Identification of Characteristics of Adult Patients in the Emergency Department Who Develop Ventricular Tachycardia or Ventricular Fibrillation During Hospital Stay

2013 ◽  
Vol 62 (4) ◽  
pp. S112-S113
Author(s):  
N. Garg ◽  
M.S. Radeos ◽  
Z. Ali ◽  
C. Wong ◽  
N. Hoang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Hospital Stay ◽  
Adult Patients

Abstract 40: Is Severe Post-shock Bradyarrhythmia In Patients Using Wearable Defibrillators Common or Serious?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Gary Freeman ◽  
Weilun Quan ◽  
Steven Szymkiewicz ◽  
Graham Nichol
Keyword(s):  
Emergency Department ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Ischemic Cardiomyopathy ◽  
Shock Therapy ◽  
Death Event ◽  
Post Shock ◽  
Initial Shock ◽  
Poor Outcomes ◽  
Cardioverter Defibrillators

Background : Previous studies have shown a 40% to 60% incidence of asystole immediately after transthoracic defibrillation of pulseless ventricular tachycardia/ventricular fibrillation (VT/VF). Such post-shock asystole has very poor outcomes. Wearable cardioverter defibrillators (WCD, LifeVest, ZOLL Lifecor) automatically record and treat VT/VF by delivering transthoracic defibrillation without the need for a bystander. Post-shock bradyarrhythmia (PSB) is of clinical concern in patients (pts) using WCD. Objective : Determine the incidence and outcomes of PSB during WCD use. Methods : ECG recordings from consecutive pts who had VT/VF while using WCD between March 2005 and March 2007 were retrospectively analyzed. All VT/VF occurring within 24 hours from the initial shock for VT/VF were defined as a single sudden death event (SDE) while those beyond 24 hours as a SDE recurrence. ECGs contained 30 seconds prior to the VT/VF detection and > 15 seconds following VT/VF termination. Severe PSB was defined as a pause longer than 10 seconds. Survival was defined as conscious at emergency department (ED) arrival or not needing to go to the ED. Pt calls and medical orders were reviewed to determine the indications for WCD use and pt post-shock status. Results : Between March 2005 and March 2007, 3564 pts used WCD for an average of 51 days. 56 pts (51% ICD explants, 28% ischemic cardiomyopathy (ICM), 11% Non-ICM, 8% delayed ICD implant, 2% others) received 142 shocks for 79 SDE. 14 pts had > 1 SDE (max = 5). 15 SDE had >1 VT/VF (max = 47). 79/79 (100%) initial SDE shocks terminated VT/VF. 76/79 (96%) of treated SDE resulted in survival. Severe PSB was found in 4 ECGs from 4 pts. 3/4 (75%) occurred after the initial SDE shock, 1/4 (25%) after VT/VF recurrence; 2/4 (50%) developed ventricular complexes prior to the end of the recording, 2/4 (50%) did not; 3/4 (75%) pts survived, 1/4 (25%) did not. Median time from VT/VF onset to shock was 44 seconds. Conclusions : WCD is an efficacious therapy. The majority of pts with severe PSB after WCD survived. Severe PSB was less frequent and had a better prognosis than that observed in EMS studies. This may be attributed to faster WCD shock therapy (median 44 seconds) compared with EMS (>10 minutes).

Pulseless ventricular tachycardia and ventricular fibrillation complicating severe traumatic brain injury in pediatrics

2019 ◽  
Vol 85 (12) ◽  
Author(s):  
Marco Piastra ◽  
Luca Tortorolo ◽  
Orazio Genovese ◽  
Tony C. Morena ◽  
Enzo Picconi ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Ventricular Tachycardia ◽  
Brain Injury ◽  
Ventricular Fibrillation ◽  
Severe Traumatic Brain Injury

scholarly journals Providing safe care for patients in the coronavirus disease 2019 (COVID-19) era: A case series evaluating risk for hospital-associated COVID-19

2021 ◽  
pp. 1-7
Author(s):  
Elizabeth B. Habermann ◽  
Aaron J. Tande ◽  
Benjamin D. Pollock ◽  
Matthew R. Neville ◽  
Henry H. Ting ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Case Series ◽  
Adult Patients ◽  
Care Hospital ◽  
Strict Adherence ◽  
Large Tertiary Care ◽  
Healthcare Associated ◽  
Serology Testing ◽  
Pcr Test

Abstract Objective: We evaluated the risk of patients contracting coronavirus disease 2019 (COVID-19) during their hospital stay to inform the safety of hospitalization for a non–COVID-19 indication during this pandemic. Methods: A case series of adult patients hospitalized for 2 or more nights from May 15 to June 15, 2020 at large tertiary-care hospital in the midwestern United States was reviewed. All patients were screened at admission with the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test. Selected adult patients were also tested by IgG serology. After dismissal, patients with negative serology and PCR at admission were asked to undergo repeat serologic testing at 14–21 days after discharge. The primary outcome was healthcare-associated COVID-19 defined as a new positive SARS-CoV-2 PCR test on or after day 4 of hospital stay or within 7 days of hospital dismissal, or seroconversion in patients previously established as seronegative. Results: Of the 2,068 eligible adult patients, 1,778 (86.0%) completed admission PCR testing, while 1,339 (64.7%) also completed admission serology testing. Of the 1,310 (97.8%) who were both PCR and seronegative, 445 (34.0%) repeated postdischarge serology testing. No healthcare-associated COVID-19 cases were detected during the study period. Of 1,310 eligible PCR and seronegative adults, no patients tested PCR positive during hospital admission (95% confidence interval [CI], 0.0%–0.3%). Of the 445 (34.0%) who completed postdischarge serology testing, no patients seroconverted (0.0%; 95% CI, 0.0%–0.9%). Conclusion: We found low likelihood of hospital-associated COVID-19 with strict adherence to universal masking, physical distancing, and hand hygiene along with limited visitors and screening of admissions with PCR.

scholarly journals Interpreting Anion Gap Values in Adult and Pediatric Patients: Examining the Reference Interval

2019 ◽  
Vol 5 (1) ◽  
pp. 126-135
Author(s):  
Nadia Ayala-Lopez ◽  
Roa Harb
Keyword(s):  
Emergency Department ◽  
Intensive Care ◽  
Pediatric Patients ◽  
Reference Interval ◽  
Adult Patients ◽  
Anion Gap ◽  
Moderate Degree ◽  
New Haven ◽  
Repeated Testing ◽  
Median Percent Change

Abstract Background The anion gap is primarily used in the diagnosis of acid-base disorders. We conducted a study to determine the anion gap reference interval in our patient population, investigated the workup of abnormal vs normal anion gaps, and examined the anion gap variation upon repeated testing. Methods A retrospective review was performed on 17137 adult and pediatric patients who presented to Yale-New Haven Hospital outpatient clinics, emergency department, or intensive care units between 2012 and 2017. Results We derived a new reference interval of 7 to 18 mmol/L with a median of 13 mmol/L in healthy adults with no significant differences owing to partitioning by sex or age. Based on the new reference interval, 5%, 23%, and 18% of healthy, emergency department, and intensive care unit adult patients, respectively, were misclassified as having high values with the previous interval of 6 to 16 mmol/L. However, there were no significant differences in the number of tests ordered in patients with anion gaps above and below the upper limit of the previous reference interval. The majority of increased anion gaps that were repeated normalized by 12 h. In a subgroup of healthy adult patients with annual testing, the median percent change in each patient's anion gap from 2015 to 2016 was approximately 13%. Conclusions The anion gap should be used with an appropriate reference interval to avoid misclassification. There may be a moderate degree of individuality that argues for comparing the anion gap with its baseline value in the same patient pending further studies that formally derive its biological variation.

Ablation of Unstable Ventricular Tachycardia and Ventricular Fibrillation

2019 ◽  
pp. 543-563.e3
Author(s):  
Srinivas R. Dukkipati ◽  
William Whang ◽  
Marc A. Miller ◽  
Jacob S. Koruth ◽  
Vivek Y. Reddy
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Fibrillation

A Clinical Study of Violence in Patients Referred on a Form I to a General Hospital Psychiatric Unit

1988 ◽  
Vol 33 (8) ◽  
pp. 711-715 ◽  
Author(s):  
A.J. Cooper
Keyword(s):  
Emergency Department ◽  
Mental Illness ◽  
Clinical Study ◽  
Hospital Stay ◽  
General Hospital ◽  
Alcohol Misuse ◽  
Psychiatric Ward ◽  
Violent Behaviour ◽  
Initial Management ◽  
Retrospective Examination

A retrospective examination of all patients referred by the emergency department of a medium sized general hospital for a mandated Form I psychiatric assessment during a 12 month period was conducted. The principal aim was an analysis of the clinical phenomena and especially the antecedents and course of violent behaviour (following admission and throughout the hospital stay) which in the majority of cases was the reason for the referral. Thirty percent had behaved violently prior to admission but within 24 hours all had settled and during the remainder of their hospital stay were indistinguishable from the generality of the ward population (for example, non-violent). Two-thirds of the patients were non-psychotic; that is, not suffering from a major mental illness; nevertheless, they required a disproportionate amount of time and effort in initial management. A high proportion had several prior admissions to the psychiatric ward, particularly for alcohol misuse and/or a personality disorder.

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