Emergency Medicine International最新文献

Background and Aim: International guidelines recommend early enteral nutrition (EEN) for critically ill patients. However, evidence supporting the optimal timing of EN in patients diagnosed with cardiogenic shock (CS) is lacking. As such, this study aimed to compare the clinical outcomes and safety of EEN versus delayed EN in patients diagnosed with CS. Methods: This retrospective cohort study was conducted using data from the Medical Information Mart for Intensive Care IV version 2.2 database. Patients who received EN within 2 days of admission were assigned to the EEN group. A 1:1 propensity score-matched (PSM) analysis was performed to control for bias in baseline characteristics and ensure the reliability of the results. To exclude the impact of confounders, an adjusted proportional hazards regression model was used to verify the independence between EEN and survival outcomes. Results: Of 1846 potentially eligible patients, 1398 received EEN and 448 received delayed EN. After 1:1 PSM, 818 patients were assigned to the EEN (n = 409) and delayed EN (n = 409) groups. Regarding cumulative survival, patients with CS receiving EEN experienced better 30-, 90-, and 180-day survival outcomes than the delayed EN group (hazard ratio [HR] 0.803 [95% confidence interval [CI] 0.647-0.998], p=0.045; HR 0.729 [95% CI 0.599-0.889], p=0.001; and HR 0.778 [95% CI 0.644-0.938], p=0.008, respectively). After adjusting for confounders, EEN was found to be independently associated with survival outcomes. Moreover, EEN did not increase the risk(s) for ileus, aspiration pneumonia, or gastrointestinal bleeding. Patients who received delayed EN experienced longer hospital stays than those receiving EEN (17 days [interquartile range [IQR] 10-25] versus 12 days [IQR 7-19 days], respectively; p < 0.001). Conclusion: EEN was not associated with harm, but rather with improved survival outcomes in patients diagnosed with CS. Further studies are required to verify these findings.

Background: Physical examination and computed tomography angiography (CTA) are used for diagnosing arterial injury in extremity trauma. In recent years, CTA has been overused to obtain more objective data. Our study aimed to investigate the effect of using CTA for the management of patients with extremity penetrating injuries, specifically in cases where vascular injury was not detected during initial examination. Methods: This retrospective study included patients with penetrating trauma who underwent CTA of the extremities. The demographic data, mechanism of injury, the side of injury, initial vascular exam (normal, soft signs, and hard signs), radiological results, and any orthopedic and vascular intervention performed were recorded. The χ ² test was used for independent variables. A significance level of p < 0.05 was used. We compared the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for physical exam and CTA for identifying arterial injury requiring intervention. Results: Of the 252 patients included in the study, 29 (21.5%) had abnormal vascular physical examination while 26 (10.3%) had an abnormal CTA. The NPV of the hard sign for identifying vascular injury was 95.4%, while the sensitivity was 57.7%, specificity was 100%, and PPV was 100%. The NPV of routine physical examination to determine the requirement for vascular intervention was 100%. The sensitivity and PPV of the soft sign in determining the need for vascular intervention were 65.4% and 77.3%, respectively. Conclusion: Vascular injury was present in all cases that had positive hard signs. CTA imaging and vascular intervention are not necessary in patients who exhibit no hard and/or soft indicators during a thorough physical examination.

Background: White blood cell (WBC) subtypes reflect immune and inflammatory conditions in patients. This study aimed to examine the association between the ratio of platelets to WBC subtypes and mortality outcomes in patients with moderate-to-severe traumatic brain injury (TBI). Method: The Trauma Registry System of the hospital was retrospectively reviewed to gather medical records of 2397 adult patients who were hospitalized from 2009 to 2020 and had moderate-to-severe TBI with a head abbreviated injury scale (AIS) score of 3 or higher. The monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were compared between the survivors (n = 2, 138) and nonsurvivors (n = 259). A multivariate logistic regression analysis was performed to investigate the independent effects of the univariate prognostic factors on mortality outcomes. The survival variations among the PLR subgroups were evaluated by the Kaplan-Meier survival analysis including a log-rank test. Results: The PLR of the deceased patients was considerably lower than that of the survivors (129.5 ± 130.1 vs. 153.2 ± 102.1, p < 0.001). However, no significant differences were observed in monocyte and neutrophil counts, MLR, or NLR between the deceased and survivor groups. A lower PLR was recognized as an independent risk factor for mortality (odds ratio: 1.26, 95% confidence interval: 1.06-1.51, p=0.010). The receiver operating characteristic (ROC) established PLR as the most strong predictor among the three ratios (area under the ROC curve = 0.627, sensitivity = 0.846, and specificity = 0.382, according to the cut-off value = 68.57). When the patient groups were divided by PLR quartile, the Kaplan-Meier analysis showed significantly worse survival in the lowest PLR quartile group (< 83.1) compared with the highest quartile group (≥ 189.1) (p < 0.001). Conclusion: Lower PLR is associated with greater mortality in adult patients with moderate-to-severe TBI. PLR may be a valuable measure for classifying mortality risk in this population.

Objective: This study evaluates the effectiveness and timeliness of posterior decompression and internal fixation in the emergency management of thoracolumbar fractures complicated by spinal cord injuries. Methods: We retrospectively analyzed 40 patients treated at our hospital from January 2019 to February 2022. Each patient underwent posterior decompression and internal fixation, with preoperative and postoperative assessments including vertebral body height, American Spinal Injury Association (ASIA) score, Visual Analog Scale (VAS) score, and urodynamic indices. Results: Postoperative improvements were noted in vertebral body height, with anterior and posterior heights increasing to 12.82 (± 1.23) mm and 3.21 (± 0.64) mm, respectively, and kyphosis angle improving to 14.26 (± 0.32). Significant enhancements were also observed in motor (from 40.78 [± 4.32] to 59.86 [± 1.37]) and sensory (from 45.98 [± 3.20] to 66.92 [± 1.28]) function scores, and a reduction in VAS score from 6.89 (± 0.78) to 1.78 (± 0.32). Urodynamic measurements showed increased maximum urine flow and detrusor pressure postintervention. All surgical wounds healed within two weeks without significant complications. Conclusion: Posterior decompression and internal fixation significantly improve spinal stability, pain, motor, and sensory functions in patients with thoracolumbar fractures and spinal cord injuries, demonstrating its effectiveness and clinical utility.

Background: Medical diagnostic laboratories as high-risk environments are often exposed to unpredictable situations such as patient fainting, blood pressure drops, chemical spills, and burns. These life-threatening events defined as medical emergencies and necessitate urgent actions. Hence, determining the most common medical emergencies in medical laboratories, so understanding and planning strategies to effective management seems to be crucial. Objective: This study aimed to investigate medical crises in Iranian medical laboratories. Methods: In this cross-sectional study, data collection was performed by a simple random sampling method through electronic and paper questionnaires filled by personnel in private and hospital laboratories in different provinces. Results: The most frequent medical emergencies were patient fainting, staff needle stick, and patient's blood pressure dropping. The occurrence of medical emergencies was 24% and 76% in men and women, respectively. Out of all, treatment was administered at the scene of the accident in 37.1% of cases, and 28.1% were discharged after sampling. Moreover, 51% of the medical diagnostic laboratories had a trolley code, with injection devices and angiocaths as available tools. In 81% of the laboratories, practicing for probable medical emergencies was not possible. A significant relationship was found between the type of client (laboratory personnel or the referring person) and the type of emergency event (p < 0.05). Conclusions: Considering the prevalence and importance of handling medical emergencies in a short time, it is necessary to design training courses for laboratory personnel and expert them to encountering with unpredictable threats in order to help affected individuals.

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.