International Journal of Emergency Medicine最新文献

Background: Acquired hemophilia A is an uncommon but potentially life-threatening bleeding disorder caused by autoantibodies against factor VIII. It can be associated with autoimmune disease, malignancy, or pregnancy.

Case report: We describe a 31-year-old woman, five weeks postpartum, who presented to the emergency department with left arm pain and swelling complicated by concern for compartment syndrome. Laboratory evaluation revealed an isolated markedly prolonged partial thromboplastin time (PTT) of 86.9 s with a normal international normalized ratio, and severely reduced factor VIII activity of 1.5%. A mixing study showed no correction, and factor VIII inhibitor titer was 16 Bethesda units, confirming acquired hemophilia A. She was admitted to the intensive care unit and treated with bypassing hemostatic therapy (recombinant factor VIIa and factor VIII concentrate), tranexamic acid, corticosteroids, rituximab, and a single dose of emicizumab, with subsequent clinical and laboratory improvement. The patient was discharged home without any complications.

Conclusions: Postpartum acquired hemophilia A is rare but can present with limb-threatening bleeding. This case emphasizes the importance of recognizing spontaneous postpartum hematomas as potential indicators of acquired hemophilia in the emergency setting.

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.