Clinical and Experimental Emergency Medicine最新文献

Objective: To explore and analyze pediatric trauma care practices across designated pediatric trauma centers (PTCs) in Switzerland. The focus was on reception, trauma team activation (TTA), trauma team composition, patient volumes, and infrastructure.

Methods: A national online survey was conducted among all eight PTCs in Switzerland using an 18-item questionnaire. The survey investigated organizational aspects, criteria for TTA, patient volume, and communication modalities in pediatric emergency departments (PEDs).

Results: All PTCs responded, revealing varying methods of TTA, with reception of major trauma patients occurring at either PEDs or adjacent adult trauma facilities. Trauma team composition and activation criteria also differ among centers, with nonsurgeons often leading the teams and anesthesiologists being the default facilitators of airway management. TTA criteria vary widely, with the most common being the request of prehospitalization staff (62.5%) and physician discretion (50%). Trauma resuscitation is predominantly led by PED attendants (75%).

Conclusion: This survey provides insights into the state of pediatric trauma care in Switzerland. The findings underscore the importance of multidisciplinary teams and variability in trauma management practices, which are often tailored to local circumstances. Despite the study limitations of using self-reported data and the small sample size owing to the country's size, the result suggest that a national trauma registry would be helpful to the evaluation and optimization of pediatric trauma care protocols.

Objective: Ketamine is a promising drug for analgesia in emergency medicine, but the high rate of side effects is a barrier to widespread 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 trauma patients were randomly allocated with the numeric rating scale ≥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: In total, 80 patients were recruited. Of these, 77 patients were analyzed. Both groups achieved a statistically significant decrease in pain scores (all P<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 for any side effect (P<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.

This bibliometric analysis of the 100 most cited articles on experimental cardiac arrest models in rats identifies key contributors, publication trends, research themes, and collaboration networks. A comprehensive literature search of the Web of Science database was performed 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 ver. 4.2.3 and categorized by primary research focus. The articles were published from 1980 to 2022 and involved 416 authors and 44 journals, averaging 106.7 citations each. The primary research themes were neurology (72%), organ transplantation (7%), cardiovascular system (6%), Cardiopulmonary resuscitation outcomes after local anesthetic toxicity (4%), and other topics (5%). The United States, Japan, and Germany were leading contributors. Major clusters identified include "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 this topic reveals the dominance of neuroscience in experimental cardiac arrest models in rats. High-impact journals such as 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 and opportunities for more extensive international and interdisciplinary collaboration, always with a focus on scientific rigor.

Objective: To evaluate the current body of literature pertaining to the use of ocular point-of-care ultrasound (POCUS) in the emergency department (ED).

Methods: A comprehensive literature search was conducted on Scopus, Web of Science, MEDLINE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Inclusion criteria were studies written in English and primary clinical studies involving ocular POCUS scans in an ED setting. Exclusion criteria were nonprimary studies (e.g., reviews or case reports), studies written in a non-English language, nonhuman studies, studies performed in a nonemergency setting, studies involving non-POCUS ocular ultrasound modalities, or studies published more than 10 years prior. Data extraction was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations.

Results: The initial search yielded 391 results with 153 duplicates. Of the remaining 238 studies selected for retrieval and screening, 24 met the inclusion criteria. These 24 included studies encompassed 2,448 patients across prospective, retrospective, cross-sectional, and case series study designs. The majority of included studies focused on the use of POCUS in the ED to measure optic nerve sheath diameter as a proxy for papilledema and metabolic aberrations, while a minority of studies used ocular POCUS to assist in the diagnosis of orbital fractures or posterior segment pathology.

Conclusion: The vast majority of studies investigating the use of ocular POCUS in recent years emphasize its utility in measuring optic nerve sheath diameter and fluctuations in intracranial pressure, though additional outcomes of interest include pathology of the posterior segment, orbit, and globe.

Objective: Chest pain, a common emergency department presentation, requires rapid evaluation. The current gold standard of care is serial troponin measurements from blood draws along with an electrocardiogram and clinical presentation. However, an optical technology-based noninvasive wearable device, the Infrasensor, which can rapidly and transcutaneously assesses cardiac troponin I (cTnI), was recently developed. We aimed to perform a pilot study to evaluate the performance of the Infrasensor in cTnI defined cohorts.

Methods: This was a 10-hospital prospective observational study in healthy US subjects with a normal cTnI level and in patients with an elevated local cTnI level. Healthy subjects as determined by a negative questionnaire and bloodwork underwent 3-minute Infrasensor measurement and levels of high-sensitivity cTnI (hs-cTnI), n-terminal pro-B-type natriuretic peptide (NTproBNP), creatinine, and glycosylated hemoglobin (HbA1c) were evaluated from blood. Patients with elevated cTnI had the same Infrasensor and blood sample measurements. Using a fivefold cross-validation technique, cTnI-based binary classification models that did and did not include age were trained on 80% and validated on 20% of the dataset (n=168; elevated hs-cTnI equally partitioned into five nearly equally-sized subsets ).

Results: Of 840 patients, 727 (87.5%) had normal (nonelevated) cTnI levels while the remaining 113 had elevated cTnI. Median age was 61 years (interquartile range, 52-71 years) for the elevated cohort and 48 years (interquartile range, 32-57 years) for the nonelevated. Overall, 416 (50.5%) were female, with 33 of 113 (29.2%) in the elevated cohort and 383 of 727 (52.7%) in the nonelevated cohort. Overall, the sensitivity, specificity, negative and positive predictive values of the Infrasensor for identifying elevated cTnI were 0.90, 0.70, 0.98 and 0.48, respectively, with a C-statistic of 0.90 (95% confidence interval, 0.89-0.99).

Conclusion: The Infrasensor accurately identifies elevated cTnI within 3 minutes of application.

Airway foreign body (FB) removal is challenging and a time-limited and lifesaving procedure. Herein, we report successful removal of a life-threatening FB in the subglottic airway in an infant by physically forcing the FB further into the distal airway to block one lung and save the other. A 12-month-old boy presented in the emergency department with choking. Upon arrival, his mental status was alert. However, respiratory failure rapidly progressed and respiratory arrest occurred. We attempted to move the FB distally by pushing the endotracheal tube as deep as possible and inserting the stylet further. The patient was successfully resuscitated, and bronchoscopic FB removal was performed. The patient was discharged without respiratory or neurologic sequelae.