JEFFREY KLINE

..No quantitative decision instrument has been derived specifically for patients with active cancer and PE...

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..We describe the use of ESA in a large prospective cohort of emergency department (ED) patients and report the outcomes of those treated with ESA compared with patients not receiving ESA...

..The objective of this study was to evaluate if normalization of an initially abnormal vital sign can be used as evidence to lower the suspicion for PE...

..Current literature lacks a simple, well-described rat model of autlogous PE. Objective: Test if moderate-severity autologous PE in Sprague-Dawley (SD) and Copenhagen (Cop) rats can produce persistent PH...

..We sought to determine one year outcomes associated with implementation of early goal directed therapy (EGDT) in the emergency department (ED) care of sepsis...

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..The aim of this work was to document the rate of pulmonary hypertension, as assessed noninvasively by estimated right ventricular systolic pressure (RVSP) of >or= 40 mm Hg 6 months after the diagnosis of submassive PE...

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..We hypothesized that low suspicion and PERC(-) would predict a post-test probability of VTE(+) or death below 2.0%...

..However, the diagnostic accuracy of emergency clinician-performed ultrasonography performed by a heterogenous group of clinicians remains undefined...

..The authors tested the accuracy of this method for forecasting a very low probability of venous thromboembolism (VTE) in symptomatic emergency department (ED) patients...

..We hypothesize that the presentation of a quantitative pretest probability of acute coronary syndrome would safely reduce unnecessary resource use in low-risk emergency department (ED) chest pain patients...

..We sought to measure the frequency of repeat CT pulmonary angiography in emergency department (ED) patients...

..Pulmonary embolism (PE) decreases the exhaled end-tidal ratio of carbon dioxide to oxygen (etCO(2)/O(2))...

..The authors conclude that this Act can be expected to have a profound influence on research and training in emergency care...

..For comparison, recent data on the diagnostic utility of the alveolar-arterial oxygen gradient and the V/Q scan are included. The potential application of these new tests to a hypothetical ED population is described...

..Patients with cancer with an incidentally discovered PE should be risk stratified the same as those who have clinically suspected PE...

..A previous study suggested that the combination of a normal D-dimer assay and normal alveolar dead-space fraction is a highly sensitive screening test for pulmonary embolism (PE)...

..To identify clinical findings and predisposing conditions associated with acute pulmonary embolism (PE) in ambulatory patients being evaluated for PE...

..To determine whether the alveolar dead space volume (V(D)alv), expressed as a percentage of the alveolar tidal volume (V(D)alv/V(T)alv), can predict the degree of vascular occlusion caused by pulmonary embolism (PE)...

..This study examined whether clinicians who document PERC negative also document results of all nine components of the PERC rule...

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..To evaluate the utility of a modified calculation of the alveolar dead space fraction (Vd/Vt), combined with plasma D-dimers, to aid in the exclusion of acute pulmonary embolism (PE)...

..0% of patients with a negative protocol would have an adverse outcome...

..The objective of this study is to measure the predictive value of 13 implicit variables...

..3 to 2.8). CONCLUSION: Nontraumatic hypotension was documented in 19% of a random sample of ED patients admitted to the hospital. Patients exposed to hypotension had a significantly increased risk of death during hospitalization...

..CONCLUSIONS: Diagnosis of pulmonary embolism on CT angiography is more reliable than diagnosis of isolated DVT on CT venography...

..A panel of three widely available tests can be used to risk stratify patients with pulmonary embolism when formal echocardiography is not available...

..CONCLUSION: This preliminary work demonstrates that the end-tidal pCO(2)/pO(2) averaged from 30 s of breathing can produce clinically relevant likelihood ratios for the diagnosis and exclusion of PE...

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..These results suggest that selective anti-inflammatory therapies targeted at neutrophil chemoattractants will reduce cardiac inflammation and reduce RV damage in the setting of PE...

..Experimental PE increased lung and systemic production of TxB(2). Inhibition at the COX-1/2 enzyme was equally as effective as inhibition of thromboxane synthase at reducing alveolar dead space and improving heart function after PE...

..84). CONCLUSIONS: In ED patients with suspected PE, the CT angiogram frequently provides evidence suggesting an important alternative diagnosis to PE. Pulmonary infiltrate suggesting pneumonia was the most common non-PE finding...

..We hypothesized that ED non-sustained hypotension increases risk of in-hospital mortality in patients with sepsis...

..Finally, we assess the potential effect of the proposed pulmonary embolism rule-out protocol on use of imaging resources and ED throughput...

..We compare the prognostic use of BNP, troponin I, D-dimer, monocyte chemoattractant protein-1, matrix metalloproteinase, myeloperoxidase, C-reactive protein, and caspase 3 as biomarkers of RV damage and adverse outcomes in submassive PE...

..quot; CONCLUSIONS: The unstructured clinical estimate of low pretest probability for PE compares favorably with the Canadian score and the Charlotte rule. Interobserver agreement for the unstructured estimate is moderate...

..These data argue against the hypothesis that UCP-2 causes decreased cardiac mechanical efficiency in septic shock...

..The aim of the study was to test if the Mortality in Emergency Department Sepsis (MEDS) score accurately predicts death among emergency department (ED) patients with severe sepsis and septic shock...

..To determine the clinical effectiveness of implementing early goal-directed therapy (EGDT) as a routine protocol in the emergency department (ED)...

..Goal-directed resuscitation for severe sepsis and septic shock has been reported to reduce mortality when applied in the emergency department...

..5% for DVT thrombus. CTV imaging produces a very small HU gradient between clot and blood in leg veins. These findings highlight the importance of ancillary radiological findings in assessing presence of DVT on CTV...

..Ketorolac reduced CINC-1 stimulated chemotaxis of isolated neutrophils. PE converted cardiac tissue into a proinflammatory phenotype. Ketorolac reduced RV inflammatory genes, reduced neutrophil influx, and improved RV function in rat PE...

..We hypothesize that ECG findings consistent with pulmonary hypertension would be observed more frequently in patients with pulmonary embolism...

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..Quantitative resuscitation consists of structured cardiovascular intervention targeting predefined hemodynamic end points. We sought to measure the treatment effect of quantitative resuscitation on mortality from sepsis...

..To help clinicians better target testing, this study sought to quantify the effect of risk factors for a positive quantitative D-dimer in patients evaluated for PE...

..45-0.76). CONCLUSIONS: Using variables available in the emergency department, three previously validated intensive care unit scoring systems demonstrated moderate accuracy for predicting in-hospital mortality...

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..The exhaled end-tidal CO2/O2 ratio and the D-dimer concentration are diagnostic markers of pulmonary embolism (PE)...

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..For individuals interested in the biochemistry of mitochondria, knowledge of this fundamental organelle is expanding at a rapid rate...

..A simple method is needed to risk stratify normotensive patients with pulmonary embolism. We studied whether bedside clinical data can predict in-hospital complications from pulmonary embolism...

..Experimental agranulocytosis reduced RV, suggesting that neutrophil influx contributed to RV damage...

..Future research should focus on ED clinical protocols to ensure appropriate resuscitation and investigation of etiology of out-of-hospital hypotension...

..This report compares a novel attribute-matching method to generate a PTP for acute coronary syndrome (ACS). We compare the new method with a validated logistic regression equation (LRE)...

..1; 95% CI 1.5-7.1). Mortality among patients who present to the ED with undifferentiated shock is high. The depth and duration of systolic blood pressure appears to have a dose-response relationship to adverse hospital outcome...

..We examined the utility of the SOFA score for assessing outcome of patients with severe sepsis with evidence of hypoperfusion at the time of emergency department (ED) presentation...

..We seek to evaluate the diagnostic performance of the procalcitonin test for the diagnosis of bacteremia in the emergency department (ED) population...

..0%) safe patients to 13.3% (95% CI 10.9% to 15.9%). CONCLUSION: Simple clinical criteria can permit safe D -dimer testing in the majority of ED patients with suspected PE. These criteria warrant prospective validation...

..We observed the value of EM echo by emergency physicians in detecting pericardial effusion in patients in PEA and near PEA states...

..The authors performed a systematic review to evaluate published literature on diagnostic performance of emergency physician-performed ultrasonography (EPPU) for the diagnosis and exclusion of deep venous thrombosis (DVT)...

..5 (95% CI 1.1-45). Among ED patients with non-traumatic undifferentiated symptomatic hypotension, the presence of hyperdynamic LVF on focused echo is highly specific for sepsis as the etiology of shock...

..Follow-up for diagnostic research studies might be facilitated if medical record review (MRR) could be used instead of telephone calls...

..Design and test the reliability of a web-based system for multicenter, real-time collection of data in the emergency department (ED), under waiver of authorization, in compliance with HIPAA...

..We determine the accuracy with which a Bayesian network can identify patients with a low pretest probability of venous thromboembolism, defined as less than or equal to 2%...

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..CONCLUSIONS: We implemented successfully a CDR in a large, urban prehospital system to detect PE rapidly as most likely cause of cardiac arrest...

..Taken together, we submit that the present case report and prior case reports are sufficient to comprise a phase I study of the safety and efficacy of tenecteplase to treat acute pulmonary embolism...

..This pattern suggests an extensive shift in cardiac physiology favoring the expression of the "fetal gene program."..

..Certain resuscitative procedures can be lifesaving, but are performed infrequently by emergency medicine (EM) residents on human subjects. Alternative training methods for gaining procedural proficiency must be explored and tested...

..other patients (25 +/- 10% vs. 48 +/- 17%, p < 0.001). CONCLUSIONS: Emergency physicians with focused training in echocardiography can accurately determine LVF in hypotensive patients...

..The apex region of the RV had few compensating adaptations...

..Optimizing risk stratification to prognose pulmonary embolism patients appears to be important to improve management, treatment and clinical outcome...

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..The purpose of this study was to determine the effects of dichloroacetate (DCA) in acute limb ischemia...

..Cardiac arrest from PE is associated with extremely low etCO(2) readings during CPR...

..Our objective was to quantify the rate of thromboprophylaxis and incidence of in-hospital VTE, based upon risk of VTE, in a cohort of patients admitted through the emergency department (ED)...

..A genetic algorithm is a computer technique for discovering relationships between variables. The purpose of this study was to use a genetic algorithm to improve the precision of Paco(2) prediction in comparison to Petco(2)...

..The authors sought to determine the effect of in vitro time, temperature, and removable tourniquet use on changes in venous point-of-care lactate concentrations...

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..Ischemic muscle function was also improved by DCA treatment. Further investigation of the potential beneficial effects of DCA treatment on muscle injury during ischemia and reperfusion is warranted...

..The aim of this study was to prospectively compare the performance of PDA and paper enrollment instruments with respect to time required and errors generated...

..Several clinical decision rules (CDRs) have been validated for pretest probability assessment of pulmonary embolism (PE), but the authors are unaware of any data quantifying and characterizing their use in emergency departments...

..The authors hypothesized that the prevalence of venous thromboembolism (VTE) would be lower among study participants and that medical acuity and refusal to provide a blood sample would be the most common reasons for nonparticipation...

..For these three time points, we estimate the pretest probability of pulmonary embolism to justify the empiric administration of heparin...

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..This study will determine if criteria that are widely and immediately available in most hospitals can be used to risk-stratify severity of PE and to clarify the role of nonmalignant thrombophilias on the prognosis of PE. ..

..In phase III, we will test the validity of the PE PREtest Consult TM and determine if the use of the PE PREtest ConsultTM will decrease unnecessary testing for PE. ..

..This project will fund a clinical study designed to test the diagnostic accuracy of a hand- held breath device that detects the altered gas exchange physiology caused by PE in post-surgical and other patients at high risk for PE. ..