Background: Intravenous adenosine is the recommended treatment for paroxysmal supraventricular tachycardia (PSVT). There is no official recommended method of giving adenosine. We compared the success rates between a standard and alternative method of first dose intravenous adenosine in PSVT. Methods: A pilot parallel randomized controlled study was conducted in the emergency department of a tertiary care hospital. Eligible patients were stable PSVT adult patients. We used block randomization and divided them into two groups, the standard method (double syringe technique of 6 mg of adenosine), and the alternative method (similar to the standard method, then immediately followed by elevating the arm to 90° perpendicular to a horizontal plane for 10 s). The primary outcome was the success rate of electrocardiogram (ECG) response which demonstrated termination of PSVT (at least two-fold of the RR-interval widening or sinus rhythm conversion). Secondary outcomes were complications within one minute after the injection. Results: We allocated 15 patients in each group and analyzed them as intention-to-treat. The success rate was 86.7% in the alternative group and 80% in the standard group (risk difference 6.7%, 95% confidence interval − 19.9 to 33.2%, P 1.00). Complications within one minute after adenosine injection were also similar in both groups, 14 of 15 patients (93%) in each group had no complications, without significant difference. Conclusions: No evidence of the difference between alternative and standard methods occurred, in terms of the success rate of ECG response and complications within one minute after adenosine injection. The standard method of adenosine injection is a safe, easy-to-administer, and widely available treatment for PSVT. Trial Registration: TCTR20200609001.

Compressions at the left ventricle increase rate of return of spontaneous circulation. This study aimed to identify the landmark of the point of maximal left ventricular diameter on the sternum (LVmax) by using chest computed tomography (CCT) in the arms-down position, which was similar to an actual cardiac arrest patient. A retrospective study was conducted between September 2014 and November 2020. We included adult patients who underwent CCT in an arms-down position and measured the rescuer’s hand. We measured the distance from the sternal notch to LVmax (DLVmax), to the lower half of sternum (DLH), and to the point of maximal force of hand, which placed the lowest palmar margin of the rescuer’s reference hand at the xiphisternal junction. Thirty-nine patients were included. The LVmax was located below the lower half of the sternum; DLVmax and DLH were 12.6 and 10.0 cm, respectively (p < 0.001). Distance from the sternal notch to the point of maximal force of the left hand, with the ulnar border located at the xiphisternal junction, was close to DLVmax; 11.3 and 12.6 cm, respectively (p = 0.076). In conclusion, LVmax was located below the lower half of the sternum, which is recommended by current guidelines.

Background/Objectives: Impaired kidney function is associated with persistently elevated cardiac troponin levels, complicating evaluation of suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The comparative performance of high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) across sampling intervals in this population remains uncertain. We aimed to identify a kidney function-adapted assay-sampling protocol combination for suspected NSTE-ACS that may support collaborative pathways between nephrologists and acute care clinicians. We therefore assessed kidney function-specific diagnostic and prognostic performance using 0/1 h and 0/3 h protocols. Methods: We conducted a prospective observational cohort study of adults presenting with suspected NSTE-ACS at a tertiary emergency department between March 2019 and December 2020. Patients were stratified according to kidney function at presentation using estimated glomerular filtration rate (eGFR). Impaired kidney function was operationally defined as eGFR < 60 mL/min/1.73 m². Serial hs-cTnT and hs-cTnI concentrations were measured at 0, 1, and 3 h and interpreted using assay-specific thresholds and delta criteria. Diagnostic performance for NSTE-ACS and prognostic performance for 30-day major adverse cardiovascular events (MACEs) were evaluated. Results: Among 140 patients, 58 (41%) had impaired kidney function. Baseline hs-cTnT and hs-cTnI concentrations were significantly higher in patients with impaired kidney function across all sampling time points. In this group, the 0/3 h protocol demonstrated superior diagnostic performance compared with the 0/1 h protocol for both assays. Using 0/3 h testing, hs-cTnI achieved the highest sensitivity (88.6%; 95% CI, 49.2–95.3), whereas hs-cTnT showed the highest negative predictive value (92.2%; 95% CI, 76.2–94.6). In patients with preserved kidney function, both assays demonstrated high specificity and positive predictive value with the 0/3 h protocol. Prognostic discrimination for 30-day MACEs also improved with a 0/3 h strategy, particularly in patients with impaired kidney function. Conclusions: In patients with impaired kidney function and suspected NSTE-ACS, extending troponin testing to 3 h improves diagnostic accuracy and short-term prognostic performance, supporting kidney function-adapted troponin strategies in emergency and nephrology care.

Early revisits to the emergency department (ED) are commonly used as a quality indicator and reflect challenges in discharge decision-making. Although the