Emergency Medicine International最新文献

Background: Neuromuscular blocking agents (NMBAs) are commonly used during tracheal intubation to ensure smoother procedural conditions, but they are associated with the risk of prolonged paralysis and respiratory complications. This study explores the relationship between the surgical pleth index (SPI) measured immediately before intubation and tracheal intubation conditions in patients who did not receive neuromuscular blockers, along with the predictive value of the SPI in these conditions.

Methods: A total of 100 surgical patients (excluded 17 patients who did not meet the eligibility criteria) undergoing elective surgery under general anesthesia at The Affiliated Lihuili Hospital of Ningbo University between November 2021 and June 2022 were included, and key parameters, including systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and SPI, were measured at different time points (T0 to T5).

Results: At T2, significant reductions in SBP, DBP, HR, and SPI were observed compared to baseline (T0, after the completion of 6 mL/kg of lactate Ringer's solution infusion) and preintubation values (T1, at the time of loss of consciousness) (p < 0.05). Postintubation, both SBP and DBP significantly increased at T5 (3 min after intubation) compared to T2 (immediately before intubation) (p < 0.05). The patients were classified into "excellent" and "good" groups based on their intubation conditions. SPI values at T3 (immediately after intubation), T4 (1 min after intubation), and T5 were significantly higher in the "good" group compared to the "excellent" group (p < 0.05). Post hoc sex-stratified receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.713 (p = 0.037) and 95% confidence interval (CI) (0.539-0.887), indicating moderate predictive value for the SPI in assessing tracheal intubation conditions.

Conclusions: The SPI proves to be a potentially useful and noninvasive tool for evaluating tracheal intubation conditions in female patients without the use of NMBAs.

Background: Fibrinogen has been used as a prognostic indicator for sepsis. However, the associations of fibrinogen and septic shock in septic patients remain unclear. This study aimed to explore the relationship between fibrinogen levels and the occurrence of septic shock in patients with sepsis.

Methods: Data were retrospectively analyzed from the Medical Information Mart for Intensive Care IV (MIMIC-IV v3.1) database. The Boruta algorithm and random forest model were used for feature selection to ensure the important variables affecting results. Multivariate logistic regression assessed the association between fibrinogen and septic shock. Subgroup analysis was conducted to evaluate the impact of additional variables on the results.

Results: The study included 3302 septic patients. Fibrinogen was significantly associated with septic shock (odds ratio [OR] = 1.46; 95% confidence interval [CI], 1.35-1.56), and the risk of septic shock increased with higher fibrinogen levels (all p values for trend < 0.001). The ROC curve demonstrated the predictive accuracy of fibrinogen for septic shock in sepsis patients. After adjustment for demographics and laboratory, fibrinogen had a higher area under curve (AUC) value (0.78; 95% CI, 0.76-0.79) than SOFA (AUC, 0.58; 95% CI, 0.56-0.61), SASP II (AUC, 0.67; 95% CI, 0.65-0.69), and APS II (AUC, 0.69; 95% CI, 0.68-0.71).

Conclusion: A linear relationship was found between fibrinogen levels and septic shock. Elevated fibrinogen levels were linked to a higher risk of septic shock in septic patients.

Background: Maternal cardiac arrest presents unique challenges due to physiological changes in pregnancy. Left lateral tilt (LLT) is commonly recommended to relieve aortocaval compression, but its impact on chest compression quality remains unclear.

Objectives: This study evaluates chest compressions performed in the LLT position from both the right and left sides to determine if they meet high quality cardiopulmonary resuscitation standards.

Methods: This randomized crossover study included 44 healthcare providers performing two-minute chest compressions' sessions on a manikin in the LLT position from both right and left sides. Compression depth, rate, recoil, force distribution, rescuer fatigue, and physiological parameters were analyzed.

Results: Both approaches maintained adequate compression rates, but left-side LLT chest compressions achieved better depth (41.23 ± 9.11 mm vs. 35.50 ± 9.54 mm, p < 0.001) and complete recoil (67.05 ± 39.05% vs. 38.39 ± 34.23%, p < 0.001). Left-side LLT chest compressions also generated higher peak force and lower residual release force. Right-side LLT chest compressions were associated with greater rescuer fatigue and instability.

Conclusion: Left-side LLT chest compression provides superior compression depth and recoil compared with right-side LLT chest compression. However, neither method consistently meets high quality cardiopulmonary resuscitation standards. These findings support the 2015 AHA guideline preference for manual uterine displacement over LLT chest compression. Further research is needed to optimize maternal cardiac arrest management.

Background: Aortic dissection (AD) is a life-threatening cardiovascular emergency associated with high mortality. Early risk stratification through reliable biomarkers is critical for guiding clinical decisions. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a novel composite index reflecting inflammation, nutritional status, and hematologic balance. Although it has shown prognostic relevance in several disease states, its utility in predicting mortality in AD remains unknown. This study aimed to investigate the prognostic value of the HALP score and other hematologic markers in patients with AD.

Methods: This retrospective study included 51 patients diagnosed with AD between January 2020 and December 2024 using contrast-enhanced thoracoabdominal computed tomography. Patients were grouped as survivors or nonsurvivors. Hematologic parameters (hemoglobin, hematocrit, red blood cell, platelet count, and mean platelet volume) and inflammatory indices (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune-inflammation index [SII], and HALP score) were recorded. The Shapiro-Wilk test assessed normality; Student's t-test or the Mann-Whitney U test was applied accordingly. ROC analysis was performed to evaluate the predictive power of each parameter. Statistical significance was defined as p < 0.05. The primary outcome was in-hospital mortality.

Results: Overall mortality was 33.3%. Nonsurvivors were older and had significantly lower levels of hemoglobin, hematocrit, RBC, and platelet count (p < 0.001). The HALP score was lower in the exitus group, though not statistically significant in direct comparison (p = 0.549). ROC analysis revealed that the HALP score had an AUC of 0.715 (95% CI: 0.572-0.857, p = 0.003), with 55.9% sensitivity and 82.4% specificity at a cutoff of 4.05. Classical parameters such as RBC (AUC = 0.824), Hgb (AUC = 0.802), and Htc (AUC = 0.811) demonstrated stronger predictive capacity. The in-hospital mortality rate was 33.3%.

Conclusions: The HALP score demonstrated high specificity and moderate sensitivity in predicting mortality in AD, suggesting its potential as a complementary biomarker. Its ease of use and accessibility make it suitable for emergency clinical settings. Prospective multicenter studies are needed to confirm its prognostic validity and routine application in AD management.

Objective: Priapism, a persisting erection not associated with sexual stimulation, can be ischaemic, with the risk of permanent erectile dysfunction, or nonischaemic. Drugs-e.g., injection therapies for erectile dysfunction, as well as neuroleptics, antidepressants and various other medicines-can also cause priapism. This study aimed to describe presentations due to priapism and provide insights into specific causes, clinical presentations, diagnostic strategies and emergency management.

Methods: A single-centre, retrospective, observational study of patients (≥ 16 years old) presenting to the University Hospital of Bern, Switzerland, between January 2010 and June 2023 due to priapism. The cases were retrieved from the electronic health records using full-text search.

Results: During the study period, 40 cases corresponding to 32 patients were included. The mean ± SD age was 48 ± 15 years, and pain was present in 21 cases (53%) on presentation. Median time of erection was 15 h (range: 1-80, n = 23). A penile blood gas analysis was performed in 32 cases (80%), and 29 of these (91%) were of the low-flow type. Most commonly suspected causes were idiopathic (n = 25, 63%) and drug-induced (n = 10, 25%). Suspected agents in the drug-induced cases were corpus cavernosum autoinjection therapy (n = 4), trazodone (n = 3), sildenafil (n = 2) and urapidil (n = 1). Puncture of the corpus cavernosum and injection of noradrenalin and adrenalin were the therapeutic measure in 35 cases (88%). In 13 cases, there was at least one recurrence, including 10 within one week. Drugs given as recurrence prophylaxis included tadalafil (n = 9) and diazepam (n = 4).

Conclusion: Presentations due to priapism appear to be rare, but the majority of the cases presented with ischaemic priapism, which is a medical emergency. The findings can be used to identify areas requiring further research (e.g., drugs used as recurrence prophylaxis) and raise awareness of this potentially severe complication-which patients are often ashamed to report.

Background: Infrared thermography (IRT), a noninvasive imaging modality capable of capturing micron-level temperature variations (resolution up to 0.03°C) and generating thermal maps, has demonstrated unique value in dynamically reflecting physiological and pathological states. Recent studies have explored its potential as a diagnostic tool for sepsis. This review assesses the feasibility of IRT in detecting sepsis and septic shock.

Methods: A systematic literature search was conducted across PubMed, Web of Science, and Scopus databases using combinations of keywords ("infrared thermography," "thermal imaging," "sepsis," "septic shock," "shock") in titles, abstracts, or topics. Articles published after 2015 were included.

Results: After applying exclusion criteria, 11 studies were analyzed. Most findings highlighted IRT's efficacy in early sepsis detection, disease progression monitoring, and prognostic evaluation.

Conclusion: IRT serves as a valuable tool for early diagnosis and monitoring of sepsis, with significant potential for broader clinical adoption. Further standardization and technical refinement are required to enhance its reliability in critical care settings.

Objective: To evaluate whether an 8-week curriculum structured by the 7E teaching model is associated with improved emergency obstetrics and gynecology (OBGYN) competencies among first-year residents.

Methods: We conducted a prospective, single-center, quasiexperimental consecutive-cohort study at the Shengjing Hospital of China Medical University (September 2022-September 2024). Consecutive training-year cohorts were compared: the 2022 cohort received traditional training (control, n = 32), and the 2023 cohort received the 7E-based program (intervention, n = 31; elicit-engage-explore-explain-elaborate-evaluate-extend). Outcomes were mapped to Kirkpatrick's four-level model (reaction, learning, behavior, and results) and included satisfaction, written examination scores, OSCE performance, Mini-CEX trajectories, and selected patient safety/process indicators.

Results: Compared with the control group, residents in the 7E cohort reported higher satisfaction (35.10 ± 1.30 vs. 23.22 ± 1.84, p < 0.001; Cronbach's α = 0.905), achieved higher written examination scores (71.23 ± 4.25 vs. 63.88 ± 5.71, p < 0.001), and demonstrated a higher OSCE excellence rate (80.65% vs. 15.63%, p < 0.001). Compliance with prespecified "golden-hour" emergency process indicators was higher in the 7E cohort (87.09% vs. 59.38%, p = 0.025). Mini-CEX trajectories showed a significant group × time interaction (β = -1.48 per week, 95% CI -1.75 to -1.21, p < 0.001), indicating faster skill improvement in the 7E cohort. Adherence to "golden-hour" emergency process indicators was higher (87.09% vs. 59.38%, p = 0.025). Severe complications occurred in 1/31 (3.23%) versus 6/32 (18.75%), corresponding to a risk ratio = 0.17 (score-based 95% CI 0.03-1.01; Fisher's exact p = 0.104).

Conclusion: The 7E-structured curriculum was associated with improved satisfaction and performance across multiple competency domains. The 7E model shows promise as a structured paradigm for competency-based emergency OBGYN education, although causal inferences are limited by the nonrandomized design and single-institution context.

Research purpose: This study aims to project the yearly emergency ambulance service (EAS) demand for Taipei from 2015 to 2051. The effects of daily average temperature on EAS demand in 2036 and 2051 will also be projected.

Research methods: Over 140,000 EAS patient records in 2015 were obtained from the Taipei Fire Department in order to conduct the EAS demand projection. The projection was computed accounting for changes in the age-gender structure compared to the base year (2015). The relationship between daily average temperature and EAS demand in 2036 and 2051 was further explored by including and excluding age-gender structure changes.

Results: Without accounting for changes in the age-gender structure, the 2051 EAS demand for age groups over 65 was consistently underestimated by 42%-90%, while that for younger age groups was overestimated by 35%-55%. In addition, the projected quadratic curve for describing the relationship between average daily temperature and EAS demand in 2051 showed a significant upward shift and increase in curvature when accounting for changes in the age-gender structure.

Conclusions: With an accurate long-term projection for EAS demand in Taipei city and other regions in Taiwan, the government can design strategies for improving the EAS system in order to deal with the rapidly aging population.

Background: ICU-acquired weakness (ICU-AW) is a severe complication among critically ill patients and represents a common secondary neuromuscular dysfunction syndrome in the intensive care unit (ICU). It significantly impairs patients' health, functional recovery, and long-term quality of life.

Methods: We conducted a comprehensive search of the Web of Science Core Collection database for publications related to ICU-AW, retrieving a total of 1866 records as of September 4, 2025. Using the bibliometric software CiteSpace and VOSviewer, we performed qualitative and quantitative analyses of publication trends, contributing countries, institutions, authors, and keyword co-occurrence patterns.

Results: The annual number of publications on ICU-AW has shown a steady upward trajectory, peaking in 2021 with 186 articles. The United States was the most productive country, contributing 512 publications (27.44%). The University of Toronto emerged as the leading institution with 43 publications. The most prolific author was Lars Larsson (Sweden, 34 publications), and the most frequently occurring keyword was "intensive care unit."

Conclusion: This study is the first to provide a comprehensive bibliometric overview of global research on ICU-AW. Our findings illuminate current research landscapes, highlight key contributors and thematic foci, and offer novel insights to guide future investigations into the pathophysiology, diagnosis, treatment, and nursing interventions for ICU-AW. Furthermore, the analysis enables evidence-based forecasting of emerging research frontiers and evolving trends in this critical field.

Background: Sepsis-associated encephalopathy (SAE) has a high mortality rate with limited prognostic biomarkers. We investigated the relationship between the Prognostic Nutritional Index (PNI) and SAE outcomes.

Methods: This multicenter cohort study (2008-2019) enrolled 3202 SAE patients. The primary outcome was 28-day all-cause mortality. Multivariable-adjusted analyses (logistic regression, propensity score matching, and inverse probability weighting) assessed PNI's prognostic value, supplemented by generalized additive models (GAMs), Kaplan-Meier, and ROC analyses. External validation was performed.

Results: PNI independently predicted 28-day mortality (adjusted OR: 0.85; 95% CI: 0.77-0.93). The GAM identified PNI = 34 as the optimal prognostic threshold. Patients with PNI < 34 had higher 28-day mortality than those with PNI ≥ 34 in both original and validation cohorts (p < 0.001). ROC analysis demonstrated strong discrimination in the original cohort (AUC = 0.879; sensitivity = 0.878; specificity = 0.880) and the validation cohort (AUC = 0.724). Higher PNI correlated with better neurological function (Glasgow Coma Scale, p < 0.001).

Conclusions: This multicenter study establishes the PNI as an independent predictor of 28-day mortality in patients with SAE. We identified that SAE patients with PNI < 34 exhibited significantly higher 28-day mortality rates and worse neurological function.