International Journal of Emergency Medicine最新文献

Background: Gamification can be defined as the use of game design elements in non-game contexts, in this case, education. As such, gamification seeks to augment the interactive approach of adult learning theory which promotes ongoing motivation and engagement. The objective of this study was to develop and implement a gamified learning module to teach the pit crew approach to Emergency Medical Services personnel in an interactive, engaging format. We created a game-based simulation scenario, an introductory video, and a post-session survey to assess the effectiveness of our educational innovation. We hypothesized that gamification would strengthen classroom engagement and attitudes toward clinical education as assessed in the post-session survey.

Methods: This was a pilot study to assess the characteristics of a novel, gamified educational session. We created teams of 5 personnel with various experience and levels of training. Our educational session began with an introductory video and the Pit Crew Card Game, a novel, interactive card game where the facilitator leads teams through a verbal scenario and administers task cards to the team leader based on interventions and other tasks the group verbalizes. After the game, teams were engaged in an interactive critical care simulation scenario where they were expected to perform tasks based on their pre-assigned roles. After the exercise, we administered a brief survey to assess learners' perceptions about the effectiveness of this novel educational session as well as whether participating in this activity would change their behaviors in future real-life critical care scenarios.

Results: 96 participants completed the post-session survey. The Pit Crew Card Game was heavily favored over traditional lecture-based learning sessions, with 84% of respondents indicating agreement. 77% agreed that the game improved their understanding of how to utilize the pit crew approach for critical care scenarios and that it was an effective teaching, teamwork, and communication tool.

Conclusion: Based on these results, we conclude that gamification has potential as a preferential and feasible learning method for critical scenario training among prehospital personnel. Participants reported that the Pit Crew Card Game increased their understanding of pit crew concepts, promoted effective communication and teamwork, and was an overall effective teaching tool. We recommend further expansion of gamified teaching strategies to the prehospital education realm and support for future research in this domain.

Background: Traumatic diaphragmatic injury (TDI) is well-known worldwide as rare and life-threatening. However, because no nationwide cohort study of penetrating and blunt TDI has been conducted in Japan and other countries where penetrating trauma is relatively uncommon, the clinical characteristics of all TDI are unknown. We aimed to describe the characteristics of TDI patients, compare penetrating TDI with blunt TDI, and identify mortality risk factors in Japan.

Methods: We retrospectively identified TDI patients between 2004 and 2019 using data from the Japan Trauma Data Bank. We extracted data on patient demographics, type of trauma, cause of trauma, physiological parameters, region of concomitant injury, associated injury, and management. We compared penetrating and blunt TDI for each variable. The primary outcome was mortality. Multivariable logistic regression was performed to identify mortality risk factors.

Results: Of the 338,744 patients, 1,147 (0.3%) had TDI, of which 771 were eligible for analysis (excluding 308 in cardiac arrest on arrival). Penetrating TDI represented 29.8% and blunt TDI 70.2%, and comparing penetrating and blunt TDI, the most common cause was self-inflicted (48.7%) vs. accident (85.6%), males were 68.7% vs. 66.0% of the patients (P = 0.50), and the mortality rate was 8.3% vs. 26.4% (P < 0.001). Multivariable analysis found that age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.04), Injury Severity Score (OR 1.03, 95%CI 1.006-1.06), Revised Trauma Score (OR 0.55, 95%CI 0.45-0.67), severe concomitant abdominal injury (OR 2.45, 95%CI 1.32-4.56), severe concomitant upper extremity injury (OR 3.38, 95%CI 1.24-9.17) were independent predictors of mortality, and computed tomography (CT) (OR 0.32, 95%CI 0.15-0.69) and diaphragm repair (OR 0.44, 95%CI 0.25-0.78) were protective factors.

Conclusions: In Japan, we found that penetrating TDI was mainly caused by self-injury and the male-female ratio was the same as for blunt TDI, although blunt TDI was much more frequent. TDI was considered highly lethal, with over 25% of patients in cardiac arrest on arrival. Our unique independent predictors were CT, severe concomitant abdominal injury, and severe concomitant upper extremity injury. These findings may help in the management of TDI in countries with less common penetrating trauma.

Background: Pyrethroid insecticides are widely used because of their low toxicity in humans. Spray-type pyrethroids are often formulated with kerosene as a carrier solvent, and inhalation of kerosene-containing products can lead to pneumonitis and the formation of lung abscesses. We report a case of chemical pneumonitis resulting in the development of a lung abscess due to the intentional inhalation of pyrethroids.

Case presentation: A man in his 50s in a psychiatric hospital for transient psychotic disorder attempted suicide during an overnight leave from the hospital. He drank sodium hypochlorite, put a nylon bag over his head, and sprayed pyrethroid insecticide inside the bag. He was found collapsed and was transported to our emergency room. On arrival, his SpO₂ was 100% on O₂ at 10 L/min by mask (100% on room air at ambulance arrival), his circulation was stable, and his Glasgow Coma Scale score was 10 (E1V3M6), which improved to 15 (E4V5M6) in about one hour. A chest computed tomography (CT) scan showed ground-glass shading in both lungs. We diagnosed him as having pneumonia and started antimicrobial therapy. On day 13 of hospitalization, we found multifocal hypo-absorptive areas, and a diagnosis of lung abscess was made based on CT imaging, and antimicrobial therapy was continued. During the hospitalization, he expectorated bloody sputum. A contrast chest CT scan obtained on day 71 of hospitalization showed a pseudoaneurysm in the abscess cavity, for which we performed successful transcatheter coil embolization. On day 77, the abscess was shrinking, and he was transferred to another hospital for continued treatment. However, he again had bloody sputum and was transferred back to our hospital on day 113. Another contrast chest CT scan revealed the formation of a new aneurysm, and on day 114, we successfully performed coil embolization again, and he was transferred back to the other hospital on day 116.

Conclusion: Spray-type pyrethroid insecticides contain the organic solvent kerosene. Inhalation of kerosene has been reported in several cases of chemical pneumonitis leading to lung abscess. Clinicians should pay attention to kerosene contained in insecticides and the circumstances under which they are used. Early recognition and aggressive treatment can likely prevent severe outcomes.

Introduction: Long QT syndrome (LQTS) is a potentially lethal medical condition that might never be diagnosed and cause sudden cardiac death. It is mainly caused by mutation in electrolyte transporter genes. Due to the significant difference in the treatment approach of heart block and other rhythm disorders that mimic this condition, it is necessary to discriminate these conditions. The occurrence of pseudo-block in electrocardiography features but without disturbance in the function of the conduction system can mask the definite diagnosis of the real underlying disorder, and this issue leads to the selection of an unfavorable treatment protocol and sometimes the sudden death of the patient.

Case presentation: We described an infant who showed evidence of atrioventricular (AV) block in initial electrocardiography (ECG) on his first day, but in further evaluations, the final diagnosis of LQTS was raised. The patient recovered after performing the treatment protocol, which included Mexiletine and beta-blockers. After the genetic test of the parents and the patient, it was determined that a defective allele of the gene had caused the condition.

Conclusion: Our report shows the importance of timely differentiation between heart block and LQTS in neonates and choosing the correct treatment approach to faster patient recovery and prevent sudden death.

Clinical key message: Primary diagnosis of LQTS in neonates might not be a straightforward process due to resembling AV pseudo-block and can cause misleading diagnosis and treatment. Long QT syndrome has several nonspecific presentations. They might be asymptomatic until adulthood and be diagnosed after sudden cardiac death. Preventive measures such as timely initiation of medications, ICD or PPM implantation, and continuous observation by caregivers are the mainstay of survival and quality of life improvement.

Background: Artificial intelligence (AI) uses a process by which machines perform human-like functions such as automated clinical decisions. This may operate efficiently in gynecologic and obstetric emergencies. We aimed to review the role and applications of AI in gynecologic and obstetric emergencies.

Methods: A literature search was carried out in November 2023 in PubMed, Cochrane Library and Google Scholar using the keywords combination of "artificial intelligence, gynecology and obstetrics". Relevant articles were selected and read. Reference lists of the selected articles were also searched.

Results: The literature demonstrated the role of AI to improve healthcare in emergency settings in several aspects such as diagnostic imaging, improving predictions in emergencies, and improving planning and resource allocation for emergency services. AI works objectively, overcoming human biases in decision-making. Creating interconnected data registries for AI will likely enhance its performance. Validation research in emergency settings has shown that AI-prediction tools perform more accurately compared with the estimation of risk and outcomes by gynecologists and obstetricians in emergency situations including endometriosis and acute abdominal pain. There was acceptance of AI and its potential benefits. Ethical dilemmas of using AI include data governance, responsibility for errors, and security issues. Providing training on AI to healthcare professionals working in emergency departments is needed.

Conclusions: Healthcare professionals should educate themselves about the anticipated role of AI in gynecologic and obstetric emergencies, its indications, limitations, and ethical considerations so that they can take steps towards its application in their future practice using defined guidelines.

Background: Institutions, departments, and individuals are increasingly facing challenges to determine how to enable their learners to acquire and curate rapidly changing knowledge and to foster the creation of lifelong learners in this information-rich digital era.

Methods: Much like the Precision Medicine initiative of 2015, in which diagnostic, treatment, and preventive care target individual patients based on their genetic and environmental profiles, educators can use the same principles to create a model of "Precision Education."

Results: In this model, future facing individualizable educational infrastructure can consider innate qualities, learning style, behavior, environment, prior experience, expertise, and assessments.

Conclusion: Educators can utilize Artificial Intelligence, the Master Adaptive Learner model, and key components of Competency Based Medical Education to transform the evolution of Health Professions Education to meet the individual and systemic needs of tomorrow's learners, educators, and institutions to improve educational and clinical outcomes.

Background: The Oakland Score predicts risk of 30-day adverse events among hospitalized patients with lower gastrointestinal bleeding (LGIB) possibly identifying patients who may be safe for discharge. The Oakland Score has not been studied among emergency department (ED) patients with LGIB. The Oakland Score composite outcome includes re-bleeding, defined as additional blood transfusion requirements and/or a further decrease in hematocrit (Hct) >/= 20% after 24 h in clinical stability; red blood cell transfusion; therapeutic intervention to control bleeding, including surgery, mesenteric embolization, or endoscopic hemostasis; in-hospital death, all cause; and re-admission with further LGIB within 28 days. Prediction variables include age, sex, previous LGIB admission, systolic blood pressure, heart rate, and hemoglobin concentration, and scores range from 0 to 35 points, with higher scores indicating greater risk.

Methods: Retrospective cohort study of adult (≥ 18 years old) patients with a primary ED diagnosis of LGIB across 21 EDs from March 1st, 2018, through March 1st, 2020. We excluded patients who were more likely to have upper gastrointestinal bleeding (esophago-gastroduodenoscopy without LGIB evaluation), patients who left against medical advice or prior to ED provider evaluation, ED patients without active health plan membership, and patients with incomplete Oakland Score variables. We assessed predictive accuracy by reporting the area under the receiver operator curve (AUROC) and sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios at multiple clinically relevant thresholds.

Results: We identified 8,283 patients with LGIB, 52% were female, mean age was 68, 49% were non-White, and 27% had an adverse event. The AUROC for predicting an adverse event was 0.85 (95% CI 0.84-0.86). There were 1,358 patients with an Oakland Score of

Conclusion: The Oakland Score had high predictive accuracy among ED patients with LGIB. Prospective evaluation is needed to understand if the risk score could augment ED decision-making and improve outcomes and resource utilization.

Background: Emergency department (ED) crowding is a growing concern worldwide and associated with negative effects. In 2013, 68% of Dutch ED-managers experienced crowding on several days of the week. This resulted into the introduction in phases of an ambulance diversion dashboard, in order to influence ED input. Increasing numbers of Dutch EDs have implemented this dashboard, visualizing regional ambulance diversions by means of a traffic light.

Methods: This is a descriptive study of a nationwide online survey of Dutch EDs, conducted between January and October 2023. It included both qualitative and quantitative questions. The outcomes and analysis are derived from descriptive data of respondents' experience of crowding as well as their usage and perceived effectiveness of the ambulance diversions dashboard.

Results: At the time of the survey, 62 of 82 Dutch EDs (75.6%) actually used the dashboard, of which 56 EDs responded (90.3% response rate). 69.7% Of ED managers experienced ED crowding more than three times a week. Of the respondents using the dashboard, 52.8% reported it only occasionally alleviates ED inflow. The purported reasons are the limited number of patients affected by the red light (ambulance diversion) and the presence of regional crowding. The effects of the orange light (impending ambulance diversion) on ED input differ greatly among hospitals, mostly due to their own internal agreements. In accordance, many respondents (53.6%) expressed dissatisfaction with the resources available to them to alleviate crowding.

Conclusion: After conducting a national survey, ED crowding is reported as a persisting nationwide problem with its prevalence largely unchanged since the introduction of the ambulance diversion dashboard. Most hospitals reported having insufficient resources to alleviate it. The effects of the ambulance diversion dashboard to decrease crowding are apparently limited because it affects a small portion of total ED presentations and because of the influence of regional crowding. The main function of the orange light is to increase ED throughput and output rather than reducing ED input.

Background: Timely emergency medical services (EMS) are particularly important among trauma patients, as inefficient EMS systems can result in potentially avoidable death before reaching a hospital. The Dhulikhel Hospital Dispatch Center coordinates and monitors a growing network of ambulances, including seven Type B ambulances staffed with a trained prehospital care provider and medical equipment. This study evaluates the prehospital care and outcomes of trauma patients transported by Type B ambulances to Dhulikhel Hospital's Emergency Department, as monitored by the Dispatch Center.

Methods: Data were collected via a retrospective chart review of Dispatch Center records, including patient demographics, injury mechanisms, prehospital care, and outcomes. Patients were included if they experienced physical trauma and were transported by a Type B ambulance to Dhulikhel Hospital's Emergency Department between 2019 and 2023.

Results: Between 2019 and 2023, 224 trauma patients were transported to the hospital and received prehospital care services from Type B ambulances monitored by the Dispatch Center. Most patients were male (59%), and nearly half were aged 18-44 (49%). The median total transport time for Dhulikhel Hospital-owned Type B ambulances was 40 min. Type B ambulances reached patients across 24 municipalities (88% in Kavrepalanchowk and Sindupalchowk districts). Falls (55%) and road traffic accidents (30%) were the most common injury mechanisms, followed by physical assault (7%). Falls were significantly associated with female, pediatric, and geriatric patients (p < 0.05), while road traffic accidents predominated among males, particularly in adults aged 25-34 years (p < 0.05). Approximately one-third of patients admitted to the hospital after evaluation in the emergency department experienced multiple injuries, and the most prevalent diagnosis of admitted cases were extremity fractures (52%).

Conclusion: Trauma cases accounted for 15% (227/1541) of all patients who received transport and prehospital care services from a Type B ambulance monitored by the Dispatch Center between 2019 and 2023. This study demonstrates the critical role of Type B ambulances and an integrated dispatch center in advancing timely and efficient prehospital care for trauma patients in Nepal.

Purpose: Here we describe a patient admitted for a stroke that was unexpectedly correlated with subclinical infective endocarditis attributable to a rarely opportunistic pathogen, Abiotrophia defectiva.

Case report: A 75-year-old man presented with a stroke. Transesophageal echocardiography suggested vegetation on all aortic valve cusps, despite the absence of clinical or laboratory signs of infection. Surprisingly, three sets of blood cultures collected without fever were positive for A. defectiva. Although the patient did not exhibit classic signs of infection during hospitalization, the severity of the valve condition necessitated replacement with a bioprosthesis.

Conclusions: This clinical case underscores the importance of investigating the infective origin of endocarditis, even in the absence of clinical or laboratory evidence. Physicians should maintain a high level of suspicion, especially in patients with highly suggestive anamnestic characteristics.