CRP improves mortality prediction by prognostic scales in community-acquired pneumonia

September 27, 2009 by  
Filed under Acute Med

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In admitted patients with community acquired pneumonia, adding CRP to either the CURB-65 score or pneumonia severity index improved the area under the receiver operator curve for those prediction tools. In fact, CRP levels greater than 25 mg/dl on admission double the probability of death previously computed in the same class of initial risk

Thorax. 2009 Jul;64(7):587-91

Preparing your emergency department for pandemic 'flu

September 26, 2009 by  
Filed under Acute Med

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Ten points to consider in preparation for pandemic influenza
* Ensure emergency department representation at the Trust level.
* Talk about pandemic flu with your staff.
* Establish a process for fit testing all your staff.
* Institute a training programme for staff in the use of personal protection equipment (PPE).
* Consider stockpiling PPE.
* Agree the processes for managing potentially infected patients within the emergency department.
* Consider how roles in the hospital and within the emergency department may change during a pandemic.
* Establish a method for communicating with staff during a pandemic.
* Consider what you can do to improve staff morale.
* Consider and discuss the ethical decisions we will be required to make.
Emergency Medicine Journal 2009;26:497-500

Pleural effusions – exudate or transudate?

September 26, 2009 by  
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Light’s criteria may misclassify some transudates as exudates. Measuring NT-Pro BNP in pleural fluid may identify heart failure-associated effusions
Chest. 2009 Sep;136(3):671-7

Acute Kidney Injury Survivors – What happens next?

September 26, 2009 by  
Filed under Acute Med, Resus

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What happens to acutely ill patients with acute kidney injury requiring in-hospital dialysis after their acute admission? How many recover and how many require chronic dialysis? A Canadian study of 3769 such patients followed up for an average of 3 years demonstrated that the incidence rate for chronic dialysis was only 2.63 per 100 person years, and that all cause mortality compared with matched controls was unchanged.
JAMA. 2009 Sep 16;302(11):1179-85

Immediate vs Delayed Intervention for NSTEACS

September 26, 2009 by  
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An early invasive strategy is recommended for high risk non-ST elevation acute coronary syndrome (ST/T wave changes, ongoing symptoms, or troponin rise) but how early is early? The French ABOARD study randomised 352 patients to an early (median time of randomisation to sheath insertion 70 mins) or delayed (21 hours) strategy. No difference in the primary outome measure of troponin elevation was observed. Good news for busy cardiologists who won’t have to get up at night for this type of patient.
JAMA. 2009 Sep 2;302(9):947-54

Clopidogrel and PPIs

September 22, 2009 by  
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PPIs such as omeprazole affect the pharmacodynamics of thienopyridines such as clopidogrel, but this does not seem to affect clinical outcomes for most patients. Pantoprazole and esomeprazole have less of an effect on the platelet response to clopidogrel.
Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials

Lancet editorial (Lancet subscription required)

Sensitive troponin improves early detection of AMI

September 22, 2009 by  
Filed under Acute Med

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Newer sensitive troponin assays (detecting 0.04 ng/ml troponin I) showed better senstivity at detecting acute myocardial infarction at 0 amp; 3 hours compared with standard assays. Specificity was however slightly lower than standard assays, suggesting non-AMI pathologies that produce a degree of cardiomyocyte injury will also be detected. Senstivity and specificity for AMI at baseline were both around 90%. Troponin I 0.04 ng/ml was an independent risk factor for adverse events at 30 days.br /br /a href=”http://content.nejm.org/cgi/content/short/361/9/868″http://content.nejm.org/cgi/content/short/361/9/868/a