Clinical and Experimental Emergency Medicine最新文献

Objective: Family presence during resuscitation (FPDR) is an established part of family-centered care. However, how physicians are educated about FPDR is relatively unclear. We aim to review the current status of FPDR simulation for physicians and medical students.

Methods: A scoping review of literature published from 1999 to May 5, 2023, and written in English was undertaken. Articles were searched for using combinations of various family-, resuscitation-, and simulation-related words as keywords, respectively.

Results: Eight articles were included in the final review. This review of FPDR simulation for physicians and medical students revealed findings in three categories: measuring cardiopulmonary resuscitation quality, investigating participant responses after FPDR simulation, and extracting exemplar good-communication elements. First, in four studies measuring resuscitation quality, physicians participated in adult resuscitation, and resuscitation quality was reduced with a family witness showing an overt reaction. Second, in three studies investigating the response to simulation training, interprofessional teams participating in pediatric resuscitation had negative responses to FPDR simulation. Third, in one study, good-communication elements during FPDR were observed during infant simulation, in which interprofessional teams participated. To the best of our knowledge, FPDR simulation training for medical students has not been reported.

Conclusion: Our literature review highlights a gap in FPDR simulation involving physicians and/ or medical students. Physicians were more concerned with resuscitation quality than supporting families during resuscitation simulations. Medical students should be considered as participants for FPDR simulation. More high-evidence studies with interprofessional teams that include physicians and/or medical students are needed to evaluate curriculum design and participant-response changes following FPDR simulation.

Objective: This study used a nationwide database to identify and analyze factors that influence emergency department (ED) length of stay (LOS) and improve the efficiency of emergency care.

Methods: This retrospective study analyzed data from the National Emergency Department Information System (NEDIS) database in Korea: 25,578,263 ED visits from 2018 to 2022. Patient demographics, clinical characteristics, and ED operational variables were examined. Univariate and multivariate logistic regression analyses were used to assess the associations between the variables and prolonged ED LOS, defined as 6 hours or more.

Results: Among the 25,578,263 patients, the median ED LOS was 2.1 hours (interquartile range, 1.050-3.830 hours), with 12.6% experiencing a prolonged ED LOS. Elderly patients (aged ≥65 years) were significantly more likely than younger patients to experience prolonged ED LOS (adjusted odds ratio [aOR], 1.415; 95% confidence interval [CI]: 1.411-1.419). Patients transferred from other hospitals (aOR, 1.469; 95% CI, 1.463-1.474) and those arriving by emergency medical services (aOR, 1.093; 95% CI, 1.077-1.108) also had high odds of prolonged LOS. Conversely, pediatric patients had a low likelihood of extended stay (aOR, 0.682; 95% CI, 0.678-0.686). Severe illness, including sepsis (aOR, 1.324; 95% CI, 1.311-1.340) and COVID-19 infection (aOR, 1.413; 95% CI, 1.399-1.427), was strongly associated with prolonged LOS.

Conclusion: Prolonged ED LOS is influenced by a combination of patient demographics, clinical severity, and systemic factors. Targeted interventions for older adults, severe illness, and operational inefficiencies such as hospital transfers are essential for reducing ED LOS and improving overall emergency care delivery.

Objective: About one million United States emergency department (ED) visits annually are due to acute decompensated heart failure (ADHF) symptoms. Characterizing the presentation of ED symptoms among ADHF patients may improve clinical care; however, sex and age differences in ED chief complaints have not been thoroughly investigated. In this paper, we describe differences in chief complaints and comorbid conditions for ED patients with ADHF diagnoses, stratified by sex and age.

Methods: We conducted a retrospective analysis of adults presenting to North Carolina EDs using the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), a statewide syndromic surveillance system, between 2010 and 2016, screening for patients with a diagnosis of ADHF. We evaluated frequencies of chief complaint categories for ED visits and comorbid conditions, stratified by sex and age, and computed standardized differences.

Results: The most common chief complaints were dyspnea (19.1%), chest pain (13.5%), and other respiratory complaints (13.4%). In the 18-44 years age group, women were more likely than men to report nausea/vomiting (6.7% vs. 4.1%) and headache (4.2% vs. 2.0%). In those 45-64 and ≥65 years, complaints were similar by sex. When stratified by age group alone, the 18-44 and 45-64 years age groups had more complaints of chest pain, whereas balance issues, weakness, and confusion were more common in the ≥65 years age group.

Conclusion: Differences in atypical ADHF symptoms were seen in in ED patients based on sex and age. Understanding the variation in ADHF symptoms among ED patients can facilitate the identification of ED patients with ADHF and improve management of ADHF-related symptoms.

Sepsis is associated with high morbidity and mortality rates in hospitalized patients. This condition has a complex pathophysiology and can swiftly progress to the severe form of septic shock, which can lead to organ dysfunction, organ failure, and death. Metabolomics has transformed the clinical and research topography of sepsis, with application to prognosis, diagnosis, and risk assessment. Metabolomics involves detecting and analyzing levels of metabolites in blood (plasma, serum, and/or erythrocytes) and urine; when applied in sepsis, this technology can improve our understanding of the pathogenesis of the disease and aid in better disease management by identifying early biomarkers. For this review article, "metabolomics," "sepsis," and "septic shock" were keywords used to search records in various databases including PubMed and Scopus from their inception until December 2023. This review article summarizes information regarding metabolic profiling performed in sepsis and septic shock and illustrates how metabolomics is advancing the diagnosis and prognosis of patients with sepsis.

This case concerns a 59-year-old male patient with a medical history of hypertension, chronic renal insufficiency, and autoimmune pancreatitis secondary to immunoglobulin G4 (IgG4)-related disease, who was on chronic steroid treatment. The patient experienced acute onset of lightheadedness, a tingling sensation in both hands, and jaw tightness after masturbating. He was found to have 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 the 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.

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.

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.