Background: Many reports have described that a left ventricular ejection fraction is now gold sta... more Background: Many reports have described that a left ventricular ejection fraction is now gold standard in identifying patients at risk for cardiac mortality. However, little information is available regarding electrocardiographic markers. We conducted for assessment of electrocardiographic markers that can be analyzed using digital 24-hour Holter electrocardiograms (ECGs) to detect high-risk patients for cardiac mortality. Methods: We retrospectively analyzed data in 217 consecutive patients (187 men, age 63±13 years) with Myocardial infarction (MI) including ischemic heart disease, dilated cardiomyopathy, and other organic heart disease, associating numerous clinical factors and ECG indices including non-sustained VT (NSVT), late potentials (LP), heart rate turbulence (HRT), and heart rate variability (HRV), with the events. The primary endpoint was all-cause mortality. Results: During a mean follow-up of 21±11 months, all-cause mortality was seen in 15 patients. Among the patients, 10 suffered from cardiac causes such as arrhythmia and heart failure. Univariate Cox regression analysis showed that LVEF, NSVT, SDNN, VLF and HRT category 2 were significantly associated with the primary endpoint (Pb0.05). Multivariate analysis revealed only HRT category 2 was the independent predictor for the primary endpoint (hazard ratio =5.23, 95%CI, 1.41-19.4; P=0.013). Conclusions: HRT was the strongest independent predictor for allcause mortality in patients with MI.
Le mauvais positionnement des e´lectrodes de l'ECG: Un cas inhabituel de mauvais positionnement f... more Le mauvais positionnement des e´lectrodes de l'ECG: Un cas inhabituel de mauvais positionnement faussant les 12 de´rivations de l'ECG et e´valuation de de´rivations frontales fausse´es par un mauvais positionnement
in a management change in 84% of cases. Major changes in management related to medication choice ... more in a management change in 84% of cases. Major changes in management related to medication choice (42.4%), admission (30%), transfer to a higher level of care (28.1%), and performance of procedures (23.3%). Conclusions: During this six-month training program in Rwanda, participants used POCUS for a range of applications. The remote QA process captured 51% of ultrasounds performed. Of scans with QA, the average score was adequate to good. POCUS routinely changed clinical management. This study demonstrates the impact of POCUS in a resource-limited setting.
The American journal of emergency medicine, Jan 3, 2015
A rare case of sequential bilateral anterior shoulder dislocation in an older adult after trauma ... more A rare case of sequential bilateral anterior shoulder dislocation in an older adult after trauma is presented. The shoulders were dislocated sequentially in 2 separate falls. To the best of our knowledge, this is the second case of sequential or non simultaneous bilateral anterior shoulder dislocation reported to date.
I read with interest Appel et al’s article “Put a Face to a Name: A Randomized Controlled Trial E... more I read with interest Appel et al’s article “Put a Face to a Name: A Randomized Controlled Trial Evaluating the Impact of Providing Clinician Photographs on Inpatients’ Recall.” This randomized controlled trial attempted to address an important issue for hospitalized patients worldwide, namely, recognizing and remembering the names and faces of those caring for them. The following methodological flaws are apparent:
Objectives: To quantify the prevalence of violent incidents involving staff working in a busy acc... more Objectives: To quantify the prevalence of violent incidents involving staff working in a busy accident and emergency (A&E) department and to assess their perceptions of the impact of a “violence at work” policy. Methods: A questionnaire survey was conducted of all members of staff working in the A&E department at Hull Royal Infirmary. They were asked to anonymously report any involvement in a violent incident at work, the trust response after the incident was reported, their perceptions of the safety of the work place after reporting of the incident and any changes implemented to make it safer. Results: 116 A&E staff members were surveyed, of which 63 (54%) responded. 83% who responded were victims of violence at work, 34% of which were physical assaults. 50% of violent incidents were reported but only 14% received any feedback from the trust. More than half of the staff (55%) either did not know of the existence or location of the trust “violence at work” policy. 84% of the staff d...
Editor-I am somewhat troubled by Professor Meadow's article [1], in which he appears to feel ... more Editor-I am somewhat troubled by Professor Meadow's article [1], in which he appears to feel aggrieved by the publication of an article by Watkins [2], called "Conviction by mathematical error?" While I do agree that the title is possibly biased, the substance of the article goes a long way towards explaining why the figure of 1 in 73 million chance of 2 siblings dying from cot death, given by Professor Meadow at the trial is likely to be inaccurate. This figure clearly stands out in my recollection of the trial coverage, and probably that of members of the public. While these children were deemed to have been murdered does not detract from the need to explain whether this statistic is accurate or not. Professor Meadow also states that because he is committed to an unpopular area of work that the BMJ should speak out on his behalf. In this particular case, Professor Meadow appeared in a criminal trial as an expert witness for the prosecution, for which I'm sure he ...
Editor - The results of the study by Jenkins et al [1] into the risks of suicide in people with a... more Editor - The results of the study by Jenkins et al [1] into the risks of suicide in people with a history of parasuicide are very interesting and may add to our understanding of the long-term suicide risks in this group of patients. However it would have been more clinical relevant had the authors reported the proportions of patients receiving ongoing treatment for their mental illness, frequency of deliberate self harm, types and intensity of treatment received, the rate of loss to treatment follow-up in both groups of patients, and the interval from first contact with the mental health services to suicide. This would provide evidence of effectiveness of various treatment options. 1. Jenkins GR, Hale R, Papanastassiou M, Crawford MJ, Tyrer P. Suicide rate 22 years after parasuicide: cohort study. BMJ 2002;325:1155. Competing interests: None declared
Cover page Emergency medicine abstracts Dr Martin Brand, SHO in Orthopaedics, Letterkenny General... more Cover page Emergency medicine abstracts Dr Martin Brand, SHO in Orthopaedics, Letterkenny General Hospital Dr Lelane van Der Poel, SHO in Emergency Medicine, Midland Regional Hospital Mullingar Mr Richard Lynch, Consultant in Emergency Medicine, Midland Regional Hospital Mullingar Corresponding Author Mr Richard Lynch Consultant in Emergency Medicine Midland Regional Hospital Mullingar Co Westmeath Tel: 044 39456 Email: [email protected] The Australian clinical toxicology investigators collaboration randomized trial of different loading transfusion rates on N-acetylcysteine. Kerr F, Dawson A, Whyte IM, Buckley N, Murray L, Graudins A, Chan B, Trudinger B. Annals of Emergency Medicine Volume 45(4):402-408 Previous research into the treatment of paracetamol poisoning has noted that most adverse reactions to N-acetylcysteine occur within the first hour of commencing treatment. Half of the total dose is infused within the first 15 minutes. It has been suggested that giving the...
Why do people complain? Our experience in the Emergency Department, Midland Regional Hospital, Mu... more Why do people complain? Our experience in the Emergency Department, Midland Regional Hospital, Mullingar From July 2004 To June 2009. Dr Ben Bella Mohammed Dafalla, Registrar in Emergency Medicine Mr Richard Lynch, Consultant in Emergency Medicine Background: The number & reason for complaints are commonly used performance indicators Objectives: a) to determine the number of complaints received by the Consultant in Emergency Medicine at the Midland Regional Hospital Mullingar b) to identify the reasons for these complaints Method: All written and verbal complaints received directly by the Consultant in Emergency Medicine or forwarded to him by senior hospital management from July 2004 to June 2009 were included Results: A total of 163 complaints were received over 5 years. All complaints were dealt with at the time they were received. During this time 167,784 patients attended the Emergency Department. The complaints were made by the patient in 43.6% and by a relative 56.4% of cases...
Introduction: Myocardial infarction (MI) is caused by the necrosis of myocardial tissue due to is... more Introduction: Myocardial infarction (MI) is caused by the necrosis of myocardial tissue due to ischemia. Right ventricular MI is present in up to 50% of patients who suffer an acute inferior or posterior wall myocardial infarction. It is associated with a mortality of 30% - 40%.
Background: Many reports have described that a left ventricular ejection fraction is now gold sta... more Background: Many reports have described that a left ventricular ejection fraction is now gold standard in identifying patients at risk for cardiac mortality. However, little information is available regarding electrocardiographic markers. We conducted for assessment of electrocardiographic markers that can be analyzed using digital 24-hour Holter electrocardiograms (ECGs) to detect high-risk patients for cardiac mortality. Methods: We retrospectively analyzed data in 217 consecutive patients (187 men, age 63±13 years) with Myocardial infarction (MI) including ischemic heart disease, dilated cardiomyopathy, and other organic heart disease, associating numerous clinical factors and ECG indices including non-sustained VT (NSVT), late potentials (LP), heart rate turbulence (HRT), and heart rate variability (HRV), with the events. The primary endpoint was all-cause mortality. Results: During a mean follow-up of 21±11 months, all-cause mortality was seen in 15 patients. Among the patients, 10 suffered from cardiac causes such as arrhythmia and heart failure. Univariate Cox regression analysis showed that LVEF, NSVT, SDNN, VLF and HRT category 2 were significantly associated with the primary endpoint (Pb0.05). Multivariate analysis revealed only HRT category 2 was the independent predictor for the primary endpoint (hazard ratio =5.23, 95%CI, 1.41-19.4; P=0.013). Conclusions: HRT was the strongest independent predictor for allcause mortality in patients with MI.
Le mauvais positionnement des e´lectrodes de l'ECG: Un cas inhabituel de mauvais positionnement f... more Le mauvais positionnement des e´lectrodes de l'ECG: Un cas inhabituel de mauvais positionnement faussant les 12 de´rivations de l'ECG et e´valuation de de´rivations frontales fausse´es par un mauvais positionnement
in a management change in 84% of cases. Major changes in management related to medication choice ... more in a management change in 84% of cases. Major changes in management related to medication choice (42.4%), admission (30%), transfer to a higher level of care (28.1%), and performance of procedures (23.3%). Conclusions: During this six-month training program in Rwanda, participants used POCUS for a range of applications. The remote QA process captured 51% of ultrasounds performed. Of scans with QA, the average score was adequate to good. POCUS routinely changed clinical management. This study demonstrates the impact of POCUS in a resource-limited setting.
The American journal of emergency medicine, Jan 3, 2015
A rare case of sequential bilateral anterior shoulder dislocation in an older adult after trauma ... more A rare case of sequential bilateral anterior shoulder dislocation in an older adult after trauma is presented. The shoulders were dislocated sequentially in 2 separate falls. To the best of our knowledge, this is the second case of sequential or non simultaneous bilateral anterior shoulder dislocation reported to date.
I read with interest Appel et al’s article “Put a Face to a Name: A Randomized Controlled Trial E... more I read with interest Appel et al’s article “Put a Face to a Name: A Randomized Controlled Trial Evaluating the Impact of Providing Clinician Photographs on Inpatients’ Recall.” This randomized controlled trial attempted to address an important issue for hospitalized patients worldwide, namely, recognizing and remembering the names and faces of those caring for them. The following methodological flaws are apparent:
Objectives: To quantify the prevalence of violent incidents involving staff working in a busy acc... more Objectives: To quantify the prevalence of violent incidents involving staff working in a busy accident and emergency (A&E) department and to assess their perceptions of the impact of a “violence at work” policy. Methods: A questionnaire survey was conducted of all members of staff working in the A&E department at Hull Royal Infirmary. They were asked to anonymously report any involvement in a violent incident at work, the trust response after the incident was reported, their perceptions of the safety of the work place after reporting of the incident and any changes implemented to make it safer. Results: 116 A&E staff members were surveyed, of which 63 (54%) responded. 83% who responded were victims of violence at work, 34% of which were physical assaults. 50% of violent incidents were reported but only 14% received any feedback from the trust. More than half of the staff (55%) either did not know of the existence or location of the trust “violence at work” policy. 84% of the staff d...
Editor-I am somewhat troubled by Professor Meadow's article [1], in which he appears to feel ... more Editor-I am somewhat troubled by Professor Meadow's article [1], in which he appears to feel aggrieved by the publication of an article by Watkins [2], called "Conviction by mathematical error?" While I do agree that the title is possibly biased, the substance of the article goes a long way towards explaining why the figure of 1 in 73 million chance of 2 siblings dying from cot death, given by Professor Meadow at the trial is likely to be inaccurate. This figure clearly stands out in my recollection of the trial coverage, and probably that of members of the public. While these children were deemed to have been murdered does not detract from the need to explain whether this statistic is accurate or not. Professor Meadow also states that because he is committed to an unpopular area of work that the BMJ should speak out on his behalf. In this particular case, Professor Meadow appeared in a criminal trial as an expert witness for the prosecution, for which I'm sure he ...
Editor - The results of the study by Jenkins et al [1] into the risks of suicide in people with a... more Editor - The results of the study by Jenkins et al [1] into the risks of suicide in people with a history of parasuicide are very interesting and may add to our understanding of the long-term suicide risks in this group of patients. However it would have been more clinical relevant had the authors reported the proportions of patients receiving ongoing treatment for their mental illness, frequency of deliberate self harm, types and intensity of treatment received, the rate of loss to treatment follow-up in both groups of patients, and the interval from first contact with the mental health services to suicide. This would provide evidence of effectiveness of various treatment options. 1. Jenkins GR, Hale R, Papanastassiou M, Crawford MJ, Tyrer P. Suicide rate 22 years after parasuicide: cohort study. BMJ 2002;325:1155. Competing interests: None declared
Cover page Emergency medicine abstracts Dr Martin Brand, SHO in Orthopaedics, Letterkenny General... more Cover page Emergency medicine abstracts Dr Martin Brand, SHO in Orthopaedics, Letterkenny General Hospital Dr Lelane van Der Poel, SHO in Emergency Medicine, Midland Regional Hospital Mullingar Mr Richard Lynch, Consultant in Emergency Medicine, Midland Regional Hospital Mullingar Corresponding Author Mr Richard Lynch Consultant in Emergency Medicine Midland Regional Hospital Mullingar Co Westmeath Tel: 044 39456 Email: [email protected] The Australian clinical toxicology investigators collaboration randomized trial of different loading transfusion rates on N-acetylcysteine. Kerr F, Dawson A, Whyte IM, Buckley N, Murray L, Graudins A, Chan B, Trudinger B. Annals of Emergency Medicine Volume 45(4):402-408 Previous research into the treatment of paracetamol poisoning has noted that most adverse reactions to N-acetylcysteine occur within the first hour of commencing treatment. Half of the total dose is infused within the first 15 minutes. It has been suggested that giving the...
Why do people complain? Our experience in the Emergency Department, Midland Regional Hospital, Mu... more Why do people complain? Our experience in the Emergency Department, Midland Regional Hospital, Mullingar From July 2004 To June 2009. Dr Ben Bella Mohammed Dafalla, Registrar in Emergency Medicine Mr Richard Lynch, Consultant in Emergency Medicine Background: The number & reason for complaints are commonly used performance indicators Objectives: a) to determine the number of complaints received by the Consultant in Emergency Medicine at the Midland Regional Hospital Mullingar b) to identify the reasons for these complaints Method: All written and verbal complaints received directly by the Consultant in Emergency Medicine or forwarded to him by senior hospital management from July 2004 to June 2009 were included Results: A total of 163 complaints were received over 5 years. All complaints were dealt with at the time they were received. During this time 167,784 patients attended the Emergency Department. The complaints were made by the patient in 43.6% and by a relative 56.4% of cases...
Introduction: Myocardial infarction (MI) is caused by the necrosis of myocardial tissue due to is... more Introduction: Myocardial infarction (MI) is caused by the necrosis of myocardial tissue due to ischemia. Right ventricular MI is present in up to 50% of patients who suffer an acute inferior or posterior wall myocardial infarction. It is associated with a mortality of 30% - 40%.
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