Recognition and Management of Supraventricular Arrhythmias and Atrial Fibrillation in the Acute Setting

Supraventricular tachycardia (SVT) is a type of tachyarrhythmia with a narrow QRS complex and regular rhythm. These patients are often symptomatic and present to the emergency department (ED) due to acute attacks called paroxysmal SVT. Attacks of SVT start suddenly with the reentry mechanism in most patients. Anginal chest pain and dyspnea occur in patients due to tachycardia. Vagal manoeuvers and adenosine is the treatments of choice for termination of SVT. In multifocal atrial tachycardia (MAT), at least three different P wave morphologies are observed in the ECG, along with variable PP, PR and RR intervals. Treatment is to correct the underlying disease. Patients with atrial flutter (AFl) tend to come to the ED with unstable findings. Atrial fibrillation (AF) is the term used to define the inactive ‘worm bag-like’ oscillations of the atria, with an absence of true atrium contraction. Ruling out atrial or ventricular thrombi with echocardiography is important to avoid embolization. Priority should be given to hemodynamic stability and the determination of factors triggering the underlying disease. IV beta-blocker and diltiazem can be used for rate control in AF with rapid ventricular response

Burnout: need help?

<p>Abstract</p> <p>Background</p> <p>Burnout syndrome is a psychological situation induced with working, especially in high-risk parts of the hospitals that affects the physical and mental conditions of the staff. The aim is to identify the characteristics of the staff related to Burnout Syndrome in the Emergency Department (ED).</p> <p>Methods</p> <p>The study includes the Maslach Burnout Inventory and other new individual research questions. The responders were the volunteers and comprised physicians, nurses, nurses' aides from EDs of all urban state hospitals of Adana (43.3%). Burnout scores were analyzed with regard to individual characteristics; supplementary work, marital status, the number of children, occupation, salary, career satisfaction, satisfaction in private life. Mann-Whitney U test and Kruskall-Wallis test were performed using SPSS 15.00.</p> <p>Results</p> <p>There were no relation between Burnout scores and supplementary work, marital status, number of children, occupation, salary, private life satisfaction, except for career satisfaction.</p> <p>Conclusion</p> <p>Presence and severity of Burnout syndrome were linked to career satisfaction without personal features and salaries. All branches of healthcare occupations in ED seem to have been affected by Burnout Syndrome similarly.</p

Can drones be a solution for defibrillation and blood transfusions? A review on the impact of new technologies in emergency healthcare

Life-threatening arrhythmias, shock and airway compromise represent the most crucial situations to treat in the daily routine of acute medicine. Rapid access to automated external defibrillators (AEDs) and other necessary equipment increases survival rates significantly. The unmanned aerial vehicles (UAV) appear to revolutionize prehospital medicine enabling advanced health care delivery to those in austere environments and difficult regions for both defibrillators and blood products (BP). Although there are still many factors to consider, drone networks show potential to greatly reduce lifesaving equipment travel times for those with cardiac arrest (CA). More research should be performed to fill the gaps in routine practice of operating drones in different clinical scenarios, and geographical variations. As far as delivery of BP via drones, key benefits are minimized risk to human life, cost, speed of delivery and ability to cover areas beyond those of conventional planes. Challenges can be airspace management of BP, decisions on appropriate level of care to deliver during transit and user acceptability. Appropriate integration of drones to ambulances and emergency medical services facilitates efforts to improve healthcare, particularly in difficult and underserved regions. In brief, indications of drone use should be individualized to deliver vital equipment and care to the victim in emergency need, while the effectivity of UAVs must be evaluated case by case basis. This article aims to review the current status of above-mentioned technology and pluses and minuses of UAVs used worldwide, along with future projections

Analysis of clinical and demographic characteristics of patients presenting with renal colic in the emergency department

<p>Abstract</p> <p>Background</p> <p>Renal colic (RC), is one of the most severe pain patterns which is most commonly diagnosed and managed in the emergency department (ED). This study is designed to evaluate the characteristics of adult patients presenting with pain and diagnosed with RC in the ED, length of stay in the ED and hospital and factors affecting these variables.</p> <p>Methods</p> <p>All consecutive adult patients who presented with side pain, flank pain, abdominal or groin pain and consequently diagnosed with urolithiasis or RC were analyzed retrospectively. Sociodemographic data, times of admission into and discharge from the ED, adjunctive complaints, results of laboratory investigations, findings on examination, treatment and drugs administered were noted.</p> <p>Results</p> <p>A total of 235 patients with a diagnostic code of urolithiasis were enrolled. Physicians were more likely to order radiological and laboratory investigations for female patients and those without hematuria in urinalysis. The peak incidence of patients diagnosed with RC (p = 0.001) was noted in August, while the winter had the lowest frequency of relevant admissions. The peak frequency was between 06:00 and 08:00. Women stayed longer in the ED (p = 0.001). Absence of hematuria in urinalysis was associated with increased length of stay (p = 0.007).</p> <p>Conclusion</p> <p>Although RC is a common ED presentation for which the emergency physician has no guidelines in terms of diagnosis and management, there is no exact pattern to guide ordering investigations. Patients with atypical presentations stay longer in the ED and are likely to undergo additional tests in management.</p

Cardiac Diseases and Interventions in 21st Century

What should a book on cardiac diseases tell us about? We are not cardiologists in most instances, nor ordinary patients preparing to be catheterized. This book tries to explain to the average medical reader about the causes, diagnostic advances, and therapeutic opportunities in the context of cardiac diseases in the modern era. The topics covered in this project will enlighten research pathways while rendering clinicians practical solutions to everyday problems in recognition and management of these entities. In brief, students, nurses, paramedical personnel, researchers, junior doctors, and experienced practitioners will benefit from this book when translating theory into practice

Poisoning in the Modern World - New Tricks for an Old Dog?

Over 400 years ago, Swiss alchemist and physician Paracelsus (1493-1541) cited: ""All substances are poisons; there is none that is not a poison. The right dose differentiates a poison from a remedy."" This is often condensed to: ""The dose makes the poison."" So, why are we overtly anxious about intoxications?In fact, poisons became a global problem with the industrial revolution. Pesticides, asbestos, occupational chemicals, air pollution, and heavy metal toxicity maintain high priority worldwide, especially in developing countries. Children between 0 and 5 years old are the most vulnerable to both acute and chronic poisonings, while older adults suffer from the chronic effects of chemicals. This book aims to raise awareness about the challenges of poisons, to help clinicians understand current issues in toxicology