Emergency Medicine International最新文献

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.

Study hypothesis: The researchers compared average intubation times between four different devices and hypothesized that a novel laryngoscope based on an enhancement of the rigid anterior commissure laryngoscope would produce faster times to intubation compared to a Macintosh blade with a bougie among inexperienced users on the difficult airway simulation.

Methods: Participants were stratified into novice, intermediate, and advanced skill levels. Each group first performed intubation on a manikin airway without modifications ("easy" airway)-using each of four devices (novel laryngoscope, Macintosh alone, Macintosh with bougie, and GlideScope) in random order-followed by the same technique on a manikin with modifications to mimic a "difficult" airway. Devices requiring the use of a bougie utilize a Seldinger technique. The primary outcome measure was the time taken to inflate the manikin's lungs with the bag ventilator.

Results: Ninety-eight participants were recruited and grouped according to their self-reported experience level: 41 novices, 39 intermediate, and 18 experts. The novel laryngoscope with gum elastic bougie (GEB) led to quicker intubation times (mean 32.0 s) compared with the Macintosh with GEB (mean 37.5 s) among the novice and intermediate groups on the difficult airway (p < 0.05). The methods that utilized a bougie (Macintosh blade with a GEB and Novel Laryngoscope with GEB) led to slower intubation times than the methods not utilizing a bougie (Macintosh blade and GlideScope).

Conclusions: In summary, the Seldinger technique is an important skill for those who perform endotracheal intubations (ETIs), even infrequently or in nonideal settings. The novel laryngoscope may be a helpful option to attain ETI with the reliability of the Seldinger technique and a consistently short ETI interval.

Objective: This study aimed to investigate the predictive value of the Systemic-Immune Inflammation Index (SII) and lipoprotein-associated phospholipase A2 (Lp-PLA2) in the early detection of glufosinate ammonium (GA) poisoning-induced neurotoxicity.

Methods: A retrospective case-control analysis of patients with acute oral GA poisoning was conducted from January 2021 to August 2024. GA poisoning patients who developed neurotoxicity were identified as the case group. The control group was matched 1:2 with the case group on the year of age interval in GA patients without neurotoxicity. Univariate and multiple logistic regression analyses were performed to explore the independent risk of neurotoxicity induced by GA poisoning. Receiver operator characteristic (ROC) curve and area under the curve (AUC) were performed to evaluate the predictive value of SII, Lp-PLA2, and combination of both in GA poisoning patients associated with neurotoxicity.

Results: A cohort of 82 patients experiencing neurotoxicity due to GA poisoning was identified, alongside a control group of 164 individuals who did not exhibit neurotoxic symptoms. The levels of SII and Lp-PLA2 were higher among the case group compared with the control group. After controlling for plasma GA concentration, lactate, neutrophil-to-lymphocyte ratio, and serum ammonia, the results of the multiple logistic regression analysis indicated that the case group was more likely to exhibit elevated levels of the SII (OR = 1.010, 95% CI: 1.004, 1.015, p < 0.001) and Lp-PLA2 (OR = 1.049, 95% CI: 1.032, 1.065, p < 0.001). Furthermore, the areas under the ROC curve of SII, Lp-PLA2, and combination of both were 0.781 (95% CI: 0.717, 0.845, p < 0.001), 0.880 (95% CI: 0.838, 0.923, p < 0.001), and 0.931 (95% CI: 0.901, 0.961, p < 0.001), respectively.

Conclusions: The study concluded that SII, Lp-PLA2, and their combination could serve as predictive biomarkers for assessing the neurotoxicity associated with glufosinate ammonium poisoning.

Background: Hydroxocobalamin is the first-line treatment for confirmed cyanide poisoning. Its empiric use in patients with smoke inhalation injury-where cyanide toxicity is often suspected but not confirmed-remains controversial. Further research is needed to fully understand the benefits and risks associated with its use. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to provide a systematic review of the use of hydroxocobalamin for the treatment of cyanide poisoning secondary to smoke inhalation injury, with a particular focus on mortality and adverse reactions.

Methods: A systematic search of the Cochrane Library, PubMed, and Embase was conducted for studies on cyanide poisoning from smoke inhalation injury treated with hydroxocobalamin. The search was limited to studies from the inception of the journals until July 30, 2025. The quality of the studies was assessed using the Newcastle-Ottawa Scale.

Results: Six studies, comprising a total of 1238 patients, were identified as meeting the inclusion criteria; however, they did not meet the quality threshold for meta-analysis. Thus, only a systematic review was performed. Two studies reported mortality rates, which were found to be similar between the hydroxocobalamin and supportive treatment groups. In contrast, two studies indicated an association between hydroxocobalamin and acute kidney injury, whereas one study proposed a potential correlation with methemoglobinemia.

Conclusions: In light of the uncertain benefits and potential risks associated with hydroxocobalamin use for cyanide poisoning from smoke inhalation injury, its administration should be approached with caution. Well-designed randomized controlled trials are urgently needed to establish optimal treatment strategies for this patient population.

Introduction: Emergency department (ED) revisits are considered a significant indicator of the quality of care provided and are used as a benchmark for the performance of individual providers and institutions. The aim of this study is to assess ED revisit rates, reasons, and hospital admission rates among our adult ED patients.

Methods: This is a retrospective chart review study conducted in a single-center tertiary referral hospital in Riyadh, Saudi Arabia. Study participants comprised adult patients who attended the ED, had been discharged, and had an ED revisit within 72 h from April 2019 to January 2020.

Results: A total of 573 patients met our inclusion criteria, of whom 53.1% were males. The majority of the patients (74.5%) revisiting the ED were categorized as CTAS Level 3, with gastrointestinal complaints being the most common presentation for revisits (23.6%). During the second visit, 94%, 4%, 0.7%, and 0.3% of the participants were discharged, admitted, discharged against medical advice, and died, respectively. Disease progression was the most common cause of revisits at 96.5%. The factors that showed statistically significant associations with nondischarge disposition in the second visit were CTAS levels in the first and second visits, dementia, functional dependency, and reason for the revisit.

Conclusion: Most ED visits within 72 h are due to disease progression rather than system- or physician-related issues, and the majority of these patients are safely discharged after the second visit. Identification of high-risk patients-such as those with higher CTAS levels, dementia, or functional dependency-may aid emergency physicians in implementing targeted discharge planning and coordinated outpatient follow-up to reduce unnecessary revisits and optimize use of emergency services. Our findings highlight the importance of structured post-discharge support and underscore the need for tailored interventions in resource-limited healthcare settings.

Acute pesticide poisoning is a significant public health issue, particularly in low- and middle-income countries where pesticides are commonly used in agriculture. While the neurological and cardiovascular effects of pesticide poisoning have been extensively studied, gastrointestinal injuries remain underexplored despite their severe complications, including bleeding, perforation, and obstruction. This mini-review examines the prevalence, mechanisms, and treatment of gastrointestinal injuries caused by acute pesticide poisoning from 2014 to 2024. Based on an analysis of 11 studies encompassing 38 cases across China, India, and Japan, we identified organophosphate compounds as the most common culprits of gastrointestinal damage. Mechanisms of injury involve multifactorial mechanisms, including the direct toxicity of pesticides, adverse therapeutic interventions such as atropine and gastric lavage, and systemic effects like endothelial dysfunction and hypoxia. Preventive strategies are discussed, including the use of proton pump inhibitors, careful atropine dosing, and balloon jejunal catheter placement to minimize complications. This review underscores the urgent need for further research to develop targeted preventive and therapeutic measures for gastrointestinal injuries caused by pesticide poisoning, aiming to improve patient survival and quality of life.