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Article ; Online: Woman With Headache and Nausea.

Kemper, Lynn T / Vedder, Issi R / Ter Avest, Ewoud

2022 Volume 79, Issue 6, Page(s) e109–e110

MeSH term(s)	Female ; Headache/etiology ; Humans ; Nausea/etiology ; Vomiting/etiology
Language	English
Publishing date	2022-05-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2021.12.013
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Book ; Thesis: Familial combinded hyperlipidemia

Avest, Ewoud ter

pathophysiology, non-invasive measurements of atherosclerosis and effects of treatment

2007

Author's details	Ewoud ter Avest
Language	English ; Dutch
Size	207 S. : graph. Darst.
Publishing country	Netherlands
Document type	Book ; Thesis
Thesis / German Habilitation thesis	Nijmegen, Univ., Diss., 2007
Note	Zsfassung in niederländ. Sprache
HBZ-ID	HT015250976
ISBN	978-90-9021385-9 ; 90-9021385-6
Database	Catalogue ZB MED Medicine, Health

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2007 E 1542	order for loan	Magazin

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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: Intra-and inter-observer variability of point of care ultrasound measurements to evaluate hemodynamic parameters in healthy volunteers.

Blanca, Deborah / Schwarz, Esther C / Olgers, Tycho Joan / Ter Avest, Ewoud / Azizi, Nasim / Bouma, Hjalmar R / Ter Maaten, Jan Cornelis

The ultrasound journal

2023 Volume 15, Issue 1, Page(s) 22

Abstract: Background: Point-of-care ultrasound (POCUS) is a valuable tool for assessing the hemodynamic status of acute patients. Even though POCUS often uses a qualitative approach, quantitative measurements have potential advantages in evaluating hemodynamic ... ...

Abstract	Background: Point-of-care ultrasound (POCUS) is a valuable tool for assessing the hemodynamic status of acute patients. Even though POCUS often uses a qualitative approach, quantitative measurements have potential advantages in evaluating hemodynamic status. Several quantitative ultrasound parameters can be used to assess the hemodynamic status and cardiac function. However, only limited data on the feasibility and reliability of the quantitative hemodynamic measurements in the point-of-care setting are available. This study investigated the intra- and inter-observer variability of PoCUS measurements of quantitative hemodynamic parameters in healthy volunteers. Methods: In this prospective observational study, three sonographers performed three repeated measurements of eight different hemodynamic parameters in healthy subjects. An expert panel of two experienced sonographers evaluated the images' quality. The repeatability (intra-observer variability) was determined by calculating the coefficient of variation (CV) between the separate measurements for each observer. The reproducibility (inter-observer variability) was assessed by determining the intra-class correlation coefficient (ICC). Results: 32 subjects were included in this study, on whom, in total, 1502 images were obtained for analysis. All parameters were in a normal physiological range. Stroke volume (SV), cardiac output (CO), and inferior vena cava diameter (IVC-D) showed high repeatability (CV under 10%) and substantial reproducibility (ICC 0.61-0.80). The other parameters had only moderate repeatability and reproducibility. Conclusions: We demonstrated good inter-observer reproducibility and good intra-observer repeatability for CO, SV and IVC-D taken in healthy subjects by emergency care physicians.
Language	English
Publishing date	2023-05-05
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2965029-X
ISSN	2524-8987 ; 2036-3176
ISSN (online)	2524-8987
ISSN	2036-3176
DOI	10.1186/s13089-023-00322-9
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Article ; Online: Prehospital clinical signs are a poor predictor of raised intracranial pressure following traumatic brain injury.

Ter Avest, Ewoud / Taylor, Sam / Wilson, Mark / Lyon, Richard L

Emergency medicine journal : EMJ

2020 Volume 38, Issue 1, Page(s) 21–26

Abstract: Background: For the prehospital diagnosis of raised intracranial pressure (ICP), clinicians are reliant on clinical signs such as the Glasgow Coma Score (GCS), pupillary response and/or Cushing's triad (hypertension, bradycardia and an irregular ... ...

Abstract	Background: For the prehospital diagnosis of raised intracranial pressure (ICP), clinicians are reliant on clinical signs such as the Glasgow Coma Score (GCS), pupillary response and/or Cushing's triad (hypertension, bradycardia and an irregular breathing pattern). This study aimed to explore the diagnostic accuracy of these signs as indicators of a raised ICP. Methods: We performed a retrospective cohort study of adult patients attended by a Helicopter Emergency Medical Service (Air Ambulance Kent, Surrey Sussex), who had sustained a traumatic brain injury (TBI), requiring prehospital anaesthesia between 1 January 2016 and 1 January 2018. We established optimal cut-off values for clinical signs to identify patients with a raised ICP and investigated diagnostic accuracy for combinations of these values. Results: Outcome data for 249 patients with TBI were available, of which 87 (35%) had a raised ICP. Optimal cut-off points for systolic blood pressure (SBP), heart rate (HR) and pupil diameter to discriminate patients with a raised ICP were, respectively, >160 mm Hg,<60 bpm and >5 mm. Cushing criteria (SBP >160 mm Hg and HR <60 bpm) and pupillary response and size were complimentary in their ability to detect patients with a raised ICP. The presence of a fixed blown pupil or a Cushing's response had a specificity of 93.2 (88.2-96.6)%, and a positive likelihood ratio (LR+) of 5.4 (2.9-10.2), whereas sensitivity and LR- were only 36.8 (26.7-47.8)% and 0.7 (0.6-0.8), respectively, (Area Under the Curve (AUC) 0.65 (0.57-0.73)). Sensitivity analysis revealed that optimal cut-off values and resultant accuracy were dependent on injury pattern. Conclusion: Traditional clinical signs of raised ICP may under triage patients to prehospital treatment with hyperosmolar drugs. Further research should identify more accurate clinical signs or alternative non-invasive diagnostic aids in the prehospital environment.
MeSH term(s)	Bradycardia/diagnosis ; Brain Injuries, Traumatic/complications ; Early Diagnosis ; Emergency Medical Services ; England ; Female ; Glasgow Coma Scale ; Humans ; Hypertension/diagnosis ; Intracranial Hypertension/diagnosis ; Intracranial Hypertension/etiology ; Male ; Middle Aged ; Pupil Disorders/diagnosis ; Respiratory Insufficiency/diagnosis ; Retrospective Studies
Language	English
Publishing date	2020-09-18
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-2020-209635
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Article ; Online: Haemodynamic effects of a prehospital emergency anaesthesia protocol consisting of fentanyl, ketamine and rocuronium in patients with trauma: a retrospective analysis of data from a Helicopter Emergency Medical Service.

Ter Avest, Ewoud / Ragavan, Dassen / Griggs, Joanne / Dias, Michael / Mitchinson, Sophie A / Lyon, Richard

BMJ open

2021 Volume 11, Issue 12, Page(s) e056487

Abstract: Objectives: Prehospital rapid sequence induction (RSI) of anaesthesia is an intervention with significant associated risk. In this study, we aimed to investigate the haemodynamic response over time of a prehospital RSI protocol of fentanyl, ketamine and ...

Abstract	Objectives: Prehospital rapid sequence induction (RSI) of anaesthesia is an intervention with significant associated risk. In this study, we aimed to investigate the haemodynamic response over time of a prehospital RSI protocol of fentanyl, ketamine and rocuronium in a heterogeneous population of trauma patients. Design, setting and participant: We performed a retrospective study of all trauma patients who received a prehospital RSI for trauma by a physician staffed Helicopter Emergency Medical Service in the UK between 1 June 2018 and 1 February 2020. Primary outcome measure: Primary outcome was defined as the incidence of clinically relevant hypotensive (systolic blood pressure (SBP) or mean arterial pressure (MAP) >20% below baseline, with an absolute SBP <90 mm Hg or MAP <65 mm Hg) or hypertensive (SBP or MAP >20% above baseline) episodes in the first 10 minutes post-RSI. Results: In total, 322 patients were included. 204 patients (63%) received a full-dose induction of 3 μg/kg fentanyl, 2 mg/kg ketamine and 1 mg/kg rocuronium, whereas 128 patients (37%) received a reduced-dose induction. Blood pressures decreased on average 12 mm Hg (95% CI 7 to 16) in the full-dose group and 6 mm Hg (95% CI 1 to 11) in the reduced-dose group, p=0.10). A hypotensive episode (mean SBP drop 53 mm Hg) was noted in 29 patients: 17 (8.3%) receiving a full dose and 12 (10.2%) receiving a reduced-dose induction, p=0.69. The blood pressure nadir was recorded on average 6-8 min after RSI. A hypertensive episode was present in 22 patients (6.8%). The highest blood pressures were recorded in the first 3 min after RSI. Conclusion: Prehospital induction of anaesthesia for trauma with fentanyl, ketamine and rocuronium is not related to a significant change in haemodynamics in most patients. However, a (delayed) hypotensive response with a significant drop in SBP should be anticipated in a minority of patients irrespective of the dose regimen chosen.
MeSH term(s)	Aircraft ; Anesthesia/methods ; Emergency Medical Services/methods ; Fentanyl/pharmacology ; Fentanyl/therapeutic use ; Hemodynamics ; Humans ; Intubation, Intratracheal/methods ; Ketamine/adverse effects ; Retrospective Studies ; Rocuronium/pharmacology
Chemical Substances	Ketamine (690G0D6V8H) ; Fentanyl (UF599785JZ) ; Rocuronium (WRE554RFEZ)
Language	English
Publishing date	2021-12-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-056487
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Cardiac Arrest Caused by an Acute Intrathoracic Gastric Volvulus Treated With Percutaneous Gastrostomy.

Ter Avest, Ewoud / Kamphuis, Denice D / Sprakel, Joost / Witteveen, Hester / Hannivoort, Laura N

Annals of emergency medicine

2020 Volume 77, Issue 2, Page(s) 249–252

Abstract: During cardiopulmonary resuscitation, one of the first priorities after establishing basic and advanced life support is to identify the cause of the arrest. We present a rare case of cardiac arrest due to a decreased venous return from mediastinal shift ... ...

Abstract	During cardiopulmonary resuscitation, one of the first priorities after establishing basic and advanced life support is to identify the cause of the arrest. We present a rare case of cardiac arrest due to a decreased venous return from mediastinal shift caused by a paraesophageal hernia with an incarcerated thoracic gastric volvulus, which was treated by percutaneous gastrostomy.
MeSH term(s)	Aged ; Contrast Media ; Diagnosis, Differential ; Female ; Gastrostomy ; Heart Arrest/diagnosis ; Heart Arrest/etiology ; Heart Arrest/therapy ; Hernia, Hiatal/complications ; Hernia, Hiatal/diagnosis ; Hernia, Hiatal/surgery ; Humans ; Stomach Volvulus/complications ; Stomach Volvulus/diagnosis ; Stomach Volvulus/surgery ; Tomography, X-Ray Computed ; Ultrasonography
Chemical Substances	Contrast Media
Language	English
Publishing date	2020-09-17
Publishing country	United States
Document type	Case Reports
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2020.07.028
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Article ; Online: Organization of prehospital care in the Netherlands: a perspective article.

Backus, Barbra E / Ter Avest, Ewoud / Gerretsen, Benjamin M / Viljac, Antonia / Tolsma, Rudolf T

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

2020 Volume 27, Issue 6, Page(s) 398–399

MeSH term(s)	Emergency Medical Services ; Humans ; Netherlands ; Triage
Language	English
Publishing date	2020-10-26
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.0000000000000776
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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: Efficacy of scheduled return visits for emergency department patients with non-specific abdominal pain.

Boendermaker, Annemieke E / Coolsma, Constant W / Emous, Marloes / Ter Avest, Ewoud

Emergency medicine journal : EMJ

2018 Volume 35, Issue 8, Page(s) 499–506

Abstract: Introduction: Many patients presenting with abdominal pain to emergency departments (EDs) are discharged without a definitive diagnosis. For these patients, often designated as having non-specific abdominal pain, re-evaluation is often advocated. We ... ...

Abstract	Introduction: Many patients presenting with abdominal pain to emergency departments (EDs) are discharged without a definitive diagnosis. For these patients, often designated as having non-specific abdominal pain, re-evaluation is often advocated. We aimed to investigate how often re-evaluation changes the diagnosis and clinical management and discern factors that could help identify patients likely to benefit from re-evaluation. Methods: This was a retrospective study conducted in the Netherlands between 1 January 2014 and 31 December 2015 of patients asked to return to the ED after an initial presentation with acute non-traumatic abdominal pain. The primary outcome was a clinically relevant change in treatment (surgery, endoscopy during admission and/or hospitalisation) and diagnosis at ED re-evaluation within 30 hours. Results: During the 2-year study period, 358 ED patients with non-specific abdominal pain were scheduled for re-evaluation. Of these, 14% (11%-18%)) did not present for re-evaluation. Re-evaluation resulted in a clinically relevant change in diagnosis and treatment in, respectively, 21.3% (17%-29%)) and 22.3% (18%-27%)) of the subjects. Of the clinical, biochemical and radiological factors available at the index visit, C reactive protein (CRP) at the index visit predicted a change in treatment (CRP >27 mg/L likelihood ratio (LR)+ 1.69 (1.21-2.36)), while an increase in CRP of >25 mg/L between index and re-evaluation visit (LR+ 2.85 (1.88-4.32)) and the conduct of radiological studies at the re-evaluation visit were associated with changes in treatment (LR+ 3.05 (2.41-3.86)). Conclusion: Re-evaluation within 30 hours for ED patients discharged with non-specific abdominal pain resulted in a clinically relevant change in diagnosis and therapy in almost one-quarter of patients. Elevated CRP at the index visit might assist in correctly identifying patients with a greater likelihood of needing treatment in follow-up, and a low threshold for radiological studies should be considered during re-evaluation.
MeSH term(s)	Abdominal Pain/diagnosis ; Adolescent ; Adult ; Aged ; Diagnosis, Differential ; Emergency Service, Hospital/utilization ; Female ; Humans ; Male ; Middle Aged ; Netherlands ; Patient Readmission/statistics & numerical data ; Retrospective Studies ; Time Factors
Language	English
Publishing date	2018-06-02
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-2017-207338
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