All Journals from Mikkel Brabrand
Background: The aim of this study was to investigate 30-day mortality for COPD patients treated by ambulances in the period before and after implementation of a pre-hospital oxygen protocol.
Methods: Prehospital High-flow oxygen was used from April to September 2012 and titrated oxygen from April to September 2013. Primary outcome was 30-day mortality.
Results: 707 patients were included; 209 in the high-flow group and 498 in the titration group. Of these, 56 and 132 arrived with acute exacerbation (AE). Overall 30-day mortality was 11.5% vs. 9.4% (p=0.41), respectively. For patients with AE, it was 19.6% vs. 4.6% (p=0.001).
Conclusion: Change of treatment protocol is associated with a lower 30-day mortality for patients registered with acute exacerbation, but not for all COPD patients.
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Quick radiological diagnosis is often needed in order to allow the clinicians to make a diagnosis. The purpose of this study was to measure examination time for radiology procedures before and after physical integration of a radiology unit in the ED. We retrospectively acquired data from the radiology information system and compared time from referral to end of radiological examination before and after physical integration of the radiology unit in the ED for 19,897 X-ray and 6,940 CT examinations. After integration examination time for X-ray examinations was reduced by 5 to 14 minutes (p<0.001). For CT head and chest examination time was reduced by 7 to 15 minutes (p<0.003) while examination time for CT abdomen was prolonged by 4 minutes (p=0.78).
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Abstract
Readmissions are treated as adverse events in many healthcare systems. Causes can be physiological deterioration or breakdown of social support systems.
We investigated data from a European multi-centre study of readmissions for changes in vital signs between index admission and readmission. Data sets were graded according to the National Early Warning Score (NEWS).
Of 487 patients in whom NEWS could be calculated on discharge and again on re-admission, 39.6% had worse vital signs with a NEWS score difference ≥ 2 points while only 7.6% had improved by ≥ 2 points. Changes in individual vital signs of 20% or more were most common in respiratory rate and heart rate.
Monitoring of respiratory rate and pulse rate post-discharge might predict some deteriorations.
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Background: Fire smoke inhalation cause a wide range of symptoms immediately or after a relatively asymptomatic period. In this review, we will focus on delayed onset pulmonary edema (DOPE); the incidence and duration of potential delay. As the symptoms may not present immediately, seemingly healthy patients could be inadvertently be sent home. Therefore, many authors recommend observation for 6-24 hours depending on the extent of inhalation injury.
Methods: A systematic literature search in Embase, Medline, and Cochrane library was performed on 14 April 2016. All studies describing smoke exposure and delayed pulmonary edema were included. Additional relevant studies were identified snowballing based on included studies.
Results: We included seven studies, with a total of 135 patients, describing pulmonary edema. Symptoms generally developed after a relatively asymptomatic period (up to 36 hours post-injury) until mechanical ventilation was needed. However, pulmonary edema developing after 36 hours was most likely due to other factors related to burn injury (excessive intravenous fluids, de novo heart failure, infection or problems related to intubation).
Conclusion: Delayed onset pulmonary edema can develop as late as 36 hours postinjury after a relatively uneventful phase. But it would have been rare to have been completely asymptomatic before developing pulmonary edema.
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Background: The relationship between increase in body temperature, heart rate, and respiratory rate has only been studied in young, healthy subjects.
Aim: To show the changes in heart and respiratory rate associated with fever in acutely admitted medical patients.
Design: A prospective observational cohort study
Methods: Vital parameters from 4,493 patients were retrospectively extracted. Linear and multiple variable regression analysis was used to calculate the change in heart and temperature rate for every degree rise in temperature (i.e. ΔHR/°C and ΔRR/°C) in the entire study group and in those with low (<36.1°C), normal (36.1-38°C) and high (>38°C) body temperatures.
Results: The ΔHR/°C and ΔRR/°C was 7.2±0.4 beats per minute (bpm) and 1.4 ±0.1 (1.2 to 1.62) breaths per minute (bpm). Adjusting for age, oxygen saturation and mean blood pressure, the results were 6.4±0.4 (5.7 to 7.1) bpm and 1.2±0.1 (1.0 to 1.4) bpm. In low, normal and high body temperature the ΔHR/°C were 2.7±1.9, 6.9±1.9 and 7.4±0.9 bpm, respectively; for ΔRR/°C the values were -0.5±0.5, 1.5±0.5 and 2.3±0.3 bpm, respectively.
Conclusions: We only found a modest association between fever and changes in heart rate and respiratory rate.
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