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Wikipedia as a highly accessed though imperfect source of knowledge on cardiopulmonary resuscitation. 维基百科作为心肺复苏知识的来源,虽然不完善,但访问量很大。
IF 1.9 Q2 Nursing Pub Date : 2024-05-23 DOI: 10.15441/ceem.24.223
Alexei A Birkun
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引用次数: 0
Can CT measured LA diameter predict the presence and the degree of LV Diastolic Dysfunction? CT 测量的 LA 直径能否预测左心室舒张功能障碍的存在和程度?
IF 1.9 Q2 Nursing Pub Date : 2024-05-23 DOI: 10.15441/ceem.24.194
Gae An Kim, Ji Ung Na, Dong Hyuk Shin, Jang Hee Lee

Objective: This study was conducted to determine whether the presence and the degree of left ventricular diastolic dysfunction (LVDD) can be predicted by the simple LA diameter measured on computed tomography (CTLAD).

Methods: Among adult patients who underwent both chest CT and echocardiography in the emergency department from January 2020 to December 2021, a retrospective cross-sectional study was conducted on patients in whom the time interval between the two tests was less than 24 hours. Receiver operating characteristic curve analysis was used to evaluate the diagnostic power of CTLAD for echocardiographic LVDD.

Results: In a study involving 373 patients, 192 (51.5%) had LVDD. Among them, 122 (63.5%) had grade 1, 61 (31.8%) had grade 2, and 9 (4.7%) had ≥grade 3 LVDD. Median CTLAD values were 4.1cm for grade 1, 4.5cm for grade 2, and 4.9cm for ≥grade 3 LVDD. The AUC value of CTLAD in distinguishing LVDD of ≥grade 1, ≥grade 2 (optimal cutoff ≥4.4cm), and ≥grade 3 (optimal cutoff ≥4.5cm) were 0.588, 0.657 (with sensitivity 61.4%, specificity 66.0%, positive predictive value [PPV] 29.5%, negative predictive value [NPV] 88.1%, odds ratio [OR] 3.1), and 0.834 (with sensitivity 88.9%, specificity 70.1%, PPV 6.8%, NPV 99.6%, OR 18.7), respectively.

Conclusion: CTLAD ≥4.4cm can be used as a rough reference value to distinguish LVDD of ≥grade 2, and CTLAD ≥4.5cm can be very reliably distinguish LVDD of ≥grade 3. CTLAD might be very useful parameter in predicting LVDD in environments where echocardiography is not available.

研究目的本研究旨在确定是否可以通过计算机断层扫描(CTLAD)测量的简单LA直径预测左心室舒张功能障碍(LVDD)的存在和程度:2020年1月至2021年12月期间,在急诊科接受胸部CT和超声心动图检查的成年患者中,对两次检查时间间隔小于24小时的患者进行了回顾性横断面研究。研究采用接收者操作特征曲线分析法评估 CTLAD 对超声心动图 LVDD 的诊断能力:在一项涉及 373 名患者的研究中,192 人(51.5%)患有 LVDD。其中,122 例(63.5%)为 1 级,61 例(31.8%)为 2 级,9 例(4.7%)为≥3 级 LVDD。1 级 LVDD 的 CTLAD 中位值为 4.1 厘米,2 级为 4.5 厘米,≥3 级为 4.9 厘米。CTLAD 在区分≥1 级、≥2 级(最佳临界值≥4.4cm)和≥3 级(最佳临界值≥4.5cm)LVDD 时的 AUC 值分别为 0.588、0.657(敏感性 61.4%,特异性 66.0%,阳性预测值 [PPV] 29.5%,阴性预测值 [NPV] 88.1%,比值比 [OR] 3.1)和 0.834(敏感性 88.9%,特异性 70.1%,PPV 6.8%,NPV 99.6%,OR 18.7):结论:CTLAD≥4.4cm可作为区分≥2级LVDD的粗略参考值,CTLAD≥4.5cm可非常可靠地区分≥3级LVDD。在没有超声心动图的情况下,CTLAD可能是预测LVDD的非常有用的参数。
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引用次数: 0
Sex and Age Differences in Atypical Chief Complaints for Acute Decompensated Heart Failure in Emergency Department Visits. 急诊科就诊的急性失代偿性心力衰竭患者非典型主诉的性别和年龄差异。
IF 1.9 Q2 Nursing Pub Date : 2024-05-23 DOI: 10.15441/ceem.24.226
Matthew L Regan, Jason J Bischof, Montika Bush, Anna E Waller, Timothy F Platts-Mills, Martin F Casey, Michelle L Meyer

Objectives: Around one million United States emergency department (ED) visits annually are due to acute decompensated heart failure (ADHF) symptoms. Characterizing ED symptom presentation of ADHF patients may improve clinical care, yet sex and age differences in ED chief complaints have not been thoroughly investigated. This paper aims to describe differences in chief complaints and comorbid conditions for ED patients with a ADHF diagnosis, stratified by sex and age.

Methods: Retrospective analysis of adults presenting to North Carolina EDs in NC DETECT, a statewide syndromic surveillance system, between 2010 and 2016 with a diagnosis of ADHF. Frequencies of chief complaint categories for ED visits and comorbid conditions, stratified by sex and age, were evaluated and standardized differences computed.

Results: Top chief complaints were dyspnea (19.1%), chest pain (13.5%), and other respiratory complaints (13.4%). In the 18-44 age group, females when compared to males reported more nausea/vomiting (6.7% versus 4.1%) and headache (4.2% versus 2.0%). In those 45-64 and 65+ years old, complaints were similar by sex. When stratified by age group alone, the 18-44 and 45-64 age groups had more complaints of chest pain, whereas balance issues, weakness, and confusion were more common in the 65+ age group.

Conclusion: Sex and age differences in atypical ADHF symptoms were seen in in ED patients with ADHF. Characterizing variation of ADHF symptoms in ED patients can inform the identification of ED patients with ADHF and the management of ADHF-related symptoms.

目的:美国每年约有一百万人因急性失代偿性心力衰竭(ADHF)症状到急诊科就诊。描述 ADHF 患者的急诊科症状表现可改善临床护理,但急诊科主诉的性别和年龄差异尚未得到深入研究。本文旨在描述诊断为 ADHF 的急诊患者在主诉和合并症方面的差异,并按性别和年龄进行分层:方法:回顾性分析 2010 年至 2016 年期间在北卡罗来纳州急诊室就诊并被诊断为 ADHF 的成年人。按性别和年龄对急诊室就诊主诉类别和合并症的频率进行了评估,并计算了标准化差异:最主要的主诉是呼吸困难(19.1%)、胸痛(13.5%)和其他呼吸道主诉(13.4%)。在 18-44 岁年龄组中,女性报告的恶心/呕吐(6.7% 对 4.1%)和头痛(4.2% 对 2.0%)比男性多。在 45-64 岁和 65 岁以上的人群中,不同性别的投诉情况相似。如果仅按年龄组进行分层,18-44 岁和 45-64 岁年龄组的主诉多为胸痛,而 65 岁以上年龄组的主诉多为平衡问题、虚弱和精神错乱:结论:急诊科 ADHF 患者的非典型 ADHF 症状存在性别和年龄差异。对急诊科 ADHF 患者的 ADHF 症状进行特征分析,可为识别急诊科 ADHF 患者和处理 ADHF 相关症状提供依据。
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引用次数: 0
Management of organophosphorus poisoning and the role of magnesium sulfate: A scoping review of literature. 有机磷中毒的处理和硫酸镁的作用:文献综述。
IF 1.9 Q2 Nursing Pub Date : 2024-04-05 DOI: 10.15441/ceem.23.179
Z. Nekoukar, Homa Talabaki, Z. Zakariaei, Mahdi Mesri, Hossein Azadeh
Organophosphorus agents are easily absorbed via respiratory, gastrointestinal, and dermal routes, and inhibit the acetylcholine transferase enzyme (AChE), which is responsible for the majority of toxicity caused by organophosphates in the body. A comprehensive search was conducted across three prominent databases, namely Google Scholar, PubMed, and Science Direct, to identify relevant articles published. The search focused on the keywords "MgSO4" or "magnesium sulfate" in conjunction with "organophosphate" or "organophosphate poisoning." Inhibition of AChE results in the accumulation of acetylcholine (ACh) in synapses and stimulation of cholinergic receptors. Considering that several studies have shown the use of magnesium sulfate (MgSO4) in inhibiting the release of ACh in the central and peripheral sympathetic and parasympathetic synapses, this study was conducted to review the role of MgSO4 in the treatment of OP. The intravenous administration of MgSO4 exhibits favorable tolerability and clinical efficacy in alleviating cardiac toxicity associated with OP exposure.
有机磷制剂很容易通过呼吸道、胃肠道和皮肤途径被吸收,并能抑制乙酰胆碱转移酶(AChE),而乙酰胆碱转移酶是有机磷在人体内产生毒性的主要原因。我们在 Google Scholar、PubMed 和 Science Direct 这三个著名数据库中进行了全面搜索,以确定已发表的相关文章。搜索的重点是关键词 "MgSO4 "或 "硫酸镁 "以及 "有机磷 "或 "有机磷中毒"。抑制 AChE 会导致乙酰胆碱(ACh)在突触中蓄积并刺激胆碱能受体。考虑到多项研究表明硫酸镁(MgSO4)可用于抑制中枢和外周交感神经和副交感神经突触中乙酰胆碱的释放,本研究对硫酸镁在治疗 OP 中的作用进行了回顾。在减轻与 OP 暴露相关的心脏毒性方面,静脉注射硫酸镁具有良好的耐受性和临床疗效。
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引用次数: 0
Comparison of Dual-Dispatch Protocols on Return of Spontaneous Circulation in Patients with Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study. 院外心脏骤停患者恢复自主循环的双调度方案比较:一项全国性观察研究。
IF 1.9 Q2 Nursing Pub Date : 2024-04-05 DOI: 10.15441/ceem.23.177
Seung Hyo Lee, Young Su Kim, Jeseong Park, H. Lim, Won Pyo Hong
ObjectiveIn South Korea, the National Fire Agency (NFA) conducted a pilot project on the advanced life support (ALS) protocol, including epinephrine administration, to improve the survival rate of out-of hospital cardiac arrest (OHCA). Therefore, this study aimed to evaluate the effect of the ALS protocol of NFA on prehospital return of spontaneous circulation (PROSC) in patients with OHCA.MethodsThis study was conducted on patients with adult-presumed cardiac arrest between January and December 2020. The main factor of interest was ambulance type according to the ALS protocol, which was divided into dedicated ALS(DA), smartphone-based ALS(SALS), and non-dedicated ALS(Non-DA), and the main analysis factor was PROSC. Multivariate logistic regression analysis was performed.ResultsDuring the study period, a total of 18,031 adult patients with OHCA were treated by the emergency medical service (EMS), including 7,520 (41.71 %) DA, 2,622 (14.54 %) SALS, and 7,889 (43.75 %) Non-DA. The prehospital ROSC ratio was 13.19% for the DA, 11.17% for the SALS, and 7.91% for the Non-DA ambulance (P < 0.01). Compared with that of the DA group, the odds ratio (95% confidence interval [CI]) for PROSC ratio in the SALS and Non-DA groups were 0.97 (0.82-1.15) and 0.57 (0.50-0.65), respectively. It was shown that the PROSC ratio of the DA group was higher than that of the Non-DA group and was not lower than that of the SALS group.ConclusionALS protocol intervention was associated with difference in PROSC rates. Therefore, continuous efforts on the systemic implementation of the ALS protocol to improve OHCA outcomes are necessary.
目的在韩国,国家消防局(NFA)开展了包括肾上腺素给药在内的高级生命支持(ALS)方案试点项目,以提高院外心脏骤停(OHCA)患者的存活率。因此,本研究旨在评估国家外国专家局的高级生命支持方案对院外心脏骤停患者院前自发循环恢复(PROSC)的影响。主要研究因素为根据ALS协议划分的救护车类型,分为专用ALS(DA)、基于智能手机的ALS(SALS)和非专用ALS(Non-DA),主要分析因素为PROSC。结果在研究期间,共有18,031名成人OHCA患者接受了急救医疗服务(EMS),其中包括7,520名(41.71%)DA患者、2,622名(14.54%)SALS患者和7,889名(43.75%)非DA患者。DA组的院前ROSC比率为13.19%,SALS组为11.17%,非DA组为7.91%(P < 0.01)。与DA组相比,SALS组和非DA组PROSC比率的几率比(95%置信区间[CI])分别为0.97(0.82-1.15)和0.57(0.50-0.65)。结果显示,DA 组的 PROSC 比率高于非 DA 组,但不低于 SALS 组。因此,有必要继续系统地实施 ALS 方案,以改善 OHCA 的预后。
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引用次数: 0
Popular websites as a source of misinformation on first aid in foreign body airway obstruction. 作为异物气道阻塞急救错误信息来源的热门网站。
IF 1.9 Q2 Nursing Pub Date : 2024-04-05 DOI: 10.15441/ceem.23.176
Alexei A Birkun, A. Gautam
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引用次数: 0
Erector spinae plane block (ESPB) for intractable, non-surgical abdominal pain: a scoping review. 治疗顽固性非手术腹痛的脊柱后凸平面阻滞术(ESPB):范围综述。
IF 1.9 Q2 Nursing Pub Date : 2024-03-15 DOI: 10.15441/ceem.23.171
Ashley Meyer, Campbell Belisle Haley, Eisa Razzak, Amanda Dos Santos, Kyle Dornhofer, Edmund Hsu, Soheil Saadat, John Christian Fox, Megan Guy

Abdominal pain is one of the most common presenting chief complaints in the emergency department (ED). 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 non-surgical abdominal pain has not yet been characterized. Our scoping review aims to review the current literature on the safety and efficacy of ESPB in the management of patients experiencing intractable, non-surgical abdominal pain. We searched PubMed and Scopus to evaluate the existing literature on ESPB for non-surgical abdominal pain. Reviewers screened 30 titles and abstracts that met the predefined inclusion and exclusion criteria. Following initial screening, 24 articles underwent full-text review. Two reviewers also screened references included in each study. A total of 14 journal articles were reviewed, including 12 case-based studies, one systematic review, and one narrative review of ESPB in the treatment of non-surgical abdominal pain. All cases described the successful use of ESPB in treating abdominal pain refractory to oral or intravenous analgesic medications, and each case reported no complications. This scoping review provides support for ESPB in the management of intractable, non-surgical abdominal pain. ESPB demonstrates 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.

腹痛是急诊科(ED)最常见的主诉之一。脊柱后凸面阻滞(ESPB)是一种超声引导下的神经阻滞,在治疗内脏和躯体性腹痛方面效果显著。尽管 ESPB 越来越受欢迎,但其在非手术腹痛治疗中的作用尚未定性。我们的范围界定综述旨在回顾ESPB在治疗顽固性非手术腹痛患者中的安全性和有效性方面的现有文献。我们检索了 PubMed 和 Scopus,以评估有关 ESPB 治疗非手术腹痛的现有文献。审稿人筛选了符合预定义纳入和排除标准的 30 篇标题和摘要。经过初步筛选,有 24 篇文章进行了全文审阅。两名审稿人还对每项研究中的参考文献进行了筛选。共审阅了 14 篇期刊论文,包括 12 篇病例研究、1 篇系统综述和 1 篇关于 ESPB 治疗非手术腹痛的叙述性综述。所有病例都描述了成功使用 ESPB 治疗口服或静脉镇痛药物难治性腹痛的情况,并且每个病例都未报告并发症。本范围综述为 ESPB 治疗难治性非手术腹痛提供了支持。ESPB在缓解功能性腹痛、肾绞痛、胰腺炎、疱疹性疼痛和癌症相关疼痛等各种病症方面均有疗效。气胸、出血和感染等理论上的风险是可能存在的,但所审查的研究并未报告此类并发症。
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引用次数: 0
Factors associated with Parental Knowledge and Attitudes towards Concussions in the Republic of Korea. 大韩民国家长对脑震荡的认识和态度的相关因素。
IF 1.9 Q2 Nursing Pub Date : 2024-03-15 DOI: 10.15441/ceem.23.155
DongWon Son, Ki Ok Ahn, Hang A Park, Ju Ok Park

Background: This study investigated the status and evaluated factors associated with knowledge and attitudes regarding concussions among Korean parents of children aged 6-18 years.

Methods: A cross-sectional online survey was employed to collect data from a panel of parents in the Republic of Korea in 2023. To assess knowledge and attitudes regarding concussions, participants completed a validated questionnaire. The outcome variables of the total knowledge and total attitude scores, which ranged from 0 to 30 and 7 to 49, respectively, were categorized into three levels based on approximately 33% increments. We conducted multivariable ordinal logistic regression analyses with the participants' and their children's demographics and characteristics as covariates.

Results: A total of 260 parents responded to the survey and demonstrated moderate concussion-related knowledge (median total score, (Inter Quartile Range (IQR) 18-22.5)). The respondents exhibited favorable attitudes toward concussions (median total score, 39 (IQR 34-43)). Multivariate ordinal regression analysis for outcomes revealed that, except for the careers of healthcare providers (adjusted odds ratio (AOR) 3.15, 95% confidence interval (CI), 1.13-8.75), no factors were associated with parental concussion-related knowledge. Among the factors, none exhibited a statistically significant association with concussion-related parental attitudes.

Conclusion: Our results confirmed the knowledge-attitude gap regarding concussions among Korean parents and novel strategies are warranted to improve parental knowledge and attitudes.

背景:本研究调查了韩国 6-18 岁儿童家长对脑震荡的认识和态度,并评估了与之相关的因素:本研究调查了韩国 6-18 岁儿童家长对脑震荡的认识和态度的现状,并对相关因素进行了评估:方法:采用横断面在线调查的方式,收集 2023 年大韩民国家长小组的数据。为了评估对脑震荡的认识和态度,参与者填写了一份经过验证的调查问卷。知识总分和态度总分的结果变量范围分别为 0 至 30 分和 7 至 49 分,并根据约 33% 的增量分为三个等级。我们以参与者及其子女的人口统计学特征和特征作为协变量,进行了多变量序数逻辑回归分析:共有 260 名家长参与了调查,他们对脑震荡相关知识的了解程度为中等(总分中位数,四分位数间距(IQR)18-22.5)。受访者对脑震荡的态度良好(总分中位数为 39 分(IQR 为 34-43))。对结果的多变量序数回归分析表明,除了医疗保健提供者的职业(调整赔率比 (AOR) 3.15,95% 置信区间 (CI),1.13-8.75)外,没有其他因素与家长的脑震荡相关知识有关。在这些因素中,没有一个因素与家长对脑震荡的态度有统计学意义:我们的研究结果证实了韩国家长在脑震荡相关知识和态度方面存在差距,因此需要采取新的策略来改善家长的知识和态度。
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引用次数: 0
Masturbation-Induced Presyncope: A Case of Painless Aortic Dissection in IgG4-Related Disease. 手淫诱发的预震:IgG4相关疾病中的一例无痛性主动脉夹层
IF 1.9 Q2 Nursing Pub Date : 2024-03-15 DOI: 10.15441/ceem.23.182
Charles Sanky, Nidhish Sasi

This case concerns a 59-year-old male with a past medical history of hypertension, chronic renal insufficiency, and autoimmune pancreatitis secondary to IgG4-related disease, on chronic steroids. The patient experienced acute onset of lightheadedness, a tingling sensation to both hands, and jaw tightness while masturbating. He was found to have a Type A aortic dissection. This is the first case of its kind to document an atypical, painless aortic dissection presentation in a patient with IgG4-related disease. This piece explores how fibroinflammatory sequelae of IgG4-related disease can result in aortic manifestations and discusses the importance of considering a broader differential including aortic syndrome when encountering patients presenting with atypical symptoms.

本病例涉及一名 59 岁男性,既往有高血压、慢性肾功能不全和继发于 IgG4 相关疾病的自身免疫性胰腺炎病史,长期服用类固醇。患者在手淫时突然感到头晕、双手刺痛和下颌发紧。他被发现患有 A 型主动脉夹层。这是首例记录 IgG4 相关疾病患者非典型、无痛性主动脉夹层表现的病例。这篇文章探讨了 IgG4 相关疾病的纤维炎症后遗症如何会导致主动脉表现,并讨论了在遇到出现不典型症状的患者时考虑包括主动脉综合征在内的更广泛鉴别的重要性。
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引用次数: 0
A case report of point-of-care ultrasound directed thrombectomy: a reversible cause of cardiac arrest managed with extracorporeal membrane oxygenation cannulation. 急诊超声定向取栓一例报告:心脏骤停可逆原因处理体外膜氧合插管。
IF 1.9 Q2 Nursing Pub Date : 2024-03-01 Epub Date: 2023-11-05 DOI: 10.15441/ceem.23.084
Megan Hoffer, Salim Aziz, Keith Boniface, Jenna E Aziz, Ali Pourmand

Extracorporeal membrane oxygenation (ECMO) has been increasingly employed in the emergency department for patients with a potentially reversible cause of cardiac arrest. We present the case of a young female patient with an in-hospital cardiac arrest who was found to have severe right heart strain on point-of-care ultrasound (POCUS), suggesting a massive pulmonary embolism. Rapid bedside diagnosis using ultrasound expedited bedside cannulation and initiation of ECMO as a bridge to surgical thrombectomy, and ultimately the patient survived with full neurologic function. With its ready availability and increasing acceptance by consultants, POCUS should be incorporated into cardiac arrest algorithms as the standard of care to rule in thrombotic and obstructive causes of cardiac arrest.

体外膜氧合(ECMO)已越来越多地用于急诊科的病人有潜在的可逆原因的心脏骤停。我们提出的情况下,一个年轻的女性患者与院内心脏骤停谁被发现有严重的右心脏紧张点护理超声(POCUS),提示一个巨大的肺栓塞。超声快速床边诊断加快了床边插管和ECMO的启动,作为手术取栓的桥梁,最终患者存活并具有完整的神经功能。随着POCUS的可用性和越来越多的医生接受,它应该被纳入心脏骤停算法,作为治疗血栓性和阻塞性心脏骤停原因的标准。
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引用次数: 0
期刊
Clinical and Experimental Emergency Medicine
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