BACKGROUND： We describe our experience of utilizing sub-dissociative dose ketamine （SDK） in managing a variety of acute and chronic painful conditions in the emergency department （ED）. METHODS： A descriptive st...BACKGROUND： We describe our experience of utilizing sub-dissociative dose ketamine （SDK） in managing a variety of acute and chronic painful conditions in the emergency department （ED）. METHODS： A descriptive study was conducted in our ED over a period of seven years （2010-2016） by retrospectively reviewing charts of patients aged 18 and older presenting to the ED with painful complaints and receiving SDK analgesia. Primary data analyses included type of SDK administration （intravenous push [IVP], short-infusion [SI] or continuous infusion [CI]）, dosing, rates of analgesic utilization before and after SDK administration, and adverse effects. RESULTS： Three hundred sixty-two patients were enrolled in the study. Mean ketamine doses given by IVP, St and CI were 26.3 rag, 23.4 rag, and 11.3 rag. The mean duration of CI was 135.87 minutes. The percentage of patients not requiring post-SDK analgesia increased by 16%, 18%, and 37% in IVP, SI and CI groups. Adverse effects were recorded for 13% of patients. CONCLUSION： SDK administered by IVP, SI, and CI in the ED for a variety of painful conditions is a feasible analgesic modality in the ED that is associated with a decrease in overall requirements of post-ketamine analgesia and opioid sparing.展开更多
At present,there is no reliable biomarker for the diagnosis of traumatic brain injury(TBI).Studies have shown that extracellular vesicles released by damaged cells into biological fluids can be used as potential bioma...At present,there is no reliable biomarker for the diagnosis of traumatic brain injury(TBI).Studies have shown that extracellular vesicles released by damaged cells into biological fluids can be used as potential biomarkers for diagnosis of TBI and evaluation of TBI severity.We hypothesize that the genetic profile of salivary extracellular vesicles in patients with head trauma differs from that in uninjured subjects.Findings from this hypothesis would help investigate the severity of TBI.This study included 19 subjects,consisting of seven healthy controls who denied history of head trauma,six patients diagnosed with concussion injury from an outpatient concussion clinic,and six patients with TBI who received treatment in the emergency department within 24 hours after injury.Real-time PCR analysis of salivary extracellular vesicles in participants was performed using TaqMan Human Inflammation array.Gene expression analysis revealed nine upregulated genes in emergency department patients(LOX5,ANXA3,CASP1,IL2RG,ITGAM,ITGB2,LTA4H,MAPK14,and TNFRSF1A)and 13 upregulated genes in concussion clinic patients compared with healthy participants(ADRB1,ADRB2,BDKRB1,HRH1,HRH2,LTB4R2,LTB4R,PTAFR,CYSLTR1,CES1,KLK1,MC2R,and PTGER3).Each patient group had a unique profile.Comparison between groups showed that 15 inflammation-related genes had significant expression change.Our results indicate that inflammation biomarkers can be used for diagnosis of TBI and evaluation of disease severity.This study was approved by the Institutional Review Board on December 18,2015(approval No.0078-12)and on June 9,2016(approval No.4093-16).展开更多
文摘BACKGROUND： We describe our experience of utilizing sub-dissociative dose ketamine （SDK） in managing a variety of acute and chronic painful conditions in the emergency department （ED）. METHODS： A descriptive study was conducted in our ED over a period of seven years （2010-2016） by retrospectively reviewing charts of patients aged 18 and older presenting to the ED with painful complaints and receiving SDK analgesia. Primary data analyses included type of SDK administration （intravenous push [IVP], short-infusion [SI] or continuous infusion [CI]）, dosing, rates of analgesic utilization before and after SDK administration, and adverse effects. RESULTS： Three hundred sixty-two patients were enrolled in the study. Mean ketamine doses given by IVP, St and CI were 26.3 rag, 23.4 rag, and 11.3 rag. The mean duration of CI was 135.87 minutes. The percentage of patients not requiring post-SDK analgesia increased by 16%, 18%, and 37% in IVP, SI and CI groups. Adverse effects were recorded for 13% of patients. CONCLUSION： SDK administered by IVP, SI, and CI in the ED for a variety of painful conditions is a feasible analgesic modality in the ED that is associated with a decrease in overall requirements of post-ketamine analgesia and opioid sparing.
基金supported by the National Heart,Lungs,and Blood Institute Grant #T32HL116249(to PQ)Additional support from the National Institute of General Medical Sciences of the NIH through grant(COBRE) #P20GM103468 Flow Cytometry Core(to PQ)+1 种基金National Center for Advancing Translational Sciences of the NIH grant #5UH3TROOO880-05(to PQ)institutional support through the Division of Hematology/oncology,Rhode Island Hospital,Providence,RI
文摘At present,there is no reliable biomarker for the diagnosis of traumatic brain injury(TBI).Studies have shown that extracellular vesicles released by damaged cells into biological fluids can be used as potential biomarkers for diagnosis of TBI and evaluation of TBI severity.We hypothesize that the genetic profile of salivary extracellular vesicles in patients with head trauma differs from that in uninjured subjects.Findings from this hypothesis would help investigate the severity of TBI.This study included 19 subjects,consisting of seven healthy controls who denied history of head trauma,six patients diagnosed with concussion injury from an outpatient concussion clinic,and six patients with TBI who received treatment in the emergency department within 24 hours after injury.Real-time PCR analysis of salivary extracellular vesicles in participants was performed using TaqMan Human Inflammation array.Gene expression analysis revealed nine upregulated genes in emergency department patients(LOX5,ANXA3,CASP1,IL2RG,ITGAM,ITGB2,LTA4H,MAPK14,and TNFRSF1A)and 13 upregulated genes in concussion clinic patients compared with healthy participants(ADRB1,ADRB2,BDKRB1,HRH1,HRH2,LTB4R2,LTB4R,PTAFR,CYSLTR1,CES1,KLK1,MC2R,and PTGER3).Each patient group had a unique profile.Comparison between groups showed that 15 inflammation-related genes had significant expression change.Our results indicate that inflammation biomarkers can be used for diagnosis of TBI and evaluation of disease severity.This study was approved by the Institutional Review Board on December 18,2015(approval No.0078-12)and on June 9,2016(approval No.4093-16).
