Early epinephrine administration in patients with cardiac arrest in case of shockable rhythm in ER

The objective of the review was to investigate the scientific production and evaluate the effectiveness of epinephrine in the treatment of cardiac arrest in terms of survival and neurological status. PubMed, Embase, and Google Scholar databases were searched up till November 2017 for published studies in English language and human subjects discussing early epinephrine administration in patients with cardiac arrest in case of shockable rhythm in emergency medicine. Prehospital epinephrine management may increase short-term survival [ROSC] yet does not improve survival to release, or neurologic results after out-of-hospital cardiac arrest OHCA. Although there is no clear proof of long-lasting advantages complying with the use of epinephrine in OHCA, there is insufficient evidence to sustain altering present guidelines which recommend its management [1 mg every 3-5 min] throughout resuscitation. As a result, there is a need for additional clinical trials to analyze whether lower dosages or alternative regimes of epinephrine administration. Furthermore, one of the most important aspects of care in cardiac arrest is basic life support [BLS] measures, consisting of adequate compressions and early defibrillation

Narrative review on different clinical aspects of thrombocytopenia

This review article aims to summarize the major causes of thrombocytopenia and characterize the main general symptoms of thrombocytopenia. As well we summarize the diagnosis and treatment methods. We conducted the search using electronic biomedical databases such as; Medline, and Embase, for studies published up to September 2017 in the English language concerning the thrombocytopenia in general. Thrombocytopenia can either be primary or secondary, in that it could go along with a broad spectrum of syndromes and diseases and may be triggered by different systems. Trigger investigation and recognition might be important and sometimes life-saving as in TTP, heparin-induced thrombocytopenia, acute leukemia or perhaps severe ITP. Taking a detailed history and a thorough physical examination can give clues concerning possible underlying illness and clinical treatments. Cautious evaluation of the peripheral blood smear is necessary. When the differential diagnosis is problematic, sometimes a short trial of therapy could help to clarify the reason. For instance, it might be difficult to differentiate inherited thrombocytopenia [without a family history] from immune thrombocytopenia [ITP]; in this example, intravenous immunoglobulin infusion will likely have no effect in inherited thrombocytopenia, however, will generally be useful in ITP

Assessment of patients with thoracic trauma in emergency department

Objective: Thoracic trauma is a common cause of significant morbidity and mortality. The present study presents a series of thoracic trauma and evaluation of epidemiologic features, distribution of pathologies, diagnosis, additional systemic injuries, management and outcome

Materials and Methods: Between May 2016 and April 2017, all patients with thorax trauma admitted to the emergency service of King Abdulaziz hospital were retrospectively reviewed with respect to age, gender, etiological factors, distribution of pathologies, additional systemic injuries, diagnosis, treatment modalities, referral and outcome

Results: A total of 228 patients with thorax trauma were encompassed in the study. Of all the patients, [140] , 61.4% were male and 88 [38.6%] were female. The majority of the patients presented with blunt thoracic trauma [218 of 228 [95.6%]], whereas 10 [4.4%] presented with penetrating injuries. Etiological factors included falls in 158 [69.3%] patients, motor vehicle accidents in 52 [22.8%], animal related accidents in 8 [3.5%] and penetrating injuries in 10 [4.4%]. Among penetrating injuries, 6 [2.6%] were stabbing injuries and 4 [1.8%] were firearm injuries. The patients aged between 16 and 85 [mean 52.2 +/- 16.9] years. The vast majority [69.3%] of the patients aged between 31 and 70 years. Blunt thoracic traumas were observed most frequently in patients aged 51-70 years [36.8%], while penetrating traumas were observed most frequently in those aged 31-50 [32,5%] years

Conclusion: Even though majority of the patients with thorax trauma received treatment as outpatients; thoracic traumas can be a life threatening condition, and should be recognized and treated immediately. Mortality differs based on etiological factors, additional systemic pathologies, capabilities of the hospital especially diagnostic and treatment facilities in emergency services. We believe that a multidisciplinary method to the patients with severe thorax trauma, and the opportunities of emergency bedside thoracotomy in emergency services will significantly decrease the morbidity and mortality