Emergency Medicine International最新文献

Background: The risk factors and association of venous thromboembolism (VTE) following emergent ventral hernia repair (EVHR) remains uncertain. This aim of the study aims was to establish the predictors of VTE after EVHR and its influence on the long-term outcomes. Methods: A total of 2093 patients from the MIMIC-IV database who underwent EVHR were recruited. Multivariate logistic regression and nomogram models were developed to predict in-hospital VTE and mortality. Calibration and receiver operating characteristic (ROC) curves were utilized to assess the model's effectiveness and reliability. Decision curve analysis (DCA) was performed to evaluate the net clinical benefits of the model. Results: The rate of in-hospital VTE was 1.6% (33/2093) after EVHR. Four independent potential factors were established after multivariate analysis, and the abovementioned risk factors fit into the nomogram. The prediction model presented good performance metrics (C-index: 0.857), the calibration and ROC curves demonstrated the accurate prediction power, and DCA indicated the superior net benefit of the established model. In-hospital and 1-year mortality rates were 0.8% (17/2093) and 4.1% (86/2076) after EVHR. The potential factors were included in the mortality prediction nomogram. The prediction model presented good performance metrics (C-index of 0.957 and 0.828, respectively), the calibration and ROC curves were consistent with the actual results, and DCA indicated the superior net benefit of the established model. Conclusion: The nomogram, derived from the logistic regression model, demonstrated excellent predictive performance for VTE occurrence and prognosis in patients following EVHR. This model could serve as a valuable reference for clinical decision-making regarding VTE prevention and for enhancing post-EVHR prognosis.

Background: Anaphylaxis is a serious allergic reaction that has a rapid onset and can result in death. Identifying the factors that trigger anaphylaxis and increase its severity is important for preventing refractory anaphylaxis (RA). In this study, we aimed to determine the factors associated with an increased risk of developing RA. Preventive measures to reduce the frequency and intensity of anaphylactic events are essential to provide the best care for allergic patients. Aggravating factors can trigger or increase the severity of anaphylaxis and therefore need to be recognized and avoided. Methods: We retrospectively analyzed the data of 1378 patients over the age of 18 who were diagnosed with anaphylaxis in our clinic between January 1, 2020, and December 31, 2024. We divided the patients into two groups: anaphylaxis and RA. We evaluated the patients' clinical characteristics in the ED, demographic information, and elicitors that caused anaphylaxis. Results: Of the 1384 anaphylaxis patients included in the study, 46 (3.3%) were diagnosed as RA. We determined that having a history of anaphylaxis is the most important determinant of the increased risk of RA. Having a history of anaphylaxis (OR: 2.87, 95% CI: 1.71-5.72), beta-blockers/ACEI use (OR: 2.47, 95% CI: 1.71-5.42), IV contrast agent (OR: 2.33, 95% CI: 1.64-5.39), and low blood pressure or related symptoms (OR: 2.34, 95% CI: 1.67-5.43) were more frequently associated with severe reactions. Conclusion: We found that having low blood pressure or related symptoms, a known history of anaphylaxis, beta-blockers/ACEI, and IV contrast agent are risk factors for RA. To prevent mortality and morbidity in patients with this risk factor, early interventions such as rapidly repeating epinephrine doses and rapid fluid resuscitation should not be avoided.

Background: Early recognition of cardiac arrest and prompt start of cardiopulmonary resuscitation (CPR) boost survival rates and reduce postarrest consequences. Little information is available about the fundamental CPR knowledge of healthcare workers who work with children in Ethiopia. Methods: All physicians, regardless of seniority, participated in this cross-sectional survey from June to August 2022. They received a structured survey that was modified from the American Heart Association (AHA) Basic Life Support (BLS) test which was made up of 10 questions about participants' job experience and 25 multiple-choice CPR knowledge questions. Data analysis was done using a multinomial logistic regression test with a p value of 0.05. Result: One hundred sixty-eight doctors with various levels of seniority participated in this study. The participants included a male-to-female ratio of 1.3:1, a median age of 28 years, 92 (57.9%) male participants, and 124 (78%) participants with less than 5 years of clinical experience. Ninety-seven participants, or 61%, had scored less than 75% whereas 13 (8.2%), participants, had good knowledge that is scoring above 75%. Participants who had training in CPR within the previous year showed significantly higher levels of knowledge than those who hadn't. Even though 90% of the participants claimed to have CPR knowledge, the majority of participants were found not to have below 75%. Conclusion: The study concludes that while many doctors believe they have adequate CPR knowledge, actual knowledge levels are insufficient. Staff should undergo regular certification and assessments to ensure they retain their resuscitation knowledge. This ongoing evaluation is crucial for maintaining high standards of care and preparedness in emergencies.

Background: Trauma is one of the leading causes of mortality worldwide, and online platforms have become essential sources of information for trauma management. YouTube can play a significant role in helping people access medical information. Methods: YouTube was searched using the keywords management of trauma and assessment of trauma to identify relevant videos. Two authors independently evaluated the videos according to the ATLS (10th edition) guidelines, the modified DISCERN (m-DISCERN) scale, and the Global Quality Scale (GQS) criteria. The videos that met the study criteria were evaluated based on the provider, video length, and view count. Results: Out of 939 videos, 667 were excluded resulting in 272 videos included in the study. According to the ATLS (10th edition) guidelines, the median score for videos was 8 (IQR 7-8). Videos uploaded by official institutions and healthcare professionals received higher scores than from uncertain sources (p = 0.003). According to the GQS, 86% of the videos were low or moderate quality; uncertain sources uploaded 78% of low-quality videos. Conclusion: YouTube is an information source about trauma management that contains videos of varying quality and has a broad audience. Official institutions and healthcare professionals should be aware of this evolving technology and publish up-to-date, accurate content to increase awareness about trauma management and help patients distinguish helpful information from misleading content.

Introduction: Cardiac arrest is a public health concern associated with unfavorable disease outcomes. Cardiopulmonary resuscitation (CPR) of optimal quality is widely acknowledged as an indispensable technique in restoring spontaneous circulation. In order to perform advanced cardiac life support (ACLS), chest compression must be paused twice: once to assess the rhythm and again to administer the shock. Australian advanced life support (ALS) recommends that the defibrillator needs to be precharged in order to administer the shock during a solitary interval in chest compressions. While performing chest compressions, precharging defibrillators can decrease hands-off time without posing a risk of injury. Aim: To compare chest compression fraction (CCF)-which is the cumulative time spent providing chest compressions divided by the total time taken for the entire resuscitation-by calculating the hands-off time duration in cardiac arrest between the Australian Resuscitation Council (ARC) and American Heart Association (AHA) protocols for CPR. Methods: A simulation-based pilot study was designed using a Laerdal Resusci Anne mannequin and a LIFEPACK 20 defibrillator. The study included six participants recruited from King Khalid University Hospital in Riyadh, Saudi Arabia, where three participants were certified ACLS providers and there were certified ALS providers. Participants were divided into two groups, ALS and ACLS, each following one protocol. For each scenario, a random job was assigned to each participant, regardless of their role as assistant, team leader, or performer of CPR. Each case's shockable and nonshockable rhythms were hidden from the team leader and the chest compressor. Ten trials of CPR were performed, each for four cycles with a total time of 8 min. The simulation was video recorded for hands-off time counting. Comparison between CCF (seconds) per cycle between the two protocols was performed using an independent sample t-test. A p value of 0.05 was used to measure statistical significance. Results: Comparing CCF in shockable rhythms between ARC and AHA protocols, it was observed that the CCF of ALS-ARC was significantly higher than ACLS-AHA in all cycles; the first cycle: t = 3.782, p=0.004; the second cycle: t = 3.380, p=0.007; the third cycle: t = 3.803, p=0.003; and the fourth cycle: t = 4.341, p=0.001. Conclusion: Precharging a defibrillator before a rhythm check during chest compression, in anticipation of a potentially shockable rhythm, reduces the time required for defibrillation and limits interruptions in chest compression during CPR. This practice effectively enhances the CCF. Enhancing the continuity of chest compressions can potentially improve survival rates in ARC.

Objectives: Sepsis, caused by the body's response to infection, poses a life-threatening condition and represents a significant global health challenge. Characterized by dysregulated immune response to infection, sepsis may lead to organ dysfunction and failure, ultimately resulting in high mortality rates. The liver plays a crucial role in sepsis, yet the role of differentially expressed genes in septic patients remains unclear in hepatocellular carcinoma (HCC). In this study, we aim to investigate the significance of differentially expressed genes related to sepsis in the occurrence and prognosis of tumors in HCC.

Methods: We conducted analyses by obtaining gene transcriptome data and clinical data of HCC cases from The Cancer Genome Atlas (TCGA). Furthermore, we obtained transcriptomic sequencing results of septic patients from the Gene Expression Omnibus (GEO) database, identified intersecting differentially expressed genes between the two, and performed survival analysis on the samples using LASSO and Cox regression analysis. Combining analyses of tumor mutation burden (TMB) and immune function, we further elucidated the mechanisms of sepsis-related genes in the prognosis and treatment of HCC.

Results: We established a prognostic model consisting of four sepsis-related genes: KRT20, PAEP, CCR3, and ANLN. Both the training and validation sets showed excellent outcomes in the prognosis of tumor patients, with significantly longer survival times observed in the low-risk group based on this model compared to the high-risk group. Furthermore, analyses, such as differential analysis of tumor mutation burden, immune function analysis, GO/KEGG pathway enrichment analysis, and drug sensitivity analysis, also demonstrated the potential mechanisms of action of sepsis-related genes.

Conclusions: Models constructed based on sepsis-related genes have shown excellent predictive ability in prognosis and differential analysis of drug sensitivity among tumor patients. These predictive models can enhance patient prognosis and inform the creation of early treatment protocols for sepsis, consequently aiding in the prevention of sepsis-induced HCC development through the modulation of the overall immune status. This may play a crucial role in patient management and immunotherapy, providing valuable reference for subsequent research.

Introduction: Over the years, numerous studies have suggested the occurrence of a peculiar phenomenon known as "CPRIC" during the revival process. The revelation of this phenomenon has ignited widespread discussion and investigation, yet many enigmas remain unsolved. This study describes the case of a 52-year-old man diagnosed with acute anterior myocardial infarction, who experienced ventricular fibrillation while awaiting further treatment. Despite ultimately not regaining spontaneous circulation, he remained conscious for a period during chest compressions and showed signs of resistance.

Methods: PubMed and Web of Science were searched until July 11, 2024. We included original studies and case reports relevant to CPRIC. For case reports, we extracted information on the author (year), country, patients, location, compression, signs of CPRIC, treatment of CPRIC, and patient outcomes. For other studies, we included the author (year), country, participants, and results. The extracted data were synthesized using a narrative approach.

Results: Of 3038 articles, 32 were included, i.e., 18 case reports (24 cases), 9 cross-sectional surveys, and 5 cohort studies. In CPRIC cases, patients exhibited various manifestations including opening their eyes, speaking, and moving. Other included studies explored healthcare workers' awareness and experiences of CPRIC, the incidence and manifestations of CPRIC, the impact of CPRIC on patient outcomes, memories and perceptions of cardiac arrest indicating consciousness, the effects of CPRIC on rescuers, and the management of CPRIC.

Conclusions: There is an urgent need to establish a globally recognized definition of CPRIC. It is crucial to develop clear algorithms that focus not only on identifying this phenomenon but also on determining the best approaches to manage it. Furthermore, CPRIC can cause multiple interruptions during CPR, making it essential to differentiate whether these interruptions are due to CPRIC or indicative of a return of spontaneous circulation.

Introduction: Traumatic pneumothorax is a life-threatening condition requiring vigilant clinical assessment and urgent management. Lung ultrasound (LUS) is considered to be a safer, rapid, and accurate modality for the early diagnosis of traumatic pneumothorax. The principle objective of this study was to evaluate the diagnostic accuracy of bedside LUS performed by trained novice physicians in the diagnosis of traumatic pneumothorax as compared to supine chest X-rays (CXRs) and/or computed tomography (CT) scans and/or air leak during needle/tube thoracostomy as composite standard.

Methods: It is a prospective, cross-sectional, single-blinded study using a nonprobability quota sampling technique. A total of 96 patients presenting to the emergency department (ED) with polytrauma and chest injuries within a period of twelve months were included. The diagnostic accuracy of bedside LUS performed by trained novice physicians was calculated in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and compared with the composite standard.

Results: The sensitivity of LUS in diagnosing traumatic pneumothorax as compared to the composite standard was 100% (95% confidence interval (CI): 59.05%-100.00%), whereas its specificity was 97.75% (95% CI: 92.12%-99.73%). Similarly, the PPV and NPV of LUS were 77.7% (95% CI: 39.99%-97.19%) and 100% (95% CI: 95.85%-100.00%), respectively.

Conclusion: The results of the study showed that the application of LUS in detecting traumatic pneumothorax had similar diagnostic accuracy as supine CXR. Bedside LUS is widely available, portable, and inexpensive. It also has the capability of real-time imaging and can be repeated as necessary with less risk of radiation exposure. Therefore, physicians working in tertiary and rural health institutions must be trained adequately in order to uplift the clinical utility of LUS for the timely and cost-effective detection of traumatic pneumothorax.

Objective: To conduct a systematic review and meta-analysis of the all-cause mortality associated with the most commonly used hemostatic treatments in patients with hemodynamically unstable pelvic fractures.

Methods: Up to April 30, 2023, we searched PubMed, Embase, Web of Science, and Cochrane, including the references to qualified papers. A meta-analysis was performed on studies that reported odds ratios (ORs) or the number of events needed to calculate them. The PROSPERO registration number was CRD42023421137.

Results: Of the 3452 titles identified in our original search, 29 met our criteria. Extraperitoneal packing (EPP) (OR = 0.626 and 95% CI = 0.413-0.949), external fixation (EF) (OR = 0.649 and 95% CI = 0.518-0.814), and arterial embolism (AE) (OR = 0.459 and 95% CI = 0.291-0.724) were associated with decreased mortality. Resuscitative endovascular balloon occlusion of the aorta (REBOA) (OR = 2.824 and 95% CI = 1.594-5.005) was associated with increased mortality. A random effect model meta-analysis of eight articles showed no difference in mortality between patients with AE and patients with EPP for the initial treatments for controlling blood loss (OR = 0.910 and 95% CI = 0.623-1.328).

Conclusion: This meta-analysis collectively suggested EF, AE, or EPP as life-saving procedures for patients with hemodynamically unstable pelvic fractures.