Ana Maria Navio Serano; Joaquín Valle Alonso; Gustavo Rene Piñero; Alejandro Rodriguez Camacho; Josefa Soriano Benet; Manuel Vaquero
Volume 7, Issue 3 , July 2019, , Pages 232-239
Abstract
Objective: To investigate the prognostic value of clinical and laboratory tests in prediction of outcome in patients at day 30 post presentation to hospital with shock and to determine the prognostic value of mid regional pro-adrenomedullin (MR-proADM) on mortality prediction at 30 days in the same patient ...
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Objective: To investigate the prognostic value of clinical and laboratory tests in prediction of outcome in patients at day 30 post presentation to hospital with shock and to determine the prognostic value of mid regional pro-adrenomedullin (MR-proADM) on mortality prediction at 30 days in the same patient cohort.Method: This prospective multicenter cohort study analyzed data from patients who had presenting with shock to the emergency departments of eleven urban, tertiary-care University hospitals in Spain between March, 2011 and May, 2011. Recruitment of patients was via convenience sampling. Inclusion criteria included age between 14 and 100 years with clinical diagnostic criteria of shock on admission. Various patient parameters were analysed, such as age, sex, past medical history. Other clinical variables were measured on arrival to hospital, including sequential organ failure assessment score (score SOFA), blood pressure, oxygen saturations, capillary refill time and shock index (SI). Laboratory variables investigated included base excess, MR-proADM, lactate, C-Reactive Protein (CRP) and procalcitonin (PCT).Results: There were 212 patients included in the study from the eleven hospitals involved. The mean age was 72.2 years old and 60.4% of the patients were men. In the discriminant analysis only age, MR-proADM and PCT remained in the final discriminant equation. The separate analysis of MR-proADM showed that, in the non-survivors group, MR-proADM levels are significantly higher than those found in the group of survivors (p<0.001).Conclusion: Age, PCT and MR-proADM were useful to predict short-term mortality in patients presenting to the emergency department shock. This suggests that PCT and MR-proADM in combination with the most common prediction models will improve prognostic value.
MohammadBagher Shamsi; Morteza Arab-Zozani; Maryam Mirzaei
Volume 7, Issue 3 , July 2019, , Pages 337-338
Abstract
DearEditor,
We were interested to read a systematic review article that was recently published in the Bulletin of Emergency and Trauma journal (volume 6, issue 2) [1]. The aim of authors was to review the evidences to evaluate the effectiveness of the RUSH protocol in determining the ...
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DearEditor,
We were interested to read a systematic review article that was recently published in the Bulletin of Emergency and Trauma journal (volume 6, issue 2) [1]. The aim of authors was to review the evidences to evaluate the effectiveness of the RUSH protocol in determining the exact types of shock in patients referred to the emergency department. We recognize that there are some incorrect approaches to reporting of this precious work. In our overview, authors presented data through literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart in the methods section. Data from literature search must be addressed to the result section. This data are not the subsections under the methods section.
Mojtaba Keikha; Mohammad Salehi-Marzijarani; Reihane Soldoozi Nejat; Hojat sheikh Motahar Vahedi; Seyed Mohammad Mirrezaie
Volume 6, Issue 4 , October 2018, , Pages 271-278
Abstract
Objective: To perform a diagnostic accuracy of the rapid ultrasound in shock (RUSH) to diagnose the etiology of undifferentiated shock in patients presenting to the emergency department (ED).Methods: We searched the Medline via PubMed, Scopus, and ISI Web of Knowledge till July 2017. Two independent ...
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Objective: To perform a diagnostic accuracy of the rapid ultrasound in shock (RUSH) to diagnose the etiology of undifferentiated shock in patients presenting to the emergency department (ED).Methods: We searched the Medline via PubMed, Scopus, and ISI Web of Knowledge till July 2017. Two independent reviewers screened studies for eligibility. Our study analysis is planned in accordance with the guidelines for meta–analysis of diagnostic studies. In the systematic search, of 397 references, 295 were excluded on the basis of the title and abstract. For the remaining 102 articles, the full text was retrieved and critically reviewed. After the selection process, five papers were included.Results: The pooled estimate of all data showed that the RUSH protocol exhibited high sensitivity (0.87, 95% Confidence Interval (CI): 0.80-0.92, I2 = 46.7%) and specificity (0.98, 95% C. I.: 0.96-0.99, I2 = 30.8%). The AUC for SROC, a global measure of the RUSH protocol performance, was 0.98 ± 0.01, indicates the high accuracy of the test. Positive and negative likelihood ratios reported from the studies ranged from 9.83 to 51.32 and 0.04 to 0.33, respectively. The pooled estimate of all data showed that the RUSH protocol exhibited high positive likelihood ratio (19.19, 95% C. I.: 11.49-32.06, I2 = 14.1%) and low negative likelihood ratio (0.23, 95% C. I.: 0.15-0.34, I2 = 18.4%).Conclusion: This meta-analysis suggests that RUSH protocol has generally good role to distinguish the states of shock in patients with undifferentiated shock referred to the emergency department.
Hernando Raphael Alvis-Miranda; Nancy Carolina Duarte-Valdivieso; Gabriel Alcala-Cerra; Luis Rafael Moscote-Salazar
Volume 2, Issue 1 , January 2014, , Pages 59-61
Abstract
Bee stings are commonly encountered worldwide. Various manifestations after bee sting have been described including local reactions which are common, systemic responses such as anaphylaxis, diffuse intravascular coagulation and hemolysis. We report a case of a 74-year-old man who developed neurologic ...
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Bee stings are commonly encountered worldwide. Various manifestations after bee sting have been described including local reactions which are common, systemic responses such as anaphylaxis, diffuse intravascular coagulation and hemolysis. We report a case of a 74-year-old man who developed neurologic deficit 5 hours after bee stings, which was confirmed to be left frontal infarction on brain CT-scan. The case does not follow the reported pattern of hypovolemic or anaphylactic shock, hemolysis and/or rhabdomyolysis, despite the potentially lethal amount of venom injected. Diverse mechanisms have been proposed to give an explanation to all the clinical manifestation of both toxic and allergic reactions secondary to bee stings. Currently, the most accepted one state that victims can develop severe syndrome characterized by the release of a large amount of cytokines.
Marta Ferreira; Jose Teixeira; Vitor Marques; Carlos Casimiro; Luis Filipe Pinheiro
Volume 1, Issue 2 , April 2013, , Pages 93-95
Abstract
The article reports a clinical case of a 39-year-old male patient who was admitted in the emergency room in shock. The clinical exams and additional tests identified a right massive hemothorax, without apparent etiological factors. He was submitted to an emergency right thoracotomy. A bulky varicose ...
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The article reports a clinical case of a 39-year-old male patient who was admitted in the emergency room in shock. The clinical exams and additional tests identified a right massive hemothorax, without apparent etiological factors. He was submitted to an emergency right thoracotomy. A bulky varicose formation in the diaphragmatic surface, with evident laceration and haemorrhage was identified. The article describes this case due to its rarity. The varicose formation was simply ligated and the evolution, as well as the outcome of this clinical case was uneventful.
