scholarly journals Evaluation of Patients with Syncope in the Emergency Department: How to Adjust Pharmacological Therapy

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 603
Author(s):  
Martina Rafanelli ◽  
Giuseppe Dario Testa ◽  
Giulia Rivasi ◽  
Andrea Ungar
Keyword(s):  
Emergency Department ◽  
Orthostatic Hypotension ◽  
Hypotensive Effect ◽  
Pharmacological Therapy ◽  
Initial Assessment ◽  
Cardiovascular Risks ◽  
Drug Management ◽  
Drug Induced ◽  
Drug History ◽  
Psychoactive Medications

The rate of syncope in the Emergency Department ranges between 0.9 and 1.7%. Syncope is mostly related to a underlying reflex or orthostatic mechanism. A bradycardic or a hypotensive phenotype, may be identified. The latter is the most common and could be constitutional or drug induced. Consequently, obtaining an accurate drug history is an important step of the initial assessment of syncope. As anti-hypertensive medication might be responsible for orthostatic hypotension, managing hypertension in patients with syncope requires finding an ideal balance between hypotensive and cardiovascular risks. The choice of anti-hypertensive molecule as well as the therapeutic regimen and dosage, influences the risk of syncope. Not only could anti-hypertensive drugs have a hypotensive effect but opioids and psychoactive medications may also be involved in the mechanism of syncope. Proper drug management could reduce syncope recurrences and their consequences.

scholarly journals Orthostatic hypotension in older adults: the role of medications

2020 ◽  
Vol 90 (4) ◽  
Author(s):  
Giulia Rivasi ◽  
Andrea Ungar
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Orthostatic Hypotension ◽  
Blood Pressure Response ◽  
Blood Pressure Reduction ◽  
Pharmacological Therapy ◽  
Drug Classes ◽  
Orthostatic Blood Pressure ◽  
Psychoactive Medications

Orthostatic hypotension (OH) is defined as an abnormal blood pressure reduction when standing and is frequently diagnosed in older adults. Pharmacological therapy is one of the main causes of orthostatic blood pressure impairment, leading to iatrogenic OH. Indeed, several medications may induce hypotensive effects and influence the blood pressure response to orthostatism. Hypotensive medications may also overlap with other determinants of OH, thus increasing the burden of symptoms and the risk of complications. Potentially hypotensive medications include both cardiovascular and psychoactive drugs, which are frequently prescribed in older patients. According to the available evidence, the antihypertensive treatment “per se” does not seem to predispose to OH, even if a higher risk is associated with polypharmacy and drug classes such as with diuretics and vasodilators. As concerns psychoactive medications, OH is a well-known adverse effect of tricyclic antidepressants, trazodone and antipsychotics. The knowledge of hemodynamic consequences of drug therapy may be helpful to improve OH treatment. A medication review is advisable in all patients presenting with OH, particularly at advanced age, aiming at optimizing medical treatment with a view to minimize the risk of iatrogenic OH.

School Nurses on the Front Lines of Medicine: Take a BREATH: The Approach to a Student With Respiratory Distress

2017 ◽  
Vol 33 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Morgann Loaec ◽  
Robert P. Olympia
Keyword(s):  
Emergency Department ◽  
Respiratory Distress ◽  
Respiratory Symptoms ◽  
School Setting ◽  
School Nurses ◽  
Initial Assessment ◽  
Level Of Care ◽  
Primary Health ◽  
Life Threatening

Students presenting with varying degrees of respiratory symptoms and distress occur commonly in the school setting. It is important to develop a differential diagnosis for respiratory distress, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary health care provider’s office, or directly to the closest emergency department via Emergency Medical Services). This article describes the initial assessment and management of a student presenting with respiratory distress.

Drug-Induced Orthostatic Hypotension

1997 ◽  
Vol 14 (1) ◽  
pp. 61-65 ◽  
Author(s):  
J.L. Montastruc ◽  
I. Laborie ◽  
H. Bagheri ◽  
J.M. Senard
Keyword(s):  
Orthostatic Hypotension ◽  
Drug Induced

scholarly journals SIKAP DAN PENGETAHUAN PERAWAT BERHUBUNGAN DENGAN PELAKSANAAN TRIAGE

2018 ◽  
Vol 9 (02) ◽  
pp. 154
Author(s):  
Dewi Ratna Sari ◽  
Sutanta .
Keyword(s):  
Emergency Department ◽  
Clinical Decision Making ◽  
Initial Assessment ◽  
Rank Test ◽  
P Value ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Cross Sectional ◽  
Spearman Rank ◽  
Emergency Units

ABSTRAKPerawat yang bekerja di unit gawat darurat (UGD) harus memiliki sikap, ketrampilan dan kemampuan untuk mengatur kemampuan fungsional dalam berbagai kondisi. Perawat harus mampu memprioritaskan perawatan pasien atas dasar pengambilan keputusan klinis dimana keterampilan penting bagi perawat dalam penilaian awal. Untuk mendukung hal tersebut diperlukan pengetahuan, sikap dan ketrampilan dalam hal pemisahan jenis dan kegawatan pasien dalam triage, sehingga dalam penanganan pasien bisa lebih optimal dan terarah. Tujuan penelitian untuk mengetahui hubungan sikap dan pengetahuan perawat dalam pelaksanaan triage di UGD RSUD Wonosari. Penelitian ini menggunakan survei analitik korelasi dengan pendekatan cross sectional. Populasi penelitian berjumlah 15 perawat yang bekerja di ruang gawat darurat, dengan metode pengambilan sampel secara total sampling. Instrumen penelitian berupa kuisioner, metode analisa data menggunakan uji spearman rank dan regresi linier berganda. Hasil penelitian tidak terdapat hubungan antara sikap dengan pelaksanaan triage di UGD RSUD Wonosari, hal ini ditunjukkan dari hasil uji Spearman rank dengan nilai sig 0,354>p-value 0,05. Terdapat hubungan antara pengetahuan dengan pelaksanaan triage di UGD RSUD Wonosari. Hal ini ditunjukkan dari nilai rank spearman 0,004 < p-value 0,05. Sehingga pelaksanaan triage dipengaruhi faktor lain yang tidak terangkum dalam analisis ini. Kesimpulan tidak ada hubungan antara sikap dengan pelaksanaan triage di UGD RSUD Wonosari. Ada hubungan antara pengetahuan dengan pelaksanaan triage di UGD RSUD Wonosari.Kata Kunci: sikap, pengetahuan, pelaksanaan triageNURSE’S ATTITUDE AND KNOWLEDGE RELATED WITH IMPLEMENTATION OF TRIAGEABSTRACTNurses working in emergency units must have the attitude, skills and ability to organize functional abilities under various conditions. Nurses should be able to prioritize patient care on the basis of clinical decision-making where skills are important to nurses in the initial assessment. To support it requires knowledge, attitude and skills in terms of separation of types and gravity of patients in triage, so that in the handling of patients can be more optimal and directed. The purpose of this research is to know the relationship of attitude and knowledge of nurses in the implementation of triage in emergency units Wonosari Hospital. This research uses analytic correlation survey with cross sectional approach. The study population was 15 nurses working in the emergency room, with sampling method in total sampling. The research instrument is questionnaire, data analysis method using spearman rank test and multiple linear regression. The result of this research shows that there is no correlation between attitude with triage implementation in emergency units Wonosari Hospital, it is shown from Spearman rank test with sig value 0,354> p-value 0,05. There is a relationship between knowledge with triage implementation at Wonosari Hospital emergency department. It is shown from spearman rank value 0,004 <p-value 0,05. So the implementation of triage is influenced by other factors not summarized in this analysis. Conclusion there is no relation between attitude with triage implementation in Wonosari Hospital emergency department. There is a relationship between knowledge with triage implementation in emergency units Wonosari Hospital.Keywords: attitude, knowledge, implementation of triage

scholarly journals Emergency Department Referral Profile of Traumatic Brain Injury Records at a Tertiary Care Hospital of Pakistan

2021 ◽  
Author(s):  
Maria Khan ◽  
Uzair Yaqoob ◽  
Zair Hassan ◽  
Muhammad Muizz Uddin
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Road Traffic ◽  
Tertiary Care ◽  
Initial Assessment ◽  
Care Hospital ◽  
Mild Tbi ◽  
Epidemiological Characteristics ◽  
The Impact

Abstract Background: Traumatic Brain Injury (TBI) is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective here is to describe the epidemiological characteristics of patients with TBI in our country and to determine the immediate outcomes of patients with TBI after the presentation.Method: This was a cross-sectional study conducted at the Lady Reading Hospital, Peshawar, Pakistan. Data were extracted from the medical records from January 1st to December 31st, 2019. Patient age, sex, type of trauma, and immediate outcome of the referral to the Emergency Department were recorded. The severity of TBI was categorized based on Glasgow Coma Scale (GCS) in mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS <8) classes. The Emergency Department referral profile was classified as admissions, disposed, detained and disposed, referred.Results: Out of 5047 patients, 3689 (73.1%) males and 1358 (26.9%) females. The most commonly affected age group was 0-10 years (25.6%) and 21-30 years (20.1%). Road Traffic accident was the predominant cause of injury (38.8%, n=1960) followed by fall (32.7%, n=1649). Most (93.6%, n=4710) of the TBIs were mild. After the full initial assessment and workup, and completing all first-aid management, the immediate outcome was divided into four, most frequent (67.2%, n=3393) of which was “disposed (discharged)”, and 9.3% (n=470) were admitted for further management.Conclusion: Our study represents a relatively commonplace picture of epidemiological data on the burden of TBI in Pakistan. As a large proportion of patients had a mild TBI, and there is a high risk of mild TBI being under-diagnosed, we warrant further investigation of mild TBI in population-based studies.

Management of Poisoning and Drug Overdose

2021 ◽  
Author(s):  
Timothy J Wiegand ◽  
Manish M Patel ◽  
Kent R. Olson
Keyword(s):  
Emergency Department ◽  
Drug Overdose ◽  
Activated Charcoal ◽  
Hospital Admissions ◽  
Clinical Laboratory ◽  
The United States ◽  
Emergency Department Visits ◽  
The Body ◽  
Smoke Inhalation ◽  
Drug Induced

Drug overdose and poisoning are leading causes of emergency department visits and hospital admissions in the United States, accounting for more than 500,000 emergency department visits and 11,000 deaths each year. This chapter discusses the approach to the patient with poisoning or drug overdose, beginning with the initial stabilization period in which the physician proceeds through the ABCDs (airway, breathing, circulation, dextrose, decontamination) of stabilization. The management of some of the more common complications of poisoning and drug overdose are summarized and include coma, hypotension and cardiac dysrhythmias, hypertension, seizures, hyperthermia, hypothermia, and rhabdomyolysis. The physician should also perform a careful diagnostic evaluation that includes a directed history, physical examination, and the appropriate laboratory tests. The next step is to prevent further absorption of the drug or poison by decontaminating the skin or gastrointestinal tract and, possibly, by administering antidotes and performing other measures that enhance elimination of the drug from the body. The diagnosis and treatment of overdoses of a number of specific drugs and poisons that a physician may encounter, as well as food poisoning and smoke inhalation, are discussed. Tables present the ABCDs of initial stabilization of the poisoned patient; mechanisms of drug-induced hypotension; causes of cardiac disturbances; drug-induced seizures; drug-induced hyperthermia; autonomic syndromes induced by drugs or poison; the use of the clinical laboratory in the initial diagnosis of poisoning; methods of gastrointestinal decontamination; methods of and indications for enhanced drug removal; toxicity of common beta blockers; common stimulant drugs; corrosive agents; dosing of digoxin-specific antibodies; poisoning with ethylene glycol or methanol; manifestations of excessive acetylcholine activity; common tricyclic and other antidepressants; seafood poisonings; drugs or classes that require activated charcoal treatment; and special circumstances for use of activated charcoal. This review contains 3 figures, 22 tables, and 198 references.

Cardiovascular risk estimation at the individual level

ESC CardioMed ◽  
2018 ◽  
pp. 846-863
Author(s):  
Yvo M. Smulders ◽  
Marie-Therese Cooney ◽  
Ian Graham
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Estimation ◽  
Pharmacological Therapy ◽  
Cardiovascular Risks ◽  
Individual Level ◽  
The Individual ◽  
Very High ◽  
Cardiovascular Risk Estimation

The absolute benefit of any measure to prevent cardiovascular disease, be it lifestyle improvement or pharmacological therapy, depends on the baseline cardiovascular risk. This risk cannot be assessed exactly, but only be estimated because many known risk determinants cannot be accounted for in existing risk scoring systems, and because the application to an individual of risk estimates derived from populations is imprecise. Several cardiovascular risk estimation methods are available, and the European Society of Cardiology has favoured the European-based Systematic COronary Risk Evaluation (SCORE) system as a basis for their cardiovascular disease prevention guidelines. SCORE estimates absolute 10-year cardiovascular mortality risk. In specific circumstances, estimation of relative risk, risk age, or lifetime risk may be considered. High- and very-high-risk population are defined by SCORE risks greater than 5% and greater than 10%, respectively, or by clinical conditions conferring (very) high risk, such as existing cardiovascular disease or chronic kidney disease. The role of additional risk information on top of the information entered in SCORE is generally limited. In particular, markers of early cardiovascular damage should be collected and interpreted with caution. Absolute cardiovascular risks in young and elderly individuals are almost always low or very high, respectively, and the options for appropriate interpretation and management of these risks are discussed.

scholarly journals Diphenhydramine-Refractory Antipsychotic-Induced Dystonia in an Adolescent Male With Cornelia de Lange Syndrome

2019 ◽  
Vol 24 (2) ◽  
pp. 160-165 ◽  
Author(s):  
Stephen M. Small ◽  
Rachel S. Bacher
Keyword(s):  
Emergency Department ◽  
First Generation ◽  
Case Reports ◽  
Genetic Disorder ◽  
Cornelia De Lange Syndrome ◽  
Adolescent Male ◽  
Qtc Interval ◽  
Drug Induced ◽  
Iatrogenic Complications ◽  
Cornelia De Lange

Cornelia de Lange Syndrome is a rare genetic disorder that results in distinctive craniofacial deformities, developmental delay, hirsutism, and other physical abnormalities. Case reports suggest some of these patients exhibit sensitivity and paradoxical reactions to certain psychoactive drugs. This report of a 16-year-old male with Cornelia de Lange is the first to describe dystonia from a first-generation antipsychotic that did not respond to conventional treatment with diphenhydramine. The patient initially presented to the Emergency Department for agitation, which progressively worsened after administration of diphenhydramine, olanzapine, and intramuscular haloperidol. The patient returned to the Emergency Department the following day because of altered mental status and lethargy that progressed to periodic lip-smacking movements and contraction of his upper extremities. His symptoms continued despite administration of diphenhydramine and loading doses of 3 antiepileptic drugs. His abnormal labs included an elevated creatine kinase and a prolonged QTc interval on his electrocardiogram. His symptoms were later deemed a probable drug-induced dystonic reaction to haloperidol once seizures were excluded by an unremarkable electroencephalogram. This case supports previous reports suggesting an association between Cornelia de Lange and paradoxical drug reactions, and it is recommended that clinicians strongly weigh the risks of prescribing first-generation antipsychotics for this patient population. These medications should be carefully titrated, with close patient monitoring to prevent adverse drug effects and other iatrogenic complications because antidotes may be rendered ineffective by this condition.

scholarly journals Delayed diagnosis of long QT syndrome in a patient with seizures

2019 ◽  
Vol 26 (3) ◽  
pp. 190-193
Author(s):  
Seung Yong Shin ◽  
Jun Young Hong ◽  
Dong Hoon Lee
Keyword(s):  
Emergency Department ◽  
Long Qt Syndrome ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Initial Assessment ◽  
Long Qt ◽  
Prolonged Qt Interval ◽  
Qt Syndrome ◽  
Seizure Episode ◽  
Diagnostic Work

Introduction: Long QT syndrome accompanied by a seizure episode is often misdiagnosed as primary epilepsy. Although patients with Long QT syndrome who are misdiagnosed and improperly managed are likely to result in fatality, their first clinical manifestations are seizure episodes in many cases. Case presentation: A 17-year-old boy visited the emergency department with poorly controlled seizure during epilepsy treatment was found to have been misdiagnosed with epilepsy when he was 7 years old. His electrocardiography showed a prolonged QT interval. After careful re-evaluation, he was finally diagnosed with Long QT syndrome and recovered without any seizure episodes in the absence of anti-epileptic agents. Discussion and conclusion: Careful initial assessment including repetitive electrocardiography, when abnormal, is required for those who visit the emergency department with a seizure or who show no definite abnormalities in diagnostic work up process.

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