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Immediate Intervention (immediate + intervention)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Accuracy of the Emergency Severity Index Triage Instrument for Identifying Elder Emergency Department Patients Receiving an Immediate Life-saving Intervention

ACADEMIC EMERGENCY MEDICINE, Issue 3 2010
Timothy F. Platts-Mills MD
Abstract Objectives:, The study objective was to determine the sensitivity and specificity of the Emergency Severity Index (ESI) triage instrument for the identification of elder patients receiving an immediate life-saving intervention in the emergency department (ED). Methods:, The authors reviewed medical records for consecutive patients 65 years or older who presented to a single academic ED serving a large community of elders during a 1-month period. ESI triage scores were compared to actual ED course with attention to the occurrence of an immediate life-saving intervention. The sensitivity and specificity of an ESI triage level of 1 for the identification of patients receiving an immediate intervention was calculated. For 50 cases, the triage nurse ESI designation was compared to the triage level determined by an expert triage nurse based on retrospective record review. Results:, Of 782 consecutive patients 65 years or older who presented to the ED, 18 (2%) had an ESI level of 1, 176 (23%) had an ESI level of 2, 461 (60%) had an ESI level of 3, 100 (13%) had an ESI level of 4, and 18 (2%) had an ESI level of 5. Twenty-six patients received an immediate life-saving intervention. ESI triage scores for these 26 individuals were as follows: ESI 1, 11 patients; ESI 2, nine patients; and ESI 3, six patients. The sensitivity of ESI to identify patients receiving an immediate intervention was 42.3% (95% confidence interval [CI] = 23.3% to 61.3%); the specificity was 99.2% (95% CI = 98.0% to 99.7%). For 17 of 50 cases in which actual triage nurse and expert nurse ESI levels disagreed, undertriage by the triage nurses was more common than overtriage (13 vs. 4 patients). Conclusions:, The ESI triage instrument identified fewer than half of elder patients receiving an immediate life-saving intervention. Failure to follow established ESI guidelines in the triage of elder patients may contribute to apparent undertriage. ACADEMIC EMERGENCY MEDICINE 2010; 17:238,243 © 2010 by the Society for Academic Emergency Medicine [source]

Sinusoidal heart rate pattern: Reappraisal of its definition and clinical significance

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2004
Houchang D. Modanlou
Abstract Objectives: To address the clinical significance of sinusoidal heart rate (SHR) pattern and review its occurrence, define its characteristics, and explain its physiopathology. Background: In 1972, Manseau et al. and Kubli et al. described an undulating wave form alternating with a flat or smooth baseline fetal heart rate (FHR) in severely affected, Rh-sensitized and dying fetuses. This FHR pattern was called ,sinusoidal' because of its sine waveform. Subsequently, Modanlou et al. described SHR pattern associated with fetal to maternal hemorrhage causing severe fetal anemia and hydrops fetalis. Both Manseau et al. and Kubli et al. stated that this particular FHR pattern, whatever its pathogenesis, was an extremely significant finding that implied severe fetal jeopardy and impending fetal death. Undulating FHR pattern: Undulating FHR pattern may be due to the following: (1) true SHR pattern; (2) drugs; (3) pre-mortem FHR pattern; (4) pseudo-SHR pattern; and (5) equivocal FHR patterns. Fetal conditions associated with SHR pattern: SHR pattern has been reported with the following fetal conditions: (1) severe fetal anemia of several etiologies; (2) effects of drugs, particularly narcotics; (3) fetal asphyxia/hypoxia; (4) fetal infection; (5) fetal cardiac anomalies; (6) fetal sleep cycles; and (7) sucking and rhythmic movements of fetal mouth. Definition of true SHR pattern: Modanlou and Freeman proposed the following definition for the interpretation of true SHR pattern: (a) stable baseline FHR of 120,160 bpm; (b) amplitude of 5,15 bpm, rarely greater; (c) frequency of 2,5 cycles per minute; (d) fixed or flat short-term variability; (e) oscillation of the sinusoidal wave from above and below a baseline; and (f) no areas of normal FHR variability or reactivity. Physiopathology: Since its early recognition, the physiopathology of SHR became a matter of debate. Murata et al. noted a rise of arginine vasopressin levels in the blood of posthemorrhagic/anemic fetal lamb. Further works by the same authors revealed that with chemical or surgical vagotomy, arginine vasopressin infusion produced SHR pattern, thus providing the role of autonomic nervous system dysfunction combined with the increase in arginine vasopressin as the etiology. Conclusion: SHR is a rare occurrence. A true SHR is an ominous sign of fetal jeopardy needing immediate intervention. The correct diagnosis of true SHR pattern should also include fetal biophysical profile and the absence of drugs such as narcotics. [source]

Parent-Child Therapy and Maternal Projections: Tripartite Psychotherapy,A New Look

AMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 2 2002
Nancy G. Berlin PhD
Tripartite psychotherapy,where the mother and child are treated together by the therapist,is underutilized as a valuable form of child psychotherapy. Here, a preliminary discussion is based on clinical observations within a brief historical context. Illustrative case examples are offered to exemplify what actually occurs between the mother, child, and therapist in session. This treatment approach is traditionally applied to work with babies and very young children. A basic premise of classical tripartite therapy holds that the presence of the infant in treatment evokes strong transference phenomena in the parent, thus offering direct and immediate intervention within the mother-child relationship. Here, the author stretches the boundaries to extend the age range to older, latency-age children who, within the attachment relationship, may be enacting negative maternal projections. [source]

Thrombosis of an extracardiac fontan tunnel: Combined treatment of thrombolysis and stenting,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2009
Ralf Rauch MD
Abstract Obstruction of the so-called Fontan tunnel represents a life-threatening complication and requires immediate intervention. We describe the successful use of prolonged thrombolysis with rt-PA, allowing stent placement in an extracardiac tunnel in a 7-year-old boy. © 2009 Wiley-Liss, Inc. [source]