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Diagnosing underlying arrhythmia in ED syncope patients remains problematic. This study investigates diagnostic yield, event prevalence, patient satisfaction and compliance, and influence on resource utilisation of an ambulatory p...
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Diagnosing underlying arrhythmia in ED syncope patients remains problematic. This study investigates diagnostic yield, event prevalence, patient satisfaction and compliance, and influence on resource utilisation of an ambulatory patch monitor in unexplained ED syncope patients.Prospective pilot study conducted in a single tertiary ED in Scotland between 17 November 2015 and 16 June 2017 with a historical unmatched comparator group. Patients 16 years or over presenting within 6?hours of unexplained syncope were fitted in the ED with an ambulatory patch ECG recorder (Zio XT monitor), which continuously records a single-lead ECG for up to 14 days. Patients with an obvious underlying cause were excluded. An unmatched historical group of 603 syncope patients with no obvious diagnosis in ED, recruited to a prior cohort study (2007–2008), were used as a comparator. Primary endpoint was symptomatic significant arrhythmia at 90-day follow-up.During the prospective study period, 86 patients were recruited. 90-day diagnostic yield for symptomatic significant arrhythmia was 10.5% (95% CI 4.0 to 16.9; 9 of 86) versus 2.0% (95% CI 0.9 to 3.1; 12 of 603) in the comparator group. 24 patients (27.9%) had a significant arrhythmia (five serious); 26 patients (30.2%) had serious outcomes (major adverse cardiac event and/or death). Blinded patch report review suggested the patch would significantly reduce requirement for standard outpatient ambulatory ECG monitoring. 56 of 76 returned patches had a diagnostic finding within±45?s of a triggered/diary event (73.7% diagnostic utility; 95%?CI 63.7 to 83.6); 34 of 56 (61%) for sinus rhythm or ectopic beats only.Routine, early ambulatory ECG monitoring in ED patients with unexplained syncope is probably warranted. A large-scale trial comparing this approach to standard care with cost-effectiveness and safety analysis is now required.NCT02683174.
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Adult cardiac surgical patients are managed by standardized protocols after surgery. For most of the patients this is an extended recovery period following elective major surgery, and communication is crucial in the management of ...
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Adult cardiac surgical patients are managed by standardized protocols after surgery. For most of the patients this is an extended recovery period following elective major surgery, and communication is crucial in the management of early postoperative period. Some patients are critically ill before surgery and undergo complex and emergency cardiac procedures. These patients are more likely to experience complications such as bleeding, cardiac tamponade, arrhythmias, infection, stroke, gut failure and renal failure. Some of these complications are life threatening and early diagnosis and treatment is essential. Near patient tests and transoesophageal echocardiography facilitate early diagnosis of bleeding and tamponade. Patients with renal or neurological dysfunction need to be managed in general intensive care unit. Cardiac advanced life support follows different algorithms for cardio pulmonary resuscitation in the event of cardiac arrest because of the unique nature of the aetiology and facilities available. Advanced cardiac support in the form of mechanical devices such as intra-aortic balloon pump and ventricular assist devices is available for patient management.
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Postoperative care of the cardiac surgical patient requires a different approach to other specialities. A brief period of sedation and ventilation is followed by protocol-guided recovery with some patients going on to require more...
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Postoperative care of the cardiac surgical patient requires a different approach to other specialities. A brief period of sedation and ventilation is followed by protocol-guided recovery with some patients going on to require more complex care. Specific complications need to be recognized and managed, including bleeding, cardiac tamponade, arrhythmias and renal failure. Prompt diagnosis and treatment can be lifesaving and requires good communication and teamwork. An array of bedside tests is available to aid decision making, including point of care coagulation tests and echocardiography. Advanced life support necessitates a unique approach requiring provision of resuscitation and anaesthesia for prompt surgical re-exploration. Pharmacological and mechanical assistance is readily available to treat cardiovascular instability as well as the ability for invasive cardiac output monitoring. Analgesia is an important aspect of postoperative care as well as active recognition of delirium.
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Active compression–decompression (ACD) devices have enhanced end-tidal carbon dioxide (ETCO10 witnessed OHCAs were resuscitated, rotating a 2?min cycle with manual CPR and a 2?min cycle of ACD-CPR. Patients were intubated and the...
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Active compression–decompression (ACD) devices have enhanced end-tidal carbon dioxide (ETCO10 witnessed OHCAs were resuscitated, rotating a 2?min cycle with manual CPR and a 2?min cycle of ACD-CPR. Patients were intubated and the ventilation rate was held constant during CPR. CPR quality parameters and ETCOMean length of the CPR episodes was 37 (SD 8) min. Mean compression depth was 76 (SD 1.3) mm versus 71 (SD1.0) mm, and mean compression rate was 100 per min (SD 6.7) versus 105 per min (SD 4.9) between ACD-CPR and manual CPR, respectively. For ETCOThis study suggests that quality controlled ACD-CPR is not superior to quality controlled manual CPR when ETCONCT00951704; Results.
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There is growing evidence that the general current approach in many centers of continued mechanical ventilation following cardiac surgery has evolved through historical experience rather than having a strong physiological basis in...
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There is growing evidence that the general current approach in many centers of continued mechanical ventilation following cardiac surgery has evolved through historical experience rather than having a strong physiological basis in current practice. There is evidence going back several decades supporting very early (in the operating room [OR]) extubation in pediatric cardiac anesthesia. The authors provide evidence from numerous sources showing that extubation in the OR or shortly after arrival in the ICU is safe and cost-effective and is not prevented by the type of cardiac surgery or the use of cardiopulmonary bypass. They query if the paradigm should not be reversed and very early extubation be the routine unless contraindicated. Like any anesthetic technique, appropriate patient selection is called for, but this technique is widely appropriate.
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Intravenous fluid therapy is one of the most common therapeutic interventions performed in the ED and is a long-established treatment. The potential benefits of fluid therapy were initially described by Dr W B O’Shaughnessy in 18...
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Intravenous fluid therapy is one of the most common therapeutic interventions performed in the ED and is a long-established treatment. The potential benefits of fluid therapy were initially described by Dr W B O’Shaughnessy in 1831 and first administered to an elderly woman with cholera by Dr Thomas Latta in 1832, with a marked initial clinical response. However, it was not until the end of the 19th century that medicine had gained understanding of infection risk that practice became safer and that the practice gained acceptance. The majority of fluid research has been performed on patients with critical illness, most commonly sepsis as this accounts for around two-thirds of shocked patients treated in the ED. However, there are few data to guide clinicians on fluid therapy choices in the non-critically unwell, by far our largest patient group. In this paper, we will discuss the best evidence and controversies for fluid therapy in medically ill patients.
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A new model of complex patient care after acute myocardial infarction (AMI) has been in operation in Poland since late 2017, comprising invasive treatment, cardiac rehabilitation and scheduled outpatient follow-up. Its stated obje...
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A new model of complex patient care after acute myocardial infarction (AMI) has been in operation in Poland since late 2017, comprising invasive treatment, cardiac rehabilitation and scheduled outpatient follow-up. Its stated objectives are to improve secondary prevention measures, quality of care and longterm health outcomes in AMI-patients. The model implements all key aspects of post-MI care recommended by the European Society of Cardiology (ESC), representing the first nation-wide model of structured and comprehensive post-MI care that closely follows ESC guidelines. The aim of this paper is to describe the background of this reform, its content and implementation as well as to assess its results. Early outcomes seem promising, with significantly lower mortality rate and lower risk of serious cardiological events in patients participating in the new model of care compared to patients who were not included. A comprehensive assessment of the reform will require further clinical data, covering a larger population and a longer period of time, as well as a holistic analysis of the programme in its wider context, taking into account potential benefits and cost-effectiveness of improved primary prevention implemented outside of this model.
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PEDIATRIC CARDIOLOGY is a condition in which the heart can't pump enough blood to meet the body's needs. PEDIATRIC CARDIOLOGY 2020 does not mean that your heart has stopped or is about to stop working. It means that your heart is ...
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PEDIATRIC CARDIOLOGY is a condition in which the heart can't pump enough blood to meet the body's needs. PEDIATRIC CARDIOLOGY 2020 does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way it should. It can affect one or both sides of the heart.
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