Clinical and Experimental Emergency Medicine最新文献

Background: Ketamine is a promising drug for analgesia in emergency medicine, but a high rate of side effects is a barrier to whispered usage. We hypothesized that ketamine bolus followed by ketamine infusion would provide a more even and longer duration of analgesia and lower rates of side effects in comparison to bolus-only administration.

Methods: This was a double-blinded, clinical trial. Eligible traumatic patients were randomly allocated with the Numerical Rating Scale (NRS) ≥6 in two study groups. The first group received a dose of 0.3 mg/kg of ketamine over 1 minute, followed by an infusion of saline 0.9% over the next 30 minutes (bolus only group). The second group was given 0.15 mg/kg of ketamine over 1 minute, followed by an infusion of 0.15 mg/kg over the next 30 minutes (bolus and infusion group). The primary outcome was to measure the average reduction in pain scores.

Results: 80 patients were recruited. Of these, 77 patients were analyzed. Both groups achieved a statistically significant decrease in pain scores (All p-values<0.001). After 30 minutes, patients in the bolus and infusion group reported lower pain scores in all intervals with lower rates of need for rescue analgesia but this difference was not statistically significant. Vital signs remained stable during the study in both groups. No statistically significant difference was observed between study groups in any side effect (p-value< 0.05).

Conclusion: Both administration protocols resulted in significant pain control. No statistically significant difference was observed between study groups in terms of analgesic efficacy and side effects.

Objective: We evaluated prognostic factors for pediatric drowning patients. The association between functional outcomes and clinical factors was investigated.

Methods: A retrospective cohort study was conducted using data for pediatric drowning patients from the Korean Community-based Severe Trauma Survey from 2016 to 2020. The primary outcome was a good prognosis at discharge, defined as a Glasgow Outcome Scale score of 1. A multivariable logistic regression analysis was performed to evaluate independent factors associated with the primary outcome.

Results: From 237,616 patients, we identified 406 drowning patients aged <19 years (mean age, 8.8 years). At discharge, 41.0% of those patients had a good recovery. The absence of prehospital cardiac arrest (adjusted odds ratio [aOR], 98.7; 95% confidence interval [CI], 32.9-295.8), indoor location (aOR, 4.0; 95% CI, 1.7-9.3), and transfer to a high-volume hospital (aOR, 2.5; 95% CI, 1.1-5.8) were significant independent factors associated with a good outcome. Age, sex, the intent of injury, and prehospital time were not associated with the outcome.

Conclusion: Our study identified independent prognostic factors for drowning patients, highlighting the importance of prehospital conditions and hospital care settings in determining outcomes. These findings could be useful in developing clinical strategies for managing such patients.

Objectives: The objective of this systematic review and meta-analysis is to evaluate the efficacy, safety, time to INR reversal, total volume of 4-factor prothrombin complex concentrate (PCC) administered of fixed-dose versus weight-based dosing strategies in patients requiring urgent warfarin reversal, with specific focus on clinical outcomes such as hemostatic efficacy, thromboembolic events, and mortality rates.

Methods: A comprehensive systematic review was conducted using the PubMed, Embase, and Cochrane databases from inception through October 2023. We searched for randomized clinical trials or observational studies that compared efficacy or safety outcomes of fixed-dose vs. variable 4-PCC dose in adult patients.

Results: A total of fourteen studies were included. The overall use of fixed-dose 4-PCC was associated with a lower likelihood of reaching the INR goal (RR = 0.84, 95% CI 0.80 - 0.89) and a significantly higher proportion of patients (169 out of 651 [26%]) required an additional dose of 4-PCC compared to the variable-dose group. The rate of mortality (RR = 0.85, 95% CI 0.70 - 1.03) and thromboembolic events (RR = 1.27, 95% CI 0.65 - 2.45) were similar between the two treatment groups.

Conclusions: This systematic review and meta-analysis showed that variable dosing of 4-PCC more successfully achieves the target INR for warfarin reversal compared to fixed dosing. However, both dosing strategies have similar mortality and thromboembolic rates. While fixed dosing offers a simpler approach, it may require additional dosing. Future studies should focus on optimizing dosing strategies to balance efficacy, safety, and practicality in various clinical scenarios.

Objectives: Prompt activation of emergency medical services (EMS) constitutes the fundamental component of bystander response to time-dependent health crises. A clear understanding of the public ability to access EMS may help to guide interventions aimed at enhancing community preparedness for emergencies. This review was conducted to summarise studies that examined public knowledge of emergency phone numbers.

Methods: The scoping review encompassed articles published since 2004 that reported the proportion of subjects who knew emergency phone numbers. Data sources included PubMed, Google Scholar and references of included articles. Relevant data from eligible publications were extracted manually to an author-developed data-charting sheet and analysed descriptively.

Results: Forty-eight articles were analysed. Reported studies, mostly cross-sectional surveys, were conducted in 26 countries, including 16 high-income, nine middle-income and one low-income country. The percentage of subjects who knew emergency numbers varied from 0.0 to 97.8 (median [interquartile range]: 64.3 [32.8-80.0]). For developed countries, it was significantly higher than for developing nations (69.6 [54.1-84.2] and 34.6 [19.4-61.5], respectively; p=0.003). The studies were generally inconsistent regarding the association of subjects' socio-demographic factors with knowledge of emergency numbers, suggesting the existence of geography-specific patterns.

Conclusions: Available studies observed low community knowledge of emergency numbers, especially in developing countries, and suggest that the problem has a global scale. Further research efforts are required to determine the best strategies for enhancing the public ability to access EMS.

Objective: The study aims to investigate the long-term impacts of traumatic brain injury (TBI) on neuroinflammation and neuronal apoptosis in pediatric and adult mice, specifically focusing on how age-at-injury influences these processes.

Methods: Controlled cortical impact (CCI) was used to induce TBI in pediatric (21-25 days old) and adult (8-12 weeks old) C57Bl/6 male mice. Neuroinflammation was evaluated through immunoreactivity for Iba-1 and GFAP, while apoptosis was assessed using markers such as Bax, Bcl- 2, and pro-caspase-3. Additionally, HSP70 expression was measured to understand the stress response.

Results: Following CCI, pediatric mice exhibited a significant reduction in NeuN expression(p < 0.001), significant increase in GFAP (p < 0.01) and AIF-1/Iba1 expression (p < 0.05) at 3 dpi compared to sham controls. In contrast, adult mice exhibited no significant change in AIF-1/Iba1 expression and a less pronounced increase in GFAP (p < 0.05) at 3 dpi compared to sham controls. Pediatric mice demonstrated a more significant increase in Bax/Bcl-2 ratio at 7 dpi (p < 0.01), While adult mice a little weak significant increase in Bax/Bcl-2 ratio at 7 dpi (p < 0.05). Both age groups showed a significant but transient increase in HSP70 levels at 7 dpi, which normalized by 90 dpi.

Conclusions: Pediatric and adult mice exhibited significant time-dependent differences in neuroinflammation and apoptosis following TBI, with pediatric mice showing more intense early responses, highlighting age-specific vulnerabilities in post-injury outcomes. Both age groups showed a significant but transient increase in HSP70 expression, suggesting an acute stress response postinjury.

Abdominal pain is one of the most common presenting chief complaints in the emergency department. Erector spinae plane block (ESPB) is an ultrasound-guided nerve block with proven effectiveness in treating visceral and somatic abdominal pain. Despite the increasing popularity of ESPB, its role in the management of nonsurgical abdominal pain has not yet been characterized. Our scoping review aims to synthesize current knowledge on the safety and efficacy of ESPB in the management of patients experiencing intractable, nonsurgical abdominal pain. We searched PubMed and Scopus to evaluate the existing literature on ESPB for nonsurgical abdominal pain. A total of 14 journal articles were included: 12 case-based studies, one systematic review, and one narrative review. All cases described the successful use of ESPB in treating abdominal pain refractory to oral or intravenous analgesic medications, and no complications were reported in any cases. This scoping review provides support for the use of ESPB to manage intractable, nonsurgical abdominal pain. ESPB has demonstrated efficacy in alleviating various conditions such as functional abdominal pain, renal colic, pancreatitis, herpetic pain, and cancer-related pain. Theoretical risks such as pneumothorax, bleeding, and infection are possible, although the studies reviewed did not report such complications.

Objective: Emergency department observation units (EDOUs) transition patients from the ED to dedicated areas where they can receive continuous monitoring. Understanding patient return visits after EDOU discharge is important for optimizing healthcare. The objective of this study was to investigate the correlations between demographic and clinical features and the likelihood of returning to the ED within 30 days following an initial EDOU assessment.

Methods: This retrospective, observational, cohort study of adult EDOU subjects was conducted between February 1, 2018, and January 31, 2023. Adult patients who were evaluated in an EDOU and returned to an ED within 30 days were compared with those who were assessed in the EDOU but did not return to the ED within 30 days. The analysis took into account multiple visits by the same subject and made adjustments for variables of sex, ethnicity, insurance status, primary diagnosis, and disposition using a generalized linear mixed model.

Results: A total of 14,910 EDOU encounters was analyzed, and 2,252 patients (15%) returned to the ED within 30 days. The analysis took into account several variables that indicated a significant association with the likelihood of returning to the ED within 30 days. These were sex (P<0.001), ethnicity (P=0.005), race (P<0.001), insurance status (P<0.001), primary diagnosis (P<0.001), and disposition (P<0.001). Emergency severity index and length of stay were not associated with ED return.

Conclusion: Understanding these factors may guide interventions, enhance EDOU care, and reduce resource strain. Further research should explore these associations and the long-term intervention impacts on improved outcomes.