International Journal of Emergency Medicine最新文献

Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is critical for improving outcomes after out-of-hospital cardiac arrest, yet untrained callers often experience high cognitive load that impedes early recognition and action. Communication strategies grounded in instructional design may reduce this burden. We evaluated whether a simplified dispatcher script developed using Cognitive Load Theory (CLT) and the ADDIE framework improves DA-CPR performance in a simulated setting.

Methods: We conducted a simulation-based randomized study among undergraduate non-medical students in Thailand. Participants without prior CPR training were randomly assigned to receive either the standard NIEMS 2013 dispatcher script or a CLT-ADDIE simplified script during a simulated cardiac arrest scenario. Participants were blinded to allocation; dispatchers received concealed assignment prior to simulation, and outcome assessors were blinded. Primary outcomes were time to cardiac arrest recognition and time to first chest compression. Secondary outcomes included CPR quality and perceived cognitive load measured by the 9-point Paas scale.

Results: Forty-two participants completed the simulation. Cardiac arrest recognition within 60 s was more frequent in the simplified group than in the standard group (90.5% vs. 47.6%, p = 0.034). Median recognition time was shorter with the simplified script (52 [45-60] vs. 74 [60-90] seconds), and perceived cognitive load was lower (median 4 [IQR 3-5] vs. 6 [IQR 5-7], p = 0.018). Qualitative observations suggested clearer task sequencing and reduced confusion.

Conclusion: A CLT-ADDIE-based simplified dispatcher script improved early recognition of cardiac arrest and reduced cognitive load in a simulated DA-CPR context. Instructional design-informed dispatcher communication may enhance bystander performance during time-critical emergencies.

Background: Venous gas embolus secondary to deep soft tissue infection is a rare but potentially fatal condition in emergency settings that requires urgent medical intervention.

Case presentation: We report a case of a 32-year-old female with an invasive mole undergoing chemotherapy who presented with fever and severe bilateral lower limb pain. Point-of-care ultrasound (POCUS) revealed gas emboli on B-mode and Doppler-mode imaging within the femoral veins and further detected emphysematous changes in adjacent intramuscular and subcutaneous tissues, suggesting critical infection and initiating immediate clinical reassessment. The patient was subsequently confirmed to have severe hypoxemia and sepsis, with computed tomography demonstrating extensive gas-forming lesions, ultimately leading to cardiac arrest despite advanced life support.

Conclusion: This case highlights the critical role of POCUS in the rapid detection of intravascular gas and deep soft tissue infection in time-critical conditions.

Background: Spontaneous intracerebral hemorrhage (ICH) is a catastrophic form of stroke affecting more than 3.3 million individuals worldwide each year and accounting for approximately 10-20% of all strokes globally. Although less common than acute ischemic stroke, ICH carries a disproportionate burden of morbidity and mortality, with 30-day case fatality rates approaching 40-50%. Therapeutic advances for ICH have progressed more slowly than for ischemic stroke, and management remains largely supportive. Patients frequently present to the emergency department (ED) in critical condition, making early recognition and rapid, guideline-concordant intervention essential to improving outcomes.

Review: This narrative review summarizes the most recent American Heart Association/American Stroke Association (AHA/ASA) guidelines for the acute management of spontaneous ICH, with emphasis on practical ED application. Hypertension remains the most important modifiable risk factor, particularly in younger patients, while cerebral amyloid angiopathy predominates in older adults. Additional risk factors include anticoagulant and antiplatelet therapy, alcohol and illicit drug use, smoking, advanced age, and genetic predisposition. Primary brain injury results from hematoma mass effect and elevated intracranial pressure, followed by secondary injury driven by edema, inflammation, and oxidative stress. Because hematoma expansion commonly occurs within the first hours after symptom onset and strongly predicts mortality, early ED management prioritizes rapid neuroimaging, controlled blood pressure reduction, timely anticoagulation reversal, seizure management, metabolic and temperature control, and prompt neurosurgical consultation when indicated. Emerging evidence supports bundled, time-sensitive care pathways to reduce delays and optimize outcomes.

Conclusion: Optimal ICH outcomes depend on rapid, structured, guideline-concordant ED care focused on limiting hematoma expansion and secondary injury. Standardized workflows and bundled interventions represent effective strategies for improving survival and functional outcomes while avoiding premature prognostication in the acute phase.

Introduction: Health systems play a pivotal role in managing chemical weapons of mass destruction (WMD) terrorist incidents, particularly in reducing casualties and facilitating crisis management. The growing recognition of the need for precise and effective preparedness in these sectors underscores the importance of this research. The present study aimed to identify the essential components of hospital preparedness and to develop and validate a comprehensive model for hospital readiness in response to chemical WMD terrorist incidents.

Methods: This study was conducted in 2025 using a three-phase exploratory sequential mixed-methods approach. First, a scoping review was conducted in accordance with Arksey and O'Malley's methodological framework and the PRISMA guideline to identify key components of hospital preparedness for chemical WMD terrorist incidents. Second, a qualitative study was conducted using semi-structured interviews, and the data were analyzed through a conventional content analysis approach to further identify preparedness components. Third, the components derived from the previous two phases were integrated and validated through two rounds of the Delphi technique. Ultimately, a comprehensive hospital preparedness model was developed.

Results: Following integration of the scoping review and qualitative findings by an expert panel, 88 preparedness components were identified. After two rounds of the Delphi technique, 82 preparedness components were finalized and classified into 16 subcategories and seven main categories: specialized training and empowerment; psychological support and ethical considerations; security measures; specialized clinical and therapeutic processes; optimal management of surge capacity; integrated information and communication management; and contingency strategic management and planning. Finally, based on the Delphi assessment, the proposed preparedness model was approved by the expert panel.

Conclusions: Hospitals facing chemical terrorism require a comprehensive preparedness strategy encompassing specialized training, psychological support, and robust clinical systems. Effective management, intersectoral coordination, and security measures are essential for an effective response. Implementing preparedness strategies aligned with the proposed model can significantly enhance health systems' readiness and resilience to chemical WMD threats.