John A. Marx

Misdiagnosis of Subarachnoid Hemorrhage

Subarachnoid hemorrhage (SAH) causes serious neurologic impairment or death in 40% to 60% of cases. Patient outcome is heavily dependent on early

Needle Thoracostomy: Size Does Matter

For tension pneumothorax, Advanced Trauma Life Support guidelines recommend insertion of a large-caliber needle into the second intercostal space in

Ultrasound Measurement of Inferior Vena Cava Can Predict Hypovolemic Shock

A small inferior vena cava (IVC) diameter has been shown to reflect hemorrhagic shock. These authors prospectively assessed IVC diameter immediately after fluid resuscitation in trauma patients who had shock on arrival to the emergency department. Using sagittal ultrasound views, the researchers measured the maximum anterior–posterior IVC diameter just below the diaphragm in the hepatic segment during the expiratory phase of breathing. Of 488 blunt trauma patients who were transferred to …

Central Location of Pulmonary Emboli Increases Likelihood of Poor Outcomes

The association between embolic clot burden and outcomes in patients with acute pulmonary embolism (PE) is poorly understood. In a prospective,

New and Established Troponin Assays Are Highly Sensitive and Specific for AMI

Early recognition or exclusion of acute myocardial infarction (AMI) is critical for determining which patients do or do not require additional diagnostic and therapeutic measures. In a prospective study, researchers compared the accuracy of a novel highly sensitive troponin I (hsTnI) assay (Architect STAT High Sensitivity Troponin; Abbott Diagnostics) and an established …

Out-of-Hospital Glucose-Insulin-Potassium Reduces Composite of Cardiac Arrest and In-Hospital Mortality

Cardiac ischemia can induce the release of free fatty acids, which in turn can increase the likelihood of arrhythmias. Glucose-insulin-potassium (GIK)

Prehospital Epinephrine for Cardiac Arrest Reduces Survival and Worsens Neurological Outcomes at 1 Month

A recent prospective, randomized, placebo-controlled trial of epinephrine for out-of-hospital cardiac arrest demonstrated that epinephrine increased

Successful Resuscitative Trauma Thoracotomy

Trauma thoracotomy was first instituted more than 40 years ago, and, although the American College of Surgeons Committee on Trauma (ACSCOT) has since

Ambulance Diversion Increases Mortality in Patients with Acute Myocardial Infarction

To determine whether ambulance diversion is associated with all-cause mortality in patients with acute myocardial infarction (AMI), researchers

Hypotensive Resuscitation in Trauma Patients Lessens Transfusion Needs

These authors report an interim analysis of the first prospective randomized trial of intraoperative hypotensive resuscitation in patients. At a single