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Article ; Online: The effect of emergency department procedural sedation on cardiac output: post hoc analysis of a prospective study.

Muller, Willemien D / van Ieperen, Ellen / Coffeng, Sophie M / Stolmeijer, Renate / Ter Avest, Ewoud

European journal of emergency medicine : official journal of the European Society for Emergency Medicine

2022 Volume 29, Issue 4, Page(s) 309–311

MeSH term(s)	Anesthesia ; Conscious Sedation ; Emergency Service, Hospital ; Humans ; Hypnotics and Sedatives/therapeutic use ; Propofol ; Prospective Studies
Chemical Substances	Hypnotics and Sedatives ; Propofol (YI7VU623SF)
Language	English
Publishing date	2022-06-28
Publishing country	England
Document type	Journal Article
ZDB-ID	1233544-7
ISSN	1473-5695 ; 0969-9546
ISSN (online)	1473-5695
ISSN	0969-9546
DOI	10.1097/MEJ.0000000000000922
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Article ; Online: Point-of-care ultrasound-guided versus standard reduction of displaced distal radius fractures in the emergency department: a randomised controlled clinical trial.

Haak, Svenja L / Borgstede, Marion G / Stolmeijer, Renate / Bens, Bas Wj / Boendermaker, Annemieke E / van der Kolk, Brigitta Britt Ym / Ter Maaten, Jan C / Ter Avest, Ewoud / Lameijer, Heleen

Emergency medicine journal : EMJ

2023 Volume 40, Issue 12, Page(s) 826–831

Abstract: Background: During closed reduction of displaced distal radius fractures, physical examination is used to determine the need for further manipulation before radiographic confirmation and cast application. Manipulation performed under ultrasound guidance ...

Abstract	Background: During closed reduction of displaced distal radius fractures, physical examination is used to determine the need for further manipulation before radiographic confirmation and cast application. Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts. Methods: This multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands. Patients aged ≥16 years presenting to the ED with a distal radius fracture requiring closed reduction were randomised to either point-of-care ultrasound (PoCUS)-guided or standard reduction. The primary outcome was the proportion of patients requiring more than one reduction attempt. The secondary outcomes were time to complete reduction and treatment plan at ED discharge (conservative or operative repair). Results: A total of 214 patients were screened, of which 211 patients were included for primary endpoint analysis (87% female, median age 68 years, 94% dorsal angulation, 59% intra-articular and 73% multifragmentary). In total, 105 patients were randomised to standard treatment and 106 patients to PoCUS-guided fracture reduction. In the standard treatment group, 13 patients (12%) required more than one reduction attempt, compared with 6 patients (6%) in the PoCUS group (OR 2.35, 95% CI 0.86 to 6.45). The median reduction time was 5 min in the PoCUS group (IQR 3-6) vs 3 min (IQR 2-4) in the standard reduction group (p<0.001). At ED discharge, operative repair was indicated for 17 (16%) patients in the standard group and 21 (20%) patients in the PoCUS group (OR 0.78, 95% CI 0.39 to 1.58). Conclusion: This study could not demonstrate that PoCUS-guided reduction of distal radius fractures was associated with a statistically significant decrease in the number of reduction attempts. Trial registration number: The Netherlands Trial Register (NTR7934).
MeSH term(s)	Humans ; Female ; Aged ; Male ; Radius Fractures/diagnostic imaging ; Radius Fractures/therapy ; Wrist Fractures ; Point-of-Care Systems ; Ultrasonography, Interventional ; Emergency Service, Hospital
Language	English
Publishing date	2023-11-28
Publishing country	England
Document type	Randomized Controlled Trial ; Multicenter Study ; Journal Article
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2023-213178
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Article ; Online: Non-invasive assessment of fluid responsiveness to guide fluid therapy in patients with sepsis in the emergency department: a prospective cohort study.

Koopmans, Nienke K / Stolmeijer, Renate / Sijtsma, Ben C / van Beest, Paul A / Boerma, Christiaan E / Veeger, Nic J / Ter Avest, Ewoud

Emergency medicine journal : EMJ

2021 Volume 38, Issue 6, Page(s) 416–422

Abstract: Background: Little is known about optimal fluid therapy for patients with sepsis without shock who present to the ED. In this study, we aimed to quantify the effect of a fluid challenge on non-invasively measured Cardiac Index (CI) in patients ... ...

Abstract	Background: Little is known about optimal fluid therapy for patients with sepsis without shock who present to the ED. In this study, we aimed to quantify the effect of a fluid challenge on non-invasively measured Cardiac Index (CI) in patients presenting with sepsis without shock. Methods: In a prospective cohort study, CI, stroke volume (SV) and systemic vascular resistance (SVR) were measured non-invasively in 30 patients presenting with sepsis without shock to the ED of a large teaching hospital in the Netherlands between May 2018 and March 2019 using the ClearSight system. After baseline measurements were performed, a passive leg raise (PLR) was done to simulate a fluid bolus. Measurements were then repeated 30, 60, 90 and 120 s after PLR. Finally, a standardised 500 mL NaCl 0.9% intravenous bolus was administered after which final measurements were done. Fluid responsiveness was defined as >15% increase in CI after a standardised fluid challenge. Measurements and main results: Seven out of 30 (23%) patients demonstrated a >15% increase in CI after PLR and after a 500 mL fluid bolus. Fluid responders had a higher estimated glomerular filtration rate (eGFR) (64 (44-78) vs 37 (23-47), p=0.009) but otherwise similar patient and treatment characteristics as non-responders. Baseline measurements of cardiac output (CO), CI, SV and SVR were unrelated to PLR fluid responsiveness. The change in CI after PLR was strongly positive correlated to the change in CI after a 500 mL NaCl 0.9% fluid bolus (r=0.88, p<0.001). Conclusion: The results of the present study demonstrate that in patients with sepsis in the absence of shock, three out of four patients do not demonstrate a clinically relevant increase in CI after a standardised fluid challenge. Non-invasive CO monitoring in combination with a PLR test has the potential to identify patients who might benefit from fluid resuscitation and may contribute to a better tailored treatment of these patients.
MeSH term(s)	Aged ; Aged, 80 and over ; Cardiac Output ; Emergency Service, Hospital ; Female ; Fluid Therapy/methods ; Humans ; Male ; Netherlands ; Prospective Studies ; Sepsis/therapy ; Stroke Volume
Language	English
Publishing date	2021-04-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2020-209771
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Article ; Online: When the factory shuts down.

Borgstede, Marion G / van den Broeke-Vos, Majoline J W / Stevens-Stolmeijer, Renate / Lameijer, Heleen

Emergency medicine journal : EMJ

2019 Volume 36, Issue 1, Page(s) 51–60

Abstract: Clinical introduction: A 56-year-old man without known medical history was brought to our ED after he was found next to his bed, agitated and with waxing and waning consciousness. He has been bedbound for 5 days after a long-standing period of ... ...

Abstract	Clinical introduction: A 56-year-old man without known medical history was brought to our ED after he was found next to his bed, agitated and with waxing and waning consciousness. He has been bedbound for 5 days after a long-standing period of malnutrition. Physical examination reveals Kussmaul breathing, heart rate of 62/min and blood pressure of 135/100 mm Hg, normal cardiac, abdominal and a non-focal neurological examination other than confusion and altered level of consciousness. An EKG was performed (figure 1).emermed;36/1/51/F1F1F1Figure 1EKG at presentation in our ED. Question: What abnormalities are the clues to the severity of his condition? How would you confirm your suspicion?The minimally prolonged QTc time.The subtle horizontal ST segment elevation in V2 and V3.The subtle positive deflection at the J point.Nothing, this EKG is not interpretable because of the movement of baseline.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Confusion/etiology ; Diabetic Ketoacidosis/complications ; Diabetic Ketoacidosis/diagnosis ; Diabetic Ketoacidosis/drug therapy ; Diagnosis, Differential ; Dyspnea/etiology ; Electrocardiography/methods ; Humans ; Hypoglycemic Agents/therapeutic use ; Hypothermia/etiology ; Insulin/therapeutic use ; Male ; Malnutrition/complications ; Malnutrition/physiopathology ; Middle Aged ; Unconsciousness/etiology
Chemical Substances	Anti-Bacterial Agents ; Hypoglycemic Agents ; Insulin
Language	English
Publishing date	2019-01-11
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2018-207676
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Article ; Online: Fortune telling: predicting hospital admissions to improve emergency department outflow.

Komdeur, Annemarijn / Theunissen, Joris / Stolmeijer, Renate / Ter Avest, Ewoud / Lameijer, Heleen / van der Vaart, Taco / Land, Martin

European journal of emergency medicine : official journal of the European Society for Emergency Medicine

2020 Volume 28, Issue 1, Page(s) 77–78

MeSH term(s)	Emergency Service, Hospital ; Hospitalization ; Hospitals ; Humans ; Patient Admission
Language	English
Publishing date	2020-12-28
Publishing country	England
Document type	Journal Article
ZDB-ID	1233544-7
ISSN	1473-5695 ; 0969-9546
ISSN (online)	1473-5695
ISSN	0969-9546
DOI	10.1097/MEJ.0000000000000740
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Article ; Online: Titration of oxygen therapy in critically ill emergency department patients: a feasibility study.

Dobbe, Anna S M / Stolmeijer, Renate / Ter Maaten, Jan C / Ligtenberg, Jack J M

BMC emergency medicine

2018 Volume 18, Issue 1, Page(s) 17

Abstract: Background: Liberal use of oxygen in an emergency situation is common. Today, most health care professionals do not adjust the amount of oxygen given when a saturation of 100% or a PaO2 which exceeds the normal range is reached- which may result in ... ...

Abstract	Background: Liberal use of oxygen in an emergency situation is common. Today, most health care professionals do not adjust the amount of oxygen given when a saturation of 100% or a PaO2 which exceeds the normal range is reached- which may result in hyperoxia. There is increasing evidence for the toxic effects of hyperoxia. Therefore, it seems justified to aim for normoxia when giving oxygen. This study evaluates whether it is feasible to aim for normoxia when giving oxygen therapy to patients at the emergency department (ED). Methods: A prospective cohort study was performed at the ED of the University Medical Center Groningen (UMCG). A protocol was developed, aiming for normoxia. During a 14 week period all patients > 18 years arriving at the ED between 8 a.m. and 23 p.m. requiring oxygen therapy registered for cardiology, internal medicine, emergency medicine and pulmonology were included. Statistical analysis was performed using student independent t-test, Mann-Whitney U-test, Fisher's exact test or a Pearson's chi-squared test. Results: During the study period the study protocol was followed and normoxia was obtained after 1 h at the ED in 86,4% of the patients. Patients with COPD were more at risk for not being titrated to normal oxygen levels. Conclusions: We showed that it is feasible to titrate oxygen therapy to normoxia at the ED. The study results will be used for further research assessing the potential beneficial effects of normoxia compared to hyper- or hypoxia in ED patients and for the development of guidelines.
MeSH term(s)	Aged ; Aged, 80 and over ; Clinical Protocols/standards ; Critical Illness/therapy ; Dose-Response Relationship, Drug ; Emergency Service, Hospital/standards ; Feasibility Studies ; Female ; Humans ; Hypercapnia/prevention & control ; Hypoxia/prevention & control ; Male ; Middle Aged ; Oxygen Inhalation Therapy/methods ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive/therapy
Language	English
Publishing date	2018-06-26
Publishing country	England
Document type	Journal Article
ISSN	1471-227X
ISSN (online)	1471-227X
DOI	10.1186/s12873-018-0169-2
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Article ; Online: Association between personal protective equipment and SARS-CoV-2 infection risk in emergency department healthcare workers.

Schmitz, Danique / Vos, Marieke / Stolmeijer, Renate / Lameijer, Heleen / Schönberger, Titus / Gaakeer, Menno I / de Groot, Bas / Eikendal, Ties / Wansink, Luuk / Ter Avest, Ewoud

European journal of emergency medicine : official journal of the European Society for Emergency Medicine

2020 Volume 28, Issue 3, Page(s) 202–209

Abstract: Background and importance: Healthcare personnel working in the emergency department (ED) is at risk of acquiring severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2). So far, it is unknown if the reported variety in infection rates among ... ...

Abstract	Background and importance: Healthcare personnel working in the emergency department (ED) is at risk of acquiring severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2). So far, it is unknown if the reported variety in infection rates among healthcare personnel is related to the use of personal protective equipment (PPE) or other factors. Objective: The aim of this study was to investigate the association between PPE use and SARS-CoV-2 infections among ED personnel in the Netherlands. Design, setting and participants: A nationwide survey, consisting of 42 questions about PPE-usage, ED layout - and workflow and SARS-CoV-2 infection rates of permanent ED staff, was sent to members of the Dutch Society of Emergency Physicians. Members were asked to fill out one survey on behalf of the ED of their hospital. The association between PPE use and the infection rate was investigated using univariable and multivariable regression analyses, adjusting for potential confounders. Outcome measures: Primary outcome was the incidence of confirmed SARS-CoV-2 infections among permanent ED staff between 1 March and 15 May 2020. Results: Surveys were sent to 64 EDs of which 45 responded (70.3%). In total, 164 ED staff workers [5.1 (3.2-7.0)%] tested positive for COVID-19 during the study period compared to 0.087% of the general population. There was significant clustering of infected ED staff in some hospitals (range: 0-23 infection). In 13 hospitals, an FFP2 (filtering facepiece particles >94% aerosol filtration) mask or equivalent and eye protection was worn for all contacts with patients with suspected or confirmed SARS-CoV-2 during the whole study period. The unadjusted staff infection rate was higher in these hospitals [7.3 (3.4-11.1) vs. 4.0 (1.9-6.1)%, absolute difference + 3.3%]. Hospital staff testing policy was identified as a potential confounder of the relation between PPE use and confirmed SARS-CoV-2 infections (collinearity statistic 0.95). After adjusting for hospital testing policy, type of PPE was not associated with incidence of COVID 19 infections among ED staff (P = 0.40). Conclusion: In this cross-sectional study, the use of high-level PPE (FFP2 or equivalent and eye protection) by ED personnel during all contacts with patients with suspected or confirmed SARS-CoV-2 does not seem to be associated with a lower infection rate of ED staff compared to lower level PPE use. Attention should be paid to ED layout and social distancing to prevent cross-contamination of ED personnel.
MeSH term(s)	Adult ; COVID-19/epidemiology ; COVID-19/prevention & control ; Cross-Sectional Studies ; Emergency Service, Hospital/organization & administration ; Female ; Gloves, Protective/statistics & numerical data ; Health Personnel/psychology ; Health Personnel/statistics & numerical data ; Humans ; Infection Control/methods ; Male ; Netherlands ; Personal Protective Equipment/statistics & numerical data ; Protective Clothing/statistics & numerical data ; Respiratory Protective Devices/statistics & numerical data ; Young Adult
Keywords	covid19
Language	English
Publishing date	2020-10-20
Publishing country	England
Document type	Journal Article
ZDB-ID	1233544-7
ISSN	1473-5695 ; 0969-9546
ISSN (online)	1473-5695
ISSN	0969-9546
DOI	10.1097/MEJ.0000000000000766
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Article ; Online: Oxygen therapy for sepsis patients in the emergency department: a little less?

Stolmeijer, Renate / ter Maaten, Jan C / Zijlstra, Jan G / Ligtenberg, Jack J M

European journal of emergency medicine : official journal of the European Society for Emergency Medicine

2014 Volume 21, Issue 3, Page(s) 233–235

Abstract: Liberal oxygen therapy has been a cornerstone in the treatment of critically ill patients. Recently, awareness of hyperoxia toxicity has emerged. We investigated the partial pressure of oxygen in arterial blood (PaO2) in sepsis patients admitted to the ... ...

Abstract	Liberal oxygen therapy has been a cornerstone in the treatment of critically ill patients. Recently, awareness of hyperoxia toxicity has emerged. We investigated the partial pressure of oxygen in arterial blood (PaO2) in sepsis patients admitted to the emergency department treated with a reduced inspired oxygen fraction of 0.4 instead of 0.6-0.8. A prospective pilot study was carried out over a 3-month period. Patients admitted with two or more SIRS criteria and a suspicion of infection were included. They received 10 l O2/min through a VentiMask 40%. Of 83 patients, 77 had a PaO2 greater than 9.5 kPa with 10 l O2/min, of whom 51 had hyperoxia. Six patients showed hypoxia with 10 l O2/min. Of the hyperoxic patients, 8% died in hospital versus 6% with normoxia. Less than 8% of patients had hypoxia with 10 l O2/min; 66% were hyperoxic. Titration of oxygen therapy to normoxia in the emergency department should be evaluated.
MeSH term(s)	Adult ; Aged ; Blood Gas Analysis ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Hyperoxia/etiology ; Hyperoxia/mortality ; Hyperoxia/physiopathology ; Male ; Middle Aged ; Netherlands ; Oximetry/methods ; Oxygen Consumption/physiology ; Oxygen Inhalation Therapy/adverse effects ; Oxygen Inhalation Therapy/methods ; Pilot Projects ; Prospective Studies ; Risk Assessment ; Sepsis/blood ; Sepsis/diagnosis ; Sepsis/therapy ; Statistics, Nonparametric ; Treatment Outcome
Language	English
Publishing date	2014-06
Publishing country	England
Document type	Journal Article
ZDB-ID	1233544-7
ISSN	1473-5695 ; 0969-9546
ISSN (online)	1473-5695
ISSN	0969-9546
DOI	10.1097/MEJ.0b013e328361c6c7
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Article ; Online: A little less saturation?

Ligtenberg, Jack J M / Stolmeijer, Renate / Broekema, Josien J / ter Maaten, Jan C / Zijlstra, Jan G

Critical care (London, England)

2013 Volume 17, Issue 3, Page(s) 439

MeSH term(s)	Emergencies ; Emergency Medical Services/methods ; Humans ; Oxygen Inhalation Therapy/adverse effects ; Oxygen Inhalation Therapy/methods
Language	English
Publishing date	2013-06-19
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/cc12726
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Article: Association between personal protective equipment and SARS-CoV-2 infection risk in emergency department healthcare workers

Schmitz, Danique / Vos, Marieke / Stolmeijer, Renate / Lameijer, Heleen / Schönberger, Titus / Gaakeer, Menno I / de Groot, Bas / Eikendal, Ties / Wansink, Luuk / Ter Avest, Ewoud

Eur. j. emerg. med

Abstract: BACKGROUND AND IMPORTANCE: Healthcare personnel working in the emergency department (ED) is at risk of acquiring severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2). So far, it is unknown if the reported variety in infection rates among ... ...

Abstract	BACKGROUND AND IMPORTANCE: Healthcare personnel working in the emergency department (ED) is at risk of acquiring severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2). So far, it is unknown if the reported variety in infection rates among healthcare personnel is related to the use of personal protective equipment (PPE) or other factors. OBJECTIVE: The aim of this study was to investigate the association between PPE use and SARS-CoV-2 infections among ED personnel in the Netherlands. DESIGN, SETTING AND PARTICIPANTS: A nationwide survey, consisting of 42 questions about PPE-usage, ED layout - and workflow and SARS-CoV-2 infection rates of permanent ED staff, was sent to members of the Dutch Society of Emergency Physicians. Members were asked to fill out one survey on behalf of the ED of their hospital. The association between PPE use and the infection rate was investigated using univariable and multivariable regression analyses, adjusting for potential confounders. OUTCOME MEASURES: Primary outcome was the incidence of confirmed SARS-CoV-2 infections among permanent ED staff between 1 March and 15 May 2020. RESULTS: Surveys were sent to 64 EDs of which 45 responded (70.3%). In total, 164 ED staff workers [5.1 (3.2-7.0)%] tested positive for COVID-19 during the study period compared to 0.087% of the general population. There was significant clustering of infected ED staff in some hospitals (range: 0-23 infection). In 13 hospitals, an FFP2 (filtering facepiece particles >94% aerosol filtration) mask or equivalent and eye protection was worn for all contacts with patients with suspected or confirmed SARS-CoV-2 during the whole study period. The unadjusted staff infection rate was higher in these hospitals [7.3 (3.4-11.1) vs. 4.0 (1.9-6.1)%, absolute difference + 3.3%]. Hospital staff testing policy was identified as a potential confounder of the relation between PPE use and confirmed SARS-CoV-2 infections (collinearity statistic 0.95). After adjusting for hospital testing policy, type of PPE was not associated with incidence of COVID 19 infections among ED staff (P = 0.40). CONCLUSION: In this cross-sectional study, the use of high-level PPE (FFP2 or equivalent and eye protection) by ED personnel during all contacts with patients with suspected or confirmed SARS-CoV-2 does not seem to be associated with a lower infection rate of ED staff compared to lower level PPE use. Attention should be paid to ED layout and social distancing to prevent cross-contamination of ED personnel.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #892115
Database	COVID19

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