Management of Heart Failure in the ED Setting:
An Evidence-Based Review of the Literature
J Emerg Med, 2018 Sep 26.
doi: 10.1016/j.jemermed.2018.08.002
Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo (DAWN) trial methods
Int J Stroke. 2017 Aug;12(6):641-652.
Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct
N Engl J Med. 2018 Jan 4;378(1):11-21.
A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3)
Int J Stroke. 2017 Oct;12(8):896-905.
Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging
N Engl J Med. 2018 Feb 22;378(8):708-718.
The European Guideline on Management of Major Bleeding and Coagulopathy Follo...Sun Yai-Cheng
The European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma: Fourth Edition
Rossaint et al. Critical Care (2016) 20:100
DOI 10.1186/s13054-016-1265-x
ACEP Policy for Fever Infants and Children Younger than 2 Years of Age in EDSun Yai-Cheng
Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever
Ann Emerg Med. 2016;67:625-639
2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment
Stroke. 2015;46:3020-3035.
With the Proliferation of Mobile Medical Apps, Which Ones Work Best in the Emergency Department?
Annals of Emergency Medicine, August 2015 Vol. 66, Issue 2, A13–15
Use of tPA for the Management of Acute Ischemic Stroke in the ED: ACEP PolicySun Yai-Cheng
ACEP Clinical Policy
Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department
Ann Emerg Med. 2015;66:322-333
Evaluation and Management of Acute Aortic Dissection: ACEP PolicySun Yai-Cheng
ACEP Clinical Policy
Evaluation and Management of Adult Patients With Suspected Acute Nontraumatic Thoracic Aortic Dissection
Ann Emerg Med. 2015;65:32-42
C-Spine Collar Clearance In The Obtunded Adult Blunt Trauma PatientSun Yai-Cheng
Cervical Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma
J Trauma Acute Care Surg. 2015;78: 430-441.
7. Symptoms
The average time from exposure to symptom
onset is 5 days, and 97.5% of people who
develop symptoms do so within 11.5 days.
Common symptoms in hospitalized patients
• fever (70%-90%)
• dry cough (60%-86%)
• shortness of breath (53%-80%)
• fatigue (38%)
• myalgias (15%-44%)
• nausea/vomiting or diarrhea (15%-39%)
• headache, weakness (25%)
• rhinorrhea (7%).
• olfactory and/or gustatory dysfunctions (64%-80%)
9. Common Complications
• pneumonia (75%), ARDS (15%)
• acute liver injury (19%)
• cardiac injury, including troponin elevation (7%-17%), acute heart
failure, dysrhythmias, and myocarditis
• prothrombotic coagulopathy resulting in venous and arterial
thromboembolic events (10%-25%)
• acute kidney injury (9%)
• neurologic manifestations, including impaired consciousness (8%)
• acute cerebrovascular disease (3%)
• shock (6%)
10. Current Evidence-Based
Treatments
• Dexamethasone therapy reduces 28-day
mortality in patients requiring supplemental
oxygen compared with usual care (21.6% vs
24.6%; age-adjusted rate ratio, 0.83 [95% CI,
0.74-0.92])
• Remdesivir improves time to recovery
(hospital discharge or no supplemental
oxygen requirement) from 15 to 11 days.
• In a randomized trial of 103 patients with
COVID-19, convalescent plasma did not
shorten time to recovery.
11. Convalescent Plasma and COVID-19
JAMA Published Online: June 12, 2020. doi:10.1001/jama.2020.10699
12. Timeline of Symptoms of Severe Covid-19
Severe Covid-19
N Engl J Med. 2020 May 15. doi: 10.1056/NEJMcp2009575
41. Filtration Efficiency of Hospital Face Mask Alternatives
JAMA Intern Med. Published online August 11, 2020. doi:10.1001/jamainternmed.2020.4221
42. Filtration Efficiency of Hospital Face Mask Alternatives
JAMA Intern Med. Published online August 11, 2020. doi:10.1001/jamainternmed.2020.4221
43. Filtration Efficiency of Hospital Face Mask Alternatives
JAMA Intern Med. Published online August 11, 2020. doi:10.1001/jamainternmed.2020.4221
44.
45. Exposure to a Surrogate Measure of Contamination From Simulated Patients by
Emergency Department Personnel Wearing Personal Protective Equipment
JAMA. Published online April 27, 2020. doi:10.1001/jama.2020.6633
8位急診醫療人員在穿著個人防護
裝備(PPE)下,執行模擬插管後,
所有人都有頭髮染污 ;7位有皮膚
染污(頸部 6人,耳朵 1人)。
46. N Engl J Med 2020; 382:1957-1958
DOI: 10.1056/NEJMc2007589
with the aerosol box,
the simulated
cough resulted in
contamination of
only the inner
surface of the box
and the
laryngoscopist’s
gloves and gowned
forearms
Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review.
JAMA. 2020;324(8):782-793. doi:10.1001/jama.2020.12839
Published online July 10, 2020.
JAMA Published Online: June 12, 2020. doi:10.1001/jama.2020.10699
Invasive Mechanical Ventilation for Covid-19–Related Respiratory Failure.
lung-protective ventilation with low tidal volumes (4-8 mL/kg, predicted body weight) and plateau pressure less than 30 mg Hg is recommended.7
Samples were obtained from 70 hospital inpatients who had a diagnosis of Covid-19. Panel A shows SARS-CoV-2 RNA titers in the first available nasopharyngeal and saliva samples. The lines indicate samples from the same patient. Results were compared with the use of a Wilcoxon signed-rank test (P<0.001). Panel B shows percentages of positivity for SARS-CoV-2 in tests of the first matched nasopharyngeal and saliva samples at 1 to 5 days, 6 to 10 days, and 11 or more days (maximum, 53 days) after the diagnosis of Covid-19.
Filtration Efficiency of Hospital Face Mask Alternatives
In a study of fitted face mask alternatives, expired N95 respirators with intact elastic bands and masks that had been subjected to ethylene oxide and hydrogen peroxide sterilization had unchanged fitted filtration efficiencies (FFEs) > 95%, while N95 respirators in the wrong size had FFEs of 90%-95%. As a group, surgical and procedure masks had lower FFEs relative to N95 respirators, with masks secured with elastic ear loops showing the lowest performance.
Bottom Line: When new N95 respirators are unavailable, N95 respirators past their expiration date; sterilized, used N95 respirators; and other less common respirators can be acceptable alternatives.
8位急診醫療人員在穿著個人防護裝備(PPE)下,執行模擬插管後,所有人都有頭髮染污 ;7位有皮膚染污(頸部6人,耳朵1人)。
After completion of the simulation and before doffing, the fluorescent markers on the participants were visualized and photographed under UV light. Of 8 participants, 6 had markers on the neck (A and B) and 1 had markers on the ear (C). Distribution of the markers on all participants is shown with each color representing 1 participant (D).