International Journal of Emergency Medicine最新文献

Background: The burden of time-sensitive illnesses that require emergency care, such as heart diseases, respiratory tract infections, and road traffic injuries, is the leading cause of premature deaths. The healthcare providers of the emergency care system lack the essential knowledge and skills across different healthcare levels in our country. In this paper, we aim to describe the development and initial implementation of a blended learning curriculum for teaching and training non-EM-trained physicians working in the emergency departments of our country.

Methods: We used a previously articulated curriculum designed by Patricia Thomas and David Kern. The model included general and specific need assessment, defining goals and objectives, selecting teaching and learning strategies, and implementation and evaluation plans.

Results: Based on the need assessment, a module-based blended learning model has been designed with well-defined goals and objectives covering knowledge and skills. This ten-week module-based course focuses on four areas of critically emergent conditions, i.e., trauma, shock, difficulty in breathing, and altered mental status. Evaluation will be made by comparing the pre and post-test scores of the participants.

Conclusion: We have developed a blended course to teach non-EM-trained physicians working in the ED of our country. We hope that through this blended learning model, we will be able to adequately train our physicians working in the emergency department without any formal training in EM, which will lead to improved patient care and outcomes.

Background: During embryogenesis, the spleen undergoes intricate developmental processes, originating from mesenchymal cells in the dorsal mesentery. An accessory spleen, a common anomaly found in autopsies and abdominal CT scans, can often be mistaken for different types of tumors. To the best of our knowledge, this is the first case in Syria documenting the occurrence of 3 accessory spleens in a patient who had previously undergone splenectomy.

Case presentation: A 33-year-old male presented with right hypochondrium pain, sharp and radiating to the right flank, exacerbated by movement and large meals. Past medical history included mild Irritable Bowel Syndrome (IBS) and splenectomy due to a traumatic accident in childhood. On admission, vital signs were stable, with abdominal tenderness in the right upper quadrant. Laboratory investigations showed normal values. Ultrasound revealed a lobulated mass at the right adrenal gland (4.5 × 5 cm) with an isoechoic to hypoechoic texture. Multi-slice computed tomography (MSCT) Scan showed multiple nodules in the right adrenal gland, regular in shape, exerting a compressive mass effect, and significant lymphadenopathy around the abdominal aorta. Elevated metanephrine levels raised suspicion of an extra-adrenal pheochromocytoma. Laparoscopic surgery was performed, revealing accessory spleens and normal adrenal tissue with no malignancy.

Conclusion: Healthcare providers should consider accessory spleens as a differential diagnosis for masses near the adrenal glands. Multiple accessory spleens in the adrenal region can complicate cases. Accessory spleens in uncommon locations like the adrenal glands can be challenging to diagnose and manage.

Background: High-pressure injection injuries are rare injuries and are frequently underestimated due to the limited external damage. Because of their association with occupational activities, these injuries are predominantly seen in hands. Facial involvement in such traumas is extremely rare. The difference in facial anatomy compared to the extremities demands careful consideration of both associated complications and treatment options.

Case: A 6-year-old girl with no significant medical history was presented to the Emergency Department with a high-pressure injection injury to her right eye with a high-pressure cleaner. This resulted in injection of air at a pressure of 8 bar into the eye. She developed significant subcutaneous emphysema in the facial and neck regions. Additionally, intraorbital and intracranial emphysema were identified without any fractures. Treatment consisted of inpatient observation and antibiotic treatment. The patient was discharged after one day of observation for continued antibiotic treatment at home. Two weeks later, the patient had no residual symptoms and there were no signs of secondary infection.

Conclusion: High-pressure injection injuries to the face are rare and demand a different approach compared to the most common high-pressure injection injuries to the extremities. The nature of the injected material is paramount in choosing the appropriate treatment. This case illustrates that a high-pressure injection injury with air in the facial region, leading to extensive emphysema, can be managed conservatively with antibiotic therapy and inpatient observation.

Background: Stroke in young needs an individualized approach before considering thrombolysis. Here we present a case of undiagnosed mitral valve prolapse presenting with stroke due to associated infective endocarditis. Young stroke patients presenting with fever need a panoramic approach. This 39-year-old female with a background history of fever and loss of weight for two months presented to the emergency department with a history of altered sensorium and aphasia. The Magnetic Resonance Imaging (MRI) showed a hyperacute infarct. Hence, thrombolysis with alteplase was considered. Post thrombolysis, the patient had a parenchymal bleed. The diagnostic evaluation yielded stroke secondary to infective endocarditis because of undiagnosed mitral valve prolapse.

Conclusion: Mitral valve prolapse is not associated with stroke in young patients. However, the undiagnosed infective endocarditis and subsequent septic emboli led to an increased risk. Emergency physicians and intensivists should anticipate infective causes before considering thrombolysis, as the results could be counterproductive.

Background: Asthma is a common chronic respiratory inflammatory disease that adversely affects patients' quality of life (QoL) and overall well-being. When asthma is not adequately controlled, there is a higher risk of exacerbations and hospitalizations, thereby increasing the direct and indirect costs associated with the treatment and productivity loss. Overreliance on SABA and underutilization of ICS in the management of asthma can result in suboptimal treatment and poor asthma control. Patients who visit the emergency department are more likely to have poorly controlled asthma. Ensuring that these patients are provided with an evidence-based treatment plan during discharge can help reduce the risk of future exacerbations and consequently reduce the burden on the UAE healthcare system.

Methods: A joint task force comprising experts from the Emirates Society of Emergency Medicine (ESEM) and Emirates Thoracic Society (ETS) reviewed published evidence and updated guidelines in asthma management to optimize the post-discharge recommendations.

Results: The ESEM-ETS experts' joint task force has developed a step-by-step plan for emergency department/hospital discharge, which is based on the GINA 2023 guideline recommendations and the medications available in the UAE. By adhering to this structured plan, emergency department physicians can play a crucial role in improving asthma care, long-term patient outcomes, and the utilization of healthcare resources.

Conclusions: Prioritizing patient education and ensuring patients are equipped with the best-suited asthma treatment plans prior to discharge can help ED physicians improve patient outcomes and reduce healthcare resource utilization in UAE hospitals.

Background: The introduction of Emergency Medicine in Rwanda in 2015 has been associated with a mortality reduction in patients presenting to Kigali University Teaching Hospital (KUTH). In the context of increasing numbers of critically ill patients presenting to Emergency Departments (ED) globally, the aim of this study was to describe the characteristics of critically ill patients, the critical care interventions performed, and the outcomes of critically ill patients presenting to the KUTH ED with the goal of informing future research into the root causes of mortality of critically ill ED patients and of identifying high yield topics for didactic and procedural training.

Methods: A descriptive observational prospective cohort pilot study analyzed all patients ≥15 years who presented to KUTH between April and June 2022 with modified South African Triage Scores of Red with alarm, Red without alarm, and Orange.

Results: Of 320 patients, 66.9% were male and median age was 40 years. Patients were triaged as Orange (65.3%), Red without alarm (22.8%), and Red with alarm (11.9%). Presentations were categorized as: medical emergencies (48.0%), traumatic injury (44.5%), and surgical emergencies (7.6%). Median length of stay was 31 h (IQR 28, 56) and boarding was 23 h (IQR 8, 48). Overall mortality was 12.2% and highest among medical emergencies (16.5%, p = 0.048) and increased significantly with triage color: Red with alarm (47.4%), Red without alarm (16.4%), and Orange (4.3%, p < 0.0001). Cardiopulmonary resuscitation (CPR) (10.3%), endotracheal intubation (8.8%), and vasopressor administration (3.1%) were the most frequent critical interventions performed. Survival after cardiac arrest was 9.1% and 32.1% after intubation. Mortality was associated with the following interventions: CPR, intubation, and use of vasopressors (p < 0.05).

Conclusions: This pilot study identified the most common critical care interventions performed and a high mortality among patients who required these interventions in the ED of a tertiary teaching hospital in Rwanda. These findings will inform didactics and procedural training for emergency care providers. Future research should focus on the root causes of mortality in these specific patient populations and identify areas of system strengthening to reduce mortality.

Objective: This study aimed to identify predictors of brain CT abnormalities in patients who sustained a mild traumatic brain injury (mTBI).

Methods: Retrospective observational cohort of adult patients with mTBI (Glasgow Coma Score 13-15) that occurred within the preceding 24 h.

Results: 2548 (91%) of the cohort had a brain CT and 698 (27%) demonstrated abnormal findings. The most frequently observed CT abnormalities were bleeding (638, 25%) and fractures (190, 7.4%). Multivariate logistic regression analysis revealed several significant predictors associated with the presence of brain CT abnormalities including older age [P < 0.0001], male sex [P < 0.0001], loss of consciousness [P = 0.0041], associated vomiting [P = 0.0011], alteration of consciousness (AOC) [P = 0102], and GCS score [P < 0.0001]. This was a robust model with an R² of 14.2%.

Conclusion: In this retrospective analysis, older age, male sex, the presence of loss of consciousness or alteration in consciousness, lower GCS score, and associated vomiting were found to be significant predictors of having an abnormal brain CT. These findings highlight the importance of considering these factors when determining the necessity of brain CT scans in patients with mTBI and suggest that existing clinical decision rules may be limited. These findings may also help to inform clinical decision rules. Early identification of individuals at a higher risk of CT abnormalities may assist in appropriate management and allocation of healthcare resources.

Background: The recreational use of nitrous oxide is becoming increasingly common among teenagers and young adults. Since 2018, the use of nitrous oxide has increased exponentially and has become a public health problem.

Case presentation: A 23-year-old patient was referred to accident and emergency (A&E) by his general practitioner for deterioration in general condition, vomiting, diarrhea and febrile headache at 39 °C. He reported that he had been partying for a month and consuming alcohol, cannabis and nitrous oxide. Three days before the consultation, he reported increased abdominal pain in the right iliac fossa. His homocysteine concentration was 51.9 μmol/L, and his plasma methyl malonate concentration increased to 4.45 μmol/L. A thoracic and abdominal CT scan revealed right iliac venous thrombosis associated with bilateral pulmonary embolism.

Conclusion: Nitrous oxide inhibits the activity of methionine synthetase. We therefore observed an increase in plasma homocysteine and 5-methyl-THF. The increase in homocysteine could be responsible for the pro-thrombotic activity resulting from nitrous oxide intoxication. At present, no threshold or duration of exposure has been identified as being particularly likely to cause complications. It is likely that other factors coexist, such as coagulation disorders and polymorphisms of the MHTFR gene, which can lead to hyperhomocysteinaemia, cannabis consumption, inflammatory conditions and others. Treatment is based on vitamin B12 supplementation and curative anticoagulation. Some authors also recommend folate supplementation. Consumption of nitrous oxide could be associated with arterial and venous thromboembolic disease.

Introduction: In recent years, tenecteplase has been competing with alteplase as a treatment for acute ischemic stroke given its ease of administration, lower dosage, cost-effectiveness, and better safety data. This paper seeks to analyze academic literature regarding the burgeoning usage of tenecteplase as a treatment for acute ischemic stroke across the world.

Method: The Web of Science database was used to collect the data from articles containing the keywords "Tenecteplase" and "Stroke" published from 1999 to 2023. The search resulted in 576 journal articles. This study analyzed metadata related to the country, institution, keywords, and date published for each article in the database pertaining to tenecteplase use for stroke.

Results: The United States led in publications (260, 39.93%), followed by Australia (101, 15.51%), and a tie for third place between Canada and China (77, 11.83% each). The three most prevalent keywords were tenecteplase (N = 324), alteplase (N = 284), and thrombolysis (N = 244). The University of Melbourne and the University of Calgary were the leading institutions publishing on the use of tenecteplase as a treatment for stroke. In 2023, the number of publications on the usage of tenecteplase for stroke was the greatest, making up 24.3% of all papers on the topic.

Conclusion: The surge in academic papers regarding tenecteplase in stroke in 2023 could be a good indicator of the drug's increasing prevalence as a treatment for stroke. Despite this finding, tenecteplase is currently not an FDA-approved therapy in the US as Genentech, the drug's manufacturer, has yet to file for federal approval for acute ischemic stroke treatment.