Prognostic accuracy of using lactate in addition to the quick Sequential Organ Failure Assessment score and the National Early Warning Score for emergency department patients with suspected infection.

Background: The aim of this study was to determine whether: (1) the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and National Early Warning Score (NEWS) clinical prediction tools alone, (2) modified versions of these prediction tools that integrate lactate into their scores, or (3) use of the two tools in tandem with lactate better predicts in-hospital 28-day mortality among adult EDpatients with suspected infection.

Methods: From 1 January through 31 December 2018, this retrospective cohort study enrolled consecutive adult patients with suspected infection evaluated at two EDs in France. Patients were included if blood cultures were obtained and non-prophylactic antibiotics were administered in the ED.

Interelectrode (Accufix) lead fracture.

An interelectrode fracture was diagnosed 7 years after the implantation of an Accufix lead. The lead body separated from the tip with the helix screwed into the atrial wall. The retention wire was intact and may have contributed to the lead rupture.

Myocardial infarction and rupture of the heart: a macroscopic pathologic study.

From an anatomical point of view, the various elements which seem to individualize myocardial infarctions complicated by rupture are: a limited increase in the volume of the heart; a propensity for the rupture to follow the first infarction of a previously healthy cardiac muscle; a myocardial necrosis of sometimes small extension with clear limits and a destruction of the muscle so severe as to amount in two thirds of the cases to a variable parietal dissection; a lesser extension and diffusion of coronary stenosis; an ever-present and totally occlusive coronary thrombosis; an insignificant or absent substitutive circulation. Those strictly anatomical facts can be reason to extend the indications of a very early direct myocardial revascularization (almost a third of all cardiac ruptures occur within 24 hours) or to contemplate an infarctectomy after the eighth hour (the necroses are usually of a moderate size and well deliminated) if it appears possible to draw the "clinical profile" of those patients prone to cardiac rupture or to read the signs that may announce the likelihood of this dreadful complication.