificant. We found patients who perceived a nearby patient was likely to die had significantly greater PTSD symptoms at 1 month. Awareness of this association may be helpful for designing ED patient management procedures to identify and treat patients with an eye to post-ACS psychological care.

  10. Perception and Attitude of Emergency Room Resident Physicians toward Middle East Respiratory Syndrome Outbreak

    Directory of Open Access Journals (Sweden)

    Mohammed Al Ghobain

    2017-01-01

    Full Text Available Introduction. Middle East respiratory syndrome (MERS outbreaks have had a considerable negative impact on health systems in Saudi Arabia. We aimed to study the psychological impact of a Middle East respiratory syndrome coronavirus (MERS-CoV outbreak on emergency room resident physicians (ERRPs. Methods. We assessed the MERS-related psychological impact and concerns of ERRPs using a self-report questionnaire. Results. The majority (91% of the ERRPs agreed that their work put them at risk of infection, but most (65% did not agree that they should not be looking after patients infected with MERS. Despite that, 54% of ERRPs reported being afraid of contracting the infection from infected patients and only 4.2% of them were willing to change their current job. The majority of the ERRPs (85% felt that their job would expose their families to risk of infection. Conclusions. Our study demonstrated the considerable psychological impact of MERS outbreaks on ERRPs. The ERRPs’ concerns and the psychological impact of MERS outbreaks should be considered in greater detail by hospital policymakers.

  11. Transitory electrocardiographic abnormalities following blunt cardiac trauma: Case report and literature review

    Directory of Open Access Journals (Sweden)

    J. Valle-Alonso

    2018-01-01

    Full Text Available Blunt cardiac trauma (BCT includes a number of diseases ranging from clinically silent arrhythmias to lethal cardiac wall rupture. The most common form is “cardiac contusion”, which is currently under debate. The absence of a clear definition and the lack of diagnostic tests of choice make diagnosing cardiac contusion difficult. We present the case report of a healthy young patient who went to the emergency department with electrocardiogram changes following blunt chest trauma, and review the current literature on the subject.

  12. Developing Emergency Room Key Performance Indicators: What to Measure and Why Should We Measure It?

    Science.gov (United States)

    Khalifa, Mohamed; Zabani, Ibrahim

    2016-01-01

    Emergency Room (ER) performance has been a timely topic for both healthcare practitioners and researchers. King Faisal Specialist Hospital and Research Center, Saudi Arabia worked on developing a comprehensive set of KPIs to monitor, evaluate and improve the performance of the ER. A combined approach using quantitative and qualitative methods was used to collect and analyze the data. 34 KPIs were developed and sorted into the three components of the ER patient flow model; input, throughput and output. Input indicators included number and acuity of ER patients, patients leaving without being seen and revisit rates. Throughput indicators included number of active ER beds, ratio of ER patients to ER staff and the length of stay including waiting time and treatment time. The turnaround time of supportive services, such as lab, radiology and medications, were also included. Output indicators include boarding time and available hospital beds, ICU beds and patients waiting for admission.

  13. Associations among emergency room visits, parenting styles, and psychopathology among pediatric patients with sickle cell.

    Science.gov (United States)

    Latzman, Robert D; Shishido, Yuri; Latzman, Natasha E; Elkin, T David; Majumdar, Suvankar

    2014-10-01

    To examine associations between frequency of emergency room (ER) visits and various parenting styles, both conjointly and interactively, and psychopathological outcomes among pediatric patients with sickle cell disease (SCD). Ninety-eight parents/caregivers of 6- to 18-year-old patients with SCD completed instruments assessing parenting style, child psychopathology, and reported on the frequency of ER visits during the previous year. ER visits were found to significantly explain Withdrawn/Depressed problems and parenting styles were found to incrementally contribute to the explanation of all forms of psychopathology. Further, Permissive parenting was found to explain Rule Breaking Behavior for those patients with low ER visit frequency but not for those with high ER visit frequency. Results of the current study confirm the importance of considering both the frequency of ER visits and parenting style in the explanation of psychopathology among pediatric patients with SCD. Results have important implications for both research and treatment. © 2014 Wiley Periodicals, Inc.

  14. The association of emergency department administration of sodium bicarbonate after out of hospital cardiac arrest with outcomes.

    Science.gov (United States)

    Chen, Yi-Chuan; Hung, Ming-Szu; Liu, Chia-Yen; Hsiao, Cheng-Ting; Yang, Yao-Hsu

    2018-03-05

    Sodium bicarbonate administration is mostly restricted to in-hospital use in Taiwan. This study was conducted to investigate the effect of sodium bicarbonate on outcomes among patients with out-of-hospital cardiac arrest (OHCA). This population-based study used a 16-year database to analyze the association between sodium bicarbonate administration for resuscitation in the emergency department (ED) and outcomes. All adult patients with OHCA were identified through diagnostic and procedure codes. The primary outcome was survival to hospital admission and secondary outcome was the rate of death within the first 30days of incidence of cardiac arrest. Cox proportional-hazards regression, logistic regression, and propensity analyses were conducted. Among 5589 total OHCA patients, 15.1% (844) had survival to hospital admission. For all patients, a positive association was noted between sodium bicarbonate administration during resuscitation in the ED and survival to hospital admission (adjusted odds ratio [OR]: 4.47; 95% confidence interval [CI]: 3.82-5.22, p<0.001). In propensity-matched patients, a positive association was also noted (adjusted OR, 4.61; 95% CI: 3.90-5.46, p<0.001). Among patients with OHCA in Taiwan, administration of sodium bicarbonate during ED resuscitation was significantly associated with an increased rate of survival to hospital admission. Copyright © 2018. Published by Elsevier Inc.

  15. [Effect of dexmedetomidine on emergence agitation after general anesthesia in children undergoing odontotherapy in day-surgery operating room].

    Science.gov (United States)

    Lin, Luo; Yueming, Zhang; Meisheng, Li; Jiexue, Wang; Yang, Ji

    2017-12-01

    To study the effectiveness of dexmedetomidine used for general anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room in reducing the incidence of emergence agitation (EA). Eighty children undergoing odontotherapy and under general anesthesia in day-surgery operating room were randomized into two groups, group A (n=40) and group B (n=40). Each patient in group A was administered with a bolus dose of dexmedetomidine (1.0 μg·kg⁻¹, saline diluted to 10 mL) pump-infused after intubation and a maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Each patient in group B was administered with a bolus dose of normal saline 10 mL pump-infused after intubation and maintenance dose of 0.1-0.4 mL·(kg·h)⁻¹ followed-up until 45 min before the end of operation. Gender, age, weight, physical status according to the American Society of Anesthesiologists, perioperative heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), sufentanil dosage, duration of surgery, time of extubation, time of regaining consciousness, and time to reach modified Aldrete's score≥12 were recorded. Behavior in postanesthesia care unit was rated on the four-point agitation scale. Compared with group B, decreases were observed in HR and MAP at the beginning of operation, in 10 and 30 min, 1 and 2 h after the beginning of operation, and after extubation of group A (Pgeneral anesthesia maintenance in children undergoing odontotherapy in day-surgery operating room, dexmedetomidine results in low incidence of EA during recovery and more stable vital signs.

  16. Cardiac Myosin Binding Protein-C Autoantibodies Are Potential Early Indicators of Cardiac Dysfunction and Patient Outcome in Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Thomas L. Lynch, IVPhD

    2017-04-01

    Full Text Available Summary: The degradation and release of cardiac myosin binding protein-C (cMyBP-C upon cardiac damage may stimulate an inflammatory response and autoantibody (AAb production. We determined whether the presence of cMyBP-C-AAbs associated with adverse cardiac function in cardiovascular disease patients. Importantly, cMyBP-C-AAbs were significantly detected in acute coronary syndrome patient sera upon arrival to the emergency department, particularly in ST-segment elevation myocardial infarction patients. Patients positive for cMyBP-C-AAbs had reduced left ventricular ejection fraction and elevated levels of clinical biomarkers of myocardial infarction. We conclude that cMyBP-C-AAbs may serve as early predictive indicators of deteriorating cardiac function and patient outcome in acute coronary syndrome patients prior to the infarction. Key Words: acute myocardial infarction, autoantibodies, cardiac myosin binding protein-c, cardiomyopathy

  17. Metabolites in Blood for Prediction of Bacteremic Sepsis in the Emergency Room.

    Directory of Open Access Journals (Sweden)

    Anna M Kauppi

    Full Text Available A metabolomics approach for prediction of bacteremic sepsis in patients in the emergency room (ER was investigated. In a prospective study, whole blood samples from 65 patients with bacteremic sepsis and 49 ER controls were compared. The blood samples were analyzed using gas chromatography coupled to time-of-flight mass spectrometry. Multivariate and logistic regression modeling using metabolites identified by chromatography or using conventional laboratory parameters and clinical scores of infection were employed. A predictive model of bacteremic sepsis with 107 metabolites was developed and validated. The number of metabolites was reduced stepwise until identifying a set of 6 predictive metabolites. A 6-metabolite predictive logistic regression model showed a sensitivity of 0.91(95% CI 0.69-0.99 and a specificity 0.84 (95% CI 0.58-0.94 with an AUC of 0.93 (95% CI 0.89-1.01. Myristic acid was the single most predictive metabolite, with a sensitivity of 1.00 (95% CI 0.85-1.00 and specificity of 0.95 (95% CI 0.74-0.99, and performed better than various combinations of conventional laboratory and clinical parameters. We found that a metabolomics approach for analysis of acute blood samples was useful for identification of patients with bacteremic sepsis. Metabolomics should be further evaluated as a new tool for infection diagnostics.

  18. Youth Versus Adult “Weightlifting” Injuries Presenting to United States Emergency Rooms: Accidental Versus Nonaccidental Injury Mechanisms

    Science.gov (United States)

    Myer, Gregory D.; Quatman, Carmen E.; Khoury, Jane; Wall, Eric J.; Hewett, Timothy E.

    2014-01-01

    Myer, GD, Quatman, CE, Khoury, J, Wall, EJ, and Hewett, TE. Youth versus adult “weightlifting” injuries presenting to united states emergency rooms: accidental versus nonaccidental injury mechanisms. J Strength Cond Res 23(7): 2054–2060, 2009—Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for “Weightlifting.” Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as “accidental” if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4, 111 patients. Accidental injuries decreased (p 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p injuries (n = 2, 565) showed that the oldest categories (19–22 and 23–30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to “dropping” and “pinching” in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13 group relative to all other groups (p injuries are the result of accidents that are potentially

  19. Extracorporeal life support in pediatric cardiac patients

    Directory of Open Access Journals (Sweden)

    Matteo Di NARDO

    2016-10-01

    Full Text Available Extracorporeal Life Support (ECLS is a valuable tool in the management of neonates and older children with severe cardiac or respiratory failure. In this review, we focus on ECLS when used for neonatal and pediatric cardiac disease. Strict selection of patients and timely deployment are necessary to optimize outcomes. Although every attempt should be made to deploy ECLS urgently rather than emergently, extracorporeal cardiopulmonary resuscitation (ECPR is being increasingly used and reasonable survival rates have been achieved after initiation of ECLS during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS are falling over time, although lethal chromosomal abnormalities, severe irreversible brain injury, and extremely low gestational age and weight (<32 weeks gestation or <1.5 kg remain firm contraindications.

  20. CARDIAC EMERGENCY: LIFT UP YOUR HEARTS

    CERN Multimedia

    2000-01-01

    50 000 deaths every year in France following heart problems. You or someone close to you, a friend, a relative, a colleague at work. You all probably know someone who has had a heart attack. Noting that 80% of all deaths occur outside hospital, the Fédération Française de Cardiologie, working in collaboration with first aid groups (rescue associations, etc.), are launching a nationwide campaign to train as many people as possible in what to do for cardiac first aid. According to specialists, more than half of all heart attack victims could have survived if someone nearby had been quick at doing what was needed. The CERN Fire Brigade is helping in this campaign by offering two free training sessions, each lasting three hours and mainly based on recognizing a heart attack, the proper way of calling for help, and practice in mouth-to-mouth resuscitation and heart massage. The courses will be held on 20 November and 6 December from4 to 7 p.m. at Building 65. So don’t wait, stop b...

  1. Witnessed arrest, but not delayed bystander cardiopulmonary resuscitation improves prehospital cardiac arrest survival.

    Science.gov (United States)

    Vukmir, R B

    2004-05-01

    This study correlated the effect of witnessing a cardiac arrest and instituting bystander CPR (ByCPR), as a secondary end point in a study evaluating the effect of bicarbonate on survival. This prospective, randomised, double blinded clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered in a prehospital urban, suburban, and rural regional emergency medical service (EMS) area. This group underwent conventional advanced cardiac life support intervention followed by empiric early administration of sodium bicarbonate (1 mEq/l), monitoring conventional resuscitation parameters. Survival was measured as presence of vital signs on emergency department (ED) arrival. Data were analysed using chi(2) with Pearson correlation and odds ratio where appropriate. The overall survival rate was 13.9% (110 of 792) of prehospital cardiac arrest patients. The mean (SD) time until provision of bystander cardiopulmonary resuscitation (ByCPR) by laymen was 2.08 (2.77) minutes, and basic life support (BLS) by emergency medical technicians was 6.62 (5.73) minutes. There was improved survival noted with witnessed cardiac arrest-a 2.2-fold increase in survival, 18.9% (76 of 402) versus 8.6% (27 of 315) compared with unwitnessed arrests (ptwo minutes (p = 0.3752). Survival after prehospital cardiac arrest is more likely when witnessed, but not necessarily when ByCPR was performed by laymen.

  2. Use of the emergency room in Elliot Lake, a rural community of Northern Ontario, Canada.

    Science.gov (United States)

    Harris, L; Bombin, M; Chi, F; DeBortoli, T; Long, J

    2004-01-01

    There is ample documentation that use of hospital emergency facilities for reasons other than urgencies/emergencies results in clogged services in many urban centers. However, little has been published about similar misuse of emergency rooms/departments in rural and remote areas, where the situation is usually compounded by a scarcity of healthcare professionals. In Canada there is a shortage of physicians in rural and remote areas as a consequence of misdistribution (most physicians staying in southern urban centers after residence), and there is a chronic misuse of facilities meant for urgencies/emergencies to cope with primary healthcare needs. We address the problem in Elliot Lake, a rural Northern Ontario community of 12,000 people. The economy of Elliot Lake was based on uranium mining until the mid-1990s, when it drastically changed to become a center for affordable retirement and recreational tourism. As a consequence, at the present time the proportion of seniors in Elliot Lake doubles the Canadian average. Our objectives are to elucidate the demographics of emergency room (ER) clients and the effect of the elderly population; the nature of ER use; the perceived level of urgency of clients versus health professionals; and possible alternatives offered to non-urgent/emergency visits. This is the first study of the kind in Northern Ontario, a region the size of France. The study, conducted in July 2001, used a prospective survey, completed by patients and attending clinicians at the time of a patient's presentation to the ER of St Joseph's General Hospital. This hospital is staffed by family physicians, a nurse practitioner, and registered nurses (RNs). The catchment area population (town plus surrounding areas) of the hospital is approximately 18,000 people. ER clients were interviewed verbally, and the attending health professionals responded to written questionnaires. Demographics were recorded (age, sex, employment and marital status), as was each client

  3. Protective effects of ulinastatin on cardiac dysfunction in mice with heat stroke and its mechanism

    Directory of Open Access Journals (Sweden)

    Jing-jing JI

    2017-06-01

    Full Text Available Objective To examine the effects of ulinastatin (UTI on cardiac dysfunction in mice with heat stroke and its possible mechanism. Methods 20 mice were divided into four groups randomly: room temperature plus normal saline (Sham+NS, room temperature plus UTI (Sham+UTI, heat stress plus normal saline (HS+NS, heat stress plus UTI (HS+UTI, 5 each. 105U/kg UTI was delivered by intraperitoneal injection before the onset of the heat stress. Room temperature groups were housed at room temperature (23.0±0.5℃, while heat stress groups were kept in an incubator at 36.5±0.5℃ and humidity of 65.0%±2.0%. The rectal temperature (Tr reaching 42℃ was taken as severe heat stroke, and the time in two heat stress groups was recorded. The mice were transferred to the room temperature (23.0±0.5℃ for natural cooling after the heat stroke onset. 6 hours after the treatment, cardiac output (CO was ultrasonographically detected, the myocardium was separated for histopathological examination and the expression of total p38 and phosphorylated p38 (p-p38 was determined by Western blotting. Results The time to reach 42℃ in HS+UTI group was significantly prolonged (P=0.044. Compared with the Sham+NS group, the CO in HS+NS and HS+UTI group decreased significantly (P=0.017, and the score of myocardial inflammation (P<0.001 and p-p38/p38 ratio (P<0.001 increased. The CO was significantly higher in HS+UTI group than in HS+NS group (P=0.030, and the score of myocardial inflammation (P<0.001 and p-p38/p38 ratio (P=0.001 were significantly lower. Conclusion Ulinastatin might improve the cardiac function in mice with heat stroke by decreasing the p-p38 and alleviating the inflammation response. DOI: 10.11855/j.issn.0577-7402.2017.04.04

  4. Role of imaging in evaluation of sudden cardiac death risk in hypertrophic cardiomyopathy.

    Science.gov (United States)

    Geske, Jeffrey B; Ommen, Steve R

    2015-09-01

    Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiomyopathy and is associated with sudden cardiac death (SCD) - an uncommon but devastating clinical outcome. This review is designed to assess the role of imaging in established risk factor assessment and its role in emerging SCD risk stratification. Recent publications have highlighted the crucial role of imaging in HCM SCD risk stratification. Left ventricular hypertrophy assessment remains the key imaging determinant of risk. Data continue to emerge on the role of systolic dysfunction, apical aneurysms, left atrial enlargement and left ventricular outflow tract obstruction as markers of risk. Quantitative assessment of delayed myocardial enhancement and T1 mapping on cardiac MRI continue to evolve. Recent multicenter trials have allowed multivariate SCD risk assessment in large HCM cohorts. Given aggregate risk with presence of multiple risk factors, a single parameter should not be used in isolation to determine implantable cardiac defibrillator candidacy. Use of all available imaging data, including cardiac magnetic resonance tissue characterization, allows a comprehensive approach to SCD stratification and implantable cardiac defibrillator decision-making.

  5. Cardiac magnetic resonance assessment of takotsubo cardiomyopathy

    International Nuclear Information System (INIS)

    Abbas, A.; Sonnex, E.; Pereira, R.S.; Coulden, R.A.

    2016-01-01

    Takotsubo cardiomyopathy is an important condition that can be difficult to differentiate from acute coronary syndrome on the basis of clinical, electrocardiogram, and cardiac enzyme assessment alone. Although coronary angiography remains important in the acute assessment of patients with suspected takotsubo cardiomyopathy, cardiac magnetic resonance (CMR) has emerged over the last decade as an important non-invasive imaging tool in the diagnosis and follow-up of this condition. We present a review highlighting the CMR features of takotsubo cardiomyopathy and its complications with particular focus on differentiating this condition from acute myocardial infarction and myocarditis.

  6. Functional modulation of cardiac form through regionally confined cell shape changes.

    Directory of Open Access Journals (Sweden)

    Heidi J Auman

    2007-03-01

    Full Text Available Developing organs acquire a specific three-dimensional form that ensures their normal function. Cardiac function, for example, depends upon properly shaped chambers that emerge from a primitive heart tube. The cellular mechanisms that control chamber shape are not yet understood. Here, we demonstrate that chamber morphology develops via changes in cell morphology, and we determine key regulatory influences on this process. Focusing on the development of the ventricular chamber in zebrafish, we show that cardiomyocyte cell shape changes underlie the formation of characteristic chamber curvatures. In particular, cardiomyocyte elongation occurs within a confined area that forms the ventricular outer curvature. Because cardiac contractility and blood flow begin before chambers emerge, cardiac function has the potential to influence chamber curvature formation. Employing zebrafish mutants with functional deficiencies, we find that blood flow and contractility independently regulate cell shape changes in the emerging ventricle. Reduction of circulation limits the extent of cardiomyocyte elongation; in contrast, disruption of sarcomere formation releases limitations on cardiomyocyte dimensions. Thus, the acquisition of normal cardiomyocyte morphology requires a balance between extrinsic and intrinsic physical forces. Together, these data establish regionally confined cell shape change as a cellular mechanism for chamber emergence and as a link in the relationship between form and function during organ morphogenesis.

  7. Intraoperative and recovery room outcome | Edomwonyi | East ...

    African Journals Online (AJOL)

    Objectives: To identify and quantitate anaesthesia related complications in the intraoperative period and in the post anaesthesia recovery room. Design: A prospective study. Setting: University of Benin Teaching Hospital; a University - affiliated tertiary centre. Subjects: Patients scheduled for elective and emergency surgery ...

  8. Role of Nuclear Medicine in the cardiac resinchronization therapy

    Energy Technology Data Exchange (ETDEWEB)

    Brandao, Simone Cristina Soares, E-mail: simonecordis@yahoo.com.br [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil); Giorgi, Maria Clementina Pinto; D' Orio, Silvana Angelina; Meneghetti, Jose Claudio [Instituto do Coracao (InCor/FM/USP), Sao Paulo, SP (Brazil)

    2011-10-15

    Cardiac resynchronization therapy (CRT) emerged as one of the most promising approaches in the treatment of cardiac dyssynchrony in heart failure patients' refractory to medical treatment. However, despite very promising clinical and functional results, individual response analyses show that a significant number of patients do not respond to treatment. The role of nuclear medicine and molecular imaging in the selection of CRT candidates by the assessment of cardiac dyssynchrony, myocardial viability, myocardial perfusion and blood flow and sympathetic cardiac activity has been discussed in this review. The potential utilization of this tool to improve the comprehension of detrimental effects of dyssynchrony on cardiac function and the evaluation and monitoring of the response to CRT were also considered. Other molecular targets that characterize glucose and fatty acid metabolism, apoptosis, angiotensin converting enzyme activity and angiogenesis that can be evaluated with this technique were described. (author)

  9. Role of Nuclear Medicine in the cardiac resinchronization therapy

    Energy Technology Data Exchange (ETDEWEB)

    Brandao, Simone Cristina Soares, E-mail: simonecordis@yahoo.com.br [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil); Giorgi, Maria Clementina Pinto; D' Orio, Silvana Angelina; Meneghetti, Jose Claudio [Instituto do Coracao (InCor/FM/USP), Sao Paulo, SP (Brazil)

    2011-10-15

    Cardiac resynchronization therapy (CRT) emerged as one of the most promising approaches in the treatment of cardiac dyssynchrony in heart failure patients' refractory to medical treatment. However, despite very promising clinical and functional results, individual response analyses show that a significant number of patients do not respond to treatment. The role of nuclear medicine and molecular imaging in the selection of CRT candidates by the assessment of cardiac dyssynchrony, myocardial viability, myocardial perfusion and blood flow and sympathetic cardiac activity has been discussed in this review. The potential utilization of this tool to improve the comprehension of detrimental effects of dyssynchrony on cardiac function and the evaluation and monitoring of the response to CRT were also considered. Other molecular targets that characterize glucose and fatty acid metabolism, apoptosis, angiotensin converting enzyme activity and angiogenesis that can be evaluated with this technique were described. (author)

  10. Guidelines for control room design reviews

    International Nuclear Information System (INIS)

    1981-09-01

    whether the control room provides the system status information, control capabilities, feedback, and analytic aids necessary for control room operators to accomplish their functions effectively. To identify characteristics of the existing control room instrumentation, controls, other equipment, and physical arrangements that may detract from operator performance. o analyze and evaluate the problems that could arise from discrepancies of the above kinds, and to analyze means of correcting those discrepancies which could lead to substantial problems. To define and put into effect a plan of action that applies human factors principles to improve control room design and enhance operator effectiveness. Particular emphasis should be placed on improvements affecting control room design and operator performance under abnormal or emergency conditions. To integrate the control room design review with other areas of human factors inquiry identified in the NRC Task Action Plan

  11. Brain-Heart Interaction: Cardiac Complications After Stroke.

    Science.gov (United States)

    Chen, Zhili; Venkat, Poornima; Seyfried, Don; Chopp, Michael; Yan, Tao; Chen, Jieli

    2017-08-04

    Neurocardiology is an emerging specialty that addresses the interaction between the brain and the heart, that is, the effects of cardiac injury on the brain and the effects of brain injury on the heart. This review article focuses on cardiac dysfunction in the setting of stroke such as ischemic stroke, brain hemorrhage, and subarachnoid hemorrhage. The majority of post-stroke deaths are attributed to neurological damage, and cardiovascular complications are the second leading cause of post-stroke mortality. Accumulating clinical and experimental evidence suggests a causal relationship between brain damage and heart dysfunction. Thus, it is important to determine whether cardiac dysfunction is triggered by stroke, is an unrelated complication, or is the underlying cause of stroke. Stroke-induced cardiac damage may lead to fatality or potentially lifelong cardiac problems (such as heart failure), or to mild and recoverable damage such as neurogenic stress cardiomyopathy and Takotsubo cardiomyopathy. The role of location and lateralization of brain lesions after stroke in brain-heart interaction; clinical biomarkers and manifestations of cardiac complications; and underlying mechanisms of brain-heart interaction after stroke, such as the hypothalamic-pituitary-adrenal axis; catecholamine surge; sympathetic and parasympathetic regulation; microvesicles; microRNAs; gut microbiome, immunoresponse, and systemic inflammation, are discussed. © 2017 American Heart Association, Inc.

  12. Effects of environmental conditions on point-of-care cardiac biomarker test performance during a simulated rescue: implications for emergency and disaster response.

    Science.gov (United States)

    Louie, Richard F; Ferguson, William J; Curtis, Corbin M; Vy, John H; Tang, Chloe S; Kost, Gerald J

    2013-01-01

    To characterize the effects of environmental stress on point-of-care (POC) cardiac biomarker testing during a simulated rescue. Multiplex test cassettes for cardiac troponin I (cTnI), brain natriuretic peptide (BNP), CK-MB, myoglobin, and D-dimer were exposed to environmental stresses simulating a 24-hour rescue from Hawaii to the Marshall Islands and back. We used Tenney environmental chambers (T2RC and BTRC) to simulate flight conditions (20°C, 10 percent relative humidity) and ground conditions (22.3-33.9°C, 73-77 percent). We obtained paired measurements using stressed versus control (room temperature) cassettes at seven time points (T1-7 with T1,2,6,7 during flight and T3-5 on ground). We analyzed paired differences (stressed minus control) with Wilcoxon signed rank test. We assessed the impact on decision-making at clinical thresholds. cTnI results from stressed test cassettes (n = 10) at T4 (p 100 ng/L. With sample median concentration of 108 pg/mL, BNP results from stressed test cassettes differed significantly from controls (p < 0.05). Despite modest, short-term temperature elevation, environmental stresses led to erroneous results. False negative cTnI and BNP results potentially could miss acute myocardial infarction and congestive heart failure, confounded treatment, and increased mortality and morbidity. Therefore, rescuers should protect POC reagents from temperature extremes.

  13. Sedation for procedures outside the operating room in children

    International Nuclear Information System (INIS)

    Molina Rodriguez, Ericka

    2014-01-01

    Sedation is defined in the pediatric population. An adequate preoperative assessment is established in patients subjected to a sedation. Fundamental characteristics of drugs used during a sedation are determined. Recommendations about surveillance and monitoring are established in a patient sedated. Principal characteristics of sedation are defined in patients exposed to radiological diagnostic and therapeutic procedures. Considerations in sedation are identified for procedures in the laboratory of digestive endoscopy. Alternatives of sedation are mentioned for oncological patients subjected to invasive procedures. Working conditions and specifications of anesthesia are determined in the cardiac catheterization room [es

  14. Cardiac asthma in elderly patients: incidence, clinical presentation and outcome

    Directory of Open Access Journals (Sweden)

    Ray Patrick

    2007-05-01

    Full Text Available Abstract Background Cardiac asthma is common, but has been poorly investigated. The objective was to compare the characteristics and outcome of cardiac asthma with that of classical congestive heart failure (CHF in elderly patients. Methods Prospective study in an 1,800-bed teaching hospital. Results Two hundred and twelve consecutive patients aged ≥ 65 years presenting with dyspnea due to CHF (mean age of 82 ± 8 years were included. Findings of cardiac echocardiography and natriuretic peptides levels were used to confirm CHF. Cardiac asthma patients were defined as a patient with CHF and wheezing reported by attending physician upon admission to the emergency department. The CHF group (n = 137 and the cardiac asthma group (n = 75, differed for tobacco use (34% vs. 59%, p 2 (47 ± 15 vs. 41 ± 11 mmHg, p Conclusion Patients with cardiac asthma represented one third of CHF in elderly patients. They were more hypercapnic and experienced more distal airway obstruction. However, outcomes were similar.

  15. A simulator-based nuclear reactor emergency response training exercise.

    Science.gov (United States)

    Waller, Edward; Bereznai, George; Shaw, John; Chaput, Joseph; Lafortune, Jean-Francois

    Training offsite emergency response personnel basic awareness of onsite control room operations during nuclear power plant emergency conditions was the primary objective of a week-long workshop conducted on a CANDU® virtual nuclear reactor simulator available at the University of Ontario Institute of Technology, Oshawa, Canada. The workshop was designed to examine both normal and abnormal reactor operating conditions, and to observe the conditions in the control room that may have impact on the subsequent offsite emergency response. The workshop was attended by participants from a number of countries encompassing diverse job functions related to nuclear emergency response. Objectives of the workshop were to provide opportunities for participants to act in the roles of control room personnel under different reactor operating scenarios, providing a unique experience for participants to interact with the simulator in real-time, and providing increased awareness of control room operations during accident conditions. The ability to "pause" the simulator during exercises allowed the instructors to evaluate and critique the performance of participants, and to provide context with respect to potential offsite emergency actions. Feedback from the participants highlighted (i) advantages of observing and participating "hands-on" with operational exercises, (ii) their general unfamiliarity with control room operational procedures and arrangements prior to the workshop, (iii) awareness of the vast quantity of detailed control room procedures for both normal and transient conditions, and (iv) appreciation of the increased workload for the operators in the control room during a transient from normal operations. Based upon participant feedback, it was determined that the objectives of the training had been met, and that future workshops should be conducted.

  16. Design, operation, and safety of single-room interventional MRI suites: practical experience from two centers.

    Science.gov (United States)

    White, Mark J; Thornton, John S; Hawkes, David J; Hill, Derek L G; Kitchen, Neil; Mancini, Laura; McEvoy, Andrew W; Razavi, Reza; Wilson, Sally; Yousry, Tarek; Keevil, Stephen F

    2015-01-01

    The design and operation of a facility in which a magnetic resonance imaging (MRI) scanner is incorporated into a room used for surgical or endovascular cardiac interventions presents several challenges. MR safety must be maintained in the presence of a much wider variety of equipment than is found in a diagnostic unit, and of staff unfamiliar with the MRI environment, without compromising the safety and practicality of the interventional procedure. Both the MR-guided cardiac interventional unit at Kings College London and the intraoperative imaging suite at the National Hospital for Neurology and Neurosurgery are single-room interventional facilities incorporating 1.5 T cylindrical-bore MRI scanners. The two units employ similar strategies to maintain MR safety, both in original design and day-to-day operational workflows, and between them over a decade of incident-free practice has been accumulated. This article outlines these strategies, highlighting both similarities and differences between the units, as well as some lessons learned and resulting procedural changes made in both units since installation. © 2014 Wiley Periodicals, Inc.

  17. [Surgical Repair for Blunt Cardiac Rupture].

    Science.gov (United States)

    Yashiki, Noriyoshi; Yachi, Tsuyoshi; Takahashi, Tomohiko

    2017-07-01

    Blunt cardiac injury is a life-threatening condition. We report 3 successful cases in which we performed surgery for blunt cardiac injury. Three individuals were injured, 2 in traffic accidents and the other being caught between a crane and a steel frame. Echocardiograms and computed tomography scans revealed pooling of bloody pericardial fluid in all 3 patients, who underwent emergency surgery. Two patients needed sutures to control persistent bleeding. Although a heart-lung machine was prepared at the start of surgery in all 3 cases, we did not need to use it for any patient. Thus, prior to performing such surgery, it is necessary to ascertain its need.

  18. LABORATORY BIOMARKERS TO FACILITATE DIFFERENTIAL DIAGNOSIS BETWEEN MEASLES AND KAWASAKI DISEASE IN A PEDIATRIC EMERGENCY ROOM: A RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Danilo Buonsenso

    2018-05-01

    Full Text Available This retrospective study was conducted to analyze clinical and laboratoristic parameters to individuate specific differences and facilitate differential diagnosis between Measles and Kawasaki Disease (KD at first evaluation in a emergency room. We found similar clinical features as duration of fever and number of KD criteria (p >0.5 but significant differences in white blood cell count, neutrophils, CRP and LDH levels (p < 0.001. LDH value ≥ 800 mg/dl had sensibility of 89% and specificity of 90% for Measles while CRP ≥ 3 mg/dl had sensibility 89% and specificity of 85% for KD. The combined use of CRP, LDH and AST showed accuracy of 86.67%.

  19. Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study.

    Science.gov (United States)

    Varvarigou, Vasileia; Farioli, Andrea; Korre, Maria; Sato, Sho; Dahabreh, Issa J; Kales, Stefanos N

    2014-11-18

    To assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties. Case distribution study (case series with survey information on referent exposures). United States law enforcement. Summaries of deaths of over 4500 US police officers provided by the National Law Enforcement Officers Memorial Fund and the Officer Down Memorial Page from 1984 to 2010. Observed and expected sudden cardiac death counts and relative risks for sudden cardiac death events during specific strenuous duties versus routine/non-emergency activities. Independent estimates of the proportion of time that police officers spend across various law enforcement duties obtained from surveys of police chiefs and front line officers. Impact of varying exposure assessments, covariates, and missing cases in sensitivity and stability analyses. 441 sudden cardiac deaths were observed during the study period. Sudden cardiac death was associated with restraints/altercations (25%, n=108), physical training (20%, n=88), pursuits of suspects (12%, n=53), medical/rescue operations (8%, n=34), routine duties (23%, n=101), and other activities (11%, n=57). Compared with routine/non-emergency activities, the risk of sudden cardiac death was 34-69 times higher during restraints/altercations, 32-51 times higher during pursuits, 20-23 times higher during physical training, and 6-9 times higher during medical/rescue operations. Results were robust to all sensitivity and stability analyses. Stressful law enforcement duties are associated with a risk of sudden cardiac death that is markedly higher than the risk during routine/non-emergency duties. Restraints/altercations and pursuits are associated with the greatest risk. Our findings have public health implications and suggest that primary and secondary cardiovascular prevention efforts are needed among law enforcement officers. © Varvarigou et al 2014.

  20. Association of a culturally defined syndrome (nervios) with chest pain and DSM-IV affective disorders in Hispanic patients referred for cardiac stress testing.

    Science.gov (United States)

    Pavlik, Valory N; Hyman, David J; Wendt, Juliet A; Orengo, Claudia

    2004-01-01

    Hispanics have a high prevalence of cardiovascular risk factors, most notably type 2 diabetes. However, in a large public hospital in Houston, Texas, Hispanic patients referred for cardiac stress testing were significantly more likely to have normal test results than were Whites or non-Hispanic Blacks. We undertook an exploratory study to determine if nervios, a culturally based syndrome that shares similarities with both panic disorder and anginal symptoms, is sufficiently prevalent among Hispanics referred for cardiac testing to be considered as a possible explanation for the high probability of a normal test result. Hispanic patients were recruited consecutively when they presented for a cardiac stress test. A bilingual interviewer administered a brief medical history, the Rose Angina Questionnaire (RAQ), a questionnaire to assess a history of nervios and associated symptoms, and the PRIME-MD, a validated brief questionnaire to diagnose DSM-IV defined affective disorders. The average age of the 114 participants (38 men and 76 women) was 57 years, and the average educational attainment was 7 years. Overall, 50% of participants reported a history of chronic nervios, and 14% reported an acute subtype known as ataque de nervios. Only 2% of patients had DSM-IV defined panic disorder, and 59% of patients had a positive RAQ score (ie, Rose questionnaire angina). The acute subtype, ataque de nervios, but not chronic nervios, was related to an increased probability of having Rose questionnaire angina (P=.006). Adjusted for covariates, a positive history of chronic nervios, but not Rose questionnaire angina, was significantly associated with a normal cardiac test result (OR=2.97, P=.04). Nervios is common among Hispanics with symptoms of cardiac disease. Additional research is needed to understand how nervios symptoms differ from chest pain in Hispanics and the role of nervios in referral for cardiac workup by primary care providers and emergency room personnel.

  1. Impact of implementing an exclusively dedicated respiratory isolation room in a Brazilian tertiary emergency department.

    Science.gov (United States)

    Lobo, Rômulo Rebouças; Borges, Marcos Carvalho; Neves, Fábio Fernandes; Vidal de Moura Negrini, Bento; Colleto, Francisco Antonio; Romeo Boullosa, José Luiz; Camila de Miranda Cardoso, Maria; Pazin-Filho, Antonio

    2011-09-01

    Occupational risk due to airborne disease challenges healthcare institutions. Environmental measures are effective but their cost-effectiveness is still debatable and most of the capacity planning is based on occupational rates. Better indices to plan and evaluate capacity are needed. To evaluate the impact of installing an exclusively dedicated respiratory isolation room (EDRIR) in a tertiary emergency department (ED) determined by a time-to-reach-facility method. A group of patients in need of respiratory isolation were first identified--group I (2004; 29 patients; 44.1±3.4 years) and the occupational rate and time intervals (arrival to diagnosis, diagnosis to respiratory isolation indication and indication to effective isolation) were determined and it was estimated that adding an EDRIR would have a significant impact over the time to isolation. After implementing the EDRIR, a second group of patients was gathered in the same period of the year--group II (2007; 50 patients; 43.4±1.8 years) and demographic and functional parameters were recorded to evaluate time to isolation. Cox proportional hazard models adjusted for age, gender and inhospital respiratory isolation room availability were obtained. Implementing an EDRIR decreased the time from arrival to indication of respiratory isolation (27.5±9.3 × 3.7±2.0; p=0.0180) and from indication to effective respiratory isolation (13.3±3.0 × 2.94±1.06; p=0.003) but not the respiratory isolation duration and total hospital stay. The impact on crude isolation rates was very significant (8.9 × 75.4/100.000 patients; p<0.001). The HR for effective respiratory isolation was 26.8 (95% CI 7.42 to 96.9) p<0.001 greater for 2007. Implementing an EDRIR in a tertiary ED significantly reduced the time to respiratory isolation.

  2. FRAMEWORK AND APPLICATION FOR MODELING CONTROL ROOM CREW PERFORMANCE AT NUCLEAR POWER PLANTS

    Energy Technology Data Exchange (ETDEWEB)

    Ronald L Boring; David I Gertman; Tuan Q Tran; Brian F Gore

    2008-09-01

    This paper summarizes an emerging project regarding the utilization of high-fidelity MIDAS simulations for visualizing and modeling control room crew performance at nuclear power plants. The key envisioned uses for MIDAS-based control room simulations are: (i) the estimation of human error associated with advanced control room equipment and configurations, (ii) the investigative determination of contributory cognitive factors for risk significant scenarios involving control room operating crews, and (iii) the certification of reduced staffing levels in advanced control rooms. It is proposed that MIDAS serves as a key component for the effective modeling of cognition, elements of situation awareness, and risk associated with human performance in next generation control rooms.

  3. FRAMEWORK AND APPLICATION FOR MODELING CONTROL ROOM CREW PERFORMANCE AT NUCLEAR POWER PLANTS

    International Nuclear Information System (INIS)

    Ronald L Boring; David I Gertman; Tuan Q Tran; Brian F Gore

    2008-01-01

    This paper summarizes an emerging project regarding the utilization of high-fidelity MIDAS simulations for visualizing and modeling control room crew performance at nuclear power plants. The key envisioned uses for MIDAS-based control room simulations are: (1) the estimation of human error associated with advanced control room equipment and configurations, (2) the investigative determination of contributory cognitive factors for risk significant scenarios involving control room operating crews, and (3) the certification of reduced staffing levels in advanced control rooms. It is proposed that MIDAS serves as a key component for the effective modeling of cognition, elements of situation awareness, and risk associated with human performance in next generation control rooms

  4. [Design and application of user managing system of cardiac remote monitoring network].

    Science.gov (United States)

    Chen, Shouqiang; Zhang, Jianmin; Yuan, Feng; Gao, Haiqing

    2007-12-01

    According to inpatient records, data managing demand of cardiac remote monitoring network and computer, this software was designed with relative database ACCESS. Its interface, operational button and menu were designed in VBA language assistantly. Its design included collective design, amity, practicability and compatibility. Its function consisted of registering, inquiring, statisticing and printing, et al. It could be used to manage users effectively and could be helpful to exerting important action of cardiac remote monitoring network in preventing cardiac-vascular emergency ulteriorly.

  5. [Operating room during natural disaster: lessons from the 2011 Tohoku earthquake].

    Science.gov (United States)

    Fukuda, Ikuo; Hashimoto, Hiroshi; Suzuki, Yasuyuki; Satomi, Susumu; Unno, Michiaki; Ohuchi, Noriaki; Nakaji, Shigeyuki

    2012-03-01

    Objective of this study is to clarify damages in operating rooms after the 2011 Tohoku Earthquake. To survey structural and non-structural damage in operating theaters, we sent questionnaires to 155 acute care hospitals in Tohoku area. Questionnaires were sent back from 105 hospitals (70.3%). Total of 280 patients were undergoing any kinds of operations during the earthquake and severe seismic tremor greater than JMA Seismic Intensity 6 hit 49 hospitals. Operating room staffs experienced life-threatening tremor in 41 hospitals. Blackout occurred but emergency electronic supply unit worked immediately in 81 out of 90 hospitals. However, emergency power plant did not work in 9 hospitals. During earthquake some materials fell from shelves in 44 hospitals and medical instruments fell down in 14 hospitals. In 5 hospitals, they experienced collapse of operating room wall or ceiling causing inability to maintain sterile operative field. Damage in electric power and water supply plus damage in logistics made many operating rooms difficult to perform routine surgery for several days. The 2011 Tohoku earthquake affected medical supply in wide area of Tohoku district and induced dysfunction of operating room. Supply-chain management of medical goods should be reconsidered to prepare severe natural disaster.

  6. Predictors of Adverse Outcomes of Patients with Chest Pain and Primary Diagnosis of Non-Cardiac Pain at the Time of Discharge from Emergency Department: A 30-Days Prospective Study.

    Science.gov (United States)

    Soltani, Mohammadhossien; Mirzaei, Masoud; Amin, Ahmad; Emami, Mahmoud; Aryanpoor, Reza; Shamsi, Farimah; Sarebanhassanabadi, Mohammadtaghi

    2016-07-01

    Chest pain is a common symptom for referring patients to emergency departments (ED). Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acute coronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. This study aimed at investigating 30 days' adverse outcomes of patients discharged from ED of a major heart center in Iran. Out of 1638 chest pain admissions to the centre during 2010-2011, 962 patients (mean age= 50.9±15.9 years) who were admitted to Afshar Heart Center's ED with chest pain as their chief complaint, and discharged with primary diagnosis of non-cardiac chest pain, were followed for any adverse cardiac events 30 days post discharge. The adverse events were: unstable angina, non-ST-elevated myocardial infarction (NSTEMI), ST elevated myocardial infarction (STEMI), coronary revascularization (percutaneous angioplasty, coronary artery bypass grafting) and death. Adverse cardiac events, including acute coronary syndrome (ACS), revascularization and death were observed in 30 patients (3.1%) including: acute MI n=5 (0.5%, sudden cardiac death inn=1 (0.1%, coronary revascularization in n=8 (0.8%) and hospitalization due to unstable angina/NSTEMI in n=16 (1-7%). Adverse events were seen more frequently in patients with history of hypertension, dyslipidemia and previous coronary artery disease. In univariate analysis, the chance of postdischarge adverse cardiac events was higher in patients with hypertension (OR=9.36, CI=3.24-27.03), previous coronary artery disease (OR= 3.8, CI=1.78-8.0), dyslipidemia (OR=3.5, CI=1.7-7.38) and discharge against medical advice (OR=2.85, CI= 1.37-5.91). The extent of adverse cardiac events in patients with a primary diagnosis of non-cardiac chest pain within 30 days of discharge was significant, mandating nation-wide registries to provide better care for these patients.

  7. The role of bedside ultrasound in the diagnosis of pericardial effusion and cardiac tamponade

    Directory of Open Access Journals (Sweden)

    Adam Goodman

    2012-01-01

    Full Text Available This review article discusses two clinical cases of patients presenting to the emergency department with pericardial effusions. The role of bedside ultrasound in the detection of pericardial effusions is investigated, with special attention to the specific ultrasound features of cardiac tamponade. Through this review, clinicians caring for patients with pericardial effusions will learn to rapidly diagnose this condition directly at the bedside. Clinicians will also learn to differentiate between simple pericardial effusions in contrast to more complicated effusions causing cardiac tamponade. Indications for emergency pericardiocentesis are covered, so that clinicians can rapidly determine which group of patients will benefit from an emergency procedure to drain the effusion.

  8. Improving outcomes of emergency bowel surgery using nela model

    International Nuclear Information System (INIS)

    Sultan, R.; Zafar, H.

    2018-01-01

    To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA). Study Design:An audit. Place and Duration of Study:Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014. Methodology:Patients undergone emergency bowel surgery during the review period were included. Demographic data, type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome was recorded. Data was then compared with the data published by NELA team in their first report. P-value for categorical variables was calculated using Chi-square tests. Results:Although the patients were younger with nearly same spectrum of disease, the mortality rate was significantly more than reported in NELA (24% versus 11%, p=0.004). Comparison showed that care at AKUH was significantly lacking in terms of proper preoperative risk assessment and documentation, case booking to operating room timing, intraoperative goal directed fluid therapy using cardiac output monitoring, postoperative intensive care for highest risk patients and review of elderly patients by MCOP specialist. Conclusion:This study helped in understanding the deficiencies in the care of patients undergoing emergency bowel surgery and alarmingly poor outcomes in a very systematic manner. In view of results of this study, it is planned to do interventions in the deficient areas to improve care given to these patients and their outcomes with the limited resources of a developing country. (author)

  9. Can sudden cardiac death in the young be predicted and prevented? Lessons from autopsy for the emergency physician.

    Science.gov (United States)

    White, Jennifer L; Chang, Anna Marie; Cesar, Sergi; Sarquella-Brugada, Georgia

    2018-06-01

    Sudden unexpected death in the young, though rare, is devastating for both the family and the community. Although only 1.3 to 8.5 cases of sudden cardiac death (SCD) occur per 100 000 young people, autopsy is often inconclusive. Many causes of SCD are related to autosomal dominant inherited risk, however; therefore, answers are important for survivors. Causes of autopsy-positive SCD in young patients include hypertrophic cardiomyopathy and arrhythmogenic right ventricular dysplasia. Autopsy-negative SCD has been related to inherited arrhythmogenic causes such as long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, Wolff- Parkinson-White syndrome, and idiopathic ventricular fibrillation. The important question for the emergency physician is how SCD can be predicted and prevented in the young so that there is no need for an autopsy.

  10. Gaining control room habitability margin at the Palisades Plant

    International Nuclear Information System (INIS)

    Harden, P.A.

    1993-01-01

    The bounding design-basis accident for control room habitability is the loss-of-coolant accident (LOCA). At Palisades, very little margin existed between the calculated control room operator thyroid dose and the 0.3-Sv (30-rem) limit of Standard Review Plan (SRP) 6.4. Also, a low rate of unfiltered air leakage into the control room during the emergency mode of operation, 5.5 x 10 -3 m 3 /s (11.6 ft 3 /min), was accounted for in the control room habitability analysis. The control room heating, ventilating and air-conditioning system at Palisades has louvered isolation dampers for the normal air intake that are exposed to a negative pressure. Considering the small margin to the thyroid dose limits and the leakage characteristics of louvered dampers, a low allowable rate of unfiltered air in-leakage raised some concern. A significant effort has been initiated to alleviate control room habitability concerns at Palisades. The first step in this effort was to evaluate the calculational models for control room habitability and gain margin through updated analytical methods. To accomplish this, a new radiological consequence analysis for the LOCA was completed

  11. Variação sazonal nos atendimentos de emergência por asma em Gama, Distrito Federal Seasonal variations in emergency room visits for asthma attacks in Gama, Brazil

    Directory of Open Access Journals (Sweden)

    Laércio Moreira Valença

    2006-08-01

    Full Text Available OBJETIVO: Quantificar o atendimento por asma em um serviço de emergência público e estudar a flutuação sazonal, considerando as condições climáticas locais, caracterizadas por duas estações, uma chuvosa e úmida e outra seca. MÉTODOS: Levantamento retrospectivo conduzido em um hospital geral comunitário. Um total de 37.642 consultas emergenciais por asma, bronquite, pneumonia, infecções de vias aéreas superiores e outras condições foram identificadas durante um período de dois anos. As informações constantes em cada guia de atendimento foram levantadas para posterior análise. RESULTADOS: Asma foi o segundo diagnóstico mais freqüente dentre as condições respiratórias (24%. A maioria das consultas por asma foi feita em crianças de zero a catorze anos (56,6%. A análise de regressão mostrou uma variação sazonal dos atendimentos, com concentração significativamente maior de casos de asma no mês de março (p = 0,0109 e concentração menor nos meses de agosto e setembro (p = 0,0485 e p = 0,0169, respectivamente. A correlação entre asma e clima foi mais significativa em relação à flutuação da umidade defasada de um e dois meses (p = 0,0026 e p = 0,0002, respectivamente. CONCLUSÃO: As visitas por asma ao pronto-socorro foram mais freqüentes durante a estação úmida. O aumento do número de casos cresceu um a dois meses após o aumento da umidade e diminuiu no período seco. Essa correlação positiva levanta a possibilidade de uma relação causal com a proliferação de ácaros domésticos e fungos ambientais.OBJECTIVE: To quantify the number of asthma attacks treated in the emergency room of a public hospital and to study seasonal fluctuations, taking into consideration the local climate, which is characterized by having only two seasons: a rainy/humid season and a dry season. METHODS: A retrospective survey was conducted in a community general hospital. A total of 37,642 emergency room consultations

  12. Optimization of the main control room habitability system in nuclear power plant

    International Nuclear Information System (INIS)

    Zheng Guanghui; Zhao Xinyan

    2013-01-01

    This article describes the optimization of main control room habitability system in nuclear power plant. It also describes the design shortage in terms of habitability in the main control room. Through modification and optimization, habitable conditions are met for personnel staying in the emergency area of the main control room for a period of time, with an aim to take accident intervention measures smoothly and reduce the accident loss and radioactive contamination as low as possible. (authors)

  13. Enduring somatic threat perceptions and post-traumatic stress disorder symptoms in survivors of cardiac events.

    Science.gov (United States)

    Meli, Laura; Alcántara, Carmela; Sumner, Jennifer A; Swan, Brendan; Chang, Bernard P; Edmondson, Donald

    2017-04-01

    Post-traumatic stress disorder due to acute cardiovascular events may be uniquely defined by enduring perceptions of somatic threat. We tested whether post-traumatic stress disorder at 1 month post-acute coronary syndrome indeed required both high peritraumatic threat during the acute coronary syndrome and ongoing cardiac threat perceptions. We assessed peritraumatic threat during emergency department enrollment of 284 patients with a provisional acute coronary syndrome diagnosis and cardiac threat perceptions and post-traumatic stress disorder symptoms 1 month post-discharge. In a multiple regression model with adjustment for important covariates, emergency department threat perceptions were associated with higher 1 month post-traumatic stress disorder symptoms only among those with high levels of ongoing cardiac threat.

  14. Functional Relevance of Coronary Artery Disease by Cardiac Magnetic Resonance and Cardiac Computed Tomography: Myocardial Perfusion and Fractional Flow Reserve

    Directory of Open Access Journals (Sweden)

    Gianluca Pontone

    2015-01-01

    Full Text Available Coronary artery disease (CAD is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT, functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach.

  15. Causal Scale of Rotors in a Cardiac System

    Science.gov (United States)

    Ashikaga, Hiroshi; Prieto-Castrillo, Francisco; Kawakatsu, Mari; Dehghani, Nima

    2018-04-01

    Rotors of spiral waves are thought to be one of the potential mechanisms that maintain atrial fibrillation (AF). However, disappointing clinical outcomes of rotor mapping and ablation to eliminate AF raise a serious doubt on rotors as a macro-scale mechanism that causes the micro-scale behavior of individual cardiomyocytes to maintain spiral waves. In this study, we aimed to elucidate the causal relationship between rotors and spiral waves in a numerical model of cardiac excitation. To accomplish the aim, we described the system in a series of spatiotemporal scales by generating a renormalization group, and evaluated the causal architecture of the system by quantifying causal emergence. Causal emergence is an information-theoretic metric that quantifies emergence or reduction between micro- and macro-scale behaviors of a system by evaluating effective information at each scale. We found that the cardiac system with rotors has a spatiotemporal scale at which effective information peaks. A positive correlation between the number of rotors and causal emergence was observed only up to the scale of peak causation. We conclude that rotors are not the universal mechanism to maintain spiral waves at all spatiotemporal scales. This finding may account for the conflicting benefit of rotor ablation in clinical studies.

  16. Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan.

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    Kodai Suzuki

    Full Text Available Although emergency resuscitative thoracotomy is performed as a salvage maneuver for critical blunt trauma patients, evidence supporting superior effectiveness of emergency resuscitative thoracotomy compared to conventional closed-chest compressions remains insufficient. The objective of this study was to investigate whether emergency resuscitative thoracotomy at the emergency department or in the operating room was associated with favourable outcomes after blunt trauma and to compare its effectiveness with that of closed-chest compressions.This was a retrospective nationwide cohort study. Data were obtained from the Japan Trauma Data Bank for the period between 2004 and 2012. The primary and secondary outcomes were patient survival rates 24 h and 28 d after emergency department arrival. Statistical analyses were performed using multivariable generalized mixed-effects regression analysis. We adjusted for the effects of different hospitals by introducing random intercepts in regression analysis to account for the differential quality of emergency resuscitative thoracotomy at hospitals where patients in cardiac arrest were treated. Sensitivity analyses were performed using propensity score matching.In total, 1,377 consecutive, critical blunt trauma patients who received cardiopulmonary resuscitation in the emergency department or operating room were included in the study. Of these patients, 484 (35.1% underwent emergency resuscitative thoracotomy and 893 (64.9% received closed-chest compressions. Compared to closed-chest compressions, emergency resuscitative thoracotomy was associated with lower survival rate 24 h after emergency department arrival (4.5% vs. 17.5%, respectively, P < 0.001 and 28 d after arrival (1.2% vs. 6.0%, respectively, P < 0.001. Multivariable generalized mixed-effects regression analysis with and without a propensity score-matched dataset revealed that the odds ratio for an unfavorable survival rate after 24 h was lower for

  17. Establishing a pediatric cardiac intensive care unit - Special considerations in a limited resources environment

    Directory of Open Access Journals (Sweden)

    Nair Suresh

    2010-01-01

    Full Text Available Pediatric cardiac intensive care has evolved as a distinct discipline in well-established pediatric cardiac programs in developed nations. With increasing demand for pediatric heart surgery in emerging economies, a number of new programs are being established. The development of robust pediatric cardiac intensive care units (PCICU is critical to the success of these programs. Because of substantial resource limitations existing models of PCICU care cannot be applied in their existing forms and structure. A number of challenges need to be addressed to deliver pediatric cardiac intensive care in the developing world. Limitations in infrastructure, human, and material resources call for a number of innovations and adaptations. Additionally, a variety of strategies are required to minimize costs of care to the individual patient. This review provides a framework for the establishment of a new PCICU program in face of resource limitations typically encountered in the developing world and emerging economies.

  18. Cardiac arrest due to lymphocytic colitis: a case report

    Directory of Open Access Journals (Sweden)

    Groth Kristian A

    2012-03-01

    Full Text Available Abstract Introduction We present a case of cardiac arrest due to hypokalemia caused by lymphocytic colitis. Case presentation A 69-year-old Caucasian man presented four months prior to a cardiac arrest with watery diarrhea and was diagnosed with lymphocytic colitis. Our patient experienced a witnessed cardiac arrest at his general practitioner's surgery. Two physicians and the emergency medical services resuscitated our patient for one hour and four minutes before arriving at our university hospital. Our patient was defibrillated 16 times due to the recurrence of ventricular tachyarrhythmias. An arterial blood sample revealed a potassium level of 2.0 mmol/L (reference range: 3.5 to 4.6 mmol/L and pH 6.86 (reference range: pH 7.37 to 7.45. As the potassium level was corrected, the propensity for ventricular tachyarrhythmias ceased. Our patient recovered from his cardiac arrest without any neurological deficit. Further tests and examinations revealed no other reason for the cardiac arrest. Conclusion Diarrhea can cause life-threatening situations due to the excretion of potassium, ultimately causing cardiac arrest due to hypokalemia. Physicians treating patients with severe diarrhea should consider monitoring their electrolyte levels.

  19. Use of task analysis in control room evaluations

    International Nuclear Information System (INIS)

    Ross, K.C.

    1981-01-01

    Responding to recently formulated regulatory requirements, the BWR Owners' Group, working in conjunction with General Electric, has formulated a method for performing human factors design reviews of nuclear power plant control rooms. This process incorporates task analyses to analyze operational aspects of panel layout and design. Correlation of operator functions defined by emergency procedures against required controls and displays has proven successful in identifying instrumentation required in the control room to adequately respond to transient conditions, and in evaluating the effectiveness of panel design and physical arrangement. Extensions of the analysis have provided information on operator response paths, frequency of use of instruments, and control room layout. The techniques used were based on a need to identify primary controls and indications required by the operator in performing each step of the applicable procedure. The relative locations of these instruments were then analyzed for information on the adequacy of the control room design for those conditions

  20. Differences between Impulsive and Non-Impulsive Suicide Attempts among Individuals Treated in Emergency Rooms of South Korea

    Science.gov (United States)

    Lim, Meerae; Lee, Soojung

    2016-01-01

    Objective A considerable proportion of suicide attempts are the result of sudden desires. Understanding such impulsive suicide attempts is necessary for effective interventions. We evaluated the impulsivity of suicide attempters treated in emergency rooms. The aim of the study was to identify the characteristics of impulsive suicide attempts by comparing these individuals to those who attempted to commit suicide in a non-impulsive manner. Methods This study analyzed suicide attempters who visited the emergency departments of seven selected university hospitals. A total of 269 medical records in which impulsivity of suicide attempt were confirmed were subject to be analyzed. The impulsivity of the suicide attempt was examined using a summative score of items 6 and 15 on the Suicide Intent Scale. Results A total of 48.0% of the participants were impelled by sudden inclinations to attempt suicide. Impulsive attempters were younger, unmarried and less physical illness than non-impulsive attempters, whereas no significant differences were found on psychiatric history and previous suicide history. Impulsive suicide attempters had suicide ideations that were not as severe (χ2=55.33, pimpulsive suicide attempts were better than non-impulsive suicide attempts (t=-3.77, psuicide attempts were the result of sudden inclinations. Impulsive attempts were made in relatively earlier stages of suicide ideation; consequently, they have less intent than non-impulsive attempts. PMID:27482239

  1. [Neonatological emergencies in delivery room] [Article in Italian] • Il neonatologo ed alcune emergenze in sala parto

    Directory of Open Access Journals (Sweden)

    Antonio Boldrini

    2014-01-01

    Full Text Available Introduction: In the delivery room the neonatologist may deal with emergencies, not always predictable by pre-natal diagnosis. Among these dangerous situations, we include: i extremely preterm birth of a newborn very/extremely low birth weight and ii shoulder dystocia in term newborns. We will discuss in details these two clinical scenarios. Methods: We reviewed the main recent papers about resuscitation of very/extremely low birth weight preterm newborns and about dystocia of shoulder reported in PubMed database. After that, we compared reported results with practice in our Unit and discussed the topics considering strategies to optimize the results and minimizing possible errors. Discussion and conclusions: In our opinion the optimization of clinical practice in Neonatology should be based on: i national or international recommendations drawn up by commissions or study groups of experts, on the basis of scientific evidence, ii local department protocols, in order to standardize staff interventions within the same unit; iii ongoing training of doctors, nurses and midwives, through simulation sessions and CRM (Crisis Resources Management. As regards shoulder dystocia, The Tuscan Group for Clinical Risk Management drawn a poster to be showed in every delivery room, in order to allow the staff to rapidly remember the correct clinical interventions. On the other hand, as regards ventilatory preterm newborns strategies, the Centro di Formazione e Simulazione NINA is working on a project of a mechatronich simulator for staff training (MERESSINA. Articoli Selezionati del “3° Convegno Pediatrico del Medio Campidano” · Guspini · 25 Maggio 2013 Guest Editor: Roberto Antonucci

  2. Ambient temperature and emergency room admissions for acute coronary syndrome in Taiwan

    Science.gov (United States)

    Liang, Wen-Miin; Liu, Wen-Pin; Chou, Sze-Yuan; Kuo, Hsien-Wen

    2008-01-01

    Acute coronary syndrome (ACS) is an important public health problem around the world. Since there is a considerable seasonal fluctuation in the incidence of ACS, climatic temperature may have an impact on the onset of this disease. The objective of this study was to assess the relationship between the average daily temperature, diurnal temperature range and emergency room (ER) admissions for ACS in an ER in Taichung City, Taiwan. A longitudinal study was conducted which assessed the correlation of the average daily temperature and the diurnal temperature range to ACS admissions to the ER of the city’s largest hospital. Daily ER admissions for ACS and ambient temperature were collected from 1 January 2000 to 31 March 2003. The Poisson regression model was used in the analysis after adjusting for the effects of holiday, season, and air pollutant concentrations. The results showed that there was a negative significant association between the average daily temperature and ER admissions for ACS. ACS admissions to the ER increased 30% to 70% when the average daily temperature was lower than 26.2°C. A positive association between the diurnal temperature range and ACS admissions was also noted. ACS admissions increased 15% when the diurnal temperature range was over 8.3°C. The data indicate that patients suffering from cardiovascular disease must be made aware of the increased risk posed by lower temperatures and larger changes in temperature. Hospitals and ERs should take into account the increased demand of specific facilities during colder weather and wider temperature variations.

  3. New Technologies for Surgery of the Congenital Cardiac Defect

    Directory of Open Access Journals (Sweden)

    David Kalfa

    2013-07-01

    Full Text Available The surgical repair of complex congenital heart defects frequently requires additional tissue in various forms, such as patches, conduits, and valves. These devices often require replacement over a patient’s lifetime because of degeneration, calcification, or lack of growth. The main new technologies in congenital cardiac surgery aim at, on the one hand, avoiding such reoperations and, on the other hand, improving long-term outcomes of devices used to repair or replace diseased structural malformations. These technologies are: 1 new patches: CorMatrix® patches made of decellularized porcine small intestinal submucosa extracellular matrix; 2 new devices: the Melody® valve (for percutaneous pulmonary valve implantation and tissue-engineered valved conduits (either decellularized scaffolds or polymeric scaffolds; and 3 new emerging fields, such as antenatal corrective cardiac surgery or robotically assisted congenital cardiac surgical procedures. These new technologies for structural malformation surgery are still in their infancy but certainly present great promise for the future. But the translation of these emerging technologies to routine health care and public health policy will also largely depend on economic considerations, value judgments, and political factors.

  4. Cardiac tamponade as the initial manifestation of pulmonary adenocarcinoma

    International Nuclear Information System (INIS)

    Letonja, M.; Debeljak, A.

    2007-01-01

    Background. Neoplastic pericarditis can be presented as acute pericarditis, pericardial effusion, effusive constrictive pericarditis or cardiac tamponade. For the majority of patients, a clinical manifestation of neoplastic pericarditis is absent or remains unrecognised during their life. Case report: A 69-year-old non-smoking woman with acute dyspnoea, tachycardia, jugular venous distension, hepatomegaly and right side pleural effusion was presented in the emergency department. The roentgen picture of the chest confirmed pleural effusion and revealed enlarged heart. An emergency echocardiogram established the diagnosis of cardiac tamponade. The patient improved immediately after the therapeutic pericardiocentesis. Cytology of pericardial fluid confirmed malignant glandular cells, consistent with metastatic adenocarcinoma. A computed chest tomography showed a right side pleural effusion and a solitary round lesion in the right lower lobe of the lung. Bronchoscopy with fundoscopic lung biopsy and brushing revealed adenocarcinoma. Cardiac tamponade as the initial manifestation of malignancy is rare and rare is also malignant pericardial effusion due the adenocarcinoma of the lung in a non-smoking woman. The presented patient had one of the longest survival reported in literature despite a limited life expectancy regardless of the treatment in the patient presented with neoplastic pericarditis. (author)

  5. Degree of agreement among sepsis diagnosis criteria in adult emergency room patients with infection

    Science.gov (United States)

    Sinto, R.; Chandra, A. T.; Lie, K. C.; Suwarto, S.

    2018-03-01

    The study on the degree of agreement among three established sepsis diagnosis criteria become the necessity to investigate the best sepsis diagnosis criteria in Indonesia further. A cross-sectional study of adult Emergency Room patients hospitalized with a diagnosis of infection in CiptoMangunkusumo Hospital, Indonesia was conducted during March and April 2017. We recorded diagnosis, gender, age, comorbidities, infection source, and origin. Every subject was classified into sepsis and non-sepsis based on 1991, 2001 and sepsis-3 criteria. Raw % and Kappa agreement coefficients (κ) were calculated according to previously established formula to measure the degree of agreement among three diagnostic criteria. As many as 278 subjects were included in this study. The raw % agreement and κ between 1991 and 2001 criteria is 69.07% and 0.34 respectively. The raw % agreement and κ between 2001 and sepsis-3 criteria is 56.12% and 0.15 respectively. The raw % agreement and κ between 1991 and sepsis-3 criteria is 48.19% and -0.02. In conclusions, there is afair agreement between 1991 and 2001 criteria, poor agreement between 2001 and sepsis-3 criteria, and poor disagreement between 1991 and sepsis-3 criteria. This necessitates further Indonesian study of the best diagnosis criteria to diagnose an infected patient with sepsis.

  6. Antifibrinolytics in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Achal Dhir

    2013-01-01

    Full Text Available Cardiac surgery exerts a significant strain on the blood bank services and is a model example in which a multi-modal blood-conservation strategy is recommended. Significant bleeding during cardiac surgery, enough to cause re-exploration and/or blood transfusion, increases morbidity and mortality. Hyper-fibrinolysis is one of the important contributors to increased bleeding. This knowledge has led to the use of anti-fibrinolytic agents especially in procedures performed under cardiopulmonary bypass. Nothing has been more controversial in recent times than the aprotinin controversy. Since the withdrawal of aprotinin from the world market, the choice of antifibrinolytic agents has been limited to lysine analogues either tranexamic acid (TA or epsilon amino caproic acid (EACA. While proponents of aprotinin still argue against its non-availability. Health Canada has approved its use, albeit under very strict regulations. Antifibrinolytic agents are not without side effects and act like double-edged swords, the stronger the anti-fibrinolytic activity, the more serious the side effects. Aprotinin is the strongest in reducing blood loss, blood transfusion, and possibly, return to the operating room after cardiac surgery. EACA is the least effective, while TA is somewhere in between. Additionally, aprotinin has been implicated in increased mortality and maximum side effects. TA has been shown to increase seizure activity, whereas, EACA seems to have the least side effects. Apparently, these agents do not differentiate between pathological and physiological fibrinolysis and prevent all forms of fibrinolysis leading to possible thrombotic side effects. It would seem prudent to select the right agent knowing its risk-benefit profile for a given patient, under the given circumstances.

  7. [Cardiac computed tomography: new applications of an evolving technique].

    Science.gov (United States)

    Martín, María; Corros, Cecilia; Calvo, Juan; Mesa, Alicia; García-Campos, Ana; Rodríguez, María Luisa; Barreiro, Manuel; Rozado, José; Colunga, Santiago; de la Hera, Jesús M; Morís, César; Luyando, Luis H

    2015-01-01

    During the last years we have witnessed an increasing development of imaging techniques applied in Cardiology. Among them, cardiac computed tomography is an emerging and evolving technique. With the current possibility of very low radiation studies, the applications have expanded and go further coronariography In the present article we review the technical developments of cardiac computed tomography and its new applications. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  8. Giant cardiac hydatid cyst with rare adhesions.

    Science.gov (United States)

    Poorzand, Hoorak; Teshnizi, Mohammad Abbasi; Baghini, Vahid Shojaei; Gifani, Mehrnoosh; Gholoobi, Arash; Zirak, Nahid

    2014-01-01

    We present a 29-year-old woman who was admitted to the emergency department with shortness of breath. Using echocardiography, a giant multi-cystic mass was detected in the right ventricle, attached to the septal leaflet of the tricuspid valve and basal portion of the interventricular septum. Serologic tests (hydatid cyst antibody) confirmed Echinococcus infection. Lung computed tomography with intravenous contrast showed involvement of the pulmonary vasculature. The patient underwent cardiac surgery and the large cardiac cyst and the one in the right pulmonary artery branch were both removed. The tricuspid valve was also replaced by a bioprosthetic one. Albendazole was started preoperatively and was continued for six months after surgery. The patient recovered uneventfully and was followed up for one year. This is a report of a rare case of a very large cardiac hydatid cyst complicated by pulmonary embolism with attachments to both the tricuspid valve and interventricular septum.

  9. A Report of Brugada Syndrome Presenting with Cardiac Arrest Triggered by Verapamil Intoxication.

    Science.gov (United States)

    Yakut, Kahraman; Erdoğan, İlkay; Varan, Birgül; Atar, İlyas

    2017-12-01

    Brugada syndrome is a disease characterized by a specific electrocardiographic pattern and an increased risk of sudden cardiac death. We present this case with the updated literature to emphasise the need to consider the diagnosis of Brugada syndrome in patients admitted to the emergency ward with sudden cardiac arrest. A 16-year-old female patient was admitted to the emergency ward with complaints of weakness and abdominal pain, and she had four cardiac arrests during her evaluation period. She was referred to our clinic for permanent pacemaker implantation. She was on a temporary pace maker after having had C-reactive protein. Her physical exam was normal except for bilaterally decreased lung sounds. Lung x-ray and computed tomography, which were performed by another institution, revealed minimal pleural effusion and nothing else of significance. Blood and peritoneal fluid samples were sterile. Echocardiographic exam and cardiac enzymes were also in the normal ranges. Electrocardiographic showed incomplete right branch block in leads V1 and V2. An ajmaline test revealed specific electrocardiographic findings of the type I Brugada pattern. We proposed implanting an implantable cardioverter defibrillator to the patient as there were positive findings on the ajmaline test as well as a history of sudden cardiac arrest. After this treatment proposal, the patient's family admitted that she had taken a high dose of verapamil and thus, the encountered bradycardia was associated with verapamil overuse. The ajmaline test was repeated as it was contemplated that the previous positive ajmaline test had been associated with verapamil overuse. Implantable cardioverter defibrillator implantation was proposed again as there was a history of sudden cardiac arrest; however, the family did not consent to implantable cardioverter defibrillator, and the patient was discharged and followed up. Brugada syndrome should be considered for patients who are admitted to the emergency ward

  10. Pediatric oncologic emergencies

    International Nuclear Information System (INIS)

    Zietz, Hallie A.

    1997-01-01

    Oncologic emergencies arise in three ways: disease or therapy induced cytopenias; a space occupying lesion causing pressure on or obstruction of surrounding tissues; or leukemia or tumors creating life-threatening metabolic or hormonal problems. Knowledge of presenting signs and symptoms of these emergencies are essential in pediatric oncologic nursing. Neutropenia opens the door for all manner of infections, but the most life threatening is septicemia progressing to shock. A variety of organisms can cause septic shock in the neutropenic patient, but episodes are most often due to gram-negative organisms and the endotoxins they release. Shock, while still compensated, may present with a elevated or subnormal temperature, flushed, warm, dry skin, widening pulse pressure, tachycardia, tachypnoea and irritability, but without medical intervention will progress to hypo tension, cool, clammy extremities, decreased urinary out- put, and eventually to bradycardia and cardiogenic shock. Another emergency in the cytopenia category is bleeding as a result of thrombocytopenia. Of greatest concern is intracranial hemorrhage that may occur at platelet counts of less than 5,000/mm3. Space-occupying lesions of the chest may produce superior vena cava syndrome (SVGS), pleural and pericardial effusions, and cardiac tamponade. SVGS is most often caused by non-Hodgkin's lymphoma (NHL) and presents as cough, hoarseness, dyspnea, orthopnea and chest pain. Signs include swelling, plethora, cyanosis, edema of conjunctiva and wheezing. Pleural and pericardial effusions present with respiratory or cardiac distress as does cardiac tamponade. Abdominal emergencies arise because of inflammation, mechanical obstruction, hemorrhage (often from steroid induced ulcers), and perforation. Pain is the most common presenting symptom, although vital sign alterations, fever, blood in vomitus or stool, abdominal distension and cessation of flatus are also important components of the acute abdomen

  11. The effect of patient origin and relevance of contact on patient and caregiver satisfaction in the emergency room

    DEFF Research Database (Denmark)

    Mygind, Anna; Nørredam, Marie Louise; Nielsen, Anette S

    2008-01-01

    AIMS: This study examined (1) whether patient and caregiver satisfaction in the emergency room (ER) varies according to patient origin, and (2) whether relevance of visit can explain any variation. METHODS: Data were obtained from a questionnaire survey of walk-in patients and their caregivers...... at four ERs in Copenhagen. The patient questionnaire was available in nine languages, and addressed patient satisfaction. The caregiver questionnaire addressed caregiver satisfaction and relevance of the patient contact in the ER. A total of 3,809 patients and 3,905 caregivers responded. The response rate...... satisfaction rates when patients were of Middle Eastern compared with Danish origin. Satisfaction of both groups was associated with the relevance of the visit as assessed by the caregiver. Visits by patients of Middle Eastern origin were less often assessed as being relevant, but caregivers were less...

  12. Commentary on nuclear power plant control room habitability - including a review of related LERs (1981-1983)

    International Nuclear Information System (INIS)

    Moeller, D.W.; Kotra, J.P.

    1985-01-01

    A review of Licensee Event Reports filed by the operator of commercial nuclear power plants from 1981 through 1983 has revealed that approximately 3% pertain to systems that maintain or monitor control room habitability. Dominant contributors were deficiencies in normal and emergency trains of heating, ventilation, air conditioning and air cleaning systems (45%), deficiencies in atmospheric monitors for toxic and radioactive substances (27%) and deficiencies in fire protection systems (13%). To correct the situation revealed by these analyses and by information provided from other sources, it is recommended that the NRC incorporate into its program plan the development of information that anticipates the conditions within a control room during emergencies, and that criteria for habitability within the control room be better defined. In addition, it is suggested than an improved protocol for testing control room air-related systems be developed, that the required thickness and number of layers of charcoal adsorption beds for control room air cleaning systems be re-evaluated, and that steps be taken to improve the quality of heating, ventilating, air conditioning and air cleaning components. It is also recommended that greater emphasis be placed on maintaining nuclear power plant control rooms in a habitable condition during emergencies so that the operators can remain there and safely shut down the plant, in contrast to placing reliance on the use of remote shutdown panels or auxiliary control facilities

  13. Importância da proteína C-reativa no diagnóstico e no prognóstico intra-hospitalar em pacientes com dor torácica na sala de emergência C-reactive protein diagnostic and prognostic value in patients presenting at the emergency room with chest pain

    Directory of Open Access Journals (Sweden)

    Alfredo Antonio Potsch

    2006-09-01

    patients admitted to the emergency room (ER with chest pain (CP without ST-segment elevation on the electrocardiogram (ECG. METHODS: From January 2002 to December 2003, 980 patients were consecutively seen in the ER with CP suggestive of acute coronary syndrome (ACS (age = 64.9 ± 14.3, men = 55%, diabetic = 18%, normal ECG = 84%. Serial CRP, creatine kinase MB mass (CKMB-mass and troponin I determinations were performed on admission, in addition to serial ECG. CRP measurements were standardized (s-CRP by the upper limit of normal (ULN of the test used (3.0 mg/L for high-sensitivity C-reactive protein [hs-CRP] and 0.1 mg/dL for titrated CRP [t-CRP]. RESULTS: One hundred and twenty-five patients were diagnosed with acute myocardial infarction (AMI, and their s-CRP values were 1.31 ± 2.90 (median = 0.47 compared to 0.79 ± 1.39 (0.30 in no-AMI patients (p = 0.031. The s-CRP > 1.0 showed 30% sensitivity and 80% specificity, plus negative and positive predictive values of 6.1% and 96.7%, respectively, for AMI diagnosis. There were forty in-hospital cardiac events (16 deaths, 22 urgent revascularizations, and 2 acute myocardial infarction. In the first quartile of the s-CRP ( 0.93 15 events (p = 0.003 occurred. In the logistic regression model, masculine gender and s-CRP > 0.32 (odds ratio 7.6, 2.8 and 2.2, respectively were independent predictors of cardiac events and left ventricular failure. CONCLUSION: In patients with chest pain presenting at the emergency room, s-CRP was not a good marker of AMI, although this diagnosis is virtually excluded by a normal value; in addition, values one-third above the upper limit of normal (>1 mg/L for hs-CRP or >0.33 mg/dL for t-CRP were predictive of in-hospital adverse cardiac events.

  14. Understanding Key Mechanisms of Exercise-Induced Cardiac Protection to Mitigate Disease: Current Knowledge and Emerging Concepts.

    Science.gov (United States)

    Bernardo, Bianca C; Ooi, Jenny Y Y; Weeks, Kate L; Patterson, Natalie L; McMullen, Julie R

    2018-01-01

    The benefits of exercise on the heart are well recognized, and clinical studies have demonstrated that exercise is an intervention that can improve cardiac function in heart failure patients. This has led to significant research into understanding the key mechanisms responsible for exercise-induced cardiac protection. Here, we summarize molecular mechanisms that regulate exercise-induced cardiac myocyte growth and proliferation. We discuss in detail the effects of exercise on other cardiac cells, organelles, and systems that have received less or little attention and require further investigation. This includes cardiac excitation and contraction, mitochondrial adaptations, cellular stress responses to promote survival (heat shock response, ubiquitin-proteasome system, autophagy-lysosomal system, endoplasmic reticulum unfolded protein response, DNA damage response), extracellular matrix, inflammatory response, and organ-to-organ crosstalk. We summarize therapeutic strategies targeting known regulators of exercise-induced protection and the challenges translating findings from bench to bedside. We conclude that technological advancements that allow for in-depth profiling of the genome, transcriptome, proteome and metabolome, combined with animal and human studies, provide new opportunities for comprehensively defining the signaling and regulatory aspects of cell/organelle functions that underpin the protective properties of exercise. This is likely to lead to the identification of novel biomarkers and therapeutic targets for heart disease.

  15. Using human factors engineering to improve patient safety in the cardiovascular operating room.

    Science.gov (United States)

    Gurses, Ayse P; Martinez, Elizabeth A; Bauer, Laura; Kim, George; Lubomski, Lisa H; Marsteller, Jill A; Pennathur, Priyadarshini R; Goeschel, Chris; Pronovost, Peter J; Thompson, David

    2012-01-01

    Despite significant medical advances, cardiac surgery remains a high risk procedure. Sub-optimal work system design characteristics can contribute to the risks associated with cardiac surgery. However, hazards due to work system characteristics have not been identified in the cardiovascular operating room (CVOR) in sufficient detail to guide improvement efforts. The purpose of this study was to identify and categorize hazards (anything that has the potential to cause a preventable adverse patient safety event) in the CVOR. An interdisciplinary research team used prospective hazard identification methods including direct observations, contextual inquiry, and photographing to collect data in 5 hospitals for a total 22 cardiac surgeries. We performed thematic analysis of the qualitative data guided by a work system model. 60 categories of hazards such as practice variations, high workload, non-compliance with evidence-based guidelines, not including clinicians' in medical device purchasing decisions were found. Results indicated that hazards are common in cardiac surgery and should be eliminated or mitigated to improve patient safety. To improve patient safety in the CVOR, efforts should focus on creating a culture of safety, increasing compliance with evidence based infection control practices, improving communication and teamwork, and designing better tools and technologies through partnership among all stakeholders.

  16. Strategic emergency department design: An approach to capacity planning in healthcare provision in overcrowded emergency rooms.

    Science.gov (United States)

    Exadaktylos, Aristomenis K; Evangelopoulos, Dimitrios S; Wullschleger, Marcel; Bürki, Leo; Zimmermann, Heinz

    2008-11-17

    Healthcare professionals and the public have increasing concerns about the ability of emergency departments to meet current demands. Increased demand for emergency services, mainly caused by a growing number of minor and moderate injuries has reached crisis proportions, especially in the United Kingdom. Numerous efforts have been made to explore the complex causes because it is becoming more and more important to provide adequate healthcare within tight budgets. Optimisation of patient pathways in the emergency department is therefore an important factor.This paper explores the possibilities offered by dynamic simulation tools to improve patient pathways using the emergency department of a busy university teaching hospital in Switzerland as an example.

  17. Type D patients report poorer health status prior to and after cardiac rehabilitation compared to non-type D patients

    DEFF Research Database (Denmark)

    Pelle, Aline J; Erdman, Ruud A M; van Domburg, Ron T

    2008-01-01

    Type D personality is an emerging risk factor in coronary artery disease (CAD). Cardiac rehabilitation (CR) improves outcomes, but little is known about the effects of CR on Type D patients.......Type D personality is an emerging risk factor in coronary artery disease (CAD). Cardiac rehabilitation (CR) improves outcomes, but little is known about the effects of CR on Type D patients....

  18. Impact of smartphone digital photography, email, and media communication on emergency room visits post-hypospadias repair.

    Science.gov (United States)

    Chua, Michael E; Saunders, Megan A; Bowlin, Paul R; Ming, Jessica M; Lopes, Roberto Iglesias; Farhat, Walid A; Dos Santos, Joana

    2017-01-01

    Advances in communication technology are shaping our medical practice. To date, there is no clear evidence that this mode of communication will have any effect on unnecessary postoperative emergency room (ER) visits. We aim to evaluate the effect of email and media communication with application of smartphone digital photography on post-hypospadias repair ER visit rates. This prospective cohort study included all patients who underwent hypospadias repair performed by a single surgeon from October 2014 to November 2015. Patients were categorized into two groups: Group A consented for smartphone photography and email communication and Group B declined. Reason for ER visits within 30 days postoperatively was assessed by another physician, who was blinded of patient group assignment. The reasons were categorized as: unnecessary ER visit, indicated ER visit, or visit unrelated to hypospadias surgery. Chi-square test and T-test were used for statistical analysis. Relative risk (RR) and corresponding 95% confidence interval (CI) were also calculated. Statistical significance was set at pcommunication with the use of smartphone digital photography significantly reduced the number of unnecessary ER visits for post-hypospadias wound checks.

  19. Perspectives on Current Training Guidelines for Cardiac Imaging and Recommendations for the Future.

    Science.gov (United States)

    Arrighi, James A; Kilic, Sena; Haines, Philip G

    2018-04-23

    To summarize current training guidelines for cardiac imaging and provide recommendations for future guidelines. The current structure of training in cardiac imaging is largely dictated by modality-specific guidelines. While there has been debate on how to define the advanced cardiac imager for over a decade, a uniform consensus has not emerged. We report the perspectives of three key stakeholders in this debate: a senior faculty member-former fellowship program director, a cardiology fellow, and an academic junior faculty imaging expert. The observations of these stakeholders suggest that there is no consensus on the definition of advanced cardiac imaging, leading to ambiguity in training guidelines. This may have negative impact on recruitment of fellows into cardiac imaging careers. Based on the current status of training in cardiac imaging, the authors suggest that the relevant professional groups reconvene to form a consensus in defining advanced cardiac imaging, in order to guide future revisions of training guidelines.

  20. Noise and room acoustic conditions in a tertiary referral hospital in Seoul, Korea

    DEFF Research Database (Denmark)

    Jeong, Cheol-Ho; Cho, Wan-Ho; Chang, Ji-ho

    2018-01-01

    Noise levels and room acoustic parameters at a tertiary referral hospital, Seoul National University Hospital in Korea, are investigated. Through a questionnaire, acoustically problematic rooms are identified. Noise levels in emergency rooms (ERs) and intensive care units (ICUs) are measured over...... level for the first night was 66 dBA, which came down to 56 dBA for the next day. The reason for the higher noise level for the first night in the ICU was frequent alarm sound and treatment noise related to a critical patient. The noise level in the measured ERs is about 10 dB lower than those measured...... about three days. Acoustically critical and problematic rooms in the otolaryngology department are measured: examination rooms, operating rooms, nurse stations, patient rooms, and audiometric rooms. The equivalent A-weighted noise level, LAeq, ranges from 54 to 56 dBA in two ERs. In an ICU, the noise...

  1. Williams Syndrome and Anesthesia for Non-cardiac Surgery: High Risk Can Be Mitigated with Appropriate Planning.

    Science.gov (United States)

    Brown, Morgan L; Nasr, Viviane G; Toohey, Rebecca; DiNardo, James A

    2018-03-23

    Patients with Williams syndrome are considered at high risk for anesthesia-related adverse events. At our institution, all William syndrome patients undergoing cardiac surgical, cardiac catheterization/interventional procedures, and cardiac imaging studies are cared for by cardiac anesthesiologists. All William syndrome patients undergoing non-cardiac surgical, interventional, or imaging studies are cared for by main operating room pediatric anesthesiologists with consultative input from a cardiac anesthesiologist. We reviewed our experience with 75 patients undergoing 202 separate anesthetics for 95 non-cardiac procedures and 107 cardiac procedures from 2012 to 2016. The mean age was 7.5 ± 7.0 years and the mean weight was 22.3 ± 17.0 kg. One hundred and eighty-seven patients had a general anesthetic (92.6%). Medications used included etomidate in 26.2%, propofol in 37.6%, isoflurane in 47.5%, and sevoflurane in 68.3%. Vasopressors and inotropes were required including calcium (22.8%), dopamine (10.4%), norepinephrine (17.3%), phenylephrine (35.1%), vasopressin (0.5%), and ephedrine (5.4%). The median length of stay after anesthesia was 2.8 days (range 0-32). No adverse events occurred in 89.6% of anesthetics. There were two cases of cardiac arrest, one of which required extracorporeal life support for resuscitation. Of the non-cardiac surgical procedures, 95.7% did not have a cardiovascular adverse event. Patients with Williams syndrome are at high risk for anesthesia, especially when undergoing cardiac procedures. The risk can be mitigated with appropriate planning and adherence to the hemodynamic goals for non-cardiac surgical procedures.

  2. Emergency cardiac surgery during transfemoral and transapical transcatheter aortic valve implantation: incidence, reasons, management, and outcome of 411 patients from a single center.

    Science.gov (United States)

    Griese, Daniel P; Reents, Wilko; Kerber, Sebastian; Diegeler, Anno; Babin-Ebell, Jörg

    2013-11-01

    Transcatheter aortic valve implantation (TAVI) is increasingly performed in high-risk patients with severe aortic valve stenosis. Incidence and impact of emergency cardiac surgery (ECS) during TAVI is unclear. Two-hundred twenty one transapical (TA) and 190 transfemoral (TF) TAVIs were performed at our hospital between 01/2009 and 12/2012. Twenty patients (4.9%) required ECS, more frequently in the TF- (n = 11; 5.8%) than in the TA-group (n = 9; 4.1%; P = 0.017). ECS-cases were evenly distributed throughout the 4 years. Baseline characteristics of the ECS-patients were not different from the non-ECS-patients. Reasons were acute cardiac failure, coronary obstruction, annular rupture, valve migration, right- and left-ventricular perforation, severe paravalvular leakage, aortic dissection, and mitral valve damage. Surgical intervention consisted of peripheral CPB, switch to TA, thoracotomy and suture of perforated cardiac chambers and conventional aortic valve replacement with concomitant repair of associated cardiovascular injury. Thirty-day mortality was 35.0%, and 55.0% could be salvaged to hospital discharge. Kaplan-Meier 1-year survival curves were significantly impaired for patients requiring ECS (TF: P proportion during TAVI. ECS dramatically affects early and late outcome after TAVI. Under optimal conditions more than half of the ECS-patients can be salvaged. With the current technology of THV-systems ECS should be an integral part of the logistic conditions surrounding TAVI and is far from being futile in this patient population. Copyright © 2013 Wiley Periodicals, Inc.

  3. Brazilian dentists' attitudes about medical emergencies during dental treatment.

    Science.gov (United States)

    Arsati, Franco; Montalli, Victor Angelo; Flório, Flavia Martão; Ramacciato, Juliana Cama; da Cunha, Fernanda Lopes; Cecanho, Rodrigo; de Andrade, Eduardo Dias; Motta, Rogério Heládio Lopes

    2010-06-01

    The main objective of this study was to evaluate the prevalence of emergencies in dental practices and the prepared-ness and the training experience in cardiopulmonary resuscitation (CPR) of Brazilian dentists in dealing with emergencies. The volunteer participants in the study were 498 Brazilian dentists who were present at the 27th International Congress of Dentistry in São Paulo. The most prevalent emergency was presyncope (reported by 54.20 percent of respondents), followed by orthostatic hypotension (44.37 percent), moderate allergic reactions (16.86 percent), hypertensive crisis (15.06 percent), asthma (15.06 percent), syncope (12.65 percent), angina (6.82 percent), convulsion (6.22 percent), hypoglycemia (5.62 percent), hyperventilation crisis (5.22 percent), choking (2.20 percent), and cerebrovascular accident (0.8 percent). Anaphylaxis, myocardial infarction, and cardiac arrest were the rarest emergencies, reported by only 0.4, 0.2, and 0.2 percent of dentists, respectively. Only 41 percent of the dentists judged themselves capable to diagnose the cause of an emergency during a dental visit. The majority responded that they would be capable of performing initial treatment of presyncope, syncope, orthostatic hypotension, convulsion, and choking. However, most of them felt unable to treat anaphylaxis, myocardial infarction, or cardiac arrest. Further, the majority felt unable to perform CPR or undertake an intravenous injection. It was concluded that the most prevalent medical emergencies in dental practice of Brazilian dentists are presyncope and orthostatic hypotension. The occurrence of life-threatening medical emergencies like anaphylaxis, myocardial infarction, cardiac arrest, and cerebrovascular accident is rare. Brazilian dentists are not fully prepared to manage medical emergencies and have insufficient experience training in CPR.

  4. Improving the quality of cardiopulmonary resuscitation by training dedicated cardiac arrest teams incorporating a mechanical load-distributing device at the emergency department.

    Science.gov (United States)

    Ong, Marcus Eng Hock; Quah, Joy Li Juan; Annathurai, Annitha; Noor, Noorkiah Mohamed; Koh, Zhi Xiong; Tan, Kenneth Boon Kiat; Pothiawala, Sohil; Poh, Ah Ho; Loy, Chye Khiaw; Fook-Chong, Stephanie

    2013-04-01

    Determine if implementing cardiac arrest teams trained with a 'pit-crew' protocol incorporating a load-distributing band mechanical CPR device (Autopulse™ ZOLL) improves the quality of CPR, as determined by no-flow ratio (NFR) in the first 10min of resuscitation. A phased, prospective, non-randomized, before-after cohort evaluation. Data collection was from April 2008 to February 2011. There were 100 before and 148 after cases. Continuous video and chest compression data of all study subjects were analyzed. All non-traumatic, collapsed patients aged 18 years and above presenting to the emergency department were eligible. Primary outcome was NFR. Secondary outcomes were return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge. After implementation, mean total NFR for the first 5min decreased from 0.42 to 0.27 (decrease=0.15, 95% CI 0.10-0.19, pCPR ratio increased from 46.4% to 88.4% (increase=41.9%, 95% CI 36.9-46.9, pTraining cardiac arrest teams in a 'pit-crew' protocol may improve the quality of CPR at the ED. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  5. Optimizing survival outcomes for adult patients with nontraumatic cardiac arrest [digest].

    Science.gov (United States)

    Jung, Julianna; Zaurova, Milana

    2016-10-22

    Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm. Management of cardiac arrest in circumstances such as pregnancy, pulmonary embolism, opioid overdose and other toxicologic causes, hypothermia, and coronary ischemia are also reviewed. [Points & Pearls is a digest of Emergency Medicine Practice].

  6. New technologies for control room habitability assessment

    International Nuclear Information System (INIS)

    Lahti, G.P.; Muraida, J.E.; Perchiazzi, W.T.; Harden, P.A.

    1994-01-01

    Older nuclear power plants typically considered only a nominal amount of unfiltered inleakage (typically 10 cfm) impacting their postaccident control room habitability. However, recent measurements of unfiltered inleakage show values in excess of the nominal 10 cfm. A reassessment for two of these ''older'' stations has been completed recently to show that the measured inleakage did not jeopardize the safety of the control room occupants. Recent concerns at the Zion Station and the Palisades Station about control room habitability in the event of a loss-of-coolant accident have led to an extensive effort to increase control room habitability margin. The heating, ventilating and air-conditioning (HVAC) system servicing each of the control rooms has the potential for unfiltered in-leakage through many locations. For example, at the Palisades Station, the current limiting control room habitability analysis allows for 25 cfm unfiltered in-leakage through its normal outside air intake louvered isolation dampers during emergency mode into the control room envelope. This leakage value was not thought to be achievable with the existing as-built configuration. Repairing the system was considered a potential solution; however, this would be costly and could negatively affect plant operation. In addition, the system would still be required to meet the low specified unfiltered in-leakage. An alternate approach was to review the analysis and reassess the most important parameters. The key effort was to determine the atmospheric dispersion factors (χ/Qs) through wind tunnel tests using scale models of the stations. The results of the wind tunnel testing could yield more realistic χ/Qs for control room habitability than previously employed methods. The wind tunnel study options were selected based on their ease of implementation, realistic results, and low cost. More importantly, the results of the studies would allow more realistic values of unfiltered inleakage

  7. Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign

    Directory of Open Access Journals (Sweden)

    Sankalp Dwivedi

    2016-01-01

    Full Text Available Central venous catheter (CVC insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ central venous catheter (CVC insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE revealed a pericardial effusion with tamponade. An emergent bedside pericardiocentesis was done revealing bloody fluid and resulted in clinical stabilization.

  8. ST Elevations and Elevated Cardiac Enzymes Not Always a STEMI: Two Case Reports.

    Science.gov (United States)

    Fernández Fernández, Juan; Deliz-Guzmán, Claudia; Andino-Colón, César; Claudio-Hernández, Héctor; Lugo-Amador, Nannette

    2016-01-01

    Chest pain is a common complaint in the emergency department (ED). Besides a careful history and physical exam; electrocardiogram, laboratory tests and imaging studies are widely available diagnostic tests that are used for patient assessment. When ST elevation and elevated cardiac enzymes are present the most likely diagnosis are ST elevation myocardial infarction (STEMI) or myocarditis. In this case report we present two low risk patients for major adverse cardiac event with ST elevation and elevated cardiac enzymes and how a careful risk assessment and detailed electrocardiogram evaluation could help differentiating between these two diagnoses.

  9. Association between weather conditions and the number of patients at the emergency room in an Argentine hospital

    Science.gov (United States)

    Rusticucci, Matilde; Bettolli, Laura M.; de los Angeles Harris, M.

    2002-02-01

    The aim of this paper is to study the relationships between hospital emergencies and weather conditions by analysing summer and winter cases of patients requiring attention at the emergency room of a hospital in the city of Buenos Aires, Argentina. Hospital data have been sorted into seven different diagnostic groups as follows: (1) respiratory, cardiovascular and chest-pain complaints; (2) digestive, genitourinary and abdominal complaints; (3) neurological and psychopathological disorders; (4) infections; (5) contusion and crushing, bone and muscle complaints; (6) skin and allergies and (7) miscellaneous complaints. In general, there is an increase of 16.7% in winter while, for group 2 and group 6, there are more patients in summer, 54% and 75% respectively. In summer, the total number of patients for group 6 shows a significant positive correlation with temperature and dew-point temperature, and a negative correlation with the sea-level pressure for the same day. In winter, the same relationship exists, however its correlation is not as strong. The lags observed between these three variables: maximum dew-point temperature, maximum temperature, minimum air pressure and the peaks in admissions are 1, 2 and 4 days respectively. In winter, increases in temperature and dew point and decreases in pressure are followed by a peak in admissions for group 2. In winter, there are significantly more cases in group 5 on warm, dry days and on warm, wet days in the summer.

  10. Non-cardiac findings on coronary computed tomography and magnetic resonance imaging

    International Nuclear Information System (INIS)

    Dewey, Marc; Schnapauff, Dirk; Teige, Florian; Hamm, Bernd

    2007-01-01

    Both multislice computed tomography (CT) and magnetic resonance imaging (MRI) are emerging as methods to detect coronary artery stenoses and assess cardiac function and morphology. Non-cardiac structures are also amenable to assessment by these non-invasive tests. We investigated the rate of significant and insignificant non-cardiac findings using CT and MRI. A total of 108 consecutive patients suspected of having coronary artery disease and without contraindications to CT and MRI were included in this study. Significant non-cardiac findings were defined as findings that required additional clinical or radiological follow-up. CT and MR images were read independently in a blinded fashion. CT yielded five significant non-cardiac findings in five patients (5%). These included a pulmonary embolism, large pleural effusions, sarcoid, a large hiatal hernia, and a pulmonary nodule (>1.0 cm). Two of these significant non-cardiac findings were also seen on MRI (pleural effusions and sarcoid, 2%). Insignificant non-cardiac findings were more frequent than significant findings on both CT (n = 11, 10%) and MRI (n = 7, 6%). Incidental non-cardiac findings on CT and MRI of the coronary arteries are common, which is why images should be analyzed by radiologists to ensure that important findings are not missed and unnecessary follow-up examinations are avoided. (orig.)

  11. Non-cardiac findings on coronary computed tomography and magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Dewey, Marc; Schnapauff, Dirk; Teige, Florian; Hamm, Bernd [Charite-Universitaetsmedizin Berlin, Humboldt-Universitaet zu Berlin, Department of Radiology, Chariteplatz 1, P.O. Box 10098, Berlin (Germany)

    2007-08-15

    Both multislice computed tomography (CT) and magnetic resonance imaging (MRI) are emerging as methods to detect coronary artery stenoses and assess cardiac function and morphology. Non-cardiac structures are also amenable to assessment by these non-invasive tests. We investigated the rate of significant and insignificant non-cardiac findings using CT and MRI. A total of 108 consecutive patients suspected of having coronary artery disease and without contraindications to CT and MRI were included in this study. Significant non-cardiac findings were defined as findings that required additional clinical or radiological follow-up. CT and MR images were read independently in a blinded fashion. CT yielded five significant non-cardiac findings in five patients (5%). These included a pulmonary embolism, large pleural effusions, sarcoid, a large hiatal hernia, and a pulmonary nodule (>1.0 cm). Two of these significant non-cardiac findings were also seen on MRI (pleural effusions and sarcoid, 2%). Insignificant non-cardiac findings were more frequent than significant findings on both CT (n = 11, 10%) and MRI (n = 7, 6%). Incidental non-cardiac findings on CT and MRI of the coronary arteries are common, which is why images should be analyzed by radiologists to ensure that important findings are not missed and unnecessary follow-up examinations are avoided. (orig.)

  12. Small Engine, Big Power: MicroRNAs as Regulators of Cardiac Diseases and Regeneration

    Directory of Open Access Journals (Sweden)

    Darukeshwara Joladarashi

    2014-09-01

    Full Text Available Cardiac diseases are the predominant cause of human mortality in the United States and around the world. MicroRNAs (miRNAs are small non-coding RNAs that have been shown to modulate a wide range of biological functions under various pathophysiological conditions. miRNAs alter target expression by post-transcriptional regulation of gene expression. Numerous studies have implicated specific miRNAs in cardiovascular development, pathology, regeneration and repair. These observations suggest that miRNAs are potential therapeutic targets to prevent or treat cardiovascular diseases. This review focuses on the emerging role of miRNAs in cardiac development, pathogenesis of cardiovascular diseases, cardiac regeneration and stem cell-mediated cardiac repair. We also discuss the novel diagnostic and therapeutic potential of these miRNAs and their targets in patients with cardiac diseases.

  13. Ocorrência e preditores clínicos de pseudocrise hipertensiva no atendimento de emergência Occurrence rate and clinical predictors of hypertensive pseudocrisis in emergency room care

    Directory of Open Access Journals (Sweden)

    Silvestre Sobrinho

    2007-05-01

    Full Text Available OBJETIVOS: Descrever a prevalência de pseudocrise hipertensiva em pacientes atendidos em unidade de emergência com níveis de pressão arterial substancialmente elevados, comparando-a entre serviços privado e público; descrever a freqüência de tratamento indevido para essa condição; identificar, no momento da triagem, preditores independentes de pseudocrise; e avaliar o prognóstico dos pacientes com pseudocrise. MÉTODOS: Durante seis meses, foram incluídos pacientes com idade > 18 anos, atendidos nas Emergências de dois hospitais (privado e público, com pressão arterial diastólica > 120 mmHg. Pseudocrise hipertensiva foi definida na ausência de critérios para crise hipertensiva, segundo as Diretrizes da Sociedade Brasileira de Cardiologia. RESULTADOS: Em 110 pacientes estudados, a prevalência de pseudocrise hipertensiva foi de 48% (intervalo de confiança de 95% [IC 95%] = 39%-58%, predominando no serviço privado (59% vs 37%; p = 0,02. A freqüência de tratamento indevido foi semelhante nos dois serviços (94% vs 95%; p = 0,87. Após análise multivariada, a presença de cefaléia na admissão (odds ratio = 5,4; IC 95% = 5,1-13; p OBJECTIVES: To describe the prevalence of hypertensive pseudocrisis in patients treated in emergency rooms with substantially elevated blood pressure levels. To compare this prevalence in private and public hospitals. To describe the frequency of wrong treatment for this condition. To identify, during triage, independent predictors of pseudocrisis. To evaluate the prognosis of patients with pseudocrisis. METHODS: Patients above the age of 18, admitted to the Emergency Rooms of two hospitals (private and public during a 6 month timeframe, with diastolic blood pressure > 120 mmHg were included in the study. Hypertensive pseudocrisis was determined when none of the criteria for hypertensive crisis were present (Guidelines of the Brazilian Society of Cardiology¹. RESULTS: In the 110 patients studied

  14. Control room envelope unfiltered air inleakage test protocols

    International Nuclear Information System (INIS)

    Lagus, P.L.; Grot, R.A.

    1997-01-01

    In 1983, the Advisory Committee on Reactor Safeguards (ACRS) recommended that the US NRC develop a control room HVAC performance testing protocol. To date no such protocol has been forthcoming. Beginning in mid-1994, an effort was funded by NRC under a Small Business Innovation Research (SBIR) grant to develop several simplified test protocols based on the principles of tracer gas testing in order to measure the total unfiltered inleakage entering a CRE during emergency mode operation of the control room ventilation system. These would allow accurate assessment of unfiltered air inleakage as required in SRP 6.4. The continuing lack of a standard protocol is unfortunate since one of the significant parameters required to calculate operator dose is the amount of unfiltered air inleakage into the control room. Often it is assumed that, if the Control Room Envelope (CRE) is maintained at +1/8 in. w.g. differential pressure relative to the surroundings, no significant unfiltered inleakage can occur it is further assumed that inleakage due to door openings is the only source of unfiltered air. 23 refs., 13 figs., 2 tabs

  15. Control room envelope unfiltered air inleakage test protocols

    Energy Technology Data Exchange (ETDEWEB)

    Lagus, P.L. [Lagus Applied Technology, San Diego, CA (United States); Grot, R.A. [Lagus Applied Technology, Olney, MD (United States)

    1997-08-01

    In 1983, the Advisory Committee on Reactor Safeguards (ACRS) recommended that the US NRC develop a control room HVAC performance testing protocol. To date no such protocol has been forthcoming. Beginning in mid-1994, an effort was funded by NRC under a Small Business Innovation Research (SBIR) grant to develop several simplified test protocols based on the principles of tracer gas testing in order to measure the total unfiltered inleakage entering a CRE during emergency mode operation of the control room ventilation system. These would allow accurate assessment of unfiltered air inleakage as required in SRP 6.4. The continuing lack of a standard protocol is unfortunate since one of the significant parameters required to calculate operator dose is the amount of unfiltered air inleakage into the control room. Often it is assumed that, if the Control Room Envelope (CRE) is maintained at +1/8 in. w.g. differential pressure relative to the surroundings, no significant unfiltered inleakage can occur it is further assumed that inleakage due to door openings is the only source of unfiltered air. 23 refs., 13 figs., 2 tabs.

  16. Point of care hematocrit and hemoglobin in cardiac surgery: a review.

    Science.gov (United States)

    Myers, Gerard J; Browne, Joe

    2007-05-01

    The use of point-of-care blood gas analyzers in cardiac surgery has been on the increase over the past decade. The availability of these analyzers in the operating room and post-operative intensive care units eliminates the time delays to transport samples to the main laboratory and reduces the amount of blood sampled to measure such parameters as electrolytes, blood gases, lactates, glucose and hemoglobin/hematocrit. Point-of-care analyzers also lead to faster and more reliable clinical decisions while the patient is still on the heart lung machine. Point-of-care devices were designed to provide safe, appropriate and consistent care of those patients in need of rapid acid/base balance and electrolyte management in the clinical setting. As a result, clinicians rely on their values to make decisions regarding ventilation, acid/base management, transfusion and glucose management. Therefore, accuracy and reliability are an absolute must for these bedside analyzers in both the cardiac operating room and the post-op intensive care units. Clinicians have a choice of two types of technology to measure hemoglobin/hematocrit during bypass, which subsequently determines their patient's level of hemodilution, as well as their transfusion threshold. All modern point-of-care blood gas analyzers measure hematocrit using a technology called conductivity, while other similar devices measure hemoglobin using a technology called co-oximetry. The two methods are analyzed and compared in this review. The literature indicates that using conductivity to measure hematocrit during and after cardiac surgery could produce inaccurate results when hematocrits are less than 30%, and, therefore, result in unnecessary homologous red cell transfusions in some patients. These inaccuracies are influenced by several factors that are common and unique to cardiopulmonary bypass, and will also be reviewed here. It appears that the only accurate, consistent and reliable method to determine hemodilution

  17. The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital.

    Science.gov (United States)

    Botelho, Renata Maria de Oliveira; Campanharo, Cássia Regina Vancini; Lopes, Maria Carolina Barbosa Teixeira; Okuno, Meiry Fernanda Pinto; Góis, Aécio Flávio Teixeira de; Batista, Ruth Ester Assayag

    2016-11-21

    to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condition before cardiac arrest, the immediate cause, initial arrest rhythm, whether epinephrine was used, and the duration of CPR. The case group (n=51) received conventional CPR guided by a metronome set at 110 beats/min. Chi-square and likelihood ratio were used to compare ROSC rates considering p≤0.05. ROSC occurred in 57.7% of the cases, though 92.8% of these patients died in the following 24 hours. No statistically significant difference was found between groups in regard to ROSC (p=0.2017) or the occurrence of death (p=0.8112). the outcomes of patients after cardiac arrest with and without the use of a metronome during CPR were similar and no differences were found between groups in regard to survival rates and ROSC. comparar a taxa de retorno da circulação espontânea e óbito após parada cardiorrespiratória, com e sem a utilização do metrônomo durante ressuscitação cardiopulmonar. estudo caso-controle aninhado a estudo de coorte, com 285 adultos atendidos em parada cardíaca em um serviço de emergência e submetidos à ressuscitação cardiopulmonar. Os dados foram coletados por meio do In-hospital Utstein Style. O grupo controle (n=60) foi selecionado pelo pareamento dos pacientes considerando-se o estado neurológico pré-parada cardiorrespiratória, causa imediata e ritmo inicial da parada, utilização de epinefrina e duração da ressuscitação. O grupo caso (n=51) foi submetido à ressuscitação cardiopulmonar convencional com a utilização do metrônomo a 110sons/min. Para comparar

  18. The 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiac care: an overview of the changes to pediatric basic and advanced life support.

    Science.gov (United States)

    Spencer, Becky; Chacko, Jisha; Sallee, Donna

    2011-06-01

    The American Heart Association (AHA) has a strong commitment to implementing scientific research-based interventions for cardiopulmonary resuscitation and emergency cardiovascular care. This article presents the 2010 AHA major guideline changes to pediatric basic life support (BLS) and pediatric advanced life support (PALS) and the rationale for the changes. The following topics are covered in this article: (1) current understanding of cardiac arrest in the pediatric population, (2) major changes in pediatric BLS, and (3) major changes in PALS. Copyright © 2011. Published by Elsevier Inc.

  19. Emergency preparedness

    International Nuclear Information System (INIS)

    1998-01-01

    According the conception of the Emergency Response Centre (ERC) of the Nuclear Regulatory Authority of the Slovak Republic (NRA), and the obtained experience from exercises, and as well as on the basis of recommendations of international missions, the NRA SR started, in 1997 the ERC extension. The new room enable the work for radiation protection group, reactor safety and logistic group separately. At the same time special room was build for work of the NECRA Technical Support Group of the Emergency Commission for Radiation Accidents of the SR.This group co-operates closely with ERC while evaluation the situation, and by using the information system of the NRA and database of ERC to generate the conditions of nuclear facilities in once of emergency. Extension of the mentioned rooms was carried out. The financing by the European Union helped to build the project RAMG. In this way the NRA gained a working site which, with its equipment and parameters belongs to the top working sites of regulatory bodies of developed European countries. The NRA preparation of exercise and special staff education was carried out in 1997, for employees of the NRA and members of Emergency Headquarters (EH) for work in ERC in case of nuclear installation accident. The task of education of member of EH was their preparation for carrying out three exercises. These exercises are described. In the area of emergency preparedness, in accordance with inspection plan of the Office, 7 team inspections were carried out in individual localities; in NPP Bohunice, two in NPP Mochovce and one in Bohunice Conditioning Centre for radioactive wastes. Solution of the task of development of science and technology in the area of 'Development of technical and programme means for analyses of accidents and solutions of crisis situations'continued in 1997. Another regulations were elaborated for activity of members of EH of the NRA. The following was was carried out: selection of data for transfer and the

  20. On-site emergency preparedness in Finland

    International Nuclear Information System (INIS)

    Vilkamo, O.

    1998-01-01

    General scheme of emergency preparedness in Finland is presented including legal framework, emergency organization and detailed description of plans and procedures. Emergency plan in Finland cover the following matters: classification of emergency situations and description of events and accidents, description of emergency organization, description of the arrangements for alerting and data transfer, management of an emergency situation and radiation protection, worker safety and radiation protection, on- and off-site radiation measurements during a preparedness situation, provision of information, rooms, equipment and facilities, post emergency debriefing and measures, a description of the maintenance of preparedness

  1. Cardiopulmonary resuscitation in the elderly: analysis of the events in the emergency department

    Directory of Open Access Journals (Sweden)

    Augusto Tricerri

    2013-10-01

    Full Text Available With the increasing number of old people in all western countries and increasing life expectancy at birth, many seniors spend the last period of their life with various afflictions that may lead to cardiac arrest. Bystander cardiopulmonary resuscitation (CPR increases survival rates. Octogenarians are the fastest growing segment of the population and despite empirical evidence that CPR is of questionable effectiveness in seniors with comorbidities, it is still the only treatment among life-sustaining ones. Cardiopulmonary resuscitation is frequently unsuccessful, but if survival is achieved, a fairly good quality of life can be expected. Various papers analyzed the effect of CPR in hospitalized patients or in cardiac arrest occurring at home or in public places, while less is known about events occurring in the emergency room (ER. We performed a retrospective analysis of cardiac arrest events occurred in ER within 54 months: we analyzed 415,001 records of ER visits (from 01/01/1999 to 30/06/2003 in San Giovanni Addolorata Hospital. Data were analyzed in terms of age and outcome. We identified 475 records with the outcome of death in ER or death on arrival. Out of them, we selected 290 medical records which had sufficient data to be analyzed. Of the 290 patients evaluated, 225 died in ER, 18 were deemed to die on arrival, and 47 survived the cardiac arrest and were admitted to intensive care unit (ICU. The overall mortality was 0.11%, while the incidence of the selected events was 0.072%. The mean age of the analyzed population was 71.3 years. The only possible diagnosis was often cardiac arrest, though most of the times we could specify and group the diagnosis even better. The analysis of the procedures showed that cardiac arrest treated by direct current (DC shock was similarly distributed in different age groups, and no difference was detectable between the two groups. The mean age of the patients who underwent tracheal intubation (TI was

  2. Emergências hipertensivas Hypertensive emergencies

    Directory of Open Access Journals (Sweden)

    Gilson Soares Feitosa-Filho

    2008-09-01

    ão controlada. Este conhecimento deve ser rotineiro ao emergencista e Intensivista no momento de decidir sobre a conduta.Emergencies and hypertensive crises are clinical situations which may represent more than 25% of all medical emergency care. Considering such high prevalence, physicians should be prepared to correctly identify these crises and differentiate between urgent and emergent hypertension. Approximately 3% of all visits to emergency rooms are due to significant elevation of blood pressure. Across the spectrum of blood systemic arterial pressure, hypertensive emergency is the most critical clinical situation, thus requiring special attention and care. Such patients present with high blood pressure and signs of acute specific target organ damage (such as acute myocardial infarction, unstable angina, acute pulmonary edema, eclampsia, and stroke. Key elements of diagnosis and specific treatment for the different presentations of hypertensive emergency will be reviewed in this article. The MedLine and PubMed databases were searched for pertinent abstracts, using the key words "hypertensive crises" and "hypertensive emergencies". Additional references were obtained from review articles. Available English language clinical trials, retrospective studies and review articles were identified, reviewed and summarized in a simple and practical way. The hypertensive crisis is a clinical situation characterized by acute elevation of blood pressure followed by clinical signs and symptoms. These signs and symptoms may be mild (headache, dizziness, tinnitus or severe (dyspnea, chest pain, coma or death. If the patient presents with mild symptoms, but without acute specific target organ damage, diagnosis is hypertensive urgency. However, if severe signs and symptoms and acute specific target organ damage are present, then the patient is experiencing a hypertensive emergency. Some patients arrive at the emergency rooms with high blood pressure, but without any other sign or symptom. In

  3. Evaluation of echocardiography and cardiac biomarker concentrations in dogs with gastric dilatation volvulus.

    Science.gov (United States)

    Aona, Brent D; Rush, John E; Rozanski, Elizabeth A; Cunningham, Suzanne M; Sharp, Claire R; Freeman, Lisa M

    2017-11-01

    To assess abnormalities in concentrations of cardiac troponin I (cTnI), lactate, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in relation to arrhythmias, echocardiographic measurements, and survival in dogs with gastric dilatation volvulus (GDV). Prospective observational study. University hospital. Twenty-two dogs with naturally occurring GDV. Concentrations of cTnI, plasma lactate, and NT-proBNP were recorded at presentation to the emergency room, the time closest to echocardiography, and the highest recorded concentrations during hospitalization. None. Cardiac rhythms were categorized on a 0-4 scale (0 = no ventricular premature complexes [VPCs], 1 = single VPCs, 2 = bigeminy or trigeminy, 3 = couplets or triplets, and 4 = R-on-T phenomenon or ventricular tachycardia). Echocardiography was performed 6-18 hours postoperatively. Fifteen dogs had ventricular arrhythmias during hospitalization (Grade 1 [n = 9], Grade 4 [n = 6]). The highest recorded cTnI concentration was significantly higher in the dogs with Grade 4 (P = 0.002) or Grade 1 (P = 0.001) arrhythmias compared to dogs without arrhythmias. Plasma lactate was significantly correlated with left ventricular internal diameter in diastole (r = -0.52, P = 0.01) and systole (r = -0.57, P = 0.006), left ventricular free wall in diastole (LWDd, r = 0.59, P = 0.004), and interventricular septal thickness in diastole (IVDs, r = 0.65, P = 0.001). Dogs that did not survive to 1 week postdischarge (3/22) had a significantly thicker LVWd (P = 0.04) and IVSd (P = 0.05), and received significantly less fluids in the first 24 (P = 0.02) and 48 hours (P = 0.03) of hospitalization. Concentrations of cTnI and NT-proBNP increased during hospitalization, but only cTnI concentrations were significantly higher in dogs with a higher arrhythmia grade. Additional research on the potential role of serial measurement of biomarkers in dogs with GDV is warranted. © Veterinary Emergency and Critical Care Society 2017.

  4. Impact of on-site cardiac catheterization on resource utilization and fatal and non-fatal outcomes after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Richard Hugues

    2006-11-01

    Full Text Available Abstract Background Patterns of care for acute myocardial infarction (AMI strongly depend on the availability of on-site cardiac catheterization facilities. Although the management found at hospitals without on-site catheterization does not lead to increased mortality, little it known about its impact on resource utilization and non-fatal outcomes. Methods We identified all patients (n = 35,289 admitted with a first AMI in the province of Quebec between January 1, 1996 and March 31, 1999 using population-based administrative databases. Medical resource utilization and non-fatal and fatal outcomes were compared among patients admitted to hospitals with and without on-site cardiac catheterization facilities. Results Cardiac catheterization and PCI were more frequently performed among patients admitted to hospitals with catheterization facilities. However, non-invasive procedures were not used more frequently at hospitals without catheterization facilities. To the contrary, echocardiography [odds ratio (OR, 2.04; 95% confidence interval (CI, 1.93–2.16] and multi-gated acquisition imaging (OR, 1.24; 95% CI, 1.17–1.32 were used more frequently at hospitals with catheterization, and exercise treadmill testing (OR, 1.02; 95% CI, 0.91–1.15 and Sestamibi/Thallium imaging (OR, 0.93; 95% CI, 0.88–0.98 were used similarly at hospitals with and without catheterization. Use of anti-ischemic medications and frequency of emergency room and physician visits, were similar at both types of institutions. Readmission rates for AMI-related cardiac complications and mortality were also similar [adjusted hazard ratio, recurrent AMI: 1.02, 95% CI, 0.89–1.16; congestive heart failure: 1.02; 95% CI, 0.90–1.15; unstable angina: 0.93; 95% CI, 0.85–1.02; mortality: 0.99; 95% CI, 0.93–1.05]. Conclusion Although on-site availability of cardiac catheterization facilities is associated with greater use of invasive cardiac procedures, non-availability of

  5. The Effects of Climate Change on Cardiac Health.

    Science.gov (United States)

    De Blois, Jonathan; Kjellstrom, Tord; Agewall, Stefan; Ezekowitz, Justin A; Armstrong, Paul W; Atar, Dan

    2015-01-01

    The earth's climate is changing and increasing ambient heat levels are emerging in large areas of the world. An important cause of this change is the anthropogenic emission of greenhouse gases. Climate changes have a variety of negative effects on health, including cardiac health. People with pre-existing medical conditions such as cardiovascular disease (including heart failure), people carrying out physically demanding work and the elderly are particularly vulnerable. This review evaluates the evidence base for the cardiac health consequences of climate conditions, with particular reference to increasing heat exposure, and it also explores the potential further implications. © 2015 S. Karger AG, Basel.

  6. Post-resuscitation care for survivors of cardiac arrest

    Directory of Open Access Journals (Sweden)

    Ashvarya Mangla

    2014-01-01

    Full Text Available Cardiac arrest can occur following a myriad of clinical conditions. With advancement of medical science and improvements in Emergency Medical Services systems, the rate of return of spontaneous circulation for patients who suffer an out-of-hospital cardiac arrest (OHCA continues to increase. Managing these patients is challenging and requires a structured approach including stabilization of cardiopulmonary status, early consideration of neuroprotective strategies, identifying and managing the etiology of arrest and initiating treatment to prevent recurrence. This requires a closely coordinated multidisciplinary team effort. In this article, we will review the initial management of survivors of OHCA, highlighting advances and ongoing controversies.

  7. Extra-cardiac manifestations of adult congenital heart disease.

    Science.gov (United States)

    Gaeta, Stephen A; Ward, Cary; Krasuski, Richard A

    2016-10-01

    Advancement in correction or palliation of congenital cardiac lesions has greatly improved the lifespan of congenital heart disease patients, resulting in a rapidly growing adult congenital heart disease (ACHD) population. As this group has increased in number and age, emerging science has highlighted the systemic nature of ACHD. Providers caring for these patients are tasked with long-term management of multiple neurologic, pulmonary, hepatic, renal, and endocrine manifestations that arise as syndromic associations with congenital heart defects or as sequelae of primary structural or hemodynamic abnormalities. In this review, we outline the current understanding and recent research into these extra-cardiac manifestations. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Source-case investigation of Mycobacterium wolinskyi cardiac surgical site infection.

    Science.gov (United States)

    Dupont, C; Terru, D; Aguilhon, S; Frapier, J-M; Paquis, M-P; Morquin, D; Lamy, B; Godreuil, S; Parer, S; Lotthé, A; Jumas-Bilak, E; Romano-Bertrand, S

    2016-07-01

    The non-tuberculous mycobacteria (NTM) Mycobacterium wolinskyi caused bacteraemia and massive colonization of an aortic prosthesis in a patient 16 days after cardiac surgery, necessitating repeat surgery and targeted antimicrobial chemotherapy. The infection control team investigated the source and conditions of infection. Peri-operative management of the patient complied with recommendations. The environmental investigation showed that although M. wolinskyi was not recovered, diverse NTM species were present in water from point-of-use taps and heater-cooler units for extracorporeal circulation. This case and increasing evidence of emerging NTM infections in cardiac surgery led to the implementation of infection control procedures in cardiac surgery wards. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  9. [Vertigo and dizziness in the emergency room].

    Science.gov (United States)

    Zwergal, A; Möhwald, K; Dieterich, M

    2017-06-01

    Vertigo and dizziness are among the most common chief complaints in the emergency department. Etiologies can be categorized into three subgroups: neurootological (vestibular), medical (especially cardiovascular, metabolic), and psychiatric disorders. The diagnostic approach in the emergency department is based on a systematic analysis of case history (type, time course of symptoms, modulating factors, associated symptoms), clinical examination of the vestibular, ocular motor, and cerebellar systems (head impulse test, nystagmus, skew deviation, positioning maneuver, test of gait and stance), as well as a basal monitoring (vital signs, 12-lead ECG, blood tests). For differentiation of peripheral and central etiologies in acute vestibular syndrome, the HINTS exam (head impulse test, nystagmus, test of skew) and examination of smooth pursuit and saccades should be applied. Nonselective use of neuroimaging is not indicated due to a low diagnostic yield. Cranial imaging should be done in the following constellations: (1) detection of focal neurological or central ocular motor and vestibular signs on clinical exam, (2) acute abasia with only minor ocular motor signs, (3) presence of various cardiovascular risk factors, (4) headache of unknown quality as an accompanying symptom. Besides the symptomatic therapy of vertigo and dizziness with antiemetics or analgesics, further diagnostic differentiation is urgent to guide proper treatment. Examples are the acute therapy in cerebral ischemia, the execution of positioning maneuvers in benign paroxysmal positional vertigo, the use of corticosteroids in acute unilateral vestibulopathy, as well as the readjustment of metabolic homeostasis in medical disorders.

  10. Biologically improved nanofibrous scaffolds for cardiac tissue engineering

    Energy Technology Data Exchange (ETDEWEB)

    Bhaarathy, V. [Centre for Nanofibers and Nanotechnology, NUSNNI, Faculty of Engineering, National University of Singapore, 117576 (Singapore); Department of Nanoscience and Technology, School of Physical Sciences, Bharathiar University, Coimbatore 641046 (India); Lee Kong Chian School of Medicine, Nanyang Technological University, 138673 (Singapore); Venugopal, J., E-mail: nnijrv@nus.edu.sg [Centre for Nanofibers and Nanotechnology, NUSNNI, Faculty of Engineering, National University of Singapore, 117576 (Singapore); Gandhimathi, C. [Centre for Nanofibers and Nanotechnology, NUSNNI, Faculty of Engineering, National University of Singapore, 117576 (Singapore); Ponpandian, N.; Mangalaraj, D. [Department of Nanoscience and Technology, School of Physical Sciences, Bharathiar University, Coimbatore 641046 (India); Ramakrishna, S. [Centre for Nanofibers and Nanotechnology, NUSNNI, Faculty of Engineering, National University of Singapore, 117576 (Singapore)

    2014-11-01

    Nanofibrous structure developed by electrospinning technology provides attractive extracellular matrix conditions for the anchorage, migration and differentiation of stem cells, including those responsible for regenerative medicine. Recently, biocomposite nanofibers consisting of two or more polymeric blends are electrospun more tidily in order to obtain scaffolds with desired functional and mechanical properties depending on their applications. The study focuses on one such an attempt of using copolymer Poly(L-lactic acid)-co-poly (ε-caprolactone) (PLACL), silk fibroin (SF) and Aloe Vera (AV) for fabricating biocomposite nanofibrous scaffolds for cardiac tissue engineering. SEM micrographs of fabricated electrospun PLACL, PLACL/SF and PLACL/SF/AV nanofibrous scaffolds are porous, beadless, uniform nanofibers with interconnected pores and obtained fibre diameter in the range of 459 ± 22 nm, 202 ± 12 nm and 188 ± 16 nm respectively. PLACL, PLACL/SF and PLACL/SF/AV electrospun mats obtained at room temperature with an elastic modulus of 14.1 ± 0.7, 9.96 ± 2.5 and 7.0 ± 0.9 MPa respectively. PLACL/SF/AV nanofibers have more desirable properties to act as flexible cell supporting scaffolds compared to PLACL for the repair of myocardial infarction (MI). The PLACL/SF and PLACL/SF/AV nanofibers had a contact angle of 51 ± 12° compared to that of 133 ± 15° of PLACL alone. Cardiac cell proliferation was increased by 21% in PLACL/SF/AV nanofibers compared to PLACL by day 6 and further increased to 42% by day 9. Confocal analysis for cardiac expression proteins myosin and connexin 43 was observed better by day 9 compared to all other nanofibrous scaffolds. The results proved that the fabricated PLACL/SF/AV nanofibrous scaffolds have good potentiality for the regeneration of infarcted myocardium in cardiac tissue engineering. - Highlights: • Fabricated nanofibrous scaffolds are porous, beadless and uniform structures. • PLACL/SF/AV nanofibers improve the

  11. Biologically improved nanofibrous scaffolds for cardiac tissue engineering

    International Nuclear Information System (INIS)

    Bhaarathy, V.; Venugopal, J.; Gandhimathi, C.; Ponpandian, N.; Mangalaraj, D.; Ramakrishna, S.

    2014-01-01

    Nanofibrous structure developed by electrospinning technology provides attractive extracellular matrix conditions for the anchorage, migration and differentiation of stem cells, including those responsible for regenerative medicine. Recently, biocomposite nanofibers consisting of two or more polymeric blends are electrospun more tidily in order to obtain scaffolds with desired functional and mechanical properties depending on their applications. The study focuses on one such an attempt of using copolymer Poly(L-lactic acid)-co-poly (ε-caprolactone) (PLACL), silk fibroin (SF) and Aloe Vera (AV) for fabricating biocomposite nanofibrous scaffolds for cardiac tissue engineering. SEM micrographs of fabricated electrospun PLACL, PLACL/SF and PLACL/SF/AV nanofibrous scaffolds are porous, beadless, uniform nanofibers with interconnected pores and obtained fibre diameter in the range of 459 ± 22 nm, 202 ± 12 nm and 188 ± 16 nm respectively. PLACL, PLACL/SF and PLACL/SF/AV electrospun mats obtained at room temperature with an elastic modulus of 14.1 ± 0.7, 9.96 ± 2.5 and 7.0 ± 0.9 MPa respectively. PLACL/SF/AV nanofibers have more desirable properties to act as flexible cell supporting scaffolds compared to PLACL for the repair of myocardial infarction (MI). The PLACL/SF and PLACL/SF/AV nanofibers had a contact angle of 51 ± 12° compared to that of 133 ± 15° of PLACL alone. Cardiac cell proliferation was increased by 21% in PLACL/SF/AV nanofibers compared to PLACL by day 6 and further increased to 42% by day 9. Confocal analysis for cardiac expression proteins myosin and connexin 43 was observed better by day 9 compared to all other nanofibrous scaffolds. The results proved that the fabricated PLACL/SF/AV nanofibrous scaffolds have good potentiality for the regeneration of infarcted myocardium in cardiac tissue engineering. - Highlights: • Fabricated nanofibrous scaffolds are porous, beadless and uniform structures. • PLACL/SF/AV nanofibers improve the

  12. DEGRO/DGK guideline for radiotherapy in patients with cardiac implantable electronic devices

    International Nuclear Information System (INIS)

    Gauter-Fleckenstein, Benjamin; Steil, Volker; Wenz, Frederik; Israel, Carsten W.; Dorenkamp, Marc; Dunst, Juergen; Roser, Mattias; Schimpf, Rainer; Schaefer, Joerg; Hoeller, Ulrike

    2015-01-01

    An increasing number of patients undergoing radiotherapy (RT) have cardiac implantable electronic devices [CIEDs, cardiac pacemakers (PMs) and implanted cardioverters/defibrillators (ICDs)]. Ionizing radiation can cause latent and permanent damage to CIEDs, which may result in loss of function in patients with asystole or ventricular fibrillation. Reviewing the current literature, the interdisciplinary German guideline (DEGRO/DGK) was developed reflecting patient risk according to type of CIED, cardiac condition, and estimated radiation dose to the CIED. Planning for RT should consider the CIED specifications as well as patient-related characteristics (pacing-dependent, previous ventricular tachycardia/fibrillation). Antitachyarrhythmia therapy should be suspended in patients with ICDs, who should be under electrocardiographic monitoring with an external defibrillator on stand-by. The beam energy should be limited to 6 (to 10) MV CIEDs should never be located in the beam, and the cumulative scatter radiation dose should be limited to 2 Gy. Personnel must be able to respond adequately in the case of a cardiac emergency and initiate basic life support, while an emergency team capable of advanced life support should be available within 5 min. CIEDs need to be interrogated 1, 3, and 6 months after the last RT due to the risk of latent damage. (orig.) [de

  13. Rural emergency medical technician pre-hospital electrocardiogram transmission.

    Science.gov (United States)

    Powell, A M; Halon, J M; Nelson, J

    2014-01-01

    Emergent care of the acute heart attack patient continues to be at the forefront of quality and cost reduction strategies throughout the healthcare industry. Although the average cardiac door-to-balloon (D2B) times have decreased substantially over the past few years, there are still vast disparities found in D2B times in populations that reside in rural areas. Such disparities are mostly related to prolonged travel time and subsequent delays in cardiac catherization lab team activation. Urban ambulance companies that are routinely staffed with paramedic level providers have been successful in the implementation of pre-hospital 12-lead electrocardiogram (ECG) protocols as a strategy to reduce D2B times. The authors sought to evaluate the evidence related to the risk and benefits associated with the replication of an ECG transmission protocol in a small rural emergency medical service. The latter is staffed with emergency medical technician-basics (EMT-B), emergency medical technician-advanced (EMT-A), and emergency medical technician-intermediate (EMT-I) level. The evidence reviewed was limited to studies with relevant data regarding the challenges and complexities of the ECG transmission process, the difficulties associated with ECG transmission in rural settings, and ECG transmission outcomes by provider level. The evidence supports additional research to further evaluate the feasibility of ECG transmission at the non-paramedic level. Multiple variables must be investigated including equipment cost, utilization, and rural transmission capabilities. Clearly, pre-hospital ECG transmission and early activation of the cardiac catheterization laboratory are critical components to successfully decreasing D2B times.

  14. Feasibility study on emergency passive habitability systems of SPWR

    International Nuclear Information System (INIS)

    Obata, H.; Tabata, H.; Urakami, M.; Naito, T.

    2000-01-01

    The major characteristic of the Simplified Pressurized Water Reactor (SPWR) is that safety systems for the emergency core cooling and the core decay heat removal functions are achieved by passive equipment. The AP600 developed in the U.S adopts passive emergency habitability system for the main control room (MCR) and the electrical equipment rooms (EER) by using the concrete of the structures as a heat sink. For the SPWR, alternative natural circulation cooling systems have been investigated: for MCR cooling, a cold water reservoir is used as heat sink; for EER cooling, outside air is instead employed. The distribution of the air-velocity and temperature in those rooms were calculated by using a three-dimensional thermal fluid analysis code. The authors verified the conceptual feasibility of these systems as the emergency passive habitability systems in the SPWR. (author)

  15. The approach to patients with possible cardiac chest pain.

    Science.gov (United States)

    Parsonage, William A; Cullen, Louise; Younger, John F

    2013-07-08

    Chest pain is a common reason for presentation in hospital emergency departments and general practice. Some patients presenting with chest pain to emergency departments and, to a lesser extent, general practice will be found to have a life-threatening cause, but most will not. The challenge is to identify those who do in a safe, timely and cost-effective manner. An acute coronary syndrome cannot be excluded on clinical grounds alone. In patients with ongoing symptoms of chest pain, without an obvious other cause, ST-segment-elevation myocardial infarction should be excluded with a 12-lead electrocardiogram at the first available opportunity. Significant recent advances in the clinical approach to patients with acute chest pain, including better understanding of risk stratification, increasingly sensitive cardiac biomarkers and new non-invasive tests for coronary disease, can help clinicians minimise the risk of unexpected short-term adverse cardiac events. An approach that integrates these advances is needed to deliver the best outcomes for patients with chest pain. All hospital emergency departments should adopt such a strategic approach, and general practitioners should be aware of when and how to access these facilities.

  16. A Report of Brugada Syndrome Presenting with Cardiac Arrest Triggered by Verapamil Intoxication

    Directory of Open Access Journals (Sweden)

    Kahraman Yakut

    2017-12-01

    Full Text Available Background: Brugada syndrome is a disease characterized by a specific electrocardiographic pattern and an increased risk of sudden cardiac death. We present this case with the updated literature to emphasise the need to consider the diagnosis of Brugada syndrome in patients admitted to the emergency ward with sudden cardiac arrest. Case Report: A 16-year-old female patient was admitted to the emergency ward with complaints of weakness and abdominal pain, and she had four cardiac arrests during her evaluation period. She was referred to our clinic for permanent pacemaker implantation. She was on a temporary pace maker after having had C-reactive protein. Her physical exam was normal except for bilaterally decreased lung sounds. Lung x-ray and computed tomography, which were performed by another institution, revealed minimal pleural effusion and nothing else of significance. Blood and peritoneal fluid samples were sterile. Echocardiographic exam and cardiac enzymes were also in the normal ranges. Electrocardiographic showed incomplete right branch block in leads V1 and V2. An ajmaline test revealed specific electrocardiographic findings of the type I Brugada pattern. We proposed implanting an implantable cardioverter defibrillator to the patient as there were positive findings on the ajmaline test as well as a history of sudden cardiac arrest. After this treatment proposal, the patient’s family admitted that she had taken a high dose of verapamil and thus, the encountered bradycardia was associated with verapamil overuse. The ajmaline test was repeated as it was contemplated that the previous positive ajmaline test had been associated with verapamil overuse. Implantable cardioverter defibrillator implantation was proposed again as there was a history of sudden cardiac arrest; however, the family did not consent to implantable cardioverter defibrillator, and the patient was discharged and followed up. Conclusion: Brugada syndrome should be

  17. The Effect of Emergency Department Overcrowding on Efficiency of Emergency Medicine Residents’ Education

    Directory of Open Access Journals (Sweden)

    Anita Sabzghabaei

    2014-09-01

    Full Text Available Introduction: Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding (EDO on the training of emergency medicine residents (EMR is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR’s education. Methods: In this cross-sectional study, the effects of overcrowding on EMR’s education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs.  The crowding level was calculated based on the national emergency department overcrowding scale (NEDOCS. The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. Results: 130 questionnaires were filled out during 61 shifts. 47 (77.05% shifts were overcrowded. The attend’s ability to teach was not affected by overcrowding in the resuscitation room (p=0.008. The similar results were seen regarding the attend’s training ability in the acute care unit. Conclusion: It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs.

  18. Fatores de risco para consultas em pronto-socorro por crianças asmáticas no Sul do Brasil Asthmatic children's risk factors for emergency room visits, Brazil

    Directory of Open Access Journals (Sweden)

    Moema Chatkin

    2000-10-01

    Full Text Available OBJETIVOS: Traçar um perfil das crianças asmáticas do município de Pelotas, RS, conhecer o manejo da doença e os fatores de risco associados a consultas em pronto-socorro, motivadas por asma. MÉTODOS: Estudo transversal aninhado a um estudo de coorte, realizado na área urbana de Pelotas, cidade de médio porte do Sul do Brasil. Participaram 981 crianças de 4-5 anos, pertencentes à coorte de 1993. RESULTADOS: A prevalência de asma encontrada na amostra estudada foi de 25,4%. A morbidade por asma foi elevada: 31% das crianças asmáticas haviam procurado o pronto-socorro no último ano, 57% tinham consultado médico e 26%, de 1 a 4 anos, foram internadas por asma. Na análise geral, escolaridade e renda familiar baixas associaram-se com consultas em pronto-socorro (RO=4,1 para 0 a 4 anos de escolaridade e RO=6,5 para menos de 1 salário-mínimo. Dormir em quartos com 3 ou mais pessoas também mostrou-se associado (RO=2,2, bem como severidade das crises (RO=2,7, uso de medicamentos para asma no último ano (RO=1,9 e internações por asma (RO=3,0. CONCLUSÕES: A prevalência de asma entre crianças pré-escolares em Pelotas é alta, levando a grande morbidade. Encontraram-se como fatores preditores de consultas em pronto-socorro por asma, após análise multivariada, a baixa escolaridade das mães, severidade das crises e internação por asma.OBJECTIVES: To study a sample of asthmatic children to get to know how the disease is managed by caretakers and to identify predictive factors associated with attendance in emergency room for asthma. METHODS: A cross-sectional study nested in a cohort was undertaken in the urban area of Pelotas, Southern Brazil. 981 children aged 4-5 years, who belong to the cohort of 1993, participated in this study. RESULTS: The asthma prevalence in the children sample was 25.4%. Morbidity for asthma was quite high: 31% of the children were seen in emergency rooms in the last year, 57% attended medical clinics and

  19. Virtual and augmented medical imaging environments: enabling technology for minimally invasive cardiac interventional guidance.

    Science.gov (United States)

    Linte, Cristian A; White, James; Eagleson, Roy; Guiraudon, Gérard M; Peters, Terry M

    2010-01-01

    Virtual and augmented reality environments have been adopted in medicine as a means to enhance the clinician's view of the anatomy and facilitate the performance of minimally invasive procedures. Their value is truly appreciated during interventions where the surgeon cannot directly visualize the targets to be treated, such as during cardiac procedures performed on the beating heart. These environments must accurately represent the real surgical field and require seamless integration of pre- and intra-operative imaging, surgical tracking, and visualization technology in a common framework centered around the patient. This review begins with an overview of minimally invasive cardiac interventions, describes the architecture of a typical surgical guidance platform including imaging, tracking, registration and visualization, highlights both clinical and engineering accuracy limitations in cardiac image guidance, and discusses the translation of the work from the laboratory into the operating room together with typically encountered challenges.

  20. Urological Emergency Admissions to a Community Hospital: A Review

    Science.gov (United States)

    Atkins, Sam O.

    1983-01-01

    A one-year study was conducted on the impact of emergency admissions to the 125-bed Southwest Community Hospital in Atlanta, Georgia. During the study in 1979, 70 urological emergency room admissions were made, of which 44 (62.8 percent) were males and 26 (37.2 percent) were females. In comparison, 93 admissions were made directly from the private office. The study considered the timeliness of diagnosis and treatment, surgical procedures performed, impact on urological emergency room nursing and medical personnel, physician response to notification, cost containment, and implied legal ramifications and organization structure. Thus, an immediate close scrutiny of urological emergency admission at the nonuniversity affiliated Southwest Community Hospital was permitted. PMID:6876189

  1. Halogenated anaesthetics and cardiac protection in cardiac and non-cardiac anaesthesia

    Directory of Open Access Journals (Sweden)

    Landoni Giovanni

    2009-01-01

    Full Text Available Volatile anaesthetic agents have direct protective properties against ischemic myocardial damage. The implementation of these properties during clinical anaesthesia can provide an additional tool in the treatment or prevention, or both, of ischemic cardiac dysfunction in the perioperative period. A recent meta-analysis showed that desflurane and sevoflurane reduce postoperative mortality and incidence of myocardial infarction following cardiac surgery, with significant advantages in terms of postoperative cardiac troponin release, need for inotrope support, time on mechanical ventilation, intensive care unit and overall hospital stay. Multicentre, randomised clinical trials had previously demonstrated that the use of desflurane can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalisation following coronary artery bypass graft surgery either with and without cardiopulmonary bypass. The American College of Cardiology/American Heart Association Guidelines recommend volatile anaesthetic agents during non-cardiac surgery for the maintenance of general anaesthesia in patients at risk for myocardial infarction. Nonetheless, e vidence in non-coronary surgical settings is contradictory and will be reviewed in this paper together with the mechanisms of cardiac protection by volatile agents.

  2. Orchestrating Professional Development for Baby Room Practitioners: Raising the Stakes in New Dialogic Encounters

    Science.gov (United States)

    Goouch, Kathleen; Powell, Sacha

    2013-01-01

    This article has emerged from a research and development project, The Baby Room, which was designed to examine how babies are cared for in daycare settings. Within the project, a form of professional development was created which designated a central space for dialogic encounter, primarily to enable the baby room practitioners who participated in…

  3. Hyperkalemia masked by pseudo-stemi infarct pattern and cardiac arrest.

    Science.gov (United States)

    Peerbhai, Shareez; Masha, Luke; DaSilva-DeAbreu, Adrian; Dhoble, Abhijeet

    2017-12-01

    Hyperkalemia is a common electrolyte abnormality and has well-recognized early electrocardiographic manifestations including PR prolongation and symmetric T wave peaking. With severe increase in serum potassium, dysrhythmias and atrioventricular and bundle branch blocks can be seen on electrocardiogram. Although cardiac arrest is a worrisome consequence of untreated hyperkalemia, rarely does hyperkalemia electrocardiographically manifest as acute ischemia. We present a case of acute renal failure complicated by malignant hyperkalemia and eventual ventricular fibrillation cardiac arrest. Recognition of this disorder was delayed secondary to an initial ECG pattern suggesting an acute ST segment elevation myocardial infarction (STEMI). Emergent coronary angiography performed showed no evidence of coronary artery disease. Pseudo-STEMI patterns are rarely seen in association with acute hyperkalemia and are most commonly described with patient without acute cardiac symptomatology. This is the first such case presenting concurrently with cardiac arrest. A brief review of this rare pseudo-infarct pattern is also given.

  4. Sustainability of protocolized handover of pediatric cardiac surgery patients to the intensive care unit.

    Science.gov (United States)

    Chenault, Kristin; Moga, Michael-Alice; Shin, Minah; Petersen, Emily; Backer, Carl; De Oliveira, Gildasio S; Suresh, Santhanam

    2016-05-01

    Transfer of patient care among clinicians (handovers) is a common source of medical errors. While the immediate efficacy of these initiatives is well documented, sustainability of practice changes that results in better processes of care is largely understudied. The objective of the current investigation was to evaluate the sustainability of a protocolized handover process in pediatric patients from the operating room after cardiac surgery to the intensive care unit. This was a prospective study with direct observation assessment of handover performance conducted in the cardiac ICU (CICU) of a free-standing, tertiary care children's hospital in the United States. Patient transitions from the operating room to the CICU, including the verbal handoff, were directly observed by a single independent observer in all phases of the study. A checklist of key elements identified errors classified as: (1) technical, (2) information omissions, and (3) realized errors. Total number of errors was compared across the different times of the study (preintervention, postintervention, and the current sustainability phase). A total of 119 handovers were studied: 41 preintervention, 38 postintervention, and 40 in the current sustainability phase. The median [Interquartile range (IQR)] number of technical errors was significantly reduced in the sustainability phase compared to the preintervention and postintervention phase, 2 (1-3), 6 (5-7), and 2.5 (2-4), respectively P = 0.0001. Similarly, the median (IQR) number of verbal information omissions was also significantly reduced in the sustainability phase compared to the preintervention and postintervention phases, 1 (1-1), 4 (3-5) and 2 (1-3), respectively. We demonstrate sustainability of an improved handover process using a checklist in children being transferred to the intensive care unit after cardiac surgery. Standardized handover processes can be a sustainable strategy to improve patient safety after pediatric cardiac surgery.

  5. Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Runza, G. [Department of Radiology, University of Palermo (Italy)], E-mail: grunza@sirm.org; La Grutta, L.; Alaimo, V. [Department of Radiology, University of Palermo (Italy); Evola, S. [Department of Cardiology, University of Palermo (Italy); Lo Re, F.; Bartolotta, T.V. [Department of Radiology, University of Palermo (Italy); Cademartiri, F. [Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam (Netherlands); Department of Radiology and Cardiology, Cardiovascular CT Unit, University Hospital, Parma (Italy); Midiri, M. [Department of Radiology, University of Palermo (Italy)

    2007-10-15

    Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation.

  6. Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain

    International Nuclear Information System (INIS)

    Runza, G.; La Grutta, L.; Alaimo, V.; Evola, S.; Lo Re, F.; Bartolotta, T.V.; Cademartiri, F.; Midiri, M.

    2007-01-01

    Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation

  7. [Coma in the emergency room].

    Science.gov (United States)

    Braun, M; Ploner, C J; Lindner, T; Möckel, M; Schmidt, W U

    2017-06-01

    Coma of unknown origin (CUO) is a frequent unspecific emergency symptom associated with a high mortality. A fast diagnostic work-up is essential given the wide spectrum of underlying diagnoses that are made up of approximately 50% primary central nervous system (CNS) pathologies and approximately 50% extracerebral, almost exclusively internal medical causes. Despite the high mortality associated with this symptom, there are currently no generally accepted management guidelines for adult patients presenting with CUO. We propose an interdisciplinary standard operating procedure (SOP) for patients with acute CUO as has been established in our maximum care hospital. The SOP is triggered by simple triage criteria that are sufficient to identify CUO patients before arrival in hospital. The in-hospital response team is led by a neurologist. Collaboration with nursing staff, internal medicine, anesthesiology, neurosurgery and trauma surgery is organized along structured pathways that include standardized laboratory tests, including cerebrospinal fluid (CSF), toxicology, computed tomography (CT) and CT angiography imaging (CTA). Our data suggest that neurologists and internists need to be placed at the beginning of the diagnostic work-up. Imaging should not just be carried out depending on the clinical syndrome because sensitivity, specificity and inter-rater reliability of the latter are not sufficient and because in many cases, multiple pathologies can be detected that could each explain CUO alone. Clinical examination, imaging and laboratory testing should be regarded as components of an integrative diagnostic approach and the final aetiological classification should only be made after the diagnostic work-up is complete.

  8. Understanding the physiology of complex congenital heart disease using cardiac magnetic resonance imaging

    International Nuclear Information System (INIS)

    Kappanayil, Mahesh; Kannan, Rajesh; Kumar, Raman Krishna

    2011-01-01

    Complex congenital heart diseases are often associated with complex alterations in hemodynamics. Understanding these key hemodynamic changes is critical to making management decisions including surgery and postoperative management. Existing tools for imaging and hemodynamic assessment like echocardiography, computed tomography and cardiac catheterization have inherent limitations. Cardiac magnetic resonance imaging (MRI) is emerging as a powerful bouquet of tools that allow not only excellent imaging, but also a unique insight into hemodynamics. This article introduces the reader to cardiac MRI and its utility through the clinical example of a child with a complex congenital cyanotic heart disease

  9. NPP accident scenario. Which emergency measures are planned in Switzerland?

    International Nuclear Information System (INIS)

    Flury, Christoph

    2016-01-01

    As a consequence of the reactor accident in Fukushima the Swiss government has ordered an extensive analysis of emergency planning in case of a NPP accident Switzerland. A special working group has analyzed the possible improvements of Swiss emergency planning based on the experiences in Japan. Under the special direction of the Bundesamt fuer Bevoelkerungsschutz (BABS) the agreed improvements were integrated into the emergency concept. The reference scenarios have been re-assessed and the zone concept adapted. The emergency measures include shelter-type rooms (basement or window-less rooms), the preventive distribution of iodine pills, measures concerning agriculture, aquatic systems, preventive evacuation, traffic regulations, and delayed evacuation.

  10. Early Recognition of Foreign Body Aspiration as the Cause of Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Muhammad Kashif

    2016-01-01

    Full Text Available Foreign body aspiration (FBA is uncommon in the adult population but can be a life-threatening condition. Clinical manifestations vary according to the degree of airway obstruction, and, in some cases, making the correct diagnosis requires a high level of clinical suspicion combined with a detailed history and exam. Sudden cardiac arrest after FBA may occur secondary to asphyxiation. We present a 48-year-old male with no history of cardiac disease brought to the emergency department after an out-of-hospital cardiac arrest (OHCA. The patient was resuscitated after 15 minutes of cardiac arrest. He was initially managed with therapeutic hypothermia (TH. Subsequent history suggested FBA as a possible etiology of the cardiac arrest, and fiberoptic bronchoscopy demonstrated a piece of meat and bone lodged in the left main stem bronchus. The foreign body was removed with the bronchoscope and the patient clinically improved with full neurological recovery. Therapeutic hypothermia following cardiac arrest due to asphyxia has been reported to have high mortality and poor neurological outcomes. This case highlights the importance of early identification of FBA causing cardiac arrest, and we report a positive neurological outcome for postresuscitation therapeutic hypothermia following cardiac arrest due to asphyxia.

  11. Control room philosophy: Principles of control room design and control room work

    International Nuclear Information System (INIS)

    Skriver, Jan; Ramberg, Jasmine; Allwin, Pernilla

    2006-01-01

    In order to provide insights for improvement of work in control rooms several factors have to be considered. Knowledge of principles including control room philosophies will guide the recommended improvements. In addition to knowledge about specific principles an advantage for an organization can be an understanding of similarities and policies used in other high risk industry. The report has been developed on the basis of a document analysis of international standards and other guiding documents. (NUREG 0711, ISO 11064, ISO 6385, IEC 60964). In addition to the document analysis which has strived to compare the documents to see similarities in important principals, experience from working with control room design, modifications and evaluations in other high risk industries has pervaded the report. Important principles have been identified which are recommended to be included in a control room philosophy. Many of these are similar to the principles identified in the international standards. An additional principal which is regarded as important is the utilization of Key Performance Indicators (KPI) which can be used as a measure to target preventative means. Further more it is critical that the control room philosophy is easy to access and comprehend for all users. One of the challenges that remain after having developed a control room philosophy is how to utilize it in the daily work situation. It is vital that the document remains as a living document, guiding the continual improvement of the control room in the various life cycle stages

  12. Suspected acute coronary syndrome in the emergency room: Limited added value of heart type fatty acid binding protein point of care or ELISA tests: The FAME-ER (Fatty Acid binding protein in Myocardial infarction Evaluation in the Emergency Room) study.

    Science.gov (United States)

    Bank, Ingrid Em; Dekker, Marieke S; Hoes, Arno W; Zuithoff, Nicolaas Pa; Verheggen, Peter Whm; de Vrey, Evelyn A; Wildbergh, Thierry X; Timmers, Leo; de Kleijn, Dominique Pv; Glatz, Jan Fc; Mosterd, Arend

    2016-08-01

    Timely recognition of acute coronary syndrome remains a challenge as many biomarkers, including troponin, remain negative in the first hours following the onset of chest pain. We assessed the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP), a cardiac biomarker with potential value immediately post symptom onset. Prospective monocentre diagnostic accuracy study of H-FABP bedside point of care (CardioDetect®) and ELISA tests in acute coronary syndrome suspected patients presenting within 24 hours of symptom onset to the emergency department, in addition to clinical findings, electrocardiography and the currently recommended biomarker high sensitivity troponin-T (hs-cTnT). The final diagnosis of acute coronary syndrome was adjudicated by two independent cardiologists, blinded to H-FABP results. Acute coronary syndrome was diagnosed in 149 (32.9%) of 453 unselected patients with suspected acute coronary syndrome (56% men, mean age 62.6 years). Negative predictive values were similar for H-FABP point of care and ELISA tests (79% vs. 78% respectively), but inferior to initial hs-cTnT (negative predictive value 86%). The addition of H-FABP point of care results to hs-cTnT increased the negative predictive value to 89%. In a multivariable logistic regression model, H-FABP point of care and ELISA tests yielded relevant diagnostic information in addition to clinical findings and ECG (likelihood ratio test pacute coronary syndrome presenting to the emergency department, H-FABP testing improves diagnostic accuracy in addition to clinical findings and electrocardiography. H-FABP, however, has no additional diagnostic value when hs-cTnT measurements are also available. © The European Society of Cardiology 2015.

  13. Cardioverter-defibrillator implantation in myeloma-associated cardiac amyloidosis.

    Science.gov (United States)

    Campanile, Alfonso; Sozzi, Fabiola B; Canetta, Ciro; Danzi, Gian Battista

    2013-01-01

    A 62-year-old woman with multiple myeloma and light-chain amyloidosis with significant heart involvement developed an in-hospital cardiac arrest. After cardiopulmonary resuscitation, a stable sinus rhythm without any cerebral damage was restored, and the patient was admitted to the coronary care unit. A cardioverter-defibrillator was implanted, and it successfully intervened in two sustained ventricular tachycardia episodes and one ventricular fibrillation episode, which were recorded during hospitalization. After achieving discrete cardiac compensation, the patient was transferred to the emergency medicine department where she underwent chemotherapy for multiple myeloma. The patient died 40 days after admission from refractory heart failure. In the literature, there are studies that describe the use of cardioverter-defibrillator implantation in cardiac amyloidosis; however, at present, there is no evidence of a beneficial effect on survival with the use of this intervention. A high index of suspicion for amyloid heart disease and early diagnosis are critical to improving outcomes.

  14. Different causes of referral to ophthalmology emergency room

    Directory of Open Access Journals (Sweden)

    Alireza Keshtkar Jafari

    2012-01-01

    Full Text Available Background: Eye-related complaints compose approximately 1-6% of complaints of patients referring to general emergency ward around the world. Eye injuries are the most common cause of referral to eye emergency ward. To understand the impact of eye injuries in Iran and to plan preventive strategies, it is important to understand the complete magnitude of the problem with regard to true population-based data and standard reproducible definitions. Aim: The main goal of this study was to identify the major causes of referrals to eye emergency ward in patients with eye-related complaints in an eye referral Hospital in Iran. Settings and Design: In a cross-sectional study, 3150 patients who referred to Farabi Hospital emergency ward, Tehran, Iran, from January to December 2007 were included in the study and their detailed information were recorded. Materials and Methods: The patients′ demographic data, medical history and final diagnosis were recorded in a questionnaire. Results: The mean age of patients was 33.2±16.8 years and 2380 patients (75.6% were males. While 299 patients (9.5% were referred for non-urgent reasons, work-related injuries were the most common cause of referral (955 patients; 30.3%. In patients referred due to trauma (1950 patients, work-related injuries occurred in 955 patients (49% and occurred accidentally (by chance in 819 patients (42%. The majority of patients referred with traumatic injuries were males (1708 patients; 87.6% versus 242 patients; 12.4%. The most common etiologies of eye trauma (1950 patients were metal filings (814 patients; 41.8%, blunt trauma (338 patients; 17.3%, fireworks (236 patients; 12.1% and sharp objects (222 patients; 11.4%. Globe injury was diagnosed in 1865 patients (95.7% of trauma cases. In patients referred due to non-traumatic reason (1200 patients, eye infection occurred in 482 patients (40.2% and 299 patients (24.9% were referred for non-urgent reasons. There was little difference

  15. Cardiac fusion and complex congenital cardiac defects in thoracopagus twins: diagnostic value of cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of); Park, Jeong-Jun [University of Ulsan College of Medicine, Asan Medical Center, Department of Pediatric Cardiac Surgery, Seoul (Korea, Republic of); Kim, Ellen Ai-Rhan [University of Ulsan College of Medicine, Asan Medical Center, Division of Neonatology, Department of Pediatrics, Seoul (Korea, Republic of); Won, Hye-Sung [University of Ulsan College of Medicine, Asan Medical Center, Department of Obstetrics and Gynecology, Seoul (Korea, Republic of)

    2014-09-15

    Most thoracopagus twins present with cardiac fusion and associated congenital cardiac defects, and assessment of this anatomy is of critical importance in determining patient care and outcome. Cardiac CT with electrocardiographic triggering provides an accurate and quick morphological assessment of both intracardiac and extracardiac structures in newborns, making it the best imaging modality to assess thoracopagus twins during the neonatal period. In this case report, we highlight the diagnostic value of cardiac CT in thoracopagus twins with an interatrial channel and complex congenital cardiac defects. (orig.)

  16. Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Daniela Aparecida Morais

    2014-08-01

    Full Text Available OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU of Belo Horizonte.METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%.RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%, "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%, "only the carry out of basic life support" (OR=0.142; p<0.05; CI95%, and "initial cardiac rhythm of asystole" (OR=0.33; p<0.05; CI 95%.CONCLUSION: early access to cardiopulmonary resuscitation was related to a favorable outcome, and the non-undertaking of advanced support, and asystole, were associated with worse outcomes. Basic and advanced life support techniques can alter survival in the event of cardiac arrest.

  17. Current and Emerging Uses of Insertable Cardiac Monitors: Evaluation of Syncope and Monitoring for Atrial Fibrillation.

    Science.gov (United States)

    Tomson, Todd T; Passman, Rod

    Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shown their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields in a cost-effective manner. While unexplained syncope continues to be the most common reason for their use, ICMs are increasingly being used for the monitoring of atrial fibrillation (AF). Recent trials have demonstrated that a substantial proportion of patients with cryptogenic stroke have AF detected only by the prolonged monitoring provided by ICMs. A particularly promising and emerging use for ICMs is in the management of anticoagulation in patients with known paroxysmal AF. The introduction in recent years of ICMs with automatic AF detection algorithms and continuous remote monitoring in combination with novel oral anticoagulants have opened the door for targeted anticoagulation guided by remote monitoring, a strategy that has recently shown promise in pilot studies of this technique. While further research is needed before official recommendations can be given, this use of ICMs opens exciting new possibilities for personalized medicine that could potentially reduce bleeding risk and improve quality of life in patients with atrial fibrillation.

  18. Biased Decision Making in Realistic Extra-Procedural Nuclear Control Room Scenarios

    DEFF Research Database (Denmark)

    Andersen, Emil; Kozin, Igor; Maier, Anja

    In normal operations and emergency situations, operators of nuclear control rooms rely on procedures to guide their decision making. However, in emergency situations, where several interacting problems can cause unpredictable adverse effects, these procedures may be insufficient in guiding...... improve safety by creating procedures that bear the risks of these biases in mind, or by specifically aiming to debias the users. Avenues for debiasing through design are discussed....

  19. Frequency of Cardiac Arrhythmias in Patients with Aluminum Phosphide Poisoning

    Directory of Open Access Journals (Sweden)

    Umair Aziz

    2015-12-01

    Full Text Available Background: Cardiac failure is the major lethal consequence of aluminum phosphide (AlP poisoning. This study was designed to determine the frequency of cardiac arrhythmias in patients with AlP poisoning. Methods: In this prospective cross-sectional study, patients with definitive history of AlP poisoning treated at emergency department of Allied Hospital Faisalabad, Faisalabad, Pakistan, from July 2013 to November 2014 were included. On admission, twelve-lead electrocardiogram (ECG was performed for all patients. During admission, all patients underwent continuous cardiac monitoring using a cardiac monitor. If an arrhythmia was suspected on the cardiac monitor, another ECG was obtained immediately.  Results: During the study period, 100 patients with AlP poisoning (63% men were treated at Allied Hospital Faisalabad. Mean age of the patients was 26.7 ± 7.9 years ranging from 16 to 54 years. Tachycardia was detected in 68 patients and bradycardia in 12 patients. Hypotension was observed in 75 patients. Eighty patients developed cardiac arrhythmia. The most frequent arrhythmia was atrial fibrillation (31% of patients followed by ventricular fibrillation (20%, ventricular tachycardia (17%, 3rd degree AV block (7% and 2nd degree AV block (5%. In total, 78 patients died, depicting a 78% mortality rate following wheat pill poisoning. Among those who died, seventy-one patients had cardiac arrhythmia. Comparison of death rate between patients with and without cardiac arrhythmia showed a significant difference (71/80 (88.8% vs. 7/20 (35%; P < 0.001.  Conclusion: Wheat pill poisoning causes a very high mortality, and circulatory collapse is the major cause of death among these patients. Most of the patients with AlP poisoning develop cardiac arrhythmias which are invariably life threatening. Early detection of cardiac disorders and proper management of arrhythmias may reduce mortalities.

  20. Gender-specific research for emergency diagnosis and management of ischemic heart disease: proceedings from the 2014 Academic Emergency Medicine Consensus Conference Cardiovascular Research Workgroup.

    Science.gov (United States)

    Safdar, Basmah; Nagurney, John T; Anise, Ayodola; DeVon, Holli A; D'Onofrio, Gail; Hess, Erik P; Hollander, Judd E; Legato, Mariane J; McGregor, Alyson J; Scott, Jane; Tewelde, Semhar; Diercks, Deborah B

    2014-12-01

    Coronary artery disease (CAD) is the most common cause of death for both men and women. However, over the years, emergency physicians, cardiologists, and other health care practitioners have observed varying outcomes in men and women with symptomatic CAD. Women in general are 10 to 15 years older than men when they develop CAD, but suffer worse postinfarction outcomes compared to age-matched men. This article was developed by the cardiovascular workgroup at the 2014 Academic Emergency Medicine (AEM) consensus conference to identify sex- and gender-specific gaps in the key themes and research questions related to emergency cardiac ischemia care. The workgroup had diverse stakeholder representation from emergency medicine, cardiology, critical care, nursing, emergency medical services, patients, and major policy-makers in government, academia, and patient care. We implemented the nominal group technique to identify and prioritize themes and research questions using electronic mail, monthly conference calls, in-person meetings, and Web-based surveys between June 2013 and May 2014. Through three rounds of nomination and refinement, followed by an in-person meeting on May 13, 2014, we achieved consensus on five priority themes and 30 research questions. The overarching themes were as follows: 1) the full spectrum of sex-specific risk as well as presentation of cardiac ischemia may not be captured by our standard definition of CAD and needs to incorporate other forms of ischemic heart disease (IHD); 2) diagnosis is further challenged by sex/gender differences in presentation and variable sensitivity of cardiac biomarkers, imaging, and risk scores; 3) sex-specific pathophysiology of cardiac ischemia extends beyond conventional obstructive CAD to include other causes such as microvascular dysfunction, takotsubo, and coronary artery dissection, better recognized as IHD; 4) treatment and prognosis are influenced by sex-specific variations in biology, as well as patient

  1. Analysis of steps adapted protocol in cardiac rehabilitation in the hospital phase

    Science.gov (United States)

    Winkelmann, Eliane Roseli; Dallazen, Fernanda; Bronzatti, Angela Beerbaum Steinke; Lorenzoni, Juliara Cristina Werner; Windmöller, Pollyana

    2015-01-01

    Objective To analyze a cardiac rehabilitation adapted protocol in physical therapy during the postoperative hospital phase of cardiac surgery in a service of high complexity, in aspects regarded to complications and mortality prevalence and hospitalization days. Methods This is an observational cross-sectional, retrospective and analytical study performed by investigating 99 patients who underwent cardiac surgery for coronary artery bypass graft, heart valve replacement or a combination of both. Step program adapted for rehabilitation after cardiac surgery was analyzed under the command of the physiotherapy professional team. Results In average, a patient stays for two days in the Intensive Care Unit and three to four days in the hospital room, totalizing six days of hospitalization. Fatalities occurred in a higher percentage during hospitalization (5.1%) and up to two years period (8.6%) when compared to 30 days after hospital discharge (1.1%). Among the postoperative complications, the hemodynamic (63.4%) and respiratory (42.6%) were the most prevalent. 36-42% of complications occurred between the immediate postoperative period and the second postoperative day. The hospital discharge started from the fifth postoperative day. We can observe that in each following day, the patients are evolving in achieving the Steps, where Step 3 was the most used during the rehabilitation phase I. Conclusion This evolution program by steps can to guide the physical rehabilitation at the hospital in patients after cardiac surgery. PMID:25859866

  2. [Emergency room services utilization in the province of Reggio Emilia: a comparison between immigrants and Italians].

    Science.gov (United States)

    Bonvicini, Laura; Broccoli, Serena; D'Angelo, Stefania; Candela, Silvia

    2011-01-01

    The aim of the study is to compare Italian and immigrant accesses to Emergency Room (ER) Services in the province of Reggio Emilia, with particular attention to time differences and to potentially inappropriate accesses. the database of ER accesses in the province of Reggio Emilia was analyzed for the years 2007- 2010. In the analysis of the resident population all autochthonous citizens and all immigrants from Developed Countries were considered Italians, while citizens from Developing Countries were Immigrants. Temporary Immigrants were those immigrants with residence and citizenship in a Developing Country. A descriptive analysis was conducted using demographic variables related to patients (age, gender, citizenship and residence) and variables related to access (admission emergency codes, cause of admission, hour, day of the week, month and discharge modality). Standardized access Ratios (SRs) were calculated for the resident population, together with 95%Confidence Intervals (95% CI). The SRs were calculated separately for children and for adults. In the years 2007-2010, 562,658 accesses to ER were recorded for Italians, 95,300 accesses for Immigrants and 6,800 for the Temporary Immigrants. Access rates for resident Immigrants were higher than Italian ones. In 2010, the SR for men was 1.24 (95%CI 1.22-1.27) while for women it was 1.18 (95%CI 1.15-1.27). Considering only non-urgent accesses, the SRs were even higher (SR men=1.65, 95% CI 1.58-1.72, women=1.43, 95% CI 1.36-1.50). Similar findings were observed in children. Immigrants access the ER services more than Italians do.They also show more non-urgent accesses in comparison with Italians. This finding is consistent with results of studies conducted in other European countries and it underlines the necessity to reorganize primary care in order to better meet immigrants' needs.

  3. Relationship between chest compression rates and outcomes from cardiac arrest.

    Science.gov (United States)

    Idris, Ahamed H; Guffey, Danielle; Aufderheide, Tom P; Brown, Siobhan; Morrison, Laurie J; Nichols, Patrick; Powell, Judy; Daya, Mohamud; Bigham, Blair L; Atkins, Dianne L; Berg, Robert; Davis, Dan; Stiell, Ian; Sopko, George; Nichol, Graham

    2012-06-19

    Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions per minute. Animal and human studies have reported that blood flow is greatest with chest compression rates near 120/min, but few have reported rates used during out-of-hospital (OOH) cardiopulmonary resuscitation or the relationship between rate and outcome. The purpose of this study was to describe chest compression rates used by emergency medical services providers to resuscitate patients with OOH cardiac arrest and to determine the relationship between chest compression rate and outcome. Included were patients aged ≥ 20 years with OOH cardiac arrest treated by emergency medical services providers participating in the Resuscitation Outcomes Consortium. Data were abstracted from monitor-defibrillator recordings during cardiopulmonary resuscitation. Multiple logistic regression analysis assessed the association between chest compression rate and outcome. From December 2005 to May 2007, 3098 patients with OOH cardiac arrest were included in this study. Mean age was 67 ± 16 years, and 8.6% survived to hospital discharge. Mean compression rate was 112 ± 19/min. A curvilinear association between chest compression rate and return of spontaneous circulation was found in cubic spline models after multivariable adjustment (P=0.012). Return of spontaneous circulation rates peaked at a compression rate of ≈ 125/min and then declined. Chest compression rate was not significantly associated with survival to hospital discharge in multivariable categorical or cubic spline models. Chest compression rate was associated with return of spontaneous circulation but not with survival to hospital discharge in OOH cardiac arrest.

  4. Optimizing Neurologically Intact Survival from Sudden Cardiac Arrest: A Call to Action

    Directory of Open Access Journals (Sweden)

    Jeffrey M. Goodloe

    2014-11-01

    Full Text Available The U.S. national out-of-hospital and in-hospital cardiac arrest survival rates, although improving recently, have remained suboptimal despite the collective efforts of individuals, communities, and professional societies. Only until very recently, and still with inconsistency, has focus been placed specifically on survival with pre-arrest neurologic function. The reality of current approaches to sudden cardiac arrest is that they are often lacking an integrative, multi-disciplinary approach, and without deserved funding and outcome analysis. In this manuscript, a multidisciplinary group of authors propose practice, process, technology, and policy initiatives to improve cardiac arrest survival with a focus on neurologic function. [West J Emerg Med. 2014;15(7:-0.

  5. Room to Groove?

    DEFF Research Database (Denmark)

    Seabrooke, Leonard

    . As long as they stay within the parameters of legitimate financial practice to signal institutional isomorphism, the `groove', creditors may well allow borrowers room for change in self-determined ways. This paper maps out the historical and conceptual terrain concerning civilizing ideas about...... the legitimacy of financial practices within global capital markets, and investigates relationships between Western `civilizers' and Emerging Market Economies during the last two periods of financial globalization, the late-nineteenth/ early-twentieth centuries and the late-twentieth century.......The use of a `standard of civilization', a preferred form of socio-political organization, in global capital markets presents both constraints and opportunities for creditors and borrowers. When imposed, civilizing standards may change how a borrower would prefer to conduct their affairs. Creditors...

  6. In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM).

    Science.gov (United States)

    Hinkelbein, Jochen; Böhm, Lennert; Braunecker, Stefan; Genzwürker, Harald V; Kalina, Steffen; Cirillo, Fabrizio; Komorowski, Matthieu; Hohn, Andreas; Siedenburg, Jörg; Bernhard, Michael; Janicke, Ilse; Adler, Christoph; Jansen, Stefanie; Glaser, Eckard; Krawczyk, Pawel; Miesen, Mirko; Andres, Janusz; De Robertis, Edoardo; Neuhaus, Christopher

    2018-05-05

    By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.

  7. Paediatric cardiac intensive care unit: current setting and organization in 2010.

    Science.gov (United States)

    Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan

    2010-10-01

    Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  8. Causes and consequences of occupational stress in emergency nurses, a longitudinal study.

    Science.gov (United States)

    Adriaenssens, Jef; De Gucht, Veronique; Maes, Stan

    2015-04-01

    This longitudinal study examines the influence of changes over time in work and organisational characteristics on job satisfaction, work engagement, emotional exhaustion, turnover intention and psychosomatic distress in emergency room nurses. Organisational and job characteristics of nurses are important predictors of stress-health outcomes. Emergency room nurses are particularly exposed to stressful work-related events and unpredictable work conditions. The study was carried out in 15 emergency departments of Belgian general hospitals in 2008 (T1) and 18 months later (T2) (n = 170). Turnover rates between T1 and T2 were high. Important changes over time were found in predictors and outcomes. Changes in job demand, control and social support predicted job satisfaction, work engagement and emotional exhaustion. In addition, changes in reward, social harassment and work agreements predicted work engagement, emotional exhaustion and intention to leave, respectively. Work-related interventions are important to improve occupational health in emergency room nurses and should focus on lowering job demands, increasing job control, improving social support and a well-balanced reward system. Nursing managers should be aware of the causes and consequences of occupational stress in emergency room nurses in order to enable preventive interventions. © 2013 John Wiley & Sons Ltd.

  9. A Structured Transfer of Care Process Reduces Perioperative Complications in Cardiac Surgery Patients.

    Science.gov (United States)

    Hall, Michael; Robertson, Jamie; Merkel, Matthias; Aziz, Michael; Hutchens, Michael

    2017-08-01

    Serious complications are common during the intensive care of postoperative cardiac surgery patients. Some of these complications may be influenced by communication during the process of handover of care from the operating room to the intensive care unit (ICU) team. A structured transfer of care process may reduce the rate of communication errors and perioperative complications. We hypothesized that a collaborative, comprehensive, structured handover of care from the intraoperative team to the ICU team would reduce a specific set of postoperative complications. We tested this hypothesis by developing and introducing a comprehensive multidisciplinary transfer of care process. We measured patient outcomes before and after the intervention using a linkage between 2 care databases: an Anesthesia Information Management System and a critical care complication registry database. There were 1127 total postoperative cardiac surgery admissions during the study period, 550 before and 577 after the intervention. There was no statistical difference between overall complications before and after the intervention (P = .154). However, there was a statistically significant reduction in preventable complications after the intervention (P = .023). The main finding of this investigation is that the introduction of a collaborative, comprehensive transfer of care process from the operating room to the ICU was associated with patients suffering fewer preventable complications.

  10. Poluição atmosférica devida à queima de biomassa florestal e atendimentos de emergência por doença respiratória em Rio Branco, Brasil - Setembro, 2005 Anthropogenic air pollution and respiratory disease-related emergency room visits in Rio Branco, Brazil - September, 2005

    Directory of Open Access Journals (Sweden)

    Márcio Dênis Medeiros Mascarenhas

    2008-01-01

    Full Text Available A poluição atmosférica é um importante problema de saúde pública, principalmente na Amazônia e grandes cidades brasileiras. Em setembro de 2005, observou-se elevada concentração de fumaça em Rio Branco, Acre, devido às queimadas. Para avaliar a relação entre a concentração diária de particulate matter Air pollution is a major public health problem in the Amazon forest and in large Brazilian cities. During September of 2005, high concentrations of smoke from biomass burning were observed in the city of Rio Branco. An ecological study was conducted to evaluate the relationship between daily concentrations of particulate matter < 2.5 µm (PM2.5 and the number of respiratory disease (RD-related emergency room visits. Daily PM2.5 concentrations exceeded recommended air quality limits on 23 days. The incidence of RDs was higher among children < 10 years of age. There was a significant positive correlation between PM2.5 concentrations and asthma emergency room visits.

  11. Realizing improved patient care through human-centered operating room design: a human factors methodology for observing flow disruptions in the cardiothoracic operating room.

    Science.gov (United States)

    Palmer, Gary; Abernathy, James H; Swinton, Greg; Allison, David; Greenstein, Joel; Shappell, Scott; Juang, Kevin; Reeves, Scott T

    2013-11-01

    Human factors engineering has allowed a systematic approach to the evaluation of adverse events in a multitude of high-stake industries. This study sought to develop an initial methodology for identifying and classifying flow disruptions in the cardiac operating room (OR). Two industrial engineers with expertise in human factors workflow disruptions observed 10 cardiac operations from the moment the patient entered the OR to the time they left for the intensive care unit. Each disruption was fully documented on an architectural layout of the OR suite and time-stamped during each phase of surgery (preoperative [before incision], operative [incision to skin closure], and postoperative [skin closure until the patient leaves the OR]) to synchronize flow disruptions between the two observers. These disruptions were then categorized. The two observers made a total of 1,158 observations. After the elimination of duplicate observations, a total of 1,080 observations remained to be analyzed. These disruptions were distributed into six categories such as communication, usability, physical layout, environmental hazards, general interruptions, and equipment failures. They were further organized into 33 subcategories. The most common disruptions were related to OR layout and design (33%). By using the detailed architectural diagrams, the authors were able to clearly demonstrate for the first time the unique role that OR design and equipment layout has on the generation of physical layout flow disruptions. Most importantly, the authors have developed a robust taxonomy to describe the flow disruptions encountered in a cardiac OR, which can be used for future research and patient safety improvements.

  12. Perimortem caesarean section following maternal gunshot wounds

    Directory of Open Access Journals (Sweden)

    Ozlem Gunevsel

    2011-01-01

    Full Text Available Perimortem caesarean section is an ethically difficult decision for emergency medicine resuscitation teams. A 34-years-old woman was attacked by her husband with a gunshot. At the time arrival to the emergency room, there was no pulse, no spontaneous breath and blood pressure was unobtainable. Although extensive advanced cardiopulmonary resuscita-tion was performed for 7 minutes, no cardiac activity was regained. During the cardiopulmonary resuscitation efforts, an abdominal ultrasonography was performed and revealed a fetal heart rate with bradycardia. Low segment caesarean section was performed by the obstetrician in the resuscitation room and a female newborn was delivered within less than one minute of the skin incision. Decision on terminating the CPR efforts should not be made in maternal cardiac arrests older than 28 weeks′ gestational age, unless the viability of the fetus had been evaluated.

  13. Nuclear power plant control room ventilation system design for meeting general criterion 19

    International Nuclear Information System (INIS)

    Murphy, K.G.; Campe, K.M.

    1975-01-01

    The requirement for protection of control room personnel against radiation is specified in General Design Criterion 19 of Appendix A, 10 CFR Part 50. The evaluation of a control room design, especially its emergency ventilation system, with respect to radiation protection primarily consists of determining the radiation doses to control room personnel under accident conditions. The accident dose assessment involves modeling and evaluation of radiological source terms, atmospheric transport of airborne activity, and protection features of the control room ventilation system. Some of the assumptions and conservatisms used in the dose analyses are based on the technical review experience of existing or proposed control room designs. A review of over 50 control room designs has revealed a great variety of design concepts, not all of which seem to have been based on radiation protection criteria. A summary of the basic control room protection requirements, design features, dose acceptance criteria, and an outline of the methods used by the Regulatory staff for accident dose evaluation are presented. (U.S.)

  14. Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Göteborg.

    Science.gov (United States)

    Engdahl, J; Abrahamsson, P; Bång, A; Lindqvist, J; Karlsson, T; Herlitz, J

    2000-02-01

    To describe patient characteristics, hospital investigations and interventions and early mortality among patients being hospitalized after out-of-hospital cardiac arrest in two hospitals. Municipality of Göteborg, Sweden. All patients suffering an out-of-hospital cardiac arrest who were successfully resuscitated and admitted to hospital between 1 October 1980 and 31 December 1996. All patients were resuscitated by the same Emergency Medical Service and admitted alive to one of the two city hospitals in Göteborg. Of 579 patients admitted to Sahlgrenska Hospital, 253 (44%) were discharged alive and of 459 patients admitted to Ostra Hospital, 152 (33%) were discharged alive (P percentage of patients admitted to Sahlgrenska Hospital underwent coronary angiography (P < 0.001), electrophysiological testing (P < 0.001), Holter recording (P < 0.001), echocardiography (P = 0.004), percutaneous transluminal coronary angioplasty (PTCA, P = 0.009), implantation of automatic implantable cardioverter defibrillator (AICD, P = 0.03) and exercise stress tests (P = 0.003). Inhabitants in the catchment area of Ostra Hospital had a less favourable socio-economic profile. Survival after out-of-hospital cardiac arrest may be affected by the course of hospital management. Other variables that might influence survival are socio-economic factors and cardiorespiratory status on admission to hospital. Further investigation is called for as more patients are being hospitalised alive after out-of-hospital cardiac arrest.

  15. Cardiac surgery in the parturient.

    Science.gov (United States)

    Chandrasekhar, Shobana; Cook, Christopher R; Collard, Charles D

    2009-03-01

    Heart disease is the primary cause of nonobstetric mortality in pregnancy, occurring in 1%-3% of pregnancies and accounting for 10%-15% of maternal deaths. Congenital heart disease has become more prevalent in women of childbearing age, representing an increasing percentage (up to 75%) of heart disease in pregnancy. Untreated maternal heart disease also places the fetus at risk. Independent predictors of neonatal complications include a maternal New York Heart Association heart failure classification >2, anticoagulation use during pregnancy, smoking, multiple gestation, and left heart obstruction. Because cardiac surgical morbidity and mortality in the parturient is higher than nonpregnant patients, most parturients with cardiac disease are first managed medically, with cardiac surgery being reserved when medical management fails. Risk factors for maternal mortality during cardiac surgery include the use of vasoactive drugs, age, type of surgery, reoperation, and maternal functional class. Risk factors for fetal mortality include maternal age >35 yr, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. Nonetheless, acceptable maternal and fetal perioperative mortality rates may be achieved through such measures as early preoperative detection of maternal cardiovascular decompensation, use of fetal monitoring, delivery of a viable fetus before the operation and scheduling surgery on an elective basis during the second trimester. Additionally, fetal morbidity may be reduced during cardiopulmonary bypass by optimizing maternal oxygen-carrying capacity and uterine blood flow. Current maternal bypass recommendations include: 1) maintaining the pump flow rate >2.5 L x min(-1) x m(-2) and perfusion pressure >70 mm Hg; 2) maintaining the hematocrit > 28%; 3) using normothermic perfusion when feasible; 4) using pulsatile flow; and 5) using alpha-stat pH management.

  16. Prenatal hypoxia induces increased cardiac contractility on a background of decreased capillary density

    Directory of Open Access Journals (Sweden)

    Ousley Victoria

    2009-01-01

    Full Text Available Abstract Background Chronic hypoxia in utero (CHU is one of the most common insults to fetal development and may be associated with poor cardiac recovery from ischaemia-reperfusion injury, yet the effects on normal cardiac mechanical performance are poorly understood. Methods Pregnant female wistar rats were exposed to hypoxia (12% oxygen, balance nitrogen for days 10–20 of pregnancy. Pups were born into normal room air and weaned normally. At 10 weeks of age, hearts were excised under anaesthesia and underwent retrograde 'Langendorff' perfusion. Mechanical performance was measured at constant filling pressure (100 cm H2O with intraventricular balloon. Left ventricular free wall was dissected away and capillary density estimated following alkaline phosphatase staining. Expression of SERCA2a and Nitric Oxide Synthases (NOS proteins were estimated by immunoblotting. Results CHU significantly increased body mass (P in utero. Conclusion These data offer potential mechanisms for poor recovery following ischaemia, including decreased coronary flow reserve and impaired angiogenesis with subsequent detrimental effects of post-natal cardiac performance.

  17. Room Acoustics

    Science.gov (United States)

    Kuttruff, Heinrich; Mommertz, Eckard

    The traditional task of room acoustics is to create or formulate conditions which ensure the best possible propagation of sound in a room from a sound source to a listener. Thus, objects of room acoustics are in particular assembly halls of all kinds, such as auditoria and lecture halls, conference rooms, theaters, concert halls or churches. Already at this point, it has to be pointed out that these conditions essentially depend on the question if speech or music should be transmitted; in the first case, the criterion for transmission quality is good speech intelligibility, in the other case, however, the success of room-acoustical efforts depends on other factors that cannot be quantified that easily, not least it also depends on the hearing habits of the listeners. In any case, absolutely "good acoustics" of a room do not exist.

  18. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions-A nationwide prospective feasibility study

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske

    2010-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...... providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases....

  19. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske

    2011-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...... providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases....

  20. New Emergency control center of Slovenske Elektrarne Bohunice NPP

    International Nuclear Information System (INIS)

    Pecko, E.

    2012-01-01

    Emergency preparedness of nuclear power plant and operation assurance in case of a possible emergency calls to have devices for emergency response with equipment for rapid detection and continuous evaluation of anticipated events. Chief executive body designated to manage a nuclear power plant during major events is the emergency committee (EC). Emergency Committee is a part of the Emergency Response Organization (ERO). The following centers are on alert to ensure the activities of the ERO - Emergency Response office: - control room (CR) and emergency control room (ECR); - emergency management center (EMC); - Monitoring Centre (MC); - emergency backup control center (EBCC); - congregations of civil protection (CP) and CP shelters; - communications with warning and notification system (VARVYR). From a historical and practical point of view in the vicinity of Jaslovske Bohunice has been set up a joint emergency control center. The center was located on the territory of the former already inoperative V1 NPP. V1 NPP is currently integrated into the organizational structure of JAVYS. Operating Bohunice V2 NPP plant is a designated part of the Slovenske Elektrarne, a. s., whose majority owner is an Italian operator ENEL. In terms of various relevant factors, it was decided to build a new emergency management center on the territory of operating V2 NPP, meet the current standards.

  1. Quality of care using a multidisciplinary team in the emergency room

    DEFF Research Database (Denmark)

    Christensen, Dorthea; Maaløe, Rikke; Jensen, Nanna Martin

    2011-01-01

    Bispebjerg Hospital has implemented a multidisciplinary team reception of critically ill and severely injured patients at the Emergency Department (ED), termed emergency call (EC) and trauma call (TC). The aim of this study was to describe the course, medical treatment and outcome for patients re...... received by this multidisciplinary team and to evaluate the quality of acute medical treatment of these patients....

  2. Instrumented cardiac microphysiological devices via multimaterial three-dimensional printing

    Science.gov (United States)

    Lind, Johan U.; Busbee, Travis A.; Valentine, Alexander D.; Pasqualini, Francesco S.; Yuan, Hongyan; Yadid, Moran; Park, Sung-Jin; Kotikian, Arda; Nesmith, Alexander P.; Campbell, Patrick H.; Vlassak, Joost J.; Lewis, Jennifer A.; Parker, Kevin K.

    2017-03-01

    Biomedical research has relied on animal studies and conventional cell cultures for decades. Recently, microphysiological systems (MPS), also known as organs-on-chips, that recapitulate the structure and function of native tissues in vitro, have emerged as a promising alternative. However, current MPS typically lack integrated sensors and their fabrication requires multi-step lithographic processes. Here, we introduce a facile route for fabricating a new class of instrumented cardiac microphysiological devices via multimaterial three-dimensional (3D) printing. Specifically, we designed six functional inks, based on piezo-resistive, high-conductance, and biocompatible soft materials that enable integration of soft strain gauge sensors within micro-architectures that guide the self-assembly of physio-mimetic laminar cardiac tissues. We validated that these embedded sensors provide non-invasive, electronic readouts of tissue contractile stresses inside cell incubator environments. We further applied these devices to study drug responses, as well as the contractile development of human stem cell-derived laminar cardiac tissues over four weeks.

  3. Epidemiological profile of work-related accidents with biological exposure among medical students in a surgical emergency room.

    Science.gov (United States)

    Reis, Phillipe Geraldo Teixeira de Abreu; Driessen, Anna Luiza; da Costa, Ana Claudia Brenner Affonso; Nasr, Adonis; Collaço, Iwan Augusto; Tomasich, Flávio Daniel Saavedra

    2013-01-01

    To evaluate the accidents with biological material among medical students interning in a trauma emergency room and identify key related situations, attributed causes and prevention. we conducted a study with a quantitative approach. Data were collected through a questionnaire applied via internet, with closed, multiple-choice questions regarding accidents with biological material. The sample comprised 100 students. thirty-two had accidents with biological material. Higher-risk activities were local anesthesia (39.47%), suture (18.42%) and needle recapping (15.79%). The main routes of exposure to biological material were the eyes or mucosa, with 34%, and syringe needle puncture, with 45%. After contamination, only 52% reported the accident to the responsible department. The main causes of accidents and routes of exposure found may be attributed to several factors, such as lack of training and failure to use personal protective equipment. Educational and preventive actions are extremely important to reduce the incidence of accidents with biological materials and improve the conduct of post-exposure. It is important to understand the main causes attributed and situations related, so as general and effective measures can be applied.

  4. To stay or to go? Balancing the risk of reprocessing plant control room evacuation following a criticality alarm

    International Nuclear Information System (INIS)

    Love, Suzanne; McCrindle, David; Harris, Neil; Haworth, Justin

    2003-01-01

    Following a criticality alarm within the Magnox Separation Plant at Sellafield, there is a conflict of interest between the risks associated with complete evacuation versus continued manning of the control room. The historic emergency response policy would be to completely evacuate the control room upon a criticality alarm. If, however, the alarm was found to be false, the inevitable loss in control over the plant could have environmental, operational and radiological release consequences. Maintaining control room manning following a genuine alarm might, however, result in an avoidable high dose to an operator. Based upon the estimated dose equivalent to a control room operator for a range of criticality incident morphologies a risk analysis was undertaken. The results indicate that the differential risk between an operator who evacuates immediately and an operator who remains for a short time to complete diagnostic checks is very small. As a consequence a new emergency policy was therefore developed on plant which results in a relatively low risk to control room operators, but still allows control over the plant to be retained following a false criticality alarm. (author)

  5. Observations of Chat Room Conversations on the Internet: Implications for Educators Addressing the Needs of Female Adolescents

    Science.gov (United States)

    Sanger, Dixie; Ritzman, Mitzi; LaCost, Barbara; Stofer, Keri; Long, Amie; Grady, Marilyn

    2005-01-01

    This qualitative study explored the meanings of chat room conversations through observations of teenagers using the Internet. Adolescent girls were a focus because of their shaky sense of self. Participants in ten chat rooms included 534 individuals. Six themes, emerging from analyzing 2526 utterances [descriptive statements], included (a)…

  6. Differences in Presentation, Management and Outcomes in Women and Men Presenting to an Emergency Department With Possible Cardiac Chest Pain.

    Science.gov (United States)

    Ruane, Lorcan; H Greenslade, Jaimi; Parsonage, William; Hawkins, Tracey; Hammett, Christopher; Lam, Carolyn Sp; Knowlman, Thomas; Doig, Shaela; Cullen, Louise

    2017-12-01

    Research suggests that female patients with acute coronary syndrome (ACS) experience delays in emergency department (ED) management and are less likely to receive guideline-based treatments and referrals for follow-up testing. Women are often found to have poorer clinical outcomes in comparison to men. This study aimed to assess current sex differences in the presentation, management and outcomes of patients with undifferentiated chest pain presenting to a tertiary ED. Data were analysed from two prospective studies conducted at a single Australian site between 2007 and 2014. Eligible patients were those of 18 years of age or older presenting with at least 5 minutes of chest pain or other symptoms for which the treating physician planned to investigate for possible ACS. Presenting symptoms, ED time measures, follow-up testing and outcomes, including 30-day ACS and mortality, were measured and compared between male and female patients. Of 2349 (60% men) patients presenting with chest pain, 153 men and 51 women were diagnosed with ACS within 30days . Presenting symptoms were similar in men and women with confirmed ACS. Time from symptom onset to ED presentation, time spent in the ED and total time in hospital were similar between the sexes. Male and female patients had similar rates of follow-up provocative testing. After adjustment for clinical factors, the odds of undergoing angiography were 1.8 (95% CI: 1.36-2.40) times higher for men than women. Of those undergoing coronary angiography within 30 days, a smaller proportion of women, compared to men, received revascularisation. Within 30 days, three (0.2%) male and one (0.1%) female patient died. Minimal sex differences were observed in the contemporary emergency management of patients presenting with suspected ACS. Thirty-day outcomes were similarly low in men and women despite lower rates of coronary angiography and revascularisation in women. Further research is required to replicate these results in different

  7. Cardiac tamponade: contrast reflux as an indicator of cardiac chamber equalization

    Directory of Open Access Journals (Sweden)

    Nauta Foeke Jacob

    2012-05-01

    Full Text Available Abstract Background Traumatic hemopericardium remains a rare entity; it does however commonly cause cardiac tamponade which remains a major cause of death in traumatic blunt cardiac injury. Objectives We present a case of blunt chest trauma complicated by cardiac tamponade causing cardiac chamber equalization revealed by reflux of contrast. Case report A 29-year-old unidentified male suffered blunt chest trauma in a motor vehicle collision. Computed tomography (CT demonstrated a periaortic hematoma and hemopericardium. Significant contrast reflux was seen in the inferior vena cava and hepatic veins suggesting a change in cardiac chamber pressures. After intensive treatment including cardiac massage this patient expired of cardiac arrest. Conclusion Reflux of contrast on CT imaging can be an indicator of traumatic cardiac tamponade.

  8. Living cardiac patch: the elixir for cardiac regeneration.

    Science.gov (United States)

    Lakshmanan, Rajesh; Krishnan, Uma Maheswari; Sethuraman, Swaminathan

    2012-12-01

    A thorough understanding of the cellular and muscle fiber orientation in left ventricular cardiac tissue is of paramount importance for the generation of artificial cardiac patches to treat the ischemic myocardium. The major challenge faced during cardiac patch engineering is to choose a perfect combination of three entities; cells, scaffolds and signaling molecules comprising the tissue engineering triad for repair and regeneration. This review provides an overview of various scaffold materials, their mechanical properties and fabrication methods utilized in cardiac patch engineering. Stem cell therapies in clinical trials and the commercially available cardiac patch materials were summarized in an attempt to provide a recent perspective in the treatment of heart failure. Various tissue engineering strategies employed thus far to construct viable thick cardiac patches is schematically illustrated. Though many strategies have been proposed for fabrication of various cardiac scaffold materials, the stage and severity of the disease condition demands the incorporation of additional cues in a suitable scaffold material. The scaffold may be nanofibrous patch, hydrogel or custom designed films. Integration of stem cells and biomolecular cues along with the scaffold may provide the right microenvironment for the repair of unhealthy left ventricular tissue as well as promote its regeneration.

  9. Wind tunnel testing to predict control room atmospheric dispersion factors

    International Nuclear Information System (INIS)

    Holmquist, L.J.; Harden, P.A.; Muraida, J.E.

    1993-01-01

    Recent concerns at Palisades about control room habitability in the event of a loss-of-coolant accident have led to an extensive effort to increase control room habitability margin. The heating, ventilating and air-conditioning (HVAC) system servicing the control room has the potential for unfiltered in-leakage through its normal outside air intake louvered isolation dampers during emergency mode. The current limiting control room habitability analysis allows for 1.2 x 10 -2 m 3 /s (25 ft 3 /min) unfiltered in-leakage into the control room envelope. This leakage value was not thought to be achievable with the existing as-built configuration. Repairing the system was considered as a potential solution; however, this would be costly and could negatively affect plant operation. In addition, the system would still be required to meet the low specified unfiltered in-leakage. A second approach to this problem was to determine the atmospheric dispersion factors (x/Q's) through a wind tunnel test using a scale model of Palisades. The results of the wind tunnel testing could yield more realistic x/Q's for control room habitability than previously employed methods. Palisades selected the wind tunnel study option based on its ease of implementation, realistic results, and low cost. More importantly, the results of the study could increase the allowable unfiltered in-leakage

  10. Cardiac and great vessel injuries after chest trauma: our 10-year experience.

    Science.gov (United States)

    Onan, Burak; Demirhan, Recep; Öz, Kürşad; Onan, Ismihan Selen

    2011-09-01

    Cardiovascular injuries after trauma present with high mortality. The aim of the study was to present our experience in cardiac and great vessel injuries after chest trauma. During the 10-year period, 104 patients with cardiac (n=94) and great vessel (n=10) injuries presented to our hospital. The demographic data, mechanism of injury, location of injury, other associated injuries, timing of surgical intervention, surgical approach, and clinical outcome were reviewed. Eighty-eight (84.6%) males presented after chest trauma. The mean age of the patients was 32.5±8.2 years (range: 12-76). Penetrating injuries (62.5%) were the most common cause of trauma. Computed tomography was performed in most cases and echocardiography was used in some stable cases. Cardiac injuries mostly included the right ventricle (58.5%). Great vessel injuries involved the subclavian vein in 6, innominate vein in 1, vena cava in 1, and descending aorta in 2 patients. Early operations after admission to the emergency were performed in 75.9% of the patients. Thoracotomy was performed in 89.5% of the patients. Operative mortality was significantly high in penetrating injuries (p=0.01). Clinicians should suspect cardiac and great vessel trauma in every patient presenting to the emergency unit after chest trauma. Computed tomography and echocardiography are beneficial in the management of chest trauma. Operative timing depends on hemodynamic status, and a multidisciplinary team approach improves the patient's prognosis.

  11. Regulation of cardiac remodeling by cardiac Na/K-ATPase isoforms

    Directory of Open Access Journals (Sweden)

    Lijun Catherine Liu

    2016-09-01

    Full Text Available Cardiac remodeling occurs after cardiac pressure/volume overload or myocardial injury during the development of heart failure and is a determinant of heart failure. Preventing or reversing remodeling is a goal of heart failure therapy. Human cardiomyocyte Na+/K+-ATPase has multiple α isoforms (1-3. The expression of the α subunit of the Na+/K+-ATPase is often altered in hypertrophic and failing hearts. The mechanisms are unclear. There are limited data from human cardiomyocytes. Abundant evidences from rodents show that Na+/K+-ATPase regulates cardiac contractility, cell signaling, hypertrophy and fibrosis. The α1 isoform of the Na+/K+-ATPase is the ubiquitous isoform and possesses both pumping and signaling functions. The α2 isoform of the Na+/K+-ATPase regulates intracellular Ca2+ signaling, contractility and pathological hypertrophy. The α3 isoform of the Na+/K+-ATPase may also be a target for cardiac hypertrophy. Restoration of cardiac Na+/K+-ATPase expression may be an effective approach for prevention of cardiac remodeling. In this article, we will overview: (1 the distribution and function of isoform specific Na+/K+-ATPase in the cardiomyocytes. (2 the role of cardiac Na+/K+-ATPase in the regulation of cell signaling, contractility, cardiac hypertrophy and fibrosis in vitro and in vivo. Selective targeting of cardiac Na+/K+-ATPase isoform may offer a new target for the prevention of cardiac remodeling.

  12. Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Taro Takeshima

    Full Text Available (1 To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER of community hospitals, and (2 to test the validity of that rule with a separate, independent set of data.Multicenter retrospective cohort study.To derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation. We tested the rule using data from one other community hospital (validation, which was not among the three "derivation" hospitals.Adults (age ≥ 16 years old who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients, and for the validation data n = 467 (from 823 patients.We analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the "ID-BactER" score. Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC were computed.There were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation and 0.74 (validation. For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively.The ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity.

  13. Management of Radiological emergencies

    International Nuclear Information System (INIS)

    Lentijo, J. C.; Gil, E.; San Nicolas, J.; Lazuen, J. A.

    2004-01-01

    Spain has a system of planning and response to emergency situations that is structured and coordinated by the General Directorship of civil Defense of the Ministry of the Interior and in which all levels of the Public Administration. state, autonomous and municipal-and owners of potentially hazardous activities participate. Activities involving a nuclear or radiological risk have specific emergency plans whose general principles are based on the general emergency system and whose technical bases are consistent with international practices and recommendations. The Consejo de Seguridad Nuclear actively participates in the design, implementation and activation of these plans, and for this purpose has an organization superimposed on its ordinary working organization that is activated in the event of an accident, as well as an Emergency Room specifically designed to deal with nuclear and radiological emergencies. (Author)

  14. Screening Criteria for Loss of Room Cooling Failure

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Mee Jeong; Yang, Joon Eon; Yoon, Churl

    2007-01-15

    In this report, we estimated the temperature of the pump rooms and reviewed the operability of the components under the loss of the HVAC (Heating, Ventilation, and Air Condition) system. The issues relevant to the HVAC system in the PSA (Probabilistic Safety Assessment) FT (Fault Tree) model are as follows: (1) Does the loss of the HVAC system bring about a function failure of other components? (2) Can the operator take action to reduce the temperature of the room in case of a HVAC function failure? At present, we do not know whether a component will lose its function or not under the loss of the HVAC. ASME Standard describes that a recovery action can be credited if the related recovery action is included in the procedure or there are similar recovery experiences in the plant. However, there is no description about the recovery action of the HVAC in the EOP (Emergency Operation Procedure) of the UCN3, 4 under the situation of a loss of the HVAC. Even though we consider this assumption positively, it would be limited to the rooms such as the Switchgear Room, Inverter Room, and Main Control Room etc. where a real recovery action can be performed easily. However, if we consider the HVAC failure in the PSA FT model according to the above background, the problem is that the unavailability induced from the loss of a HVAC is highly unrealistically. From a viewpoint of the PSA, it is not true that the related system always fails even though the HVAC system fails. Therefore, we reviewed the necessity of the HVAC model through the identification of the operable temperature of the components' within the pump room and the change of the temperature of the pump room under the situation of a loss of the HVAC system. In this paper, we performed a heat up calculation for the Auxiliary Feedwater Motor Operated Pump (AFW MDP) room, PAB-077-11A with CFX 10 and RATT when the HVAC system is failed. We also reviewed the operability of the components under a loss of the HVAC. Room

  15. Screening Criteria for Loss of Room Cooling Failure

    International Nuclear Information System (INIS)

    Hwang, Mee Jeong; Yang, Joon Eon; Yoon, Churl

    2007-01-01

    In this report, we estimated the temperature of the pump rooms and reviewed the operability of the components under the loss of the HVAC (Heating, Ventilation, and Air Condition) system. The issues relevant to the HVAC system in the PSA (Probabilistic Safety Assessment) FT (Fault Tree) model are as follows: (1) Does the loss of the HVAC system bring about a function failure of other components? (2) Can the operator take action to reduce the temperature of the room in case of a HVAC function failure? At present, we do not know whether a component will lose its function or not under the loss of the HVAC. ASME Standard describes that a recovery action can be credited if the related recovery action is included in the procedure or there are similar recovery experiences in the plant. However, there is no description about the recovery action of the HVAC in the EOP (Emergency Operation Procedure) of the UCN3, 4 under the situation of a loss of the HVAC. Even though we consider this assumption positively, it would be limited to the rooms such as the Switchgear Room, Inverter Room, and Main Control Room etc. where a real recovery action can be performed easily. However, if we consider the HVAC failure in the PSA FT model according to the above background, the problem is that the unavailability induced from the loss of a HVAC is highly unrealistically. From a viewpoint of the PSA, it is not true that the related system always fails even though the HVAC system fails. Therefore, we reviewed the necessity of the HVAC model through the identification of the operable temperature of the components' within the pump room and the change of the temperature of the pump room under the situation of a loss of the HVAC system. In this paper, we performed a heat up calculation for the Auxiliary Feedwater Motor Operated Pump (AFW MDP) room, PAB-077-11A with CFX 10 and RATT when the HVAC system is failed. We also reviewed the operability of the components under a loss of the HVAC. Room

  16. Initial Efficacy of a Cardiac Rehabilitation Transition Program: Cardiac TRUST

    Science.gov (United States)

    Zullo, Melissa; Boxer, Rebecca; Moore, Shirley M.

    2012-01-01

    Patients recovering from cardiac events are increasingly using postacute care, such as home health care and skilled nursing facility services. The purpose of this pilot study was to test the initial efficacy, feasibility, and safety of a specially designed postacute care transitional rehabilitation intervention for cardiac patients. Cardiac Transitional Rehabilitation Using Self- Management Techniques (Cardiac TRUST) is a family-focused intervention that includes progressive low-intensity walking and education in self-management skills to facilitate recovery following a cardiac event. Using a randomized two-group design, exercise self-efficacy, steps walked, and participation in an outpatient cardiac rehabilitation program were compared in a sample of 38 older adults; 17 who received the Cardiac TRUST program and 21 who received usual care only. At discharge from postacute care, the intervention group had a trend for higher levels of self-efficacy for exercise outcomes (X=39.1, SD=7.4) than the usual care group (X=34.5; SD=7.0) (t-test 1.9, p=.06). During the 6 weeks following discharge, compared with the usual care group, the intervention group had more attendance in out-patient cardiac rehabilitation (33% compared to 11.8%, F=7.1, p=.03) and a trend toward more steps walked during the first week (X=1,307, SD=652 compared to X=782, SD=544, t-test 1.8, p=.07). The feasibility of the intervention was better for the home health participants than for those in the skilled nursing facility and there were no safety concerns. The provision of cardiac-focused rehabilitation during postacute care has the potential to bridge the gap in transitional services from hospitalization to outpatient cardiac rehabilitation for these patients at high risk for future cardiac events. Further evidence of the efficacy of Cardiac TRUST is warranted. PMID:22084960

  17. A New Face of Cardiac Emergencies: Human Immunodeficiency Virus-Related Cardiac Disease.

    Science.gov (United States)

    Tsabedze, Nqoba; Vachiat, Ahmed; Zachariah, Don; Manga, Pravin

    2018-02-01

    The human immunodeficiency virus epidemic is a major health challenge of the twenty-first century as the transition from infectious complications to noncommunicable disease becomes more evident. These patients may present to the emergency department with a variety of cardiovascular diseases, such as acute coronary syndromes, heart failure, pericardial disease, infective endocarditis, venothromboembolism, and other conditions. Increased awareness is needed among health care professionals to enhance adequate identification and promote prompt management of these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Integrative computational models of cardiac arrhythmias -- simulating the structurally realistic heart

    Science.gov (United States)

    Trayanova, Natalia A; Tice, Brock M

    2009-01-01

    Simulation of cardiac electrical function, and specifically, simulation aimed at understanding the mechanisms of cardiac rhythm disorders, represents an example of a successful integrative multiscale modeling approach, uncovering emergent behavior at the successive scales in the hierarchy of structural complexity. The goal of this article is to present a review of the integrative multiscale models of realistic ventricular structure used in the quest to understand and treat ventricular arrhythmias. It concludes with the new advances in image-based modeling of the heart and the promise it holds for the development of individualized models of ventricular function in health and disease. PMID:20628585

  19. Managing psychiatric emergencies in persons with mental health ...

    African Journals Online (AJOL)

    Background: Psychiatric emergencies are commonly encountered by the emergency room team where non-mental health specialists are often the first care providers. Materials and Methods: The study took place at the University of Ibadan Health Service, it was a descriptive cross-sectional study and participants were ...

  20. Digital angiography and surgery in the same room

    International Nuclear Information System (INIS)

    Goldman, M.L.; Hack, S.N.; Sarrafizadeh, M.S.; Marar, H.G.; Behar, D.J.; Chigurupati, R.C.; Klein, S.I.; Widlus, D.M.; Fortune, J.B.

    1986-01-01

    Albany Medical Center and private industries (XRE and United X-ray corporations) have collaborated to develop a room within the operating suite that allows high-speed and high-resolution digital angiography and surgery to be performed simultaneously. Patients who have sustained massive trauma can be transferred directly from the ambulance to this new facility. While the patient is undergoing exploratory laparotomy, other vital areas of the body can be evaluated by angiography. This combined approach of surgery and angiography has also led to improved management of patients with massive or occult intestinal hemorrhage and patients with peripheral vascular disease. Other patients undergoing difficult emergency or elective surgery, as in the biliary tract, can now have available the benefits of an operating room facility that also allows high-resolution fluoroscopy and complete angiography to be undertaken

  1. Alternative research funding to improve clinical outcomes: model of prediction and prevention of sudden cardiac death.

    Science.gov (United States)

    Myerburg, Robert J; Ullmann, Steven G

    2015-04-01

    Although identification and management of cardiovascular risk markers have provided important population risk insights and public health benefits, individual risk prediction remains challenging. Using sudden cardiac death risk as a base case, the complex epidemiology of sudden cardiac death risk and the substantial new funding required to study individual risk are explored. Complex epidemiology derives from the multiple subgroups having different denominators and risk profiles, while funding limitations emerge from saturation of conventional sources of research funding without foreseeable opportunities for increases. A resolution to this problem would have to emerge from new sources of funding targeted to individual risk prediction. In this analysis, we explore the possibility of a research funding strategy that would offer business incentives to the insurance industries, while providing support for unresolved research goals. The model is developed for the case of sudden cardiac death risk, but the concept is applicable to other areas of the medical enterprise. © 2015 American Heart Association, Inc.

  2. Three-dimensional point-cloud room model in room acoustics simulations

    DEFF Research Database (Denmark)

    Markovic, Milos; Olesen, Søren Krarup; Hammershøi, Dorte

    2013-01-01

    acquisition and its representation with a 3D point-cloud model, as well as utilization of such a model for the room acoustics simulations. A room is scanned with a commercially available input device (Kinect for Xbox360) in two different ways; the first one involves the device placed in the middle of the room...... and rotated around the vertical axis while for the second one the device is moved within the room. Benefits of both approaches were analyzed. The device's depth sensor provides a set of points in a three-dimensional coordinate system which represents scanned surfaces of the room interior. These data are used...... to build a 3D point-cloud model of the room. Several models are created to meet requirements of different room acoustics simulation algorithms: plane fitting and uniform voxel grid for geometric methods and triangulation mesh for the numerical methods. Advantages of the proposed method over the traditional...

  3. Three-dimensional point-cloud room model for room acoustics simulations

    DEFF Research Database (Denmark)

    Markovic, Milos; Olesen, Søren Krarup; Hammershøi, Dorte

    2013-01-01

    acquisition and its representation with a 3D point-cloud model, as well as utilization of such a model for the room acoustics simulations. A room is scanned with a commercially available input device (Kinect for Xbox360) in two different ways; the first one involves the device placed in the middle of the room...... and rotated around the vertical axis while for the second one the device is moved within the room. Benefits of both approaches were analyzed. The device's depth sensor provides a set of points in a three-dimensional coordinate system which represents scanned surfaces of the room interior. These data are used...... to build a 3D point-cloud model of the room. Several models are created to meet requirements of different room acoustics simulation algorithms: plane fitting and uniform voxel grid for geometric methods and triangulation mesh for the numerical methods. Advantages of the proposed method over the traditional...

  4. Sugammadex - A short review and clinical recommendations for the cardiac anesthesiologist

    Directory of Open Access Journals (Sweden)

    Hemmerling Thomas

    2010-01-01

    Full Text Available This review outlines the basic pharmacodynamic and pharmacokinetic properties of sugammadex for the cardiac anesthesiologist. It describes the different clinical scenarios when sugammadex can be used during cardiac surgery and gives clinical recommendations. Sugammadex is a unique reversal drug that binds a chemical complex with rocuronium and vecuronium, by which the neuromuscular blockade is quickly reversed. It is free of any clinical side-effects and doses of 2 mg/kg or more reliably reverse neuromuscular blockade within 5-15 min, depending on the depth of the neuromuscular blockade. Doses below 2 mg/kg should be avoided at any time because of the inherent risk of recurarization. Sugammadex should not replace good clinical practice - titration of neuromuscular blocking drugs to clinical needs and objective monitoring of neuromuscular blockade in the operating room or intensive care unit. Neuromuscular transmission should be determined in all patients before sugammadex is considered and 5 min after its administration to ensure that extubation is performed with normal neuromuscular transmission.

  5. Long-term evaluation of cardiac and vascular toxicity in patients with Philadelphia chromosome-positive leukemias treated with bosutinib.

    Science.gov (United States)

    Cortes, Jorge E; Jean Khoury, H; Kantarjian, Hagop; Brümmendorf, Tim H; Mauro, Michael J; Matczak, Ewa; Pavlov, Dmitri; Aguiar, Jean M; Fly, Kolette D; Dimitrov, Svetoslav; Leip, Eric; Shapiro, Mark; Lipton, Jeff H; Durand, Jean-Bernard; Gambacorti-Passerini, Carlo

    2016-06-01

    Vascular and cardiac safety during tyrosine kinase inhibitor (TKI) therapy is an emerging issue. We evaluated vascular/cardiac toxicities associated with long-term bosutinib treatment for Philadelphia chromosome-positive (Ph+) leukemia based on treatment-emergent adverse events (TEAEs) and changes in QTc intervals and ejection fraction in two studies: a phase 1/2 study of second-/third-/fourth-line bosutinib for Ph+ leukemia resistant/intolerant to prior TKIs (N = 570) and a phase 3 study of first-line bosutinib (n = 248) versus imatinib (n = 251) in chronic phase chronic myeloid leukemia. Follow-up time was ≥48 months (both studies). Incidences of vascular/cardiac TEAEs in bosutinib-treated patients were 7%/10% overall with similar incidences observed with first-line bosutinib (5%/8%) and imatinib (4%/6%). Few patients had grade ≥3 vascular/cardiac events (4%/4%) and no individual TEAE occurred in >2% of bosutinib patients. Exposure-adjusted vascular/cardiac TEAE rates (patients with events/patient-year) were low for second-line or later bosutinib (0.037/0.050) and not significantly different between first-line bosutinib (0.015/0.024) and imatinib (0.011/0.017; P ≥ 0.267). Vascular/cardiac events were managed mainly with concomitant medications (39%/44%), bosutinib treatment interruptions (18%/21%), or dose reductions (4%/8%); discontinuations due to these events were rare (0.7%/1.0%). Based on logistic regression modelling, performance status >0 and history of vascular or cardiac disorders were prognostic of vascular/cardiac events in relapsed/refractory patients; hyperlipidemia/hypercholesterolemia and older age were prognostic of cardiac events. In newly diagnosed patients, older age was prognostic of vascular/cardiac events; history of diabetes was prognostic of vascular events. Incidences of vascular and cardiac events were low with bosutinib in the first-line and relapsed/refractory settings following long-term treatment in patients

  6. 5 A study analysing the diagnostic performance of ECG interpretation for 30-day major cardiac events in the emergency department.

    Science.gov (United States)

    Morris, Niall; Body, Rick

    2017-12-01

    This study evaluates the diagnostic accuracy of an Emergency Medicine (EM) clinician at identifying ischaemia on an ECG using 30-day major adverse cardiac events (MACE) as the primary outcome. This is a secondary analysis of a prospective, multi-centre, observational cohort at 14 centres: the Bedside Evaluation of Sensitive Troponin study. All fourteen Emergency Departments were based in the United Kingdom. Emergency physicians' assessments of the ECG were collected using a standardised form. Clinicians were asked to judge whether the ECG demonstrated ischaemia, the presence of ST depression (STD) and if there was abnormal T wave inversion (ATWI). Patients provided written informed consent and underwent serial high sensitivity troponin testing. 30 day follow-up was performed by research nurses using a standardised form via telephone. The primary outcome was 30-day major adverse cardiac events, defined as acute myocardial infarction, any cause of death and coronary revascularisation. In total, 756 patients were included in the analysis. Clinicians' ECG diagnosis of ischaemia for 30-day MACE: ECG ischaemia produces a sensitivity (Sn) of 19.54% (95% CI:11.81% to 29.43%), specificity (Sp) of 93.27% (95% CI:91.10% to 95.05%), positive predictive value (PPV) of 27.42% (95% CI:18.47% to 38.65%) and negative predictive value (NPV) of 89.91% (95%CI 88.92% to 90.83%). ECG ST depression produces Sn of 16.09% (9.09% to 25.52%), Sp of 89.69% (87.13% to 91.89%), PPV 16.87 (10.68% to 25.62%), and NPV 89.15% (88.19% to 90.04%). ECG ATWI produces Sn of 4.60% (1.27% to 11.36%), Sp of 91.63% (89.27% to 93.62%), PPV of 6.67% (2.59% to 16.12%) and NPV of 88.07% (87.52% to 88.6). This is the first prospective, multi-centre cohort study, that assess the diagnostic performance of EM clinician's ECG interpretation, with 30-day MACE as the primary outcome. The findings are highly relevant to EM as they represent the ECG terms used by popular acute coronary syndrome clinical decision rules

  7. Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery.

    Science.gov (United States)

    Alsoufi, Bahaaldin; Awan, Abid; Manlhiot, Cedric; Guechef, Alexander; Al-Halees, Zohair; Al-Ahmadi, Mamdouh; McCrindle, Brian W; Kalloghlian, Avedis

    2014-02-01

    Survival of children having cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest following surgical correction of congenital heart disease. Demographic, anatomical, clinical, surgical and support details of children requiring postoperative ECPR (2007-12) were included in multivariable logistic regression models to determine the factors associated with survival. Thirty-nine children, median age 44 days (4 days-10 years), required postoperative ECPR at a median interval of 1 day (up to 15 days) after surgery. Thirteen (33%) children had single-ventricle pathology; Risk Adjustment in Congenital Heart Surgery (RACHS)-1 categories were 2, 3, 4 and 6 in 6, 15, 13 and 5 patients, respectively. Median CPR duration was 34 (8-125) min, while median support duration was 4 (1-17) days. Seven (18%) patients underwent cardiac re-operation, 28 (72%) survived >24 h after support discontinuation and 16 (41%) survived. Survival rates in neonates, infants and older children were 53, 39 and 17% (P=0.13). Survival rates for single- vs two-ventricle pathology patients were 54 and 35%, (P=0.25) and 50, 47, 23 and 60% in RACHS-1 2, 3, 4 and 6 patients, respectively (P=0.37). Survivors had shorter CPR duration (25 vs 34 min, P=0.05), lower pre-arrest lactate (2.6 vs 4.6 mmol/l, P=0.05) and postextracorporeal membrane oxygenation (ECMO) peak lactate (15.4 vs 20.0 mmol/l, P<0.001). On multivariable analysis, factors associated with death were higher immediate post-ECMO lactate (odds ratio, OR 1.34 per mmol/l, P=0.008) and renal failure requiring haemodialysis (OR 14.1, P=0.01). ECPR plays a valuable role in children having refractory postoperative cardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance

  8. Cardiac tumors: optimal cardiac MR sequences and spectrum of imaging appearances.

    LENUS (Irish Health Repository)

    O'Donnell, David H

    2012-02-01

    OBJECTIVE: This article reviews the optimal cardiac MRI sequences for and the spectrum of imaging appearances of cardiac tumors. CONCLUSION: Recent technologic advances in cardiac MRI have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MRI provides optimal assessment of the location, functional characteristics, and soft-tissue features of cardiac tumors, allowing accurate differentiation of benign and malignant lesions.

  9. Diagnostic and prognostic value of high-sensitivity cardiac troponin T in patients with syncope.

    Science.gov (United States)

    Christ, Michael; Geier, Felicitas; Popp, Steffen; Singler, Katrin; Smolarsky, Alexander; Bertsch, Thomas; Müller, Christian; Greve, Yvonne

    2015-02-01

    We examined the diagnostic and predictive value of high-sensitivity cardiac troponin T (cTnThs) in patients with syncope. We performed an analysis of consecutive patients with syncope presenting to the emergency department. The primary end point was the accuracy to diagnose a cardiac syncope. In addition, the study explored the prognostic relevance of cTnThs in patients with cardiac and noncardiac syncope. A total of 360 patients were enrolled (median age, 70.5 years; male, 55.8%; 23.9% aged >80 years). Cardiac syncope was present in 22% of patients, reflex syncope was present in 40% of patients, syncope due to orthostatic hypotension was present in 20% of patients, and unexplained syncope was present in 17.5% of patients. A total of 148 patients (41%) had cTnThs levels above the 99% confidence interval (CI) (cutoff point). The diagnostic accuracy for cTnThs levels to determine the diagnosis of cardiac syncope was quantified by the area under the curve (0.77; CI, 0.72-0.83; P value of cTnThs levels within 30 days: Patients with increased cTnThs levels had a 52% likelihood for adverse events, patients with cTnThs levels below the cutoff point had a low risk (negative predictive value, 83.5%). Increased cTnThs levels indicate adverse prognosis in patients with noncardiac causes of syncope, but not in patients with cardiac syncope being a risk factor for adverse outcome by itself. Patients with syncope presenting to the emergency department have a high proportion of life-threatening conditions. cTnThs levels show a limited diagnostic and predictive accuracy for the identification of patients with syncope at high risk. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Burnout in Cardiac Anesthesiologists: Results From a National Survey in Italy.

    Science.gov (United States)

    Sanfilippo, Filippo; Noto, Alberto; Palumbo, Gaetano J; Ippolito, Mariachiara; Gagliardone, Mariapia; Scarlata, Maria; Bignami, Elena; Sangalli, Fabio; Cattaneo, Sergio; Blangetti, Ilaria; Scolletta, Sabino; Locatelli, Alessandro; Tritapepe, Luigi; Lorini, Ferdinando L; Arcadipane, Antonio

    2018-05-16

    There is increasing burnout incidence among medical disciplines, and physicians working in emergency settings seem at higher risk. Cardiac anesthesiology is a stressful anesthesiology subspecialty dealing with high-risk patients. The authors hypothesized a high risk of burnout in cardiac anesthesiologists. National survey conducted on burnout SETTING: Italian cardiac centers. Cardiac anesthesiologists. The authors administered via email an anonymous questionnaire divided into 3 parts. The first 2 parts evaluated workload and private life. The third part consisted of the Maslach Burnout Inventory test with its 3 constituents: high emotional exhaustion, high depersonalization, and low personal accomplishment. The authors measured the prevalence and risk of burnout through the Maslach Burnout Inventory questionnaire and analyzed factors influencing burnout. Among 670 contacts from 71 centers, 382 cardiac anesthesiologists completed the survey (57%). The authors found the following mean Maslach Burnout Inventory values: 14.5 ± 9.7 (emotional exhaustion), 9.1 ± 7.1 (depersonalization), and 33.7 ± 8.9 (personal accomplishment). A rate of 34%, 54%, and 66% of respondents scored in "high" or "moderate-high" risk of burnout (emotional exhaustion, depersonalization, and personal accomplishment, respectively). The authors found that, if offered to change subspecialty, 76% of respondents would prefer to remain in cardiac anesthesiology. This preference and parenthood were the only 2 investigated factors with a protective effect against all components of burnout. Significantly lower burnout scores were found in more experienced anesthesiologists. A relatively high incidence of burnout was found in cardiac anesthesiologists, especially regarding high depersonalization and low personal accomplishment. Nonetheless, most of the respondents would choose to remain in cardiac anesthesiology. Copyright © 2018 Elsevier Inc. All rights reserved.

  11. Cardiac gated ventilation

    International Nuclear Information System (INIS)

    Hanson, C.W. III; Hoffman, E.A.

    1995-01-01

    There are several theoretic advantages to synchronizing positive pressure breaths with the cardiac cycle, including the potential for improving distribution of pulmonary and myocardial blood flow and enhancing cardiac output. The authors evaluated the effects of synchronizing respiration to the cardiac cycle using a programmable ventilator and electron beam CT (EBCT) scanning. The hearts of anesthetized dogs were imaged during cardiac gated respiration with a 50 msec scan aperture. Multi slice, short axis, dynamic image data sets spanning the apex to base of the left ventricle were evaluated to determine the volume of the left ventricular chamber at end-diastole and end-systole during apnea, systolic and diastolic cardiac gating. The authors observed an increase in cardiac output of up to 30% with inspiration gated to the systolic phase of the cardiac cycle in a non-failing model of the heart

  12. Emergency room management of ureteral calculi: current practices.

    Science.gov (United States)

    Phillips, Elizabeth; Kieley, Sam; Johnson, Elizabeth B; Monga, Manoj

    2009-06-01

    To evaluate current practice patterns in U.S. emergency departments (EDs) for the diagnosis, treatment, and counseling of patients with ureteral calculi. Hospital-based ED physicians were invited by e-mail to participate in a Survey-Monkey survey. E-mails were delivered in March 2008 by Direct Medical Data using a listserv provided by the American Medical Association. Of the e-mails sent, 173 e-mails were opened, and 135 physicians responded. Physicians were compensated with a $10 Amazon.com gift card. Ninety percent of ED physicians use noncontrast CT as their initial imaging modality, and 63% use alpha-blockers for medical expulsive therapy. Only 13% of evaluated EDs have guidelines for the management of renal colic, and only 58% of these guidelines that recommend the use of an alpha-blocker. Alpha-blocker use was more common with physicians who have been practicing fewer than 5 years (81%) compared with those with more than 10 years of experience (56%). The majority of physicians used ketorolac and morphine to achieve effective analgesia. Although the average responses concerning the chance of spontaneous stone passage for stones 4 mm (44%) were close to evidence-based values, great variation in the answers was noted (standard deviations: 12% and 22%, respectively). Indeed, 38% of respondents stated that stones 95% chance of passage. Twenty-eight percent of ED physicians would arrange follow-up with a primary care physician, while the remainder would arrange follow-up with a urologist. This study establishes a need for educational opportunities for ED physicians in the management of renal colic. The development of collaborative practice guidelines between urology and emergency medicine associations may be warranted.

  13. Evaluation of the Recognition of Stroke in the Emergency Room (ROSIER scale in Chinese patients in Hong Kong.

    Directory of Open Access Journals (Sweden)

    Hui-lin Jiang

    Full Text Available BACKGROUND AND PURPOSE: The objective of this study was to determine the performance of the Recognition Of Stroke In the Emergency Room (ROSIER scale in risk-stratifying Chinese patients with suspected stroke in Hong Kong. METHODS: This was a prospective cohort study in an urban academic emergency department (ED over a 7-month period. Patients over 18 years of age with suspected stroke were recruited between June 2011 and December 2011. ROSIER scale assessment was performed in the ED triage area. Logistic regression analysis was used to estimate the impacts of diagnostic variables, including ROSIER scale, past history and ED characteristics. FINDINGS: 715 suspected stroke patients were recruited for assessment, of whom 371 (52% had acute cerebrovascular disease (302 ischaemic strokes, 24 transient ischaemic attacks (TIA, 45 intracerebral haemorrhages, and 344 (48% had other illnesses i.e. stroke mimics. Common stroke mimics were spinal neuropathy, dementia, labyrinthitis and sepsis. The suggested cut-off score of>0 for the ROSIER scale for stroke diagnosis gave a sensitivity of 87% (95%CI 83-90, a specificity of 41% (95%CI 36-47, a positive predictive value of 62% (95%CI 57-66, and a negative predictive value of 75% (95%CI 68-81, and the AUC was 0.723. The overall accuracy at cut off>0 was 65% i.e. (323+141/715. INTERPRETATION: The ROSIER scale was not as effective at differentiating acute stroke from stroke mimics in Chinese patients in Hong Kong as it was in the original studies, primarily due to a much lower specificity. If the ROSIER scale is to be clinically useful in Chinese suspected stroke patients, it requires further refinement.

  14. [The evaluation of academic emergency department design].

    Science.gov (United States)

    Deniz, Turgut; Aydinuraz, Kuzey; Oktay, Cem; Saygun, Meral; Ağalar, Fatih

    2007-01-01

    In our study which was based upon a questionnaire, the inner and outer architectural designs of emergency services of Emergency Medicine Departments were investigated. In this descriptive study, a standard questionnaire was sent to 26 Emergency Medicine Departments which were operating at that time. In the questionnaire, the internal, external architectural and functional features were questioned. Answers of 22 Emergency Medicine Departments were analysed. Two Emergency Medicine Departments that were not operating at that time were not included in the study. The analysis of the replies revealed that only 59% (n=13) of the Emergency Medicine Departments were designed as an emergency service prior to the construction. The ambulance parking areas were not suitable in 77% of the emergency units while only 54.5% (n=12) had protection against adverse weather conditions. In only 59% (n=13) of the emergency units, a triage unit was present and in only one of the in only one (4.5%), a decontamination room was available. It was understood that only 32% (n=8) of the emergency units were appropriate in enlarging their capacity taking the local risk factors into consideration. There was a toilette for disabled patients in only 18% (n=4) of the units as well. Considering a 12-year of history of the Emergency Medicine in Turkey, the presence of a lecture room is still 68% (n=15) in emergency departments which reflects that academic efforts in this field is emerging in challenging physical conditions. The results of our study revealed that emergency service architecture was neglected in Turkey and medical care given was precluded by the insufficient architecture. The design of emergency services has to be accomplished under guidance of scientific data and rules taking advices of architects who have knowledge and experience on this field.

  15. An ethical framework for cardiac report cards: a qualitative study

    Directory of Open Access Journals (Sweden)

    Rawal Shail

    2005-03-01

    Full Text Available Abstract Background The recent proliferation of health care report cards, especially in cardiac care, has occurred in the absence of an ethical framework to guide in their development and implementation. An ethical framework is a consistent and comprehensive theoretical foundation in ethics, and is formed by integrating ethical theories, relevant literature, and other critical information (such as the views of stakeholders. An ethical framework in the context of cardiac care provides guidance for developing cardiac report cards (CRCs that are relevant and legitimate to all stakeholders. The purpose of this study is to develop an ethical framework for CRCs. Methods Delphi technique – 13 panelists: 2 administrators, 2 cardiac nurses, 5 cardiac patients, 2 cardiologists, 1 member of the media, and 1 outcomes researcher. Panelists' views regarding the ethics of CRCs were analyzed and organized into themes. Results We have organized panelists' views into ten principles that emerged from the data: 1 improving quality of care, 2 informed understanding, 3 public accountability, 4 transparency, 5 equity, 6 access to information 7 quality of information, 8 multi-stakeholder collaboration, 9 legitimacy, and 10 evaluation and continuous quality improvement. Conclusion We have developed a framework to guide the development and dissemination of CRCs. This ethical framework can provide necessary guidance for those generating CRCs and may help them avoid a number of difficult issues associated with existing ones.

  16. An ethical framework for cardiac report cards: a qualitative study.

    Science.gov (United States)

    Richard, Shawn A; Rawal, Shail; Martin, Douglas K

    2005-03-28

    The recent proliferation of health care report cards, especially in cardiac care, has occurred in the absence of an ethical framework to guide in their development and implementation. An ethical framework is a consistent and comprehensive theoretical foundation in ethics, and is formed by integrating ethical theories, relevant literature, and other critical information (such as the views of stakeholders). An ethical framework in the context of cardiac care provides guidance for developing cardiac report cards (CRCs) that are relevant and legitimate to all stakeholders. The purpose of this study is to develop an ethical framework for CRCs. Delphi technique - 13 panelists: 2 administrators, 2 cardiac nurses, 5 cardiac patients, 2 cardiologists, 1 member of the media, and 1 outcomes researcher. Panelists' views regarding the ethics of CRCs were analyzed and organized into themes. We have organized panelists' views into ten principles that emerged from the data: 1) improving quality of care, 2) informed understanding, 3) public accountability, 4) transparency, 5) equity, 6) access to information 7) quality of information, 8) multi-stakeholder collaboration, 9) legitimacy, and 10) evaluation and continuous quality improvement. We have developed a framework to guide the development and dissemination of CRCs. This ethical framework can provide necessary guidance for those generating CRCs and may help them avoid a number of difficult issues associated with existing ones.

  17. Room with a View: Ethical Encounters in Room 13

    Science.gov (United States)

    Grube, Vicky

    2012-01-01

    In this article, the author describes ethical encounters in Room 13, a schoolroom where children made what they wanted, posed their own questions, and ran an art room like a small business. In Room 13 children had the responsibility to maintain all aspects of the art studio. Specific decisions fell to an annually elected management team, a small…

  18. Staff and patient exposure to X-ray radiation during cardiac procedures

    International Nuclear Information System (INIS)

    Jankowski, J.; Papierz, D.; Domienik, J.; Kacprzyk, J.; Tybor-Czerwinska, M.; Werduch, A.

    2008-01-01

    The aim of this study was to define and compare staff and patient doses during the most common types of cardiac procedures. The influence of operators' technique and quality of X-ray unit in use on doses received by the staff and patients was investigated. The study was conduced in two independent hemodynamic rooms (I and II). The doses to hand for medical staff (operators and nurses) were monitored. For hand dose assessment, ring thermoluminescent dosimeters were used. Regarding patient dosimetry, dose-area product was collected for selected procedures. The monthly hand doses ranged from 0.4 mSv to 41.2 mSv in room I and from 0.1 to 8.95 mSv in room II. On the basis of the above measurements, the annual doses were estimated. The maximum annual hand doses for the operator and for the nurse in room I were 232.8 mSv/year and 11.5 mSv/year and in room II - 29.8 mSv/year and 14.1 mSv/year, respectively. Additionally, to compare the doses received by the particular medical operators, the doses were normalized to the total workload. Hand dose per procedure ranged from 109 to 614 μSv/procedure and were significantly larger in room I. The typical DAP values (median) recorded for the CA and CA+PTCA procedures were 55 Gy/cm 2 and 171 Gy/cm 2 in room I and 35 Gy/cm 2 and 87 Gy/cm 2 in the room II, respectively. As a result of this survey, the impact of medical operator's experience as well as technique and quality of available X-ray units on doses received by staff and patients has been proven. On the basis of the above results, the special need for monitoring hand doses for medical staff, apart from the effective dose, has been recognized. (author)

  19. Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

    Science.gov (United States)

    Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2018-04-01

    The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Operating room management and operating room productivity: the case of Germany.

    Science.gov (United States)

    Berry, Maresi; Berry-Stölzle, Thomas; Schleppers, Alexander

    2008-09-01

    We examine operating room productivity on the example of hospitals in Germany with independent anesthesiology departments. Linked to anesthesiology group literature, we use the ln(Total Surgical Time/Total Anesthesiologists Salary) as a proxy for operating room productivity. We test the association between operating room productivity and different structural, organizational and management characteristics based on survey data from 87 hospitals. Our empirical analysis links improved operating room productivity to greater operating room capacity, appropriate scheduling behavior and management methods to realign interests. From this analysis, the enforcing jurisdiction and avoiding advance over-scheduling appear to be the implementable tools for improving operating room productivity.

  1. Cardiac function and cognition in older community-dwelling cardiac patients.

    Science.gov (United States)

    Eggermont, Laura H P; Aly, Mohamed F A; Vuijk, Pieter J; de Boer, Karin; Kamp, Otto; van Rossum, Albert C; Scherder, Erik J A

    2017-11-01

    Cognitive deficits have been reported in older cardiac patients. An underlying mechanism for these findings may be reduced cardiac function. The relationship between cardiac function as represented by different echocardiographic measures and different cognitive function domains in older cardiac patients remains unknown. An older (≥70 years) heterogeneous group of 117 community-dwelling cardiac patients under medical supervision by a cardiologist underwent thorough echocardiographic assessment including left ventricular ejection fraction, cardiac index, left atrial volume index, left ventricular mass index, left ventricular diastolic function, and valvular calcification. During a home visit, a neuropsychological assessment was performed within 7.1 ± 3.8 months after echocardiographic assessment; the neuropsychological assessment included three subtests of a word-learning test (encoding, recall, recognition) to examine one memory function domain and three executive function tests, including digit span backwards, Trail Making Test B minus A, and the Stroop colour-word test. Regression analyses showed no significant linear or quadratic associations between any of the echocardiographic functions and the cognitive function measures. None of the echocardiographic measures as representative of cardiac function was correlated with memory or executive function in this group of community-dwelling older cardiac patients. These findings contrast with those of previous studies. © 2017 Japanese Psychogeriatric Society.

  2. Optimization of recirculating laminar air flow in operating room air conditioning systems

    Directory of Open Access Journals (Sweden)

    Enver Yalcin

    2016-04-01

    Full Text Available The laminar flow air-conditioning system with 100% fresh air is used in almost all operating rooms without discrimination in Turkey. The laminar flow device which is working with 100% fresh air should be absolutely used in Type 1A operating rooms. However, there is not mandatory to use of 100% fresh air for Type 1B defined as places performed simpler operation. Compared with recirculating laminar flow, energy needs of the laminar flow with 100 % fresh air has been emerged about 40% more than re-circulated air flow. Therefore, when a recirculating laminar flow device is operated instead of laminar flow system with 100% fresh air in the Type 1B operating room, annual energy consumption will be reduced. In this study, in an operating room with recirculating laminar flow, optimal conditions have been investigated in order to obtain laminar flow form by analyzing velocity distributions at various supply velocities by using computational fluid dynamics method (CFD.

  3. CEBAF Control Room Renovation

    International Nuclear Information System (INIS)

    Michael Spata; Thomas Oren

    2005-01-01

    The Machine Control Center (MCC) at Jefferson Lab's Continuous Electron Beam Accelerator Facility (CEBAF) was initially constructed in the early 1990s and based on proven technology of that era. Through our experience over the last 15 years and in our planning for the facility's 12 GeV upgrade we reevaluated the control room environment to capitalize on emerging visualization and display technologies and improve workflow processes and ergonomic attributes. This effort also sets the foundation for the redevelopment of the accelerator's control system to deliver high reliability performance with improvements in beam specifications management and information flow. The complete renovation was performed over a three-week maintenance period with no interruption to beam operations. We present the results of this effort

  4. CEBAF Control Room Renovation

    International Nuclear Information System (INIS)

    Michael Spata; Thomas Oren

    2005-01-01

    The Machine Control Center at Jefferson Lab's Continuous Electron Beam Accelerator Facility was initially constructed in the early 1990s and based on proven technology of that era. Through our experience over the last 15 years and in our planning for the facilities 12 GeV upgrade we reevaluated the control room environment to capitalize on emerging visualization and display technologies and improve on workflow processes and ergonomic attributes. This effort also sets the foundation for the redevelopment of the accelerator's control system to deliver high reliability performance with improvements in beam specifications management and information flow. The complete renovation was performed over a three-week period with no interruption to beam operations. We present the results of this effort

  5. Criteria for the design of the control room complex for a nuclear power generating station

    International Nuclear Information System (INIS)

    Anon.

    1981-01-01

    This Standard addresses the central control room of a nuclear power generating station and the overall complex in which this room is housed. It is not intended to cover special or normally unattended control rooms, such as those provided for radioactive waste handling or for emergency shutdown operations. The nuclear power generating station control room complex provides a protective envelope for plant operating personnel and for instrument and control equipment vital to the operation of the plant during normal and abnormal conditions. In this capacity, the control room complex must be designed and constructed to meet the following criteria contained in Appendix A of 10CFR50, General Design criteria for Nuclear Power Plants: (1) Criterion 2: design bases for protection against natural phenomena; (2) Criterion 3: fire protection; (3) Criterion 4: environmental and missile design bases; (4) Criterion 5: sharing of structures, systems and components (multiunit stations only); and (5) Criterion 19: control room

  6. Cardiac function and cognition in older community-dwelling cardiac patients

    NARCIS (Netherlands)

    Eggermont, Laura H.P.; Aly, Mohamed F.A.; Vuijk, Pieter J.; de Boer, Karin; Kamp, Otto; van Rossum, Albert C.; Scherder, Erik J.A.

    2017-01-01

    Background: Cognitive deficits have been reported in older cardiac patients. An underlying mechanism for these findings may be reduced cardiac function. The relationship between cardiac function as represented by different echocardiographic measures and different cognitive function domains in older

  7. Clinical statistics of patients with dizziness consulting the emergency outpatient clinic

    International Nuclear Information System (INIS)

    Ogawa, Yasuo; Hagiwara, Akira; Kitajima, Naoharu; Inagaki, Taro; Shimizu, Masaaki; Furuse, Hiroko; Konomi, Ujimoto; Yukawa, Kumiko; Suzuki, Mamoru

    2007-01-01

    Between May 2004 and April 2006, 468 emergency patients with vertigo or dizziness consulted the otorhinolarygological emergency room of Tokyo Medical University. Patients with vertigo or dizziness comprised about 9% of the whole otorhinolaryngological emergency patients. The number of female patients was larger than that of male patients. About half of the patients were brought to our hospital by ambulance. Nystagmus was observed in 219 patients (46.8%). Incidence of nystagmus was highest on positional nystagmus test. Brain CT was obtained in 185 patients (39.5%), but there were no abnormal findings in any patients. The most frequent diagnosis was inner ear disorder (22%), followed by Meniere's disease (7%), vestibular neuritis (6%), Benign paroxysmal positional vertigo (BPPV) (6%). Cerebral infarction was observed in 1.9%. Eighty-four patients were admitted. Major diseases requiring admission were vestibular neuritis and inner ear disorder. In patients with cerebral infarction, brain CT was normal. These patients were all elderly males over 60 years old. Their nystagmus in the emergency room did not suggest central disorder, or they did not have other neurological findings. Neurological signs and symptoms appeared thereafter. In the emergency room, establishing a diagnosis by limited examination is difficult. Careful examination is necessary, since vertigo or dizzy patient with a central disorder can show sudden change. (author)

  8. Locating AED Enabled Medical Drones to Enhance Cardiac Arrest Response Times.

    Science.gov (United States)

    Pulver, Aaron; Wei, Ran; Mann, Clay

    2016-01-01

    Out-of-hospital cardiac arrest (OOHCA) is prevalent in the United States. Each year between 180,000 and 400,000 people die due to cardiac arrest. The automated external defibrillator (AED) has greatly enhanced survival rates for OOHCA. However, one of the important components of successful cardiac arrest treatment is emergency medical services (EMS) response time (i.e., the time from EMS "wheels rolling" until arrival at the OOHCA scene). Unmanned Aerial Vehicles (UAV) have regularly been used for remote sensing and aerial imagery collection, but there are new opportunities to use drones for medical emergencies. The purpose of this study is to develop a geographic approach to the placement of a network of medical drones, equipped with an automated external defibrillator, designed to minimize travel time to victims of out-of-hospital cardiac arrest. Our goal was to have one drone on scene within one minute for at least 90% of demand for AED shock therapy, while minimizing implementation costs. In our study, the current estimated travel times were evaluated in Salt Lake County using geographical information systems (GIS) and compared to the estimated travel times of a network of AED enabled medical drones. We employed a location model, the Maximum Coverage Location Problem (MCLP), to determine the best configuration of drones to increase service coverage within one minute. We found that, using traditional vehicles, only 4.3% of the demand can be reached (travel time) within one minute utilizing current EMS agency locations, while 96.4% of demand can be reached within five minutes using current EMS vehicles and facility locations. Analyses show that using existing EMS stations to launch drones resulted in 80.1% of cardiac arrest demand being reached within one minute Allowing new sites to launch drones resulted in 90.3% of demand being reached within one minute. Finally, using existing EMS and new sites resulted in 90.3% of demand being reached while greatly reducing

  9. Association between patient unconscious or not alert conditions and cardiac arrest or high-acuity outcomes within the Medical Priority Dispatch System "Falls" protocol.

    Science.gov (United States)

    Clawson, Jeff; Olola, Christopher; Scott, Greg; Schultz, Bryon; Pertgen, Richard; Robinson, Don; Bagwell, Barry; Patterson, Brett

    2010-01-01

    Falls are one of the most common types of complaints received by 9-1-1 emergency medical dispatch centers. They can be accidental or may be caused by underlying medical problems. Though "not alert" falls patients with severe outcomes mostly are "hot" transported to the hospital, some of these cases may be due to other acute medical events (cardiac, respiratory, circulatory, or neurological), which may not always be apparent to the emergency medical dispatcher (EMD) during call processing. The objective of this study was to characterize the risk of cardiac arrest and "hot-transport" outcomes in patients with "not alert" condition, within the Medical Priority Dispatch System (MPDS®) Falls protocol descriptors. This retrospective study used 129 months of de-identified, aggregate, dispatch datasets from three US emergency communication centers. The communication centers used the Medical Priority Dispatch System version 11.3-OMEGA type (released in 2006) to interrogate Emergency Medical System callers, select dispatch codes assigned to various response configurations, and provide pre-arrival instructions. The distribution of cases and percentages of cardiac arrest and hot-transport outcomes, categorized by MPDS® code, was profiled. Assessment of the association between MPDS® Delta-level 3 (D-3) "not alert" condition and cardiac arrest and hot-transport outcomes then followed. Overall, patients within the D-3 and D-2 "long fall" conditions had the highest proportions (compared to the other determinants in the "falls" protocol) of cardiac arrest and hot-transport outcomes, respectively. "Not alert" condition was associated significantly with cardiac arrest and hot-transport outcomes (pdeterminant within the MPDS® "fall" protocol was associated significantly with severe outcomes for short falls (falls. As reported to 9-1-1, the complaint of a "fall" may include the presence of underlying conditions that go beyond the obvious traumatic injuries caused by the fall itself.

  10. Clinical Nihilism in Neuro-Emergencies

    Science.gov (United States)

    Hemphill, J. Claude; White, Douglas B.

    2009-01-01

    Mortality and morbidity remain high from neurological emergencies such as acute stroke, traumatic brain injury, and hypoxic-ischemic encephalopathy after cardiac arrest. Decisions regarding initial aggressiveness of care must be made at the time of presentation and perceived prognosis is often used as part of this decision-making process. However, these decisions are predicated on the accuracy of early outcome prediction. Decisions to limit treatment early after neuro-emergencies must be balanced with avoidance of self-fulfilling prophecies of poor outcome due to clinical nihilism. This article examines the role of prognostication early after neuro-emergencies, the potential impact of early treatment limitations, and how these may relate to communication with patients and surrogate decision makers in the context of these acute neurological events. PMID:19218017

  11. Work-Practice Changes Associated with an Electronic Emergency-Department Whiteboard

    DEFF Research Database (Denmark)

    Hertzum, Morten; Simonsen, Jesper

    2013-01-01

    , existing work practices, and the clinicians’ experience. Another change in the work practices is distributed access to whiteboard information from the computers in patient rooms. A decrease in the mental workload of the coordinating nurse was envisaged but has not emerged. Achieving more changes appears......Electronic whiteboards are introduced at emergency departments (EDs) to improve work practices. This study investigates whether the time physicians and nurses at an ED spend in patient rooms versus at the control desk increases after the introduction of an electronic whiteboard. After using...... this whiteboard for four months nurses, but not physicians, spend more of their time with the patients. With the electronic whiteboard, nurses spend 28% of their time in patient rooms and physicians 20%. Importantly, the changes facilitated by the electronic whiteboard are also dependent on implementation issues...

  12. Short-term effects of ambient air pollution on emergency room admissions due to cardiovascular causes in Beijing, China.

    Science.gov (United States)

    Ma, Yuxia; Zhao, Yuxin; Yang, Sixu; Zhou, Jianding; Xin, Jinyuan; Wang, Shigong; Yang, Dandan

    2017-11-01

    Ambient air pollution has been a major global public health issue. A number of studies have shown various adverse effects of ambient air pollution on cardiovascular diseases. In the current study, we investigated the short-term effects of ambient air pollution on emergency room (ER) admissions due to cardiovascular causes in Beijing from 2009 to 2012 using a time-series analysis. A total of 82430 ER cardiovascular admissions were recorded. Different gender (male and female) and age groups (15yrs ≤ age pollutant model. Three major pollutants (SO 2 , NO 2 and PM 10 ) had lag effects of 0-2 days on cardiovascular ER admissions. The relative risks (95% CI) of per 10 μg/m 3 increase in PM 10 , SO 2 and NO 2 were 1.008 (0.997-1.020), 1.008(0.999-1.018) and 1.014(1.003-1.024), respectively. The effect was more pronounced in age ≥65 and males in Beijing. We also found the stronger acute effects on the elderly and females at lag 0 than on the younger people and males at lag 2. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. The utility of cardiac CT beyond the assessment of suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Kakouros, N. [Johns Hopkins Hospital, Baltimore, MD (United States); Giles, J.; Crundwell, N.B. [Conquest Hospital, St Leonards-on-Sea, East Sussex (United Kingdom); McWilliams, E.T.M., E-mail: eric.mcwilliams@esht.nhs.uk [Conquest Hospital, St Leonards-on-Sea, East Sussex (United Kingdom)

    2012-07-15

    Extensive work has been done over recent years to improve the spatial and temporal resolution of electrocardiogram (ECG)-gated cardiac computed tomography (CT). Advances in both hardware and software analysis have enabled the development of non-invasive coronary angiography. However, these high-quality examinations lend themselves to multiple additional applications beyond coronary angiography. In this review, we illustrate and discuss some established and some emerging applications of ECG-gated cardiac CT beyond the assessment of suspected coronary disease, particularly in light of recent recommendations on the appropriate use of this technology.

  14. The utility of cardiac CT beyond the assessment of suspected coronary artery disease

    International Nuclear Information System (INIS)

    Kakouros, N.; Giles, J.; Crundwell, N.B.; McWilliams, E.T.M.

    2012-01-01

    Extensive work has been done over recent years to improve the spatial and temporal resolution of electrocardiogram (ECG)-gated cardiac computed tomography (CT). Advances in both hardware and software analysis have enabled the development of non-invasive coronary angiography. However, these high-quality examinations lend themselves to multiple additional applications beyond coronary angiography. In this review, we illustrate and discuss some established and some emerging applications of ECG-gated cardiac CT beyond the assessment of suspected coronary disease, particularly in light of recent recommendations on the appropriate use of this technology.

  15. Coronary ostial involvement in acute aortic dissection: detection with 64-slice cardiac CT.

    LENUS (Irish Health Repository)

    Ryan, E Ronan

    2012-02-01

    A 41-year-old man collapsed after lifting weights at a gym. Following admission to the emergency department, a 64-slice cardiac computed tomography (CT) revealed a Stanford Type A aortic dissection arising from a previous coarctation repair. Multiphasic reconstructions demonstrated an unstable, highly mobile aortic dissection flap that extended proximally to involve the right coronary artery ostium. Our case is an example of the application of electrocardiogram-gated cardiac CT in directly visualizing involvement of the coronary ostia in acute aortic dissection, which may influence surgical management.

  16. The economics of cardiac biomarker testing in suspected myocardial infarction.

    Science.gov (United States)

    Goodacre, Steve; Thokala, Praveen

    2015-03-01

    Suspected myocardial infarction (MI) is a common reason for emergency hospital attendance and admission. Cardiac biomarker measurement is an essential element of diagnostic assessment of suspected MI. Although the cost of a routinely available biomarker may be small, the large patient population and consequences in terms of hospital admission and investigation mean that the economic impact of cardiac biomarker testing is substantial. Economic evaluation involves comparing the estimated costs and effectiveness (outcomes) of two or more interventions or care alternatives. This process creates some difficulties with respect to cardiac biomarkers. Estimating the effectiveness of cardiac biomarkers involves identifying how they help to improve health and how we can measure this improvement. Comparison to an appropriate alternative is also problematic. New biomarkers may be promoted on the basis of reducing hospital admission or length of stay, but hospital admission for low risk patients may incur significant costs while providing very little benefit, making it an inappropriate comparator. Finally, economic evaluation may conclude that a more sensitive biomarker strategy is more effective but, by detecting and treating more cases, is also more expensive. In these circumstances it is unclear whether we should use the more effective or the cheaper option. This article provides an introduction to health economics and addresses the specific issues relevant to cardiac biomarkers. It describes the key concepts relevant to economic evaluation of cardiac biomarkers in suspected MI and highlights key areas of uncertainty and controversy. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  17. SUDDEN CARDIAC DEATH AND THE USE OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS IN PEDIATRIC-PATIENTS

    NARCIS (Netherlands)

    SILKA, MJ; KRON, J; DUNNIGAN, A; DICK, M; BINKBOELKENS, M; ERICKSON, CC; JEDEIKIN, R; WETZEL, GT; VANHARE, GF; CAMPBELL, R; WALSH, E; SAUL, JP; SCHAFFER, MS; KARPAWICH, P; VOGEL, RL; BENSON, DW; DEAL, B; SCAGLIOTTI, D; STERBA, R; HORDOF, AJ; KRONGRAD, E; KANTER, RJ; EPSTEIN, M; COHEN, M; BEDER, S; HAMILTON, R; FOURNIER, A; HUBBARD, J; CHRISTIANSEN, JL; JENNINGS, J; VILLAFANE, J; PORTER, CBJ; CASE, C; GILLETTE, PC; BELAND, M; KUGLER, JD; OCONNOR, BK; ALLENDER, H; HERNDON, SP; SMITH, RT; BURTON, D; KURER, CC; BYRUM, C; GUAM, WE; FRIEDMAN, R; PERRY, JC; SCOTT, W; MEHTA, AV; PICKHOFF, AS; FISH, F; YEAGER, S; KAWABORI, [No Value; TRIPPLE, M; ROSENFELD, LE

    Background. During the past decade. the implantable cardioverter-defibrillator (ICD) has emerged as the primary therapeutic option for survivors of sudden cardiac death (SCD). Investigation of the clinical efficacy of these devices has primarily assessed outcome in adults with coronary artery

  18. Cardiac magnetic resonance imaging in clinical practice

    Directory of Open Access Journals (Sweden)

    Adriana Dias Barranhas

    2014-01-01

    Full Text Available Objective To evaluate and describe indications, mainly diagnoses and cardiac magnetic resonance imaging findings observed in clinical practice. Materials and Methods Retrospective and descriptive study of cardiac magnetic resonance performed at a private hospital and clinic in the city of Niterói, RJ, Brazil, in the period from May 2007 to April 2011. Results The sample included a total of 1000 studies performed in patients with a mean age of 53.7 ± 16.2 years and predominance for male gender (57.2%. The majority of indications were related to assessment of myocardial perfusion at rest and under pharmacological stress (507/1000; 51%, with positive results in 36.2% of them. Suspected myocarditis was the second most frequent indication (140/1000; 14%, with positive results in 63.4% of cases. These two indications were followed by study of arrhythmias (116/1000; 12%, myocardial viability (69/1000; 7% and evaluation of cardiomyopathies (47/1000; 5%. In a subanalysis, it was possible to identify that most patients were assessed on an outpatient basis (58.42%. Conclusion Cardiac magnetic resonance has been routinely performed in clinical practice, either on an outpatient or emergency/inpatient basis, and myocardial ischemia represented the main indication, followed by investigation of myocarditis, arrhythmogenic right ventricular dysplasia and myocardial viability.

  19. Closed-loop approach for situation awareness of medical devices and operating room infrastructure

    Directory of Open Access Journals (Sweden)

    Rockstroh Max

    2015-09-01

    Full Text Available In recent years, approaches for information and control integration in the digital operating room have emerged. A major step towards an intelligent operating room and a cooperative technical environment would be autonomous adaptation of medical devices and systems to the surgical workflow. The OR staff should be freed from information seeking and maintenance tasks. We propose a closed-loop concept integrating workflow monitoring, processing and (semi-automatic interaction to bridge the gap between OR integration of medical devices and workflow-related information management.

  20. Control room habitability Analysis and Testing for Wolsong Unit 1

    Energy Technology Data Exchange (ETDEWEB)

    Lee, J. B. [KHNP Central Research Institute, Daejeon (Korea, Republic of)

    2013-05-15

    In response to this recommendation, KHNP has established CRH program and performed tracer gas in leakage tests. These activities are described herein including the emergency ventilation system analysis, acceptance criteria calculation for the test and Control Room Envelope (CRE) discrimination, and the results of the tracer gas tests are presented. CRH analysis including unfiltered in leakage tests according to the methodology in ASTM E741 was performed for Wolsong Unit 1. The results show that the integrity of the control room of Wolsong Unit 1 is in good condition to maintain the reactor in a safe condition under accident conditions, which complies with the US NRC regulatory guides 1.78, 1.196 and 1.197.

  1. Locating Errors Through Networked Surveillance: A Multimethod Approach to Peer Assessment, Hazard Identification, and Prioritization of Patient Safety Efforts in Cardiac Surgery.

    Science.gov (United States)

    Thompson, David A; Marsteller, Jill A; Pronovost, Peter J; Gurses, Ayse; Lubomski, Lisa H; Goeschel, Christine A; Gosbee, John W; Wahr, Joyce; Martinez, Elizabeth A

    2015-09-01

    The objectives were to develop a scientifically sound and feasible peer-to-peer assessment model that allows health-care organizations to evaluate patient safety in cardiovascular operating rooms and to establish safety priorities for improvement. The locating errors through networked surveillance study was conducted to identify hazards in cardiac surgical care. A multidisciplinary team, composed of organizational sociology, organizational psychology, applied social psychology, clinical medicine, human factors engineering, and health services researchers, conducted the study. We used a transdisciplinary approach, which integrated the theories, concepts, and methods from each discipline, to develop comprehensive research methods. Multiple data collection was involved: focused literature review of cardiac surgery-related adverse events, retrospective analysis of cardiovascular events from a national database in the United Kingdom, and prospective peer assessment at 5 sites, involving survey assessments, structured interviews, direct observations, and contextual inquiries. A nominal group methodology, where one single group acts to problem solve and make decisions was used to review the data and develop a list of the top priority hazards. The top 6 priority hazard themes were as follows: safety culture, teamwork and communication, infection prevention, transitions of care, failure to adhere to practices or policies, and operating room layout and equipment. We integrated the theories and methods of a diverse group of researchers to identify a broad range of hazards and good clinical practices within the cardiovascular surgical operating room. Our findings were the basis for a plan to prioritize improvements in cardiac surgical care. These study methods allowed for the comprehensive assessment of a high-risk clinical setting that may translate to other clinical settings.

  2. Indications, imaging technique, and reading of cardiac computed tomography: survey of clinical practice

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, M.H.; Zimmermann, E.; Germershausen, C.; Hamm, B. [Charite - Universitaetsmedizin Berlin, Department of Radiology, Berlin (Germany); Schlattmann, P. [University Hospital of Friedrich-Schiller University Jena, Department of Medical Statistics, Computer Sciences and Documentation, Jena (Germany); Dewey, Marc [Charite - Universitaetsmedizin Berlin, Department of Radiology, Berlin (Germany); Charite - Universitaetsmedizin Berlin, Humboldt-Universitaet zu Berlin, Department of Radiology, Berlin, PO Box 10098 (Germany)

    2012-01-15

    To obtain an overview of the current clinical practice of cardiac computed tomography (CT). A 32-item questionnaire was mailed to a total of 750 providers of cardiac CT in 57 countries. A total of 169 questionnaires from 38 countries were available for analysis (23%). Most CT systems used (94%, 207/221) were of the latest generation (64-row or dual-source CT). The most common indications for cardiac CT was exclusion of coronary artery disease (97%, 164/169). Most centres used beta blockade (91%, 151/166) and sublingual nitroglycerine (80%, 134/168). A median slice thickness of 0.625 mm with a 0.5-mm increment and an 18-cm reconstruction field of view was used. Interpretation was most often done using source images in orthogonal planes (92%, 155/169). Ninety percent of sites routinely evaluate extracardiac structures on a large (70%) or cardiac field of view (20%). Radiology sites were significantly more interested in jointly performing cardiac CT together with cardiology than cardiologists. The mean examination time was 18.6 {+-} 8.4 min, and reading took on average 28.7 {+-} 17.8 min. Cardiac CT has rapidly become established in clinical practice, and there is emerging consensus regarding indications, conduct of the acquisition, and reading. (orig.)

  3. The role of the control room operator

    International Nuclear Information System (INIS)

    Williams, M.C.

    A control room operator at an Ontario Hydro nuclear power plant operates a reactor-turbine unit according to approved procedures within imposed constraints to meet the objectives of the organization. A number of operating and administrative tasks make up this role. Control room operators spend approximately six percent of their time physically operating equipment exclusive of upset conditions, and another one percent operating in upset conditions. Testing occupies five percent of an operator's time. Operators must be trained to recognize the entire spectrum of inputs available to them and use them all effectively. Any change in system or unit state is always made according to an approved procedure. Extensive training is required; operators must be taught and pracised in what to do, and must know the reasons behind their actions. They are expected to memorize emergency procedures, to know when to consult operating procedures, and to have sufficient understanding and practice to perform these procedures reliably

  4. Respiratory and Cardiac Resuscitation Skills of the High School Athletic Coach.

    Science.gov (United States)

    Furney, Steven

    Athletic coaches (n=149) responded to a survey questionnaire on two cardiac and respiratory emergency procedures: cardiopulmonary resuscitation (CPR) and the Heimlich maneuver. The coaches were asked to indicate how proficient they were at these skills, how important these skills were to their job, the availability and the need for in-service…

  5. Patient satisfaction, preventive services, and emergency room use among African-Americans with type 2 diabetes.

    Science.gov (United States)

    Gary, Tiffany L; Maiese, Eric M; Batts-Turner, Marian; Wang, Nae-Yuh; Brancati, Fredrick L

    2005-12-01

    The aim of this study was to determine the relationship between patient satisfaction and diabetes- related preventive health care and emergency room (ER) use. We studied 542 urban African-Americans with type 2 diabetes aged > or =25 years who were enrolled in a primary carebased intervention trial to improve diabetes control and reduce adverse health events; 73% female, mean age 58 years, 35% had yearly household incomes of Consumer Assessment of Health Plans Survey (CAHPS) and use of diabetes-related preventive health care and ER were assessed by self-report. We then followed participants for 12 months to determine ER use prospectively. In general, participants gave favorable ratings of their care; over 70% reported that they had no problem getting care, over 60% reported the highest ratings on the communication and courtesy domains, and mean ratings (0-10 scale) for personal doctor and overall health care were high (8.8 and 8.4, respectively). Using poisson regression models adjusted for age, education, and self-reported rating of health, several aspects of patient satisfaction were associated with subsequent ER use. Participants who reported that medical staff were usually helpful or that doctors and nurses usually spent enough time were 0.49 and 0.37 times, respectively, less likely to use the ER (all p < 0.05). However, few aspects of patient satisfaction were associated with better preventive services. These data suggest that greater patient satisfaction was associated with lower ER use in urban African-Americans. Whether measures to improve patient satisfaction would reduce ER use requires further prospective study.

  6. Relationship Between Emergency Medical Services Response Time and Bystander Intervention in Patients With Out-of-Hospital Cardiac Arrest.

    Science.gov (United States)

    Goto, Yoshikazu; Funada, Akira; Goto, Yumiko

    2018-04-27

    The response time of emergency medical services (EMS) is an important determinant of survival after out-of-hospital cardiac arrest. We sought to identify upper limits of EMS response times and bystander interventions associated with neurologically intact survival. We analyzed the records of 553 426 patients with out-of-hospital cardiac arrest in a Japanese registry between 2010 and 2014. The primary study end point was 1-month neurologically intact survival (Cerebral Performance Category scale 1 or 2). Increased EMS response time was associated with significantly decreased adjusted odds of 1-month neurologically intact survival (adjusted odds ratio [aOR] for each 1-minute increase, 0.89; 95% confidence interval [CI], 0.89-0.90), although this relationship was modified by bystander interventions. The bystander interventions and the ranges of EMS response times that were associated with increased adjusted 1-month neurologically intact survival were as follows: bystander defibrillation, from ≤2 minutes (aOR, 3.10 [95% CI, 1.25-7.31]) to 13 minutes (aOR, 5.55 [95% CI, 2.66-11.2]); bystander conventional cardiopulmonary resuscitation, from 3 minutes (aOR 1.48 [95% CI, 1.02-2.12]) to 11 minutes (aOR 2.41 [95% CI, 1.61-3.56]); and bystander chest-compression-only cardiopulmonary resuscitation, from ≤2 minutes (aOR 1.57 [95% CI, 1.01-2.25]) to 11 minutes (aOR 1.92 [95% CI, 1.45-2.56]). However, the increase in neurologically intact survival of those receiving bystander interventions became statistically insignificant compared with no bystander interventions when the EMS response time was outside these ranges. The upper limits of the EMS response times associated with improved 1-month neurologically intact survival were 13 minutes when bystanders provided defibrillation (typically with cardiopulmonary resuscitation) and 11 minutes when bystanders provided cardiopulmonary resuscitation without defibrillation. © 2018 The Authors. Published on behalf of the

  7. Emergency room visits for respiratory conditions in children increased after Guagua Pichincha volcanic eruptions in April 2000 in Quito, Ecuador Observational Study: Time Series Analysis

    Directory of Open Access Journals (Sweden)

    Jagai Jyotsna S

    2007-07-01

    Full Text Available Abstract Background This study documented elevated rates of emergency room (ER visits for acute upper and lower respiratory infections and asthma-related conditions in the children of Quito, Ecuador associated with the eruption of Guagua Pichincha in April of 2000. Methods We abstracted 5169 (43% females ER records with primary respiratory conditions treated from January 1 – December 27, 2000 and examined the change in pediatric ER visits for respiratory conditions before, during, and after exposure events of April, 2000. We applied a Poisson regression model adapted to time series of cases for three non-overlapping disease categories: acute upper respiratory infection (AURI, acute lower respiratory infection (ALRI, and asthma-related conditions in boys and girls for three age groups: 0–4, 5–9, and 10–15 years. Results At the main pediatric medical facility, the Baca Ortiz Pediatric Hospital, the rate of emergency room (ER visits due to respiratory conditions substantially increased in the three weeks after eruption (RR = 2.22, 95%CI = [1.95, 2.52] and RR = 1.72 95%CI = [1.49, 1.97] for lower and upper respiratory tract infections respectively. The largest impact of eruptions on respiratory distress was observed in children younger than 5 years (RR = 2.21, 95%CI = [1.79, 2.73] and RR = 2.16 95%CI = [1.67, 2.76] in boys and girls respectively. The rate of asthma and asthma-related diagnosis doubled during the period of volcano fumarolic activity (RR = 1.97, 95%CI = [1.19, 3.24]. Overall, 28 days of volcanic activity and ash releases resulted in 345 (95%CI = [241, 460] additional ER visits due to respiratory conditions. Conclusion The study has demonstrated strong relationship between ash exposure and respiratory effects in children.

  8. Emergency room visits for respiratory conditions in children increased after Guagua Pichincha volcanic eruptions in April 2000 in Quito, Ecuador observational study: time series analysis.

    Science.gov (United States)

    Naumova, Elena N; Yepes, Hugo; Griffiths, Jeffrey K; Sempértegui, Fernando; Khurana, Gauri; Jagai, Jyotsna S; Játiva, Edgar; Estrella, Bertha

    2007-07-24

    This study documented elevated rates of emergency room (ER) visits for acute upper and lower respiratory infections and asthma-related conditions in the children of Quito, Ecuador associated with the eruption of Guagua Pichincha in April of 2000. We abstracted 5169 (43% females) ER records with primary respiratory conditions treated from January 1-December 27, 2000 and examined the change in pediatric ER visits for respiratory conditions before, during, and after exposure events of April, 2000. We applied a Poisson regression model adapted to time series of cases for three non-overlapping disease categories: acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), and asthma-related conditions in boys and girls for three age groups: 0-4, 5-9, and 10-15 years. At the main pediatric medical facility, the Baca Ortiz Pediatric Hospital, the rate of emergency room (ER) visits due to respiratory conditions substantially increased in the three weeks after eruption (RR = 2.22, 95%CI = [1.95, 2.52] and RR = 1.72 95%CI = [1.49, 1.97] for lower and upper respiratory tract infections respectively. The largest impact of eruptions on respiratory distress was observed in children younger than 5 years (RR = 2.21, 95%CI = [1.79, 2.73] and RR = 2.16 95%CI = [1.67, 2.76] in boys and girls respectively). The rate of asthma and asthma-related diagnosis doubled during the period of volcano fumarolic activity (RR = 1.97, 95%CI = [1.19, 3.24]). Overall, 28 days of volcanic activity and ash releases resulted in 345 (95%CI = [241, 460]) additional ER visits due to respiratory conditions. The study has demonstrated strong relationship between ash exposure and respiratory effects in children.

  9. Detecting early cardiac dysfunction with radionuclide cardiac blood-pool imaging

    International Nuclear Information System (INIS)

    Wu Kegui; Chen Daguang; Lin Haoxue

    1992-01-01

    Cardiac function was measured by radionuclide cardiac blood-pool imaging in 15 normal persons, 19 cases of hypertension, 32 cases of coronary heart disease, 35 cases of coronary heart disease combined with hypertension and 44 cases of myocardial infarction. Significant differences have been found in indices of cardiac function between normal subjects and patients with coronary heart disease and coronary heart disease combined with hypertension, even though the patients were without any clinical sin of cardiac failure. Lowered regional EF and decreased ventricular was motion were found in 38.8% of patients, while 65.7%of patients revealed marked abnormality in MFR. The results indicate that latent cardiac dysfunction is common in patients with coronary heart disease. The earliest change is diastolic function abnormalities

  10. Cardiac Function Remains Impaired Despite Reversible Cardiac Remodeling after Acute Experimental Viral Myocarditis

    Directory of Open Access Journals (Sweden)

    Peter Moritz Becher

    2017-01-01

    Full Text Available Background. Infection with Coxsackievirus B3 induces myocarditis. We aimed to compare the acute and chronic phases of viral myocarditis to identify the immediate effects of cardiac inflammation as well as the long-term effects after resolved inflammation on cardiac fibrosis and consequently on cardiac function. Material and Methods. We infected C57BL/6J mice with Coxsackievirus B3 and determined the hemodynamic function 7 as well as 28 days after infection. Subsequently, we analyzed viral burden and viral replication in the cardiac tissue as well as the expression of cytokines and matrix proteins. Furthermore, cardiac fibroblasts were infected with virus to investigate if viral infection alone induces profibrotic signaling. Results. Severe cardiac inflammation was determined and cardiac fibrosis was consistently colocalized with inflammation during the acute phase of myocarditis. Declined cardiac inflammation but no significantly improved hemodynamic function was observed 28 days after infection. Interestingly, cardiac fibrosis declined to basal levels as well. Both cardiac inflammation and fibrosis were reversible, whereas the hemodynamic function remains impaired after healed viral myocarditis in C57BL/6J mice.

  11. Current role of cardiac and extra-cardiac pathologies in clinically indicated cardiac computed tomography with emphasis on status before pulmonary vein isolation

    Energy Technology Data Exchange (ETDEWEB)

    Sohns, J.M.; Lotz, J. [Goettingen University Medical Center (Germany). Inst. for Diagnostic and Interventional Radiology; German Center for Cardiovascular Research (DZHK), Goettingen (Germany); Menke, J.; Staab, W.; Fasshauer, M.; Kowallick, J.T.; Zwaka, P.A.; Schwarz, A. [Goettingen University Medical Center (Germany). Inst. for Diagnostic and Interventional Radiology; Spiro, J. [Koeln University Hospital (Germany). Radiology; Bergau, L.; Unterberg-Buchwald, C. [Goettingen University Medical Center (Germany). Cardiology and Pneumology

    2014-09-15

    Purpose: The aim of this study was to assess the incidence of cardiac and significant extra-cardiac findings in clinical computed tomography of the heart in patients with atrial fibrillation before pulmonary vein isolation (PVI). Materials and Methods: 224 patients (64 ± 10 years; male 63%) with atrial fibrillation were examined by cardiac 64-slice multidetector CT before PVI. Extra-cardiac findings were classified as 'significant' if they were recommended to additional diagnostics or therapy, and otherwise as 'non-significant'. Additionally, cardiac findings were documented in detail. Results: A total of 724 cardiac findings were identified in 203 patients (91% of patients). Additionally, a total of 619 extra-cardiac findings were identified in 179 patients (80% of patients). Among these extra-cardiac findings 196 (32%) were 'significant', and 423 (68%) were 'non-significant'. In 2 patients (1%) a previously unknown malignancy was detected (esophageal cancer and lung cancer, local stage, no metastasis). 203 additional imaging diagnostics followed to clarify the 'significant' findings (124 additional CT, costs 38,314.69 US dollars). Overall, there were 3.2 cardiac and 2.8 extra-cardiac findings per patient. Extra-cardiac findings appear significantly more frequently in patients over 60 years old, in smokers and in patients with a history of cardiac findings (p < 0.05). Conclusion: Cardiac CT scans before PVI should be screened for extracardiac incidental findings that could have important clinical implications for each patient. (orig.)

  12. Emergency Contraception: a survey of Hospital Emergency Departments Staffs

    Directory of Open Access Journals (Sweden)

    Marco Bo

    2011-06-01

    Full Text Available The World Health Organization defines emergency contraception (EC as a means to prevent unwanted pregnancy. In countries where EC is dispensed behind the counter, emergency departments are a preferred point of care for its prescription and dispensing. In light of this situation and as no studies on emergency contraception in emergency departments in Italy have been conducted to date, this study was designed with a view to analyze the responses of emergency room physicians in relation to their prescribing habits and knowledge about the drug and in relation to frequency and profile of women arriving for care at hospital emergency departments in Piedmont and requesting prescription for the morning-after pill. This cross-sectional survey involved 29 hospital emergency departments in Piedmont where no gynecologists are on active duty. The survey instrument was a 24-item questionnaire. Analysis of responses revealed that in the physicians’ opinion the vast majority of requests came from Italian nationals (97% ranging in age from 18 to 30 years (76%, single and not cohabiting with a partner (60%, and nulliparous (64.0%. Women mostly request EC for first-time and the most common reasons were condom breakage or slippage. Just over half the physicians (52% stated that emergency contraception prescription was not an appropriate part of care provided at an emergency department and 72% stated they felt uneasy about prescribing emergency contraception. The survey also revealed gaps in physician knowledge about the pharmacokinetic and pharmacodynamic properties of emergency contraception pills.

  13. Emergency Contraception: a survey of Hospital Emergency Departments Staffs

    Directory of Open Access Journals (Sweden)

    Marco Bo

    2011-03-01

    Full Text Available The World Health Organization defines emergency contraception (EC as a means to prevent unwanted pregnancy. In countries where EC is dispensed behind the counter, emergency departments are a preferred point of care for its prescription and dispensing. In light of this situation and as no studies on emergency contraception in emergency departments in Italy have been conducted to date, this study was designed with a view to analyze the responses of emergency room physicians in relation to their prescribing habits and knowledge about the drug and in relation to frequency and profile of women arriving for care at hospital emergency departments in Piedmont and requesting prescription for the morning-after pill. This cross-sectional survey involved 29 hospital emergency departments in Piedmont where no gynecologists are on active duty. The survey instrument was a 24-item questionnaire. Analysis of responses revealed that in the physicians’ opinion the vast majority of requests came from Italian nationals (97% ranging in age from 18 to 30 years (76%, single and not cohabiting with a partner (60%, and nulliparous (64.0%. Women mostly request EC for first-time and the most common reasons were condom breakage or slippage. Just over half the physicians (52% stated that emergency contraception prescription was not an appropriate part of care provided at an emergency department and 72% stated they felt uneasy about prescribing emergency contraception. The survey also revealed gaps in physician knowledge about the pharmacokinetic and pharmacodynamic properties of emergency contraception pills.

  14. [Cardiological emergency network in Lombardy].

    Science.gov (United States)

    Marzegalli, Maurizio; Fontana, Giancarlo; Sesana, Giovanni; Grieco, Niccolò; Lombardi, Federico; Elena, Corrada; Ieva, Francesca; Paganoni, Anna Maria

    2008-10-01

    To achieve a reduction of time to reperfusion through the organization of an interhospital network and the involvement of the Regional Health Authority. Four major endpoints were identified: institutional governance action, clinical management of acute ST-elevation myocardial infarction (STEMI), priority actions for cardiac arrest and early defibrillation, actions to avoid the delay related to decision-making, and logistic factors. Since 2001 in the urban area of Milan a network has been operating among 23 coronary care units, the 118 Dispatch Center (national free number for medical emergencies) and the Health Country Government Agency named Group for Prehospital Cardiac Emergency. In order to monitor the network activity and time to treatment and clinical outcomes a periodic monthly survey, called MOMI (One Month Monitoring Myocardial Infarction), was undertaken and repeated twice yearly. Data were evaluated according to hospital admission modality. Global times are: symptom onset to first medical contact 116 min (interquartile range [IQR] 189), time to first ECG 7 min (IQR 12), door-to-balloon time 77 min (IQR 81.7). Non-parametric test showed that the modality of hospital admittance was the most critical determinant of door-to-balloon time. The shortest one (49.5 min) was that of patients transported by means of advanced rescue units with 12-lead ECG teletransmission and activation of a fast track directly to the cath lab. Our data show how in a complex urban area the organization of an interhospital network and the availability of ECG teletransmission are effective in reducing time to reperfusion, in the treatment of major arrhythmias and in pre-alert of coronary care units and cath labs in case of confirmed STEMI. This experience also stimulated an improvement in technological equipment of rescue units with extension of 12-lead teletransmission to basic life support units. Through the Health Country Government Agency and the Scientific Societies we carry on

  15. Short-term effects of ambient air pollution on emergency room admissions due to cardiovascular causes in Beijing, China

    International Nuclear Information System (INIS)

    Ma, Yuxia; Zhao, Yuxin; Yang, Sixu; Zhou, Jianding; Xin, Jinyuan; Wang, Shigong; Yang, Dandan

    2017-01-01

    Ambient air pollution has been a major global public health issue. A number of studies have shown various adverse effects of ambient air pollution on cardiovascular diseases. In the current study, we investigated the short-term effects of ambient air pollution on emergency room (ER) admissions due to cardiovascular causes in Beijing from 2009 to 2012 using a time-series analysis. A total of 82430 ER cardiovascular admissions were recorded. Different gender (male and female) and age groups (15yrs ≤ age <65 yrs and age ≥ 65 yrs) were also examined by single model and multiple-pollutant model. Three major pollutants (SO 2 , NO 2 and PM 10 ) had lag effects of 0–2 days on cardiovascular ER admissions. The relative risks (95% CI) of per 10 μg/m 3 increase in PM 10 , SO 2 and NO 2 were 1.008 (0.997–1.020), 1.008(0.999–1.018) and 1.014(1.003–1.024), respectively. The effect was more pronounced in age ≥65 and males in Beijing. We also found the stronger acute effects on the elderly and females at lag 0 than on the younger people and males at lag 2. - Highlights: • Significant associations were found between air pollution and emergency admissions of cardiovascular diseases. • Air pollutants had lag effects on age and gender groups. • Stronger effects of air pollutants were observed for age ≥65 yrs and males. • More acute effects of air pollutants were found for age ≥65 yrs and females. - Air pollutants had significant lag effects on different age and gender groups. The effects were more pronounced in age ≥65 and males in Beijing, China.

  16. Hypoxia Room

    Data.gov (United States)

    Federal Laboratory Consortium — The Hypoxia Room is a 8x8x8 ft. clear vinyl plastic and aluminum frame construction enclosure located within USAREIM laboratory 028. The Hypoxia Room (manufactured...

  17. Temporal variation of out-of-hospital cardiac arrests in an equatorial climate.

    Science.gov (United States)

    Ong, Marcus Eh; Ng, Faith Sp; Yap, Susan; Yong, Kok Leong; Peberdy, Mary A; Ornato, Joseph P

    2010-01-01

    We aimed to determine whether there is a seasonal variation of out-of-hospital cardiac arrests (OHCA) in an equatorial climate, which does not experience seasonal environmental change. We conducted an observational prospective study looking at the occurrence of OHCA in Singapore. Included were all patients with OHCA presented to Emergency Departments across the country. We examined the monthly, daily, and hourly number of cases over a three-year period. Data was analyzed using analysis of variance (ANOVA). From October, 1st 2001 to October, 14th 2004, 2428 patients were enrolled in the study. Mean age for cardiac arrests was 60.6 years with 68.0% male. Ethnic distribution was 69.5% Chinese, 15.0% Malay, 11.0% Indian, and 4.4% Others. There was no significant seasonal variation (spring/summer/fall/winter) of events (ANOVA P = 0.71), monthly variation (P = 0.88) or yearly variation (P = 0.26). We did find weekly peaks on Mondays and a circadian pattern with daily peaks from 9-10 am. We did not find any discernable seasonal pattern of cardiac arrests. This contrasts with findings from temperate countries and suggests a climatic influence on cardiac arrest occurrence. We also found that sudden cardiac arrests follow a circadian pattern.

  18. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams.

    Science.gov (United States)

    Chalwin, R P; Flabouris, A

    2013-09-01

    Efforts are ongoing to improve outcomes from cardiac arrest and medical emergencies. A promising quality improvement modality is use of non-technical skills (NTS) that aim to address human factors through improvements in performance of leadership, communication, situational awareness and decision-making. Originating in the airline industry, NTS training has been successfully introduced into anaesthesia, surgery, emergency medicine and other acute medical specialities. Some aspects of NTS have already achieved acceptance for cardiac arrest teams. Leadership skills are emphasised in advanced life support training and have shown favourable results when employed in simulated and clinical resuscitation scenarios. The application of NTS in medical emergency teams as part of a rapid response system attending medical emergencies is less certain; however, observations of simulations have also shown promise. This review highlights the potential benefits of NTS competency for cardiac arrest teams and, more importantly, medical emergency teams because of the diversity of clinical scenarios encountered. Discussion covers methods to assess and refine NTS and NTS training to optimise performance in the clinical environment. Increasing attention should be applied to yielding meaningful patient and organisational outcomes from use of NTS. Similarly, implementation of any training course should receive appropriate scrutiny to refine team and institutional performance. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

  19. A systematic approach to emergencies in uveitis.

    Science.gov (United States)

    Al-Dhibi, Hassan A; Al-Mahmood, Ammar M; Arevalo, J Fernando

    2014-01-01

    Uveitis is a common cause of preventable blindness although it is consider a sight-threatening condition particularly in cases with posterior segment inflammation. To deal with emergency conditions in uveitis, we must aware of the essential signs and symptoms that reflect a true uveitic emergency. Failure to recognize these essential signs and symptoms of a true uveitic emergency may result in a devastating visual outcome. This review provides general ophthalmologists and residents, clinical guidelines for the main uveitic entities that require immediate recognition and urgent intervention in the emergency room to prevent severe permanent visual loss.

  20. Effect of Room Ventilation Rates in Rodent Rooms with Direct-Exhaust IVC Systems.

    Science.gov (United States)

    Geertsema, Roger S; Lindsell, Claire E

    2015-09-01

    When IVC are directly exhausted from a rodent housing room, the air quality of the room can become independent of the intracage air quality and may reduce the need for high room ventilation rates. This study assessed the effect of decreasing the ventilation rate in rodent rooms using direct-exhaust IVC systems. The study was conducted over 16 wk and compared conditions in 8 rodent rooms that had ventilation rates of 5 to 6 air changes per hour (ACH) with those in rooms at 10 to 12 ACH. At the low ventilation rate, rooms had higher CO₂ concentrations, higher dew point temperature, and lower particulate levels and spent a greater percentage of time above the temperature set point than did rooms at the high rate. The levels of allergens and endotoxins in room air were the same regardless of the ventilation rate. Differences seen in parameters within cages at the 2 ventilation rates were operationally irrelevant. We detected no total volatile organic compounds in the room that were attributable to ammonia, regardless of the ventilation rate. Clearing the air of ethanol after a spill took longer at the low compared with high rate. However, ethanol clearance was faster at the low rate when the demand-control system was activated than at the high ventilation rate alone. Air quality in the room and in the cages were acceptable with room ventilation rates of 5 to 6 ACH in rodent rooms that use direct-exhaust IVC systems.

  1. Epidemiology and Outcomes After In-Hospital Cardiac Arrest After Pediatric Cardiac Surgery

    Science.gov (United States)

    Gupta, Punkaj; Jacobs, Jeffrey P.; Pasquali, Sara K.; Hill, Kevin D.; Gaynor, J. William; O’Brien, Sean M.; He, Max; Sheng, Shubin; Schexnayder, Stephen M.; Berg, Robert A.; Nadkarni, Vinay M.; Imamura, Michiaki; Jacobs, Marshall L.

    2014-01-01

    Background Multicenter data regarding cardiac arrest in children undergoing heart operations are limited. We describe epidemiology and outcomes associated with postoperative cardiac arrest in a large multiinstitutional cohort. Methods Patients younger than 18 years in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2007 through 2012) were included. Patient factors, operative characteristics, and outcomes were described for patients with and without postoperative cardiac arrest. Multivariable models were used to evaluate the association of center volume with cardiac arrest rate and mortality after cardiac arrest, adjusting for patient and procedural factors. Results Of 70,270 patients (97 centers), 1,843 (2.6%) had postoperative cardiac arrest. Younger age, lower weight, and presence of preoperative morbidities (all p < 0.0001) were associated with cardiac arrest. Arrest rate increased with procedural complexity across common benchmark operations, ranging from 0.7% (ventricular septal defect repair) to 12.7% (Norwood operation). Cardiac arrest was associated with significant mortality risk across procedures, ranging from 15.4% to 62.3% (all p < 0.0001). In multivariable analysis, arrest rate was not associated with center volume (odds ratio, 1.06; 95% confidence interval, 0.71 to 1.57 in low- versus high-volume centers). However, mortality after cardiac arrest was higher in low-volume centers (odds ratio, 2.00; 95% confidence interval, 1.52 to 2.63). This association was present for both high- and low-complexity operations. Conclusions Cardiac arrest carries a significant mortality risk across the stratum of procedural complexity. Although arrest rates are not associated with center volume, lower-volume centers have increased mortality after cardiac arrest. Further study of mechanisms to prevent cardiac arrest and to reduce mortality in those with an arrest is warranted. PMID:25443018

  2. Nuclear power plant control room task analysis. Pilot study for pressurized water reactors

    International Nuclear Information System (INIS)

    Barks, D.B.; Kozinsky, E.J.; Eckel, S.

    1982-05-01

    The purposes of this nuclear plant task analysis pilot study: to demonstrate the use of task analysis techniques on selected abnormal or emergency operation events in a nuclear power plant; to evaluate the use of simulator data obtained from an automated Performance Measurement System to supplement and validate data obtained by traditional task analysis methods; and to demonstrate sample applications of task analysis data to address questions pertinent to nuclear power plant operational safety: control room layout, staffing and training requirements, operating procedures, interpersonal communications, and job performance aids. Five data sources were investigated to provide information for a task analysis. These sources were (1) written operating procedures (event-based); (2) interviews with subject matter experts (the control room operators); (3) videotapes of the control room operators (senior reactor operators and reactor operators) while responding to each event in a simulator; (4) walk-/talk-throughs conducted by control room operators for each event; and (5) simulator data from the PMS

  3. Current Roles and Future Applications of Cardiac CT: Risk Stratification of Coronary Artery Disease

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Yeonyee Elizabeth [Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Lim, Tae-Hwan [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736 (Korea, Republic of)

    2014-07-01

    Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.

  4. Randomised trial comparing the recording ability of a novel, electronic emergency documentation system with the AHA paper cardiac arrest record.

    Science.gov (United States)

    Grigg, Eliot; Palmer, Andrew; Grigg, Jeffrey; Oppenheimer, Peter; Wu, Tim; Roesler, Axel; Nair, Bala; Ross, Brian

    2014-10-01

    To evaluate the ability of an electronic system created at the University of Washington to accurately document prerecorded VF and pulseless electrical activity (PEA) cardiac arrest scenarios compared with the American Heart Association paper cardiac arrest record. 16 anaesthesiology residents were randomly assigned to view one of two prerecorded, simulated VF and PEA scenarios and asked to document the event with either the paper or electronic system. Each subject then repeated the process with the other video and documentation method. Five types of documentation errors were defined: (1) omission, (2) specification, (3) timing, (4) commission and (5) noise. The mean difference in errors between the paper and electronic methods was analysed using a single factor repeated measures ANOVA model. Compared with paper records, the electronic system omitted 6.3 fewer events (95% CI -10.1 to -2.5, p=0.003), which represents a 28% reduction in omission errors. Users recorded 2.9 fewer noise items (95% CI -5.3 to -0.6, p=0.003) when compared with paper, representing a 36% decrease in redundant or irrelevant information. The rate of timing (Δ=-3.2, 95% CI -9.3 to 3.0, p=0.286) and commission (Δ=-4.4, 95% CI -9.4 to 0.5, p=0.075) errors were similar between the electronic system and paper, while the rate of specification errors were about a third lower for the electronic system when compared with the paper record (Δ=-3.2, 95% CI -6.3 to -0.2, p=0.037). Compared with paper documentation, documentation with the electronic system captured 24% more critical information during a simulated medical emergency without loss in data quality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Room temperature superconductors

    International Nuclear Information System (INIS)

    Sleight, A.W.

    1995-01-01

    If the Holy Grail of room temperature superconductivity could be achieved, the impact on could be enormous. However, a useful room temperature superconductor for most applications must possess a T c somewhat above room temperature and must be capable of sustaining superconductivity in the presence of magnetic fields while carrying a significant current load. The authors will return to the subject of just what characteristics one might seek for a compound to be a room temperature superconductor. 30 refs., 3 figs., 1 tab

  6. Community involvement in out of hospital cardiac arrest

    Science.gov (United States)

    Shams, Ali; Raad, Mohamad; Chams, Nour; Chams, Sana; Bachir, Rana; El Sayed, Mazen J.

    2016-01-01

    Abstract Out of hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Developing countries including Lebanon report low survival rates and poor neurologic outcomes in affected victims. Community involvement through early recognition and bystander cardiopulmonary resuscitation (CPR) can improve OHCA survival. This study assesses knowledge and attitude of university students in Lebanon and identifies potential barriers and facilitators to learning and performing CPR. A cross-sectional survey was administered to university students. The questionnaire included questions regarding the following data elements: demographics, knowledge, and awareness about sudden cardiac arrest, CPR, automated external defibrillator (AED) use, prior CPR and AED training, ability to perform CPR or use AED, barriers to performing/learning CPR/AED, and preferred location for attending CPR/AED courses. Descriptive analysis followed by multivariate analysis was carried out to identify predictors and barriers to learning and performing CPR. A total of 948 students completed the survey. Participants’ mean age was 20.1 (±2.1) years with 53.1% women. Less than half of participants (42.9%) were able to identify all the presenting signs of cardiac arrest. Only 33.7% of participants felt able to perform CPR when witnessing a cardiac arrest. Fewer participants (20.3%) reported receiving previous CPR training. Several perceived barriers to learning and performing CPR were also reported. Significant predictors of willingness to perform CPR when faced with a cardiac arrest were: earning higher income, previous CPR training and feeling confident in one's ability to apply an AED, or perform CPR. Lacking enough expertise in performing CPR was a significant barrier to willingness to perform CPR. University students in Lebanon are familiar with the symptoms of cardiac arrest, however, they are not well trained in CPR and lack confidence to perform it. The attitude towards the importance of

  7. Emergency Response Guideline Development

    International Nuclear Information System (INIS)

    Gary D Storrick

    2007-01-01

    Task 5 of the collaborative effort between ORNL, Brazil, and Westinghouse for the International Nuclear Energy Research Initiative entitled 'Development of Advanced Instrumentation and Control for an Integrated Primary System Reactor' focuses on operator control and protection system interaction, with particular emphasis on developing emergency response guidelines (ERGs). As in the earlier tasks, we will use the IRIS plant as a specific example of an integrated primary system reactor (IPSR) design. The present state of the IRIS plant design--specifically, the lack of a detailed secondary system design--precludes establishing detailed emergency procedures at this time. However, we can create a structure for their eventual development. This report summarizes our progress to date. Section 1.2 describes the scope of this effort. Section 2 compares IPSR ERG development to the recent AP1000 effort, and identifies three key plant differences that affect the ERGs and control room designs. The next three sections investigate these differences in more detail. Section 3 reviews the IRIS Safety-by-Design philosophy and its impact on the ERGs. Section 4 looks at differences between the IRIS and traditional loop PWR I and C Systems, and considers their implications for both control room design and ERG development. Section 5 examines the implications of having one operating staff control multiple reactor units. Section 6 provides sample IRIS emergency operating procedures (EOPs). Section 7 summarizes our conclusions

  8. Mediastinal Bronchogenic Cyst With Acute Cardiac Dysfunction: Two-Stage Surgical Approach.

    Science.gov (United States)

    Smail, Hassiba; Baste, Jean Marc; Melki, Jean; Peillon, Christophe

    2015-10-01

    We describe a two-stage surgical approach in a patient with cardiac dysfunction and hemodynamic compromise resulting from a massive and compressive mediastinal bronchogenic cyst. To drain this cyst, video-assisted mediastinoscopy was performed as an emergency procedure, which immediately improved the patient's cardiac function. Five days later and under video thoracoscopy, resection of the cyst margins was impossible because the cyst was tightly adherent to the left atrium. We performed deroofing of this cyst through a right thoracotomy. The patient had an uncomplicated postoperative recovery, and no recurrence was observed at the long-term follow-up visit. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Stimulating endogenous cardiac regeneration

    Directory of Open Access Journals (Sweden)

    Amanda eFinan

    2015-09-01

    Full Text Available The healthy adult heart has a low turnover of cardiac myocytes. The renewal capacity, however, is augmented after cardiac injury. Participants in cardiac regeneration include cardiac myocytes themselves, cardiac progenitor cells, and peripheral stem cells, particularly from the bone marrow compartment. Cardiac progenitor cells and bone marrow stem cells are augmented after cardiac injury, migrate to the myocardium, and support regeneration. Depletion studies of these populations have demonstrated their necessary role in cardiac repair. However, the potential of these cells to completely regenerate the heart is limited. Efforts are now being focused on ways to augment these natural pathways to improve cardiac healing, primarily after ischemic injury but in other cardiac pathologies as well. Cell and gene therapy or pharmacological interventions are proposed mechanisms. Cell therapy has demonstrated modest results and has passed into clinical trials. However, the beneficial effects of cell therapy have primarily been their ability to produce paracrine effects on the cardiac tissue and recruit endogenous stem cell populations as opposed to direct cardiac regeneration. Gene therapy efforts have focused on prolonging or reactivating natural signaling pathways. Positive results have been demonstrated to activate the endogenous stem cell populations and are currently being tested in clinical trials. A potential new avenue may be to refine pharmacological treatments that are currently in place in the clinic. Evidence is mounting that drugs such as statins or beta blockers may alter endogenous stem cell activity. Understanding the effects of these drugs on stem cell repair while keeping in mind their primary function may strike a balance in myocardial healing. To maximize endogenous cardiac regeneration,a combination of these approaches couldameliorate the overall repair process to incorporate the participation ofmultiple cell players.

  10. Development of a displacement immunoassay for human heart-type fatty acid-binding protein in plasma : the basic conditions

    NARCIS (Netherlands)

    van der Voort, D; Pelsers, MMAL; Korf, J; Hermens, WT; Glatz, JFC

    2003-01-01

    To risk-stratify patients with chest pain who are admitted to emergency rooms and for whom initial evaluation is not conclusive, the use of cardiac markers has become a standard procedure. A recently introduced early plasma marker for acute myocardial infarction (AMI) is the 14.5-kDa cytoplasmic

  11. Room acoustics modeling using a point-cloud representation of the room geometry

    DEFF Research Database (Denmark)

    Markovic, Milos; Olesen, Søren Krarup; Hammershøi, Dorte

    2013-01-01

    Room acoustics modeling is usually based on the room geometry that is parametrically described prior to a sound transmission calculation. This is a highly room-specific task and rather time consuming if a complex geometry is to be described. Here, a run time generic method for an arbitrary room...... geometry acquisition is presented. The method exploits a depth sensor of the Kinect device that provides a point based information of a scanned room interior. After post-processing of the Kinect output data, a 3D point-cloud model of the room is obtained. Sound transmission between two selected points...... level of user immersion by a real time acoustical simulation of a dynamic scenes....

  12. TUGAS ROOM ATTENDANT DALAM MENANGANI COMPLAINT TAMU DELUXE ROOM HOTEL HYAAT REGENCY BANDUNG

    Directory of Open Access Journals (Sweden)

    Reza Gustia Purnama

    2016-05-01

    Full Text Available Abstract - The problem is how meticulous the duties and responsibilities of the room attendant in the deluxe room Hotel Hyatt Regency Bandung, standard operational procedures in the deluxe room Hotel Hyatt Regency Bandung, and handling guest complaint in deluxe room Hotel Hyatt Regency Bandung. Author uses descriptive analysis, which is a form of writing in the actual situation describes strive about the object of research, then the data obtained in the form of a report compiled in. Based on the results of observation it can be concluded that the task and responsibility of the room attendant in the deluxe room Hyatt Regency Bandung already carry it out in accordance with standard operational procedures (SOP which is divided into two shifts, morning and evening shift which has a slightly different task, standard operational procedures in the deluxe room Hyatt Regency Bandung has been standard operating procedure in applying it at the hotel Hyatt Regency Bandung, and Guest complaint handling in deluxe room Hyatt Regency Bandung Hotel how to deal with and resolve the complaint vary slightly in view of the type of complaint. Based on the results of observation and discussion, the authors conclude that the Duty room attendant in handling customers compaint deluxe room in the Hyatt Regency Bandung Hotel when his handlers was conducted appropriately and propesional effects will be good for the image of the hyatt regency hotel bandung.   Keywords: Room Attendant, Complaint, Deluxe room   Abstraksi - Masalah yang di teliti adalah tugas dan tanggung jawab room attendant di deluxe room Hotel Hyatt Regency Bandung, standar operasional prosedur di deluxe room Hotel Hyatt Regency Bandung, dan penanganan complaint tamu di deluxe room Hotel Hyatt Regency Bandung.  Metode yang di gunakan menggunakan analisis deskriptif, yaitu bentuk penulisan yang di upayakan menggambarkan keadaan yang sebenarnya tetang objek penelitian,kemudian data yang di peroleh disusun

  13. Electronic registration of out-of-hospital cardiac arrests

    DEFF Research Database (Denmark)

    Nielsen, Niels Dalsgaard; Dahl, Michael; Gade, John

    2007-01-01

    of cardiac arrest. 83 of those (28 %) received first aid. The first aid was provided by layman (68 %), physicians (11 %), nurses (11 %) and first-aiders (4 %). In 6 % the identity of the first aid provider was unknown. The majority of the patients (n = 177 (58 %)) had asystole upon ambulance arrival. 37 (12...... patients according to whether they received first aid, the identity of the first aid provider and the initial cardiac rhythm as diagnosed by the patient monitor.   Results: 18,666 patients where in contact with an emergency ambulance in the study period. Of those 296 (89/100,000/year) met the definition...... a considerably higher incidence rate for OHCA, than documented by the analogue nationwide registry. Further we discovered a high rate of first aid to OHCA-patients. Finally our data showed a high occurence of asystolia in patients who met the official criteria for OHCA....

  14. Bedside Echocardiography for Rapid Diagnosis of Malignant Cardiac Tamponade

    Directory of Open Access Journals (Sweden)

    Alaina Brinley

    2017-01-01

    Full Text Available History of present illness: A 47-year-old female with metastatic breast cancer presented to the Emergency Department with chest pain and shortness of breath. She was hypotensive and her EKG showed sinus tachycardia with low voltage. A bedside ultrasound was performed that detected a pericardial effusion and evidence of cardiac tamponade. The patient’s vitals improved with a fluid bolus and she went emergently to the cardiac catheterization lab for fluoroscopy and echocardiography guided pericardiocentesis. A total of 770 mL of fluid was removed from her pericardial space. Significant findings: The video shows a subxiphoid view of the heart with evidence of a large pericardial effusion with tamponade – note the anechoic stripe in the pericardial sac (see red arrow. This video demonstrates paradoxical right ventricular collapse during diastole and right atrial collapse during systole which is indicative of tamponade.1,2 Figure 1 is from the same patient and shows sonographic pulsus paradoxus. This is an apical 4 chamber view of the heart with the sampling gate of the pulsed wave doppler placed over the mitral valve. The Vpeak max and Vpeak min are indicated. If there is more than a 25% difference with inspiration between these 2 values, this is highly suggestive of tamponade.1 In this case, there is a 32.4% difference between the Vpeak max 69.55 cm/s and Vpeak min 46.99 cm/s. Discussion: Cardiac tamponade is distinguished from pericardial effusion by right ventricular compression/collapse and hemodynamic instability. Findings can include hypotension, tachycardia, distant heart sounds, and jugular venous distension.3,4 One might also see a plethoric IVC without respiratory variation indicative of elevated right atrial pressures.1 Detection of right ventricular collapse for cardiac tamponade has sensitivities ranging from 48%-100% and specificities ranging from 33%-100%.5 A larger effusion is more likely to lead to cardiac tamponade. However

  15. Measuring and improving cardiopulmonary resuscitation quality inside the emergency department.

    Science.gov (United States)

    Crowe, Christopher; Bobrow, Bentley J; Vadeboncoeur, Tyler F; Dameff, Christian; Stolz, Uwe; Silver, Annemarie; Roosa, Jason; Page, Rianne; LoVecchio, Frank; Spaite, Daniel W

    2015-08-01

    To evaluate CPR quality during cardiac resuscitation attempts in an urban emergency department (ED) and determine the influence of the combination of scenario-based training, real-time audiovisual feedback (RTAVF), and post-event debriefing on CPR quality. CPR quality was recorded using an R Series monitor-defibrillator (ZOLL Medical) during the treatment of adult cardiac arrest patients. Phase 1 (P1; 11/01/2010-11/15/2012) was an observation period of CPR quality. Phase 2 (P2; 11/15/2012-11/08/2013) was after a 60-min psychomotor skills CPR training and included RTAVF and post-event debriefing. A total of 52 cardiac arrest patients were treated in P1 (median age 56 yrs, 63.5% male) and 49 in P2 (age 60 yrs, 83.7% male). Chest compression (CC) depth increased from 46.7 ± 3.8mm in P1 to 61.6 ± 2.8mm in P2 (p training, real-time audiovisual CPR feedback, and post-event debriefing was associated with improved CPR quality and compliance with CPR guidelines in this urban teaching emergency department. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. The crisis in United States hospital emergency services.

    Science.gov (United States)

    Harrison, Jeffrey P; Ferguson, Emily D

    2011-01-01

    Emergency services are critical for high-quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (U.S.) acute care hospital staffs ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers. Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities. U.S. acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, U.S. emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staffs ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state-of-the-art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement. This research uses the AHA annual surveys,which represent self-reported data by individual hospital staff. However, the AHA expendssignificant resources to validate reported information and the annual survey data are widely used for hospital research. The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure. This article has important information on US emergency service availability in the hospital industry.

  17. Relación entre consultas a urgencias por enfermedad respiratoria y contaminación atmosférica en Ciudad Juárez, Chihuahua Relationship between emergency room visits for respiratory disease and atmospheric pollution in Ciudad Juárez, Chihuahua

    Directory of Open Access Journals (Sweden)

    Leticia Hernández-Cadena

    2000-08-01

    Full Text Available OBJETIVO: Analizar la relación entre las concentraciones ambientales de partículas de diámetro OBJECTIVE: To assess the relationship of <=10 µm particles (PM10 and atmospheric ozone concentrations, with the daily number of emergency visits due to asthma and acute respiratory diseases, among children aged under 15, living in Ciudad Juarez, Chihuahua, Mexico. MATERIAL AND METHODS: Between 1998 and 1999, an ecologic study was conducted. Atmospheric data were obtained from the Environmental Protection Agency (EPA, from eight monitoring stations located in Ciudad Juarez, Chihuahua, and El Paso, Texas. From July 1997 to December 1998, data from emergency room visits for respiratory illness were abstracted from existing medical records of two Mexican Institute of Social Security (IMSS hospitals in Ciudad Juarez. Diagnoses were classified into two groups: a asthma, and b upper respiratory infections (URI, according to the International Classification of Diseases (ICD-9 and/or IDC-10. Statistical analysis was carried out using the Poisson regression time series method. RESULTS: During the study period, the mean 24-hour PM10 level was 34.46 µg/m³ (SD=17.99 and the mean ozone level was 51.60 ppb (SD=20.70. The model shows that an increase of 20 µg/m³ in the mean 24-hour exposure to PM10 was related to an increase of 4.97% (95% CI 0.97-9.13 in emergency visits for asthma, with a 5-day lag, as well as to an increase of 9% (95% CI 1.8-16.8 when a cumulative 5-day exposure was considered. URI increased 2.95% as a cause of emergency room visits, for each 20 µg/m³ increase in the mean 24-hour exposure to PM10. The impact of PM10 on emergency visits for asthma was greater on days with ozone ambient levels exceeded 49 ppb (median value. CONCLUSIONS: A positive association was found between environmental PM10 and ozone concentrations and the daily number of emergency room visits due to asthma and acute respiratory diseases, even with levels lower than the

  18. Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?

    Science.gov (United States)

    Fothergill, Rachael T; Williams, Julia; Edwards, Melanie J; Russell, Ian T; Gompertz, Patrick

    2013-11-01

    U.K ambulance services assess patients with suspected stroke using the Face Arm Speech Test (FAST). The Recognition Of Stroke In the Emergency Room (ROSIER) tool has been shown superior to the FAST in identifying strokes in emergency departments but has not previously been tested in the ambulance setting. We investigated whether ROSIER use by ambulance clinicians can improve stroke recognition. Ambulance clinicians used the ROSIER in place of the FAST to assess patients with suspected stroke. As the ROSIER includes all FAST elements, we calculated a FAST score from the ROSIER to enable comparisons between the two tools. Ambulance clinicians' provisional stroke diagnoses using the ROSIER and calculated FAST were compared with stroke consultants' diagnosis. We used stepwise logistic regression to compare the contribution of individual ROSIER and FAST items and patient demographics to the prediction of consultants' diagnoses. Sixty-four percent of strokes and 78% of nonstrokes identified by ambulance clinicians using the ROSIER were subsequently confirmed by a stroke consultant. There was no difference in the proportion of strokes correctly detected by the ROSIER or FAST with both displaying excellent levels of sensitivity. The ROSIER detected marginally more nonstroke cases than the FAST, but both demonstrated poor specificity. Facial weakness, arm weakness, seizure activity, age, and sex predicted consultants' diagnosis of stroke. The ROSIER was not better than the FAST for prehospital recognition of stroke. A revised version of the FAST incorporating assessment of seizure activity may improve stroke identification and decision making by ambulance clinicians.

  19. Cardiac rehabilitation

    Science.gov (United States)

    ... rehab; Heart failure - cardiac rehab References Anderson L, Taylor RS. Cardiac rehabilitation for people with heart disease: ... of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed ...

  20. Sudden Cardiac Arrest due to Brugada Syndrome: a Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    R Soleimanirad

    2013-04-01

    Full Text Available Brugada Syndrome is a rare cause of sudden cardiac arrest and has a unique ECG pattern. In fact, with ST-segment elevation down sloping in the right precordial leads (v1-v3, RBBB pattern in lateral leads and J-point elevation is revealed. We must notice and avoid trigger factors of this syndrome during general anesthesia. Patient is a 39 old man who attended to emergency department with sudden cardiac arrest and resuscitate. He was transferred to ICU for management of hypoxic ischemic encephalopathy. Complementary studies concluded the diagnosis of Brugada syndrome. We must consider Brugada syndrome within patients with family history of sudden cardiac arrest. Moreover, we must avoid trigger factors of this syndrome such as fever, bradicardia and electrolyte abnormality (specialy Na, Ca abnormalities during general anesthesia and if they appear, we should treat them.

  1. What clues are available for differential diagnosis of headaches in emergency settings?

    Science.gov (United States)

    Mert, Ertan; Ozge, Aynur; Taşdelen, Bahar; Yilmaz, Arda; Bilgin, Nursel G

    2008-04-01

    The correct diagnosis of headache disorders in an emergency room is important for developing early management strategies and determining optimal emergency room activities. This prospective clinical based study was performed in order to determine demographic and clinical clues for differential diagnosis of primary and secondary headache disorders and also to obtain a classification plot for the emergency room practitioners. This study included 174 patients older than 15 years of age presenting in the emergency room with a chief complaint of headache. Definite headache diagnoses were made according to ICHD-II criteria. Classification and regression tree was used as new method for the statistical analysis of the differential diagnostic process. Our 174 patients with headache were diagnosed as basically primary (72.9%) and secondary (27.1%) headaches. Univariate analysis with cross tabs showed three important results. First, unilateral pain location caused 1.431-fold increase in the primary headache risk (p = 0.006). Second, having any triggers caused 1.440-fold increase in the primary headache risk (p = 0.001). Third, having associated co-morbid medical disorders caused 4.643-fold increase in the secondary headache risk (p < 0.001). It was concluded that the presence of comorbidity, the patient's age, the existence of trigger and relaxing factors, the pain in other body parts that accompanies headache and the quality of pain in terms of location and duration were all important clues for physicians in making an accurate differentiation between primary and secondary headaches.

  2. Cardiac dysfunction in heart failure: the cardiologist's love affair with time.

    Science.gov (United States)

    Brutsaert, Dirk L

    2006-01-01

    Translating research into clinical practice has been a challenge throughout medical history. From the present review, it should be clear that this is particularly the case for heart failure. As a consequence, public awareness of this disease has been disillusionedly low, despite its prognosis being worse than that of most cancers and many other chronic diseases. We explore how over the past 150 years since Ludwig and Marey concepts about the evaluation of cardiac performance in patients with heart failure have emerged. From this historical-physiologic perspective, we have seen how 3 increasingly reductionist approaches or schools of thought have evolved in parallel, that is, an input-output approach, a hemodynamic pump approach, and a muscular pump approach. Each one of these has provided complementary insights into the pathophysiology of heart failure and has resulted in measurements or derived indices, some of which still being in use in present-day cardiology. From the third, most reductionist muscular pump approach, we have learned that myocardial and ventricular relaxation properties as well as temporal and spatial nonuniformities have been largely overlooked in the 2 other, input-output and hemodynamic pump, approaches. A key message from the present review is that relaxation and nonuniformities can be fully understood only from within the time-space continuum of cardiac pumping. As cyclicity and rhythm are, in some way, the most basic aspects of cardiac function, considerations of time should dominate over any measurement of cardiac performance as a muscular pump. Any measurement that is blind for the arrow of cardiac time should therefore be interpreted with caution. We have seen how the escape from the time domain-as with the calculation of LV ejection fraction-fascinating though as it may be, has undoubtedly served to hinder a rational scientific debate on the recent, so-called systolic-diastolic heart failure controversy. Lacking appreciation of early

  3. Defining the Intrinsic Cardiac Risks of Operations to Improve Preoperative Cardiac Risk Assessments.

    Science.gov (United States)

    Liu, Jason B; Liu, Yaoming; Cohen, Mark E; Ko, Clifford Y; Sweitzer, Bobbie J

    2018-02-01

    Current preoperative cardiac risk stratification practices group operations into broad categories, which might inadequately consider the intrinsic cardiac risks of individual operations. We sought to define the intrinsic cardiac risks of individual operations and to demonstrate how grouping operations might lead to imprecise estimates of perioperative cardiac risk. Elective operations (based on Common Procedural Terminology codes) performed from January 1, 2010 to December 31, 2015 at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program were studied. A composite measure of perioperative adverse cardiac events was defined as either cardiac arrest requiring cardiopulmonary resuscitation or acute myocardial infarction. Operations' intrinsic cardiac risks were derived from mixed-effects models while controlling for patient mix. Resultant risks were sorted into low-, intermediate-, and high-risk categories, and the most commonly performed operations within each category were identified. Intrinsic operative risks were also examined using a representative grouping of operations to portray within-group variation. Sixty-six low, 30 intermediate, and 106 high intrinsic cardiac risk operations were identified. Excisional breast biopsy had the lowest intrinsic cardiac risk (overall rate, 0.01%; odds ratio, 0.11; 95% CI, 0.02 to 0.25) relative to the average, whereas aorto-bifemoral bypass grafting had the highest (overall rate, 4.1%; odds ratio, 6.61; 95% CI, 5.54 to 7.90). There was wide variation in the intrinsic cardiac risks of operations within the representative grouping (median odds ratio, 1.40; interquartile range, 0.88 to 2.17). A continuum of intrinsic cardiac risk exists among operations. Grouping operations into broad categories inadequately accounts for the intrinsic cardiac risk of individual operations.

  4. Case of a cardiac arrest patient who survived after extracorporeal cardiopulmonary resuscitation and 1.5 hours of resuscitation: A case report.

    Science.gov (United States)

    Moon, Seong Ho; Kim, Jong Woo; Byun, Joung Hun; Kim, Sung Hwan; Kim, Ki Nyun; Choi, Jun Young; Jang, In Seok; Lee, Chung Eun; Yang, Jun Ho; Kang, Dong Hun; Park, Hyun Oh

    2017-11-01

    Per the American Heart Association guidelines, extracorporeal cardiopulmonary resuscitation should be considered for in-hospital patients with easily reversible cardiac arrest. However, there are currently no consensus recommendations regarding resuscitation for prolonged cardiac arrest cases. We encountered a 48-year-old man who survived a cardiac arrest that lasted approximately 1.5 hours. He visited a local hospital's emergency department complaining of chest pain and dyspnea that had started 3 days earlier. Immediately after arriving in the emergency department, a cardiac arrest occurred; he was transferred to our hospital for extracorporeal membrane oxygenation (ECMO). Resuscitation was performed with strict adherence to the American Heart Association/American College of Cardiology advanced cardiac life support guidelines until ECMO could be placed. On hospital day 7, he had a full neurologic recovery. On hospital day 58, additional treatments, including orthotopic heart transplantation, were considered necessary; he was transferred to another hospital. To our knowledge, this is the first case in South Korea of patient survival with good neurologic outcomes after resuscitation that lasted as long as 1.5 hours. Documenting cases of prolonged resuscitation may lead to updated guidelines and improvement of outcomes of similar cases in future. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  5. Pharmacological modulations of cardiac ultra-rapid and slowly activating delayed rectifier currents: potential antiarrhythmic approaches.

    Science.gov (United States)

    Islam, Mohammed A

    2010-01-01

    Despite the emerging new insights into our understandings of the cellular mechanisms underlying cardiac arrhythmia, medical therapy for this disease remains unsatisfactory. Atrial fibrillation (AF), the most prevalent arrhythmia, is responsible for significant morbidity and mortality. On the other hand, ventricular fibrillation results in sudden cardiac deaths in many instances. Prolongation of cardiac action potential (AP) is a proven principle of antiarrhythmic therapy. Class III antiarrhythmic agents prolong AP and QT interval by blocking rapidly activating delayed rectifier current (I(Kr)). However, I(Kr) blocking drugs carry the risk of life-threatening proarrhythmia. Recently, modulation of atrial-selective ultra-rapid delayed rectifier current (I(Kur)), has emerged as a novel therapeutic approach to treat AF. A number of I(Kur) blockers are being evaluated for the treatment of AF. The inhibition of slowly activating delayed rectifier current (I(Ks)) has also been proposed as an effective and safer antiarrhythmic approach because of its distinguishing characteristics that differ in remarkable ways from other selective class III agents. Selective I(Ks) block may prolong AP duration (APD) at rapid rates without leading to proarrhythmia. This article reviews the pathophysiological roles of I(Kur) and I(Ks) in cardiac repolarization and the implications of newly developed I(Kur) and I(Ks) blocking agents as promising antiarrhythmic approaches. Several recent patents pertinent to antiarrhythmic drug development have been discussed. Further research will be required to evaluate the efficacy and safety of these agents in the clinical setting.

  6. Emergency response facility technical data system of Taiwan Power Company

    International Nuclear Information System (INIS)

    Lin, E.; Liang, T.M.

    1987-01-01

    Taiwan Power Company (Taipower) has developed its emergency response facility program since 1981. This program is integrated with the following activities to enhance the emergency response capability of nuclear power plants: (1) survey of the plant instrumentation based on the requirements of R.G. 1.97; (2) improvement of plant specific emergency operating procedures based on the emergency response guidelines developed by the Owners group; (3) implementation of the detailed control room design review with the consideration of human engineering and task analysis; and (4) organization, staff and communication of emergency planning of nuclear power plant. The emergency response facility programs of Taipower are implemented in Chinshan (GE BWR4/MARK I), Kuosheng (GE BWR6/MARK III) and Maanshan (W PWR). The major items included in each program are: (1) to establish new buildings for On-Site Technical Support Center, Near-Site Emergency Operation Facility; (2) to establish an Emergency Executive Center at Taipower headquarters; (3) to establish the communication network between control room and emergency response facilities; and (4) to install a dedicated Emergency Response Facility Technical Data System (ERFTDS) for each plant. The ERFTDS provides the functions of data acquisition, data processing, data storage and display in meeting with the requirements of NUREG 0696. The ERFTDS is designed with plant specific requirements. These specific requirements are expected to be useful not only for the emergency condition but also for normal operation conditions

  7. Developing an active emergency medical service system based on WiMAX technology.

    Science.gov (United States)

    Li, Shing-Han; Cheng, Kai-An; Lu, Wen-Hui; Lin, Te-Chang

    2012-10-01

    The population structure has changed with the aging of population. In the present, elders account for 10.63% of the domestic population and the percentage is still gradually climbing. In other words, the demand for emergency services among elders in home environment is expected to grow in the future. In order to improve the efficiency and quality of emergency care, information technology should be effectively utilized to integrate medical systems and facilities, strengthen human-centered operation designs, and maximize the overall performance. The improvement in the quality and survival rate of emergency care is an important basis for better life and health of all people. Through integrated application of medical information systems and information communication technology, this study proposes a WiMAX-based emergency care system addressing the public demands for convenience, speed, safety, and human-centered operation of emergency care. This system consists of a healthcare service center, emergency medical service hospitals, and emergency ambulances. Using the wireless transmission capability of WiMAX, patients' physiological data can be transmitted from medical measurement facilities to the emergency room and emergency room doctors can provide immediate online instructions on emergency treatment via video and audio transmission. WiMAX technology enables the establishment of active emergency medical services.

  8. CEBAF Control Room Renovation

    International Nuclear Information System (INIS)

    Michael Spata; Anthony Cuffe; Thomas Oren

    2005-01-01

    The Machine Control Center (MCC) at Jefferson Lab's Continuous Electron Beam Accelerator Facility (CEBAF) was constructed in the early 1990s and based on proven technology of that era. Through our experience over the last 15 years and in our planning for the facilities 12 GeV upgrade we reevaluated the control room environment to capitalize on emerging visualization and display technologies and improve on work-flow processes and ergonomic attributes. The renovation was performed in two phases during the summer of 2004, with one phase occurring during machine operations and the latter, more extensive phase, occurring during our semi-annual shutdown period. The new facility takes advantage of advances in display technology, analog and video signal management, server technology, ergonomic workspace design, lighting engineering, acoustic ceilings and raised flooring solutions to provide a marked improvement in the overall environment of machine operations

  9. Emergency control centers for nuclear power plants

    International Nuclear Information System (INIS)

    Anon.

    1979-01-01

    Guidance is provided for the development and implementation of emergency control centers for nuclear power plants, including nuclear plant control room, nuclear plant company headquarters, emergency control center, and nuclear plant alternate emergency control center. Requirements and recommendations are presented for the mission, communications, instrumentation and equipment associated with each type of control center. Decisional aids, manning requirements and resources are also given; the decision aids cover both the accident assessment and protective action areas. Both normal and alternate means of communications are considered. Off-site emergency control centers, although not covered in the strict sense by this standard, are considered in an appendix

  10. [An urban EMS at the start of a cross-sectoral quality management system: prioritized implementation of the 2010 ERC recommendations and long-term survival after cardiac arrest].

    Science.gov (United States)

    Günther, Andreas; Harding, Ulf; Gietzelt, Matthias; Gradaus, Frank; Tute, Erik; Fischer, Matthias

    2015-01-01

    Due to limited resources, the 2010 European Resuscitation Council (ERC) guidelines could not be fully implemented in the Emergency Medical Services (EMS) of Brunswick, Germany. This is why implementation was prioritized according to local conditions. Thus, prehospital therapeutic hypothermia, mechanical chest compression and feedback systems were not established. Clinical data and long-term results were assessed by a QM system and room for improvement was identified. All attempted resuscitations from 2011 until 2014 were recorded and compared against the German Resuscitation Registry. Outcomes of adult patients following non-traumatic cardiac arrest were analyzed by year. 812 resuscitations were attempted (incidence 81.2/100,000 inhabitants/year). In the two years following full implementation since 2013 the discharge rate from hospital was 16.4 %, the discharge rate with a favorable neurologic outcome was 14.1 %, the 1-year survival rate was 14.4 % in 2013. A significant improvement of risk-adjusted ROSC rate during the investigation period was demonstrated. The discharge rates remained unchanged; the increase in the discharge rates paralleled the increase in CPR incidence. EMS response times were remarkably shorter. The implementation of the ERC guidelines chosen appears to be generally safe. Fast EMS response contributed to superior results. All links of the chain of survival showed room for improvement, especially the proportion of lay rescuer CPR and telephone-assisted CPR. The high CPR incidence might indicate room for improvement in prevention. Access to resuscitation care can hardly be evaluated. Age-related access to pre-hospital resuscitation seems to be appropriate. Copyright © 2015. Published by Elsevier GmbH.

  11. Analytical evaluation of a new point of care system for measuring cardiac Troponin I

    NARCIS (Netherlands)

    Kemper, D.W.; Semjonow, V.; de Theije, F.; Keizer, D.; van Lippen, L.; Mair, J.; Wille, B.; Christ, M.; Geijer, F.; Hausfater, P.; Pariente, D.; Scharnhorst, V.; Curvers, J.; Nieuwenhuis, J.

    2017-01-01

    OBJECTIVES: Point-of-care cardiac troponin testing with adequate analytical performances has the potential to improve chest pain patients flow in the emergency department. We present the analytical evaluation of the newly developed Philips Minicare cTnI point-of-care immunoassay. DESIGN & METHODS:

  12. Churg-Strauss syndrome cardiac involvement evaluated by cardiac magnetic resonance imaging and positron-emission tomography: a prospective study on 20 patients

    International Nuclear Information System (INIS)

    Marmursztejn, Julien; Guillevin, Loic; Cohen, Pascal; Guilpain, Philippe; Pagnoux, Christian; Mouthon, Luc; Trebossen, Regine; Legmann, Paul; Vignaux, Olivier; Duboc, Denis

    2013-01-01

    Churg-Strauss syndrome (CSS) cardiac involvement is associated with a poor prognosis. Recently cardiac MRI (CMRI) has emerged as a promising technique to detect early CSS cardiac involvement. However, CMRI-detected myocardial delayed enhancement (MDE) could correspond to fibrosis or inflammation. Fluoro-2-deoxyglucose PET (FDG-PET) was previously used in other systemic diseases to distinguish between them. To determine whether the CMRI-MDE detected in CSS patients reflected fibrosis or myocardial inflammation, patients in CSS remission underwent FDG-PET. Twenty consecutive CSS patients in remission (BVAS = 0) were recruited. Fourteen patients [eight men, six women; mean (S.D.) age 49 (9) years; mean disease duration 3.5 (2.9) years] with CMRI-detected MDE, and six patients [four men, two women; mean (S.D.) age 44 (15) years; mean disease duration 3.5 (5.3) years] with normal CMRI underwent FDG-PET. Segments with MDE on CMRI were analysed on FDG-PET images, with myocardial FDG hypo-fixation defining fibrosis and hyper-fixation corresponding inflammation. Among the 14 patients with MDE on CMRI, FDG-PET showed 10 had hypo-fixation, 2 had hyper-fixation and 2 had normal scans. CSS duration at the time of CMRI was shorter for patients with myocardial inflammation than in those with fibrosis. The six patients with normal CMRI had normal FDG-PET images. For CSS patients in remission, CMRI detected subclinical active myocardial lesions and could be recommended to assess cardiac involvement. However, because CMRI-detected MDE can reflect fibrosis or inflammation, FDG-PET might help to distinguish between the two. (authors)

  13. Churg-Strauss syndrome cardiac involvement evaluated by cardiac magnetic resonance imaging and positron-emission tomography: a prospective study on 20 patients

    Energy Technology Data Exchange (ETDEWEB)

    Marmursztejn, Julien [Department of Cardiology, Service Frederic Joliot CEA Orsay, Hopital Cochin, AP-HP, Universite Paris Descartes, Sorbonne Paris Cite, Paris, (France); Department of Radiology, Service Frederic Joliot CEA Orsay, Hopital Cochin, AP-HP, Universite Paris Descartes, Sorbonne Paris Cite, Paris, (France); Guillevin, Loic; Cohen, Pascal; Guilpain, Philippe; Pagnoux, Christian; Mouthon, Luc [Department of Internal Medicine, Service Frederic Joliot CEA Orsay, Hopital Cochin, AP-HP, Universite Paris Descartes, Sorbonne Paris Cite, Paris, (France); Trebossen, Regine [Department of Nuclear Medicine, Service Frederic Joliot CEA Orsay, Hopital Cochin, AP-HP, Universite Paris Descartes, Sorbonne Paris Cite, Paris, (France); Legmann, Paul; Vignaux, Olivier [Department of Radiology, Service Frederic Joliot CEA Orsay, Hopital Cochin, AP-HP, Universite Paris Descartes, Sorbonne Paris Cite, Paris, (France); Duboc, Denis [Department of Cardiology, Service Frederic Joliot CEA Orsay, Hopital Cochin, AP-HP, Universite Paris Descartes, Sorbonne Paris Cite, Paris, (France)

    2013-07-01

    Churg-Strauss syndrome (CSS) cardiac involvement is associated with a poor prognosis. Recently cardiac MRI (CMRI) has emerged as a promising technique to detect early CSS cardiac involvement. However, CMRI-detected myocardial delayed enhancement (MDE) could correspond to fibrosis or inflammation. Fluoro-2-deoxyglucose PET (FDG-PET) was previously used in other systemic diseases to distinguish between them. To determine whether the CMRI-MDE detected in CSS patients reflected fibrosis or myocardial inflammation, patients in CSS remission underwent FDG-PET. Twenty consecutive CSS patients in remission (BVAS = 0) were recruited. Fourteen patients [eight men, six women; mean (S.D.) age 49 (9) years; mean disease duration 3.5 (2.9) years] with CMRI-detected MDE, and six patients [four men, two women; mean (S.D.) age 44 (15) years; mean disease duration 3.5 (5.3) years] with normal CMRI underwent FDG-PET. Segments with MDE on CMRI were analysed on FDG-PET images, with myocardial FDG hypo-fixation defining fibrosis and hyper-fixation corresponding inflammation. Among the 14 patients with MDE on CMRI, FDG-PET showed 10 had hypo-fixation, 2 had hyper-fixation and 2 had normal scans. CSS duration at the time of CMRI was shorter for patients with myocardial inflammation than in those with fibrosis. The six patients with normal CMRI had normal FDG-PET images. For CSS patients in remission, CMRI detected subclinical active myocardial lesions and could be recommended to assess cardiac involvement. However, because CMRI-detected MDE can reflect fibrosis or inflammation, FDG-PET might help to distinguish between the two. (authors)

  14. Improving operating room safety

    Directory of Open Access Journals (Sweden)

    Garrett Jill

    2009-11-01

    Full Text Available Abstract Despite the introduction of the Universal Protocol, patient safety in surgery remains a daily challenge in the operating room. This present study describes one community health system's efforts to improve operating room safety through human factors training and ultimately the development of a surgical checklist. Using a combination of formal training, local studies documenting operating room safety issues and peer to peer mentoring we were able to substantially change the culture of our operating room. Our efforts have prepared us for successfully implementing a standardized checklist to improve operating room safety throughout our entire system. Based on these findings we recommend a multimodal approach to improving operating room safety.

  15. Influenza epidemics, seasonality, and the effects of cold weather on cardiac mortality

    Science.gov (United States)

    2012-01-01

    Background More people die in the winter from cardiac disease, and there are competing hypotheses to explain this. The authors conducted a study in 48 US cities to determine how much of the seasonal pattern in cardiac deaths could be explained by influenza epidemics, whether that allowed a more parsimonious control for season than traditional spline models, and whether such control changed the short term association with temperature. Methods The authors obtained counts of daily cardiac deaths and of emergency hospital admissions of the elderly for influenza during 1992–2000. Quasi-Poisson regression models were conducted estimating the association between daily cardiac mortality, and temperature. Results Controlling for influenza admissions provided a more parsimonious model with better Generalized Cross-Validation, lower residual serial correlation, and better captured Winter peaks. The temperature-response function was not greatly affected by adjusting for influenza. The pooled estimated increase in risk for a temperature decrease from 0 to −5°C was 1.6% (95% confidence interval (CI) 1.1-2.1%). Influenza accounted for 2.3% of cardiac deaths over this period. Conclusions The results suggest that including epidemic data explained most of the irregular seasonal pattern (about 18% of the total seasonal variation), allowing more parsimonious models than when adjusting for seasonality only with smooth functions of time. The effect of cold temperature is not confounded by epidemics. PMID:23025494

  16. Control room philosophy: Principles of control room design and control room work; Kontrollrumsfilosofi: Principer foer kontrollrumsutformning och kontrollrumsarbete

    Energy Technology Data Exchange (ETDEWEB)

    Skriver, Jan; Ramberg, Jasmine; Allwin, Pernilla [Scandpower Risk Management AB, Uppsala (Sweden)

    2006-01-15

    In order to provide insights for improvement of work in control rooms several factors have to be considered. Knowledge of principles including control room philosophies will guide the recommended improvements. In addition to knowledge about specific principles an advantage for an organization can be an understanding of similarities and policies used in other high risk industry. The report has been developed on the basis of a document analysis of international standards and other guiding documents. (NUREG 0711, ISO 11064, ISO 6385, IEC 60964). In addition to the document analysis which has strived to compare the documents to see similarities in important principals, experience from working with control room design, modifications and evaluations in other high risk industries has pervaded the report. Important principles have been identified which are recommended to be included in a control room philosophy. Many of these are similar to the principles identified in the international standards. An additional principal which is regarded as important is the utilization of Key Performance Indicators (KPI) which can be used as a measure to target preventative means. Further more it is critical that the control room philosophy is easy to access and comprehend for all users. One of the challenges that remain after having developed a control room philosophy is how to utilize it in the daily work situation. It is vital that the document remains as a living document, guiding the continual improvement of the control room in the various life cycle stages.

  17. Post-cardiac injury syndrome: an atypical case following percutaneous coronary intervention.

    Science.gov (United States)

    Paiardi, Silvia; Cannata, Francesco; Ciccarelli, Michele; Voza, Antonio

    2017-12-01

    Post-cardiac injury syndrome (PCIS) is a syndrome characterized by pericardial and/or pleural effusion, triggered by a cardiac injury, usually a myocardial infarction or cardiac surgery, rarely a minor cardiovascular percutaneous procedure. Nowadays, the post-cardiac injury syndrome, is regaining importance and interest as an emerging cause of pericarditis, especially in developed countries, due to a great and continuous increase in the number and complexity of percutaneous cardiologic procedures. The etiopathogenesis seems mediated by the immunitary system producing immune complexes, which deposit in the pericardium and pleura and trigger an inflammatory response. We present the atypical case of a 76-year-old man presenting with a hydro-pneumothorax, low-grade fever and elevated inflammation markers, after two complex percutaneous coronary interventions, executed 30 and 75 days prior. The clinical features of our case are consistent with the diagnostic criteria of PCIS: prior injury of the pericardium and/or myocardium, fever, leucocytosis, elevated inflammatory markers, remarkable steroid responsiveness and latency period. Only one element does not fit with this diagnosis and does not find any further explanation: the air accompanying the pleural effusion, determining a hydro-pneumothorax and requiring a pleural drainage catheter positioning. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Evolution of echocardiography in subclinical detection of cancer therapy-related cardiac dysfunction.

    Science.gov (United States)

    Moudgil, Rohit; Hassan, Saamir; Palaskas, Nicolas; Lopez-Mattei, Juan; Banchs, Jose; Yusuf, Syed Wamique

    2018-05-11

    Cancer therapies have resulted in increased survivorship in oncological patients. However, the benefits have been marred by the development of premature cardiovascular disease. The current definition outlines measurement of ejection fraction as a mean to diagnose cancer therapeutic-related cardiac dysfunction (CTRCD); however, up to 58% of the patients do not regain their cardiac function after the CTRCD diagnosis, despite therapeutic interventions. Therefore, there has been a growing interest in the markers for early myocardial changes (ie, changes with normal left ventricular ejection fraction [LVEF]) that may predict the development of subsequent left ventricular ejection fraction reduction or progression to heart failure. This review will highlight the use of diastolic parameters, tissue Doppler imaging (TDI), and speckle tracking echocardiogram (STE) as emerging technologies which can potentially detect cardiac dysfunction thereby stratifying patients for cardioprotective therapies. The goal of this manuscript was to highlight the concepts and discuss the current controversies surrounding these echocardiographic imaging modalities. © 2018 Wiley Periodicals, Inc.

  19. Mathematical cardiac electrophysiology

    CERN Document Server

    Colli Franzone, Piero; Scacchi, Simone

    2014-01-01

    This book covers the main mathematical and numerical models in computational electrocardiology, ranging from microscopic membrane models of cardiac ionic channels to macroscopic bidomain, monodomain, eikonal models and cardiac source representations. These advanced multiscale and nonlinear models describe the cardiac bioelectrical activity from the cell level to the body surface and are employed in both the direct and inverse problems of electrocardiology. The book also covers advanced numerical techniques needed to efficiently carry out large-scale cardiac simulations, including time and space discretizations, decoupling and operator splitting techniques, parallel finite element solvers. These techniques are employed in 3D cardiac simulations illustrating the excitation mechanisms, the anisotropic effects on excitation and repolarization wavefronts, the morphology of electrograms in normal and pathological tissue and some reentry phenomena. The overall aim of the book is to present rigorously the mathematica...

  20. Resuscitation after prolonged cardiac arrest: role of cardiopulmonary bypass and systemic hyperkalemia.

    Science.gov (United States)

    Liakopoulos, Oliver J; Allen, Bradley S; Buckberg, Gerald D; Hristov, Nikola; Tan, Zhongtuo; Villablanca, J Pablo; Trummer, Georg

    2010-06-01

    The purpose of this study was to determine (1) the role of emergency cardiopulmonary bypass (CPB) after prolonged cardiac arrest and failed cardiopulmonary resuscitation, and (2) the use of systemic hyperkalemia during CPB to convert intractable ventricular fibrillation (VF). Thirty-one pigs (34 +/- 2 kg) underwent 15 minutes of cardiac arrest after induced VF, followed by 10 minutes of cardiopulmonary resuscitation-advanced life support. Peripheral CPB was used if cardiopulmonary resuscitation failed to restore stable circulation. Damage was assessed by evaluating hemodynamics, biochemical variables (creatine kinase-MB, neuron-specific enolase), neurologic deficit score, and brain magnetic resonance imaging. Cardiopulmonary resuscitation alone was successful in only 19% (6 of 31 pigs). Cardiopulmonary bypass was initiated in 81% of animals (25 of 31 pigs) either for hypotension (5 of 25 pigs) or intractable VF (20 of 25 pigs). Defibrillation was successful in 7 of 20 animals during the first 10 minutes after initiating CPB. Ventricular fibrillation persisted more than 10 minutes in 13 of 20 pigs, and animals were treated either with repeated defibrillation (6 of 13 pigs) or with a potassium bolus (7 of 13 pigs) to induce transient cardiac arrest. Overall survival at 24 hours was 84% with cardiopulmonary resuscitation (100% of pigs with hypotension; 71% in CPB-VF < 10 minutes). Despite CPB, fatal myocardial failure occurred after VF duration of more than 10 minutes in all pigs treated with electrical defibrillation, whereas hyperkalemia allowed 100% cardioversion and 86% survival. Biochemical variables remained elevated in all groups. Similarly, severe brain injury was present in all animals as confirmed by neurologic deficit score (197 +/- 10) and magnetic resonance imaging. Emergency CPB after prolonged cardiac arrest improves survival and allows systemic hyperkalemia to convert intractable VF, but fails to reduce neurologic damage. 2010 The Society of Thoracic