International Journal of Emergency Medicine最新文献

Platelet gene resistance may result in acute thrombosis, although clinical reports are scarce.This article presents a classic case of acute in-stent thrombosis and discusses its diagnostic and therapeutic strategies.The patient, a 57-year-old male, was admitted due to chest pain that lasted for one hour. After a thorough examination, he was diagnosed with acute ST-segment elevation myocardial infarction. Acute thrombosis rapidly occurred within 30 minutes following emergency coronary stent implantation.

Background: Snakebites caused by Bitis nasicornis and Bitis gabonica are rare but can lead to severe systemic and local complications, including acute compartment syndrome (ACS). The role of surgical intervention in snakebite management remains controversial, with limited data available for snakebite envenomation.

Case presentation: Two cases of upper limb envenomation by Bitis nasicornis and Bitis gabonica were managed at the General University Hospital in Prague in year 2024. Both developed acute compartment syndrome requiring prompt antivenom therapy, fasciotomy, and intensive care. In the first case, antivenom (EchiTab-Plus-ICP) was given within 1 h, 10 vials in total, and fasciotomy at 10 h; the patient was discharged on day 16 with preserved limb function. In the second, antivenom (SAIMR) was administered within 3 h, 4 vials in total (the maximum available in Europe at that time), and fasciotomy at 8 h; recovery was complete by day 7. Diagnosis of ACS was based on clinical signs without intracompartmental pressure measurement.

Conclusion: These cases highlight that timely surgical intervention, combined with intensive care and antivenin may play a critical role in preventing irreversible tissue damage following viperid envenomation. However, universal guidelines are lacking. Incorporating intracompartmental pressure monitoring into treatment protocols may further improve diagnostic accuracy and patient outcomes.

Background: ST-elevation myocardial infarction is a life-threatening condition and the electrocardiogram is an essential tool for its prompt diagnosis. However, ST-segment elevation migration can occur due to several factors, including lead misplacement, coronary vasospasm, thrombus migration, aortic dissection, and acute pericarditis.

Case presentation: A 47-year-old man with chest pain whose electrocardiogram revealed ST-segment elevation in different territories within one hour. The apparent ST-segment elevation migration was attributed to limb lead reversal, as confirmed by the cardiac catheterization findings, which were consistent with the second electrocardiogram.

Conclusions: The accurate identification of ST-segment elevation is important to the cardiologist in order to determine the culprit vessel. This case highlights the accidental electrocardiogram electrode misplacement can result in misdiagnosis, which can be identified by recognizing unusual P-QRS pattern, using familiar-language electrode labeling, and performing serial electrocardiogram reviews.

Background: Toxic encephalopathy, which results from exposure to neurotoxic substances, poses a considerable clinical challenge, especially for occupational groups like painters and construction workers.

Case presentation: This case report describes a 35-year-old female painter who experienced acute toxic encephalopathy, presenting with severe headache, nausea, and vomiting. Initially, her condition was misdiagnosed as cervical spondylosis. However, recognizing her occupational exposure to organic solvents was essential for arriving at the correct diagnosis. This case highlights the importance of thorough evaluations, particularly detailed occupational histories, to avoid misdiagnosis and ensure timely management of such conditions. Neuroimaging results showed bilateral symmetric white matter changes, which supported the diagnosis of organic solvent toxicity. This finding aligns with existing literature that discusses how lipid solubility can disrupt neuronal function. The patient's positive outcome following prompt treatment underscores the critical need for early recognition of toxic encephalopathy, as it can significantly improve recovery chances.

Conclusion: This case enhances our understanding of the complexities associated with diagnosing acute encephalopathy caused by organic solvents and underscores the urgent need for healthcare providers to be more aware of occupational hazards.

Background: Peri-intubation cardiac arrest is defined as cardiac arrest that occurs within 20 min of airway management. Incidence in the pediatric population ranges from 0.7% to 1.7%. Identifying pre-intubation risk factors may improve preparedness and outcomes during emergency intubations. This study aims to identify clinical and physiological predictors associated with peri-intubation cardiac arrest in pediatric patients undergoing emergency airway management in a tertiary care emergency department.

Methods: A retrospective case-control study was conducted at the emergency department of a tertiary care hospital in Karachi, Pakistan, from January 2019 to June 2023. Pediatric patients (< 18 years) who experienced cardiac arrest within 20 min of intubation were included as cases. For each case, four controls were randomly selected from the same cohort who were intubated without arrest. Pre-intubation clinical data, laboratory parameters, and vital signs were analyzed. Multivariable logistic regression was used to identify independent predictors of peri-intubation cardiac arrest.

Results: A total of 1031 pediatric patients underwent intubation in the ED, with 25 cases (2.4%) of peri-intubation cardiac arrest identified. For comparison, 100 controls without cardiac arrest were randomly selected, resulting in a total study cohort of 125 patients. Multivariate analysis identified several independent predictors of peri-intubation cardiac arrest. Age less than one year (aOR: 4.37; p = 0.042), hypoxemia (SpO₂ < 92%) (aOR: 19.81; p = 0.003), elevated heart rate (aOR: 1.42; p = 0.045), low systolic blood pressure (aOR: 6.56; p = 0.043), elevated shock index (≥ 1.2) (aOR: 5.52; p = 0.046), modified shock index ≥ 1.3 (aOR: 6.27; p = 0.012), lactate ≥ 2 mmol/L (aOR: 10.09; p = 0.047) and capillary refill time > 3 s (aOR: 5.78; p = 0.038), were found to be independent predictors of peri-intubation cardiac arrest.

Conclusion: Pre-intubation physiological instability is strongly associated with peri-intubation cardiac arrest in pediatric patients. Early recognition of high-risk features such as hypoxemia, tachycardia, hypotension, elevated lactate levels, delayed capillary refill time, and elevated shock indices may allow for better preparation and resuscitation planning. These findings support the need for structured pre-intubation assessment protocols in emergency settings.