Measurement of left atrial size as a predictor of severity of illness in sickle cell disease.

Background: Sickle cell disease (SCD) is characterized by microvascular occlusion which leads to multiorgan damage, including left ventricular diastolic dysfunction. Left ventricular diastolic dysfunction has been shown to be an independent risk factor for death in SCD patients. Left atrial dilation (LAD) has been used as a surrogate marker for identification of left ventricular diastolic dysfunction.

Impact of an individualized pain plan to treat sickle cell disease vaso-occlusive episodes in the emergency department.

To address acute vaso-occlusive episodes (VOEs), the leading cause of emergency department (ED) visits among individuals with sickle cell disease (SCD), we conducted the clinical study, ALIGN (An Individualized Pain Plan with Patient and Provider Access for Emergency Department care of SCD), across 8 sites. We hypothesized an improvement of 0.5 standard deviations in perceived quality of ED pain treatment of a VOE after implementing individualized pain plans (IPPs) accessible to both patients and providers.

[Endovascular aortic replacement in a patient with bicuspid aortic valve disease].

A 49-year-old male with a history of left ventricular systolic function dilated cardiomyopathy and severe symptomatic bicuspid aortic stenosis recently diagnosed (syncope, chest pain and dyspnea) was admitted to the coronary care unit. During hospitalization, he developed cardiogenic shock requiring double inotropic support. High surgical risk and an elevated chance of graft rejection contraindicated surgical replacement or heart transplant.

Electronic Health Record-Embedded Individualized Pain Plans for Emergency Department Treatment of Vaso-occlusive Episodes in Adults With Sickle Cell Disease: Protocol for a Preimplementation and Postimplementation Study.

Background: Individuals living with sickle cell disease often require aggressive treatment of pain associated with vaso-occlusive episodes in the emergency department. Frequently, pain relief is poor. The 2014 National Heart, Lung, and Blood Institute evidence-based guidelines recommended an individualized treatment and monitoring protocol to improve pain management of vaso-occlusive episodes.

General Pediatric Clinical Applications of POCUS: Part 2.

The use of point-of-care ultrasound (POCUS) performed by non-radiologists has become more widespread and is entering new arenas of clinical care, particularly in the world of pediatrics. Children are prime candidates for ultrasound because they are more at risk to the harmful effects of ionizing radiation than adults. This is the second part of a two-part article reviewing 10 uses of POCUS that pediatricians can apply to their practice in both inpatient and outpatient settings.

General Pediatric Clinical Applications of POCUS: Part 1.

The use of point-of-care ultrasound (POCUS) performed by non-radiologists has become more widespread and is entering new arenas of clinical care. Children in particular are prime candidates for ultrasound, as they are both usually thinner than adults and are particularly at risk from the harmful effects of ionizing radiation. In this two-part article, we propose 10 uses of POCUS that pediatricians can apply to their practice in both inpatient and outpatient settings.

Bedside Use of Speckle Tracking Echocardiography in the Emergency Department to Identify Acute Myocardial Infarction.

Background: Rapid diagnosis of acute myocardial infarction (AMI) in the emergency department (ED) is often hindered by the limitations of the electrocardiogram (ECG). Speckle tracking echocardiography (STEch) is a semiautomated, computer-assisted process that provides accurate detection of regional ventricular wall motion abnormalities and can be performed at the bedside by operators with limited experience.

Case Reports: Two separate patients, each with history and ECG findings concerning for AMI, were evaluated using STEch performed by an emergency physician.

Strain analysis for the identification of hypertensive cardiac end-organ damage in the emergency department.

Hypertensive emergency is a life-threatening state. End-organ damage affecting the heart accounts for up to 52% of hypertensive emergencies commonly encountered in the emergency department. Recent evidence indicates that strain echocardiography with computerized speckle-tracking is more sensitive at identifying hypertension induced changes in the left ventricle (LV) mechanical function than traditional 2-D echocardiography.

Bedside ultrasound as a predictive tool for acute chest syndrome in sickle cell patients.

Background: Acute chest syndrome (ACS) is the leading cause of death for patients with sickle cell disease (SCD). Early recognition of ACS improves prognosis.

Objective: Investigate the use of bedside lung ultrasound (BLU) in identification of early pulmonary findings associated with ACS in SCD patients.

Emergency physician use of tissue Doppler bedside echocardiography in detecting diastolic dysfunction: an exploratory study.

Introduction: This study evaluates the agreement between emergency physician (EP) assessment of diastolic dysfunction (DD) by a simplified approach using average peak mitral excursion velocity (e') and an independent cardiologist's diagnosis of DD by estimating left atrial (LA) pressure using American Society of Echocardiography (ASE) guidelines.

Methods: This was a secondary analysis of 48 limited bedside echocardiograms (LBE) performed as a part of a research study of patients presenting to the Emergency Department (ED) with elevated blood pressure but without decompensated heart failure. EPs diagnosed DD based on e' < 9 cm/s alone.

A hypertension emergency department intervention aimed at decreasing disparities: Design of a randomized clinical trial.

Effective interventions to identify and treat uncontrolled hypertension (HTN), particularly in underrepresented populations that use the emergency department (ED) for primary care, are critically needed. Uncontrolled HTN contributes significantly to cardiovascular morbidity and mortality and is more frequently encountered among patients presenting to the ED as compared to the primary care setting. EDs serve as the point of entry into the health care system for high-risk patient populations, including minority and low-income patients.

Correlation between Subclinical Heart Disease and Cardiovascular Risk Profiles in an Urban Emergency Department Population with Elevated Blood Pressures: A Pilot Study.

Background: Uncontrolled hypertension is a primary risk factor for development of cardiovascular complications.

Objective: Determine the point prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction in an urban emergency department (ED) population with elevated blood pressures (BP) and examine correlations between subclinical disease and patient cardiovascular risk profiles.

Methods: A convenience sample of patients with EBP (>140/90 on two measurements) had limited bedside echocardiograms (LBE).

Spherical, cylindrical and tetrahedral symmetries; hydrogenic states at high magnetic field in Si:P.

Phosphorous donors in silicon have an electronic structure that mimics the hydrogen atom, albeit on a larger length, smaller energy and smaller magnetic field scale. While the hydrogen atom is spherically symmetric, an applied magnetic field imposes cylindrical symmetry, and the solid-state analogue involves, in addition, the symmetry of the Si crystal. For one magnetic field direction, all six conduction-band valleys of Si:P become equivalent.