International Journal of Emergency Medicine最新文献

Introduction: The Republic of Moldova, an upper-middle-income nation in Eastern Europe, has encountered overlapping public health and humanitarian challenges that have tested the resilience of its health system. Following the COVID-19 pandemic and 2022 influx of refugees from neighbouring Ukraine, the Ministry of Health (MoH) identified an urgent need to upskill healthcare providers in emergency care. The World Health Organization-International Committee of the Red Cross Basic Emergency Care (BEC) course was selected as a rapid solution to train a range of providers in managing acute patients. This study assessed BEC's effects on emergency care knowledge and confidence in Moldova.

Methods: From February 2023 to December 2024, 15 BEC courses were taught in Moldova. Participants completed pre- and post-course knowledge tests, confidence self-assessments, and feedback forms. Quantitative scores were assessed using descriptive statistics and nonparametric testing, and qualitative responses were analysed thematically.

Results: Of 371 enrolled participants, 312 (84%) completed all course requirements. Post-course knowledge scores were significantly higher than pre-course (mean score: +20.2%, p < 0.001). Self-reports also improved, with mean scores (ranging from 1 - least - to 4 - most) increasing from 1.85 (SD: 0.91) to 2.17 (SD: 0.67) for confidence (p < 0.001) and 1.58 (SD: 0.79) to 2.07 (SD: 0.61) for competence (p < 0.001). Most (89%) found the course highly relevant to their work and rated instructors as excellent (97%). Participants valued the symptom-based approach, hands-on simulations, short course duration, and interactive teaching, while suggesting more time for hands-on skills practice.

Conclusion: National BEC implementation in Moldova showed that a standardized short course can generate significant gains in emergency care knowledge and confidence across diverse provider cadres in a matter of days. Participants gained significant emergency care knowledge and confidence, even though the healthcare system was under immense strain at the time of implementation. The rollout's decentralized delivery and high acceptability underscore its potential for national scalability and integration into existing preparedness frameworks. Moldova's experience demonstrates how targeted education can strengthen surge capacity and sustainably contribute to resilient health systems, even amid crises.

Background: Recurrent syncope with seizure-like stiffening may mimic epilepsy or neurological disorders, and when routine tests are repeatedly normal, intermittent arrhythmia can be easily overlooked.

Case presentation: We report a case of a 65-year-old man with hypertension, hyperuricaemia, dyslipidaemia, and asthma who experienced recurrent syncopal episodes over one month. He presented several times to emergency departments and tertiary hospitals. Neurological and cardiovascular investigations-including brain MRI, echocardiography, coronary angiography, laboratory tests, and a previous Holter ECG-were consistently unremarkable. The initial diagnosis was hypertensive crisis based on marked post-event blood pressure surges, which was later recognized as a secondary phenomena rather than the primary cause of syncope. On the index admission, continuous emergency monitoring captured a sinus arrest of ~ 17 s with absent arterial pulse waveform, followed by bradyarrhythmia. Post-event blood pressure spiked to 220/110 mmHg. A repeat Holter ECG confirmed intermittent Mobitz II and complete AV block with asystole up to 18.6 s. EEG, performed during this admission to exclude epilepsy, was normal. A dual-chamber permanent pacemaker was implanted with complete resolution of symptoms (Shen et al, Circulation 136(5):e60-e122, 2017; Kusumoto et al, Circulation 140(8): e382-e482, 2019; Brignole et al, Eur Heart J 39(21):1883-1948, 2018).

Conclusion: This case demonstrates how intermittent AV block may masquerade as seizure or hypertensive crisis, underlining the critical role of emergency department monitoring and prolonged ECG recording in recurrent unexplained syncope.

Purpose: End-tidal carbon dioxide (ETCO₂) monitoring is a vital, noninvasive technique for assessing ventilation, circulatory status, and predicting adverse events in pediatric emergency departments (EDs). This review aims to synthesize current evidence, examine barriers, and highlight strategies to optimize ETCO₂ monitoring in pediatric emergency settings.

Methods: A narrative review of the literature was conducted, encompassing epidemiological data, clinical guidelines, expert consensus statements, and recent studies targeting ETCO₂ monitoring in pediatric emergencies. Key topics evaluated include physiological principles, airway management, prognostic value in cardiac arrest, procedural sedation safety, sepsis triage, limitations, and future directions. Data from both high- and low-resource settings were included.

Results: ETCO₂ monitoring demonstrates high sensitivity and specificity for confirming endotracheal tube placement and early detection of respiratory compromise-identifying hypoventilation, apnea, and airway obstruction minutes before pulse oximetry. During CPR, persistently low ETCO₂ values correlate with poor outcomes, while sudden increases signal return of spontaneous circulation. In procedural sedation, routine capnography reduces hypoxic episodes and adverse events. In sepsis, ETCO₂ inversely correlates with lactate levels, offering a rapid, non-invasive marker of perfusion, though its reliability diminishes in multisystemic shock. Challenges include equipment limitations, provider training gaps, lack of universal protocols, and cost barriers-especially in low-resource settings.

Conclusion: ETCO₂ monitoring is an essential tool in pediatric emergency care, enhancing safety and clinical decision-making across multiple scenarios. Addressing implementation barriers through education, standardized protocols, and accessible technology is crucial to ensure widespread adoption and improved outcomes for critically ill children.