Clinical and Experimental Emergency Medicine最新文献

Objective: To determine whether a transesophageal echocardiography (TEE) probe can accurately measure temperature and be used to monitor temperature changes over time without overheating in an experimental model of hypothermia and rewarming.

Methods: A 6L water bath was heated with a sous vide immersion circulator to 24C, 28C, 32C and 36C to simulate severe hypothermia, moderate hypothermia, mild hypothermia, and normothermia. A TEE probe, esophageal temperature probe, and bladder temperature probe were used to measure temperature. Temperatures were recorded every 60 seconds for 15 minutes prior to raising temperature to the next predetermined temperature.

Results: The TEE probe reported temperatures with a mean difference of 0.60°C (95% CI, 0.51°C - 0.69°C) compared to the reported temperature of the sous vide immersion circulator. The esophageal probe and bladder probe reported temperatures with a mean difference of -0.19°C (95% CI, -0.23°C - -0.14°C) and - 0.20°C (95% CI, -0.26°C - -0.14°C) respectively.

Conclusion: During this simulation, the TEE tip temperature did not increase apart from expected changes from water temperature changes. The probe temperature was less accurate than the esophageal and bladder temperature probes but demonstrated precision in monitoring temperature changes and stable hypothermia. Based on this study, TEE probes should not be relied upon for an accurate initial temperature but can likely be used to monitor changes in temperature over time.

In South Korea, growing frustration among medical doctors over government healthcare policies, such as increasing medical student intake, has led to a surge in doctors considering practicing medicine abroad. Despite efforts to address specialty shortages, 82% of doctors believe these policies fail to tackle underlying issues like low compensation and legal protections for high-risk procedures. Engaging with public health perspectives, physicians can frame healthcare challenges and advocate for policy change. By addressing broader social determinants of health (SDOH), doctors can contribute to more effective, equitable healthcare policies.

Objective: Traumatic brain injury (TBI) often occurs alongside injuries to other body regions, worsening patient outcomes. This study aimed to evaluate the impact of concomitant injuries on clinical outcomes in patients with isolated versus non-isolated TBI.

Method: A retrospective cross-sectional analysis was conducted using data from the Emergency Department-based Injury In-depth Surveillance System (EDIIS), encompassing 180,058 TBI patients admitted to 23 tertiary hospitals from January 1, 2020, to December 31, 2022. Patients were categorized into isolated TBI (iTBI, n = 127,673) and non-isolated TBI (niTBI, n = 52,385) groups based on injury diagnostic codes. Clinical outcomes-including 24-hour and 30-day mortality, hospital admission, and interhospital transfer-were compared. Multivariate logistic regression analyses adjusted for potential confounders were performed.

Result: niTBI patients exhibited significantly higher 24-hour mortality (1.5% vs. 0.4%), 30-day mortality (2.6% vs. 1.0%), hospital admissions (24.5% vs. 8.4%), and interhospital transfers (3.6% vs. 1.1%) compared to iTBI patients (all p < 0.001). Concomitant injuries increased the adjusted odds of 24-hour mortality (aOR = 1.456; 95% CI: 1.286-1.648) and 30-day mortality (aOR = 1.111; 95% CI: 1.022-1.208). Thoracic injuries were the most significant predictor of adverse outcomes in niTBI patients, nearly sixfold increasing the odds of 24-hour mortality (aOR = 5.958; 95% CI: 5.057-7.019).

Conclusions: Concomitant injuries significantly worsen clinical outcomes in TBI patients, with thoracic injuries being the most critical predictor of mortality. These findings highlight the importance of comprehensive trauma assessment and targeted prevention strategies to improve survival rates and optimize resource allocation for patients with multiple injuries.

Objective: In the context of acute cardiogenic pulmonary edema (ACPE), a frequently encountered medical emergency associated with high early mortality rates, there is a need to predict short-term outcomes for risk stratification.Our aim was to derive and validate a model, a simple clinical scoring system using baseline vital signs, clinical and presenting characteristics, and readily available laboratory tests, that allows accurate prediction of short-term mortality in individuals experiencing ACPE.

Methods: This retrospective cohort study included 1088 patients with ACPE from six health centers. Subjects were randomly allocated into derivation and validation cohorts at a 4:3 ratio, facilitating comprehensive examination and validation of prognostic model. Independent predictors of mortality (p<0.05) from the multivariable model were included in the risk score. The discriminant ability of the score was tested by ROC analysis.

Results: In the derivation cohort (n=623), age, blood urea nitrogen, heart rate, intubation, anemia, and systolic blood pressure were identified as independent predictors of mortality in multivariable analysis. These variables were used to develop a risk score ranging from 0 to 6 by scoring 0 and 1. The SABIHA score provided a good calibration with a concordance index of 0.879 (95% CI: 0.821-0.937). While the probability of short-term mortality was 80.0% in the high risk group, this rate was only 3.3% in the low risk group. This score also performed well on the validation set.

Conclusions: A simple clinical score consisting of routinely obtained variables can be used in risk stratification to predict short-term outcomes in patients with ACPE.

Objective: Rapid sequence intubation (RSI) involves the administration of induction agents and neuromuscular blockers before endotracheal intubation (ETI). However, RSI seems to be underutilized outside emergency departments (ED). We compared RSI adoption rates and ETI outcomes outside and within EDs and investigated whether RSI adoption affected ETI outcomes outside EDs.

Methods: This retrospective study included adults who underwent emergency ETI outside the operating room at a university hospital between March 2022 and February 2023. The exclusion criteria included CPR, intentional RSI avoidance, and tube exchange via the introducer. The primary outcome was the first-pass success rate. Secondary outcomes included multiple (≥3) attempts, prolonged (>5 min) ETI, and complications. The association between RSI adoption and outcomes outside the ED was assessed using multivariable logistic regression.

Results: A total of 490 ETI cases were included: 290 males, 68.3±14.7 y. Cases outside ED (n=286) received less RSI than cases at ED (n=204): 12.6% vs. 86.8%, p<0.001. They showed less first-attempt success (62.2% vs. 88.2%) and more multiple attempts (11.5% vs. 2.0%), total time of ETI (8.4±8.3 vs. 2.5±2.5 min, p<0.001), and complications (32.2% vs. 19.6%, p=0.003). However, multivariable logistic regression revealed no significant association between RSI adoption and outcomes outside the ED: odds ratio 1.74 [95% CI: 0.783-3.84], 0.167 [0.022-1.30], 1.04 [0.405-2.69]), and 1.50 [0.664-3.40]), respectively.

Conclusion: Outside the ED, RSI adoption was lower and ETI outcomes were poorer than those within the ED. However, no association was found between RSI adoption and ETI outcomes outside the ED.

This study aimed to conduct a bibliometric analysis of the 100 most cited articles on experimental cardiac arrest models in rats, identifying key contributors, publication trends, research themes, and collaboration networks. A comprehensive literature search was performed on the Web of Science (WoS) database on June 11, 2024, using keywords related to cardiac arrest and rat models. The top 100 most cited articles were analyzed using the Biblioshiny web application from the Bibliometrix R package (version 4.2.3), categorized by primary research focus. Articles, published from 1980 to 2022, involved 416 authors across 44 journals, averaging 106.7 citations each. Primary research themes were neurology (72%), organ transplantation (7%), cardiovascular system (6%), CPR outcomes after local anesthetic toxicity (4%), and other topics (5%). The United States, Japan, and Germany were leading contributors, with limited international collaborations. Major clusters identified included "Cerebral Ischemia and Outcomes," "Brain Imaging Metrics," and "Blood Brain Barrier". The most commonly used methodologies for cardiac arrest induction were asphyxia, induction by magnesium or potassium chloride and electrical stimulation. This first bibliometric analysis on the topic reveals a dominance of neuroscience in experimental cardiac arrest models in rats. High-impact journals like the "Journal of Cerebral Blood Flow and Metabolism" play critical roles in disseminating significant research. The study highlights substantial gaps in global research engagement, with minimal contributions from lower-income countries and few international collaborations. This analysis provides a roadmap for future research directions and opportunities for more extensive international and interdisciplinary collaboration, always with a focus on scientific rigor.