Pub Date : 2024-07-29DOI: 10.1186/s12245-024-00666-6
Nina Fischer, Xinfei Miao, Danielle Weck, Jacob Matalon, Cameron C Neeki, Troy Pennington, Fanglong Dong, Sarkis Arabian, Michael M Neeki
Background: The recent global pandemic due to severe acute respiratory syndrome coronavirus-2 resulted in a high rate of multi-organ failure and mortality in a large patient population across the world. As such, a possible correlation between acute kidney injury (AKI) and increased mortality rate in these patients has been suggested in literature.
Methods: This is a two-year retrospective study of critically ill adult patients infected with COVID-19 that were admitted to the intensive care unit (ICU) on ventilatory support. Two groups of patients were identified in this study, those who were directly admitted to the ICU or those who were initially admitted to the Medical Floor and were later transferred to the ICU due to either worsening respiratory status or change in their hemodynamic conditions. Within each group, three subgroups were created based on the status of AKI, namely, those who did not develop AKI, those who developed AKI, and those who with previous history of dialysis dependent AKI.
Results: The AKI subgroup had the highest mortality rate in the ICU and Floor patients. Of note, those patients who were directly admitted to the Floor and were later transferred to the ICU for worsening conditions also experienced a higher mortality rate if they had developed AKI during their course of hospital stay.
Conclusions: This study identified a statistically significant higher mortality in patients who developed AKI than those who did not develop AKI among critically ill patients.
Trial registration: Clinicaltrials.gov registration number NCT05964088. Date of registration: July 24 2023.
背景:最近由严重急性呼吸系统综合征冠状病毒-2引起的全球大流行导致全球大量患者出现多器官功能衰竭,死亡率居高不下。因此,有文献认为急性肾损伤(AKI)与这些患者的死亡率增加之间可能存在关联:这是一项为期两年的回顾性研究,研究对象是感染 COVID-19 并进入重症监护室(ICU)接受呼吸机支持治疗的成年重症患者。本研究确定了两组患者,一组是直接入住重症监护室的患者,另一组是最初入住内科楼层,后因呼吸状况恶化或血液动力学状况改变而转入重症监护室的患者。在每组患者中,根据 AKI 状态分为三个亚组,即未发生 AKI 者、发生 AKI 者和既往有透析依赖性 AKI 病史者:AKI 亚组的重症监护室和楼层患者死亡率最高。值得注意的是,那些直接入住楼层病房,后因病情恶化转入重症监护室的患者,如果在住院期间发生了 AKI,死亡率也会更高:本研究发现,在危重病人中,发生 AKI 的病人死亡率明显高于未发生 AKI 的病人:试验注册:Clinicaltrials.gov 注册号 NCT05964088。注册日期:2023 年 7 月 24 日:2023年7月24日。
{"title":"Mortality and morbidity associated with new onset acute kidney injury in critically ill COVID-19 infection patients.","authors":"Nina Fischer, Xinfei Miao, Danielle Weck, Jacob Matalon, Cameron C Neeki, Troy Pennington, Fanglong Dong, Sarkis Arabian, Michael M Neeki","doi":"10.1186/s12245-024-00666-6","DOIUrl":"10.1186/s12245-024-00666-6","url":null,"abstract":"<p><strong>Background: </strong>The recent global pandemic due to severe acute respiratory syndrome coronavirus-2 resulted in a high rate of multi-organ failure and mortality in a large patient population across the world. As such, a possible correlation between acute kidney injury (AKI) and increased mortality rate in these patients has been suggested in literature.</p><p><strong>Methods: </strong>This is a two-year retrospective study of critically ill adult patients infected with COVID-19 that were admitted to the intensive care unit (ICU) on ventilatory support. Two groups of patients were identified in this study, those who were directly admitted to the ICU or those who were initially admitted to the Medical Floor and were later transferred to the ICU due to either worsening respiratory status or change in their hemodynamic conditions. Within each group, three subgroups were created based on the status of AKI, namely, those who did not develop AKI, those who developed AKI, and those who with previous history of dialysis dependent AKI.</p><p><strong>Results: </strong>The AKI subgroup had the highest mortality rate in the ICU and Floor patients. Of note, those patients who were directly admitted to the Floor and were later transferred to the ICU for worsening conditions also experienced a higher mortality rate if they had developed AKI during their course of hospital stay.</p><p><strong>Conclusions: </strong>This study identified a statistically significant higher mortality in patients who developed AKI than those who did not develop AKI among critically ill patients.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov registration number NCT05964088. Date of registration: July 24 2023.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-25DOI: 10.1186/s12245-024-00660-y
Ahmed Hasanin, Filippo Sanfilippo, Martin W Dünser, Hassan M Ahmed, Laurent Zieleskiewicz, Sheila Nainan Myatra, Maha Mostafa
Acute circulatory shock is a life-threatening emergency requiring an efficient and timely management plan, which varies according to shock etiology and pathophysiology. Specific guidelines have been developed for each type of shock; however, there is a need for a clear timeline to promptly implement initial life-saving interventions during the early phase of shock recognition and management. A simple, easily memorable bundle of interventions could facilitate standardized management with clear targets and specified timeline. The authors propose the "MINUTES" acronym which summarizes essential interventions which should be performed within the first 30 min following shock recognition. All the interventions in the MINUTES bundle are suitable for any patient with undifferentiated shock. In addition to the acronym, we suggest a timeline for each step, balancing the feasibility and urgency of each intervention. The MINUTES acronym includes seven sequential steps which should be performed in the first 30 min following shock recognition: Maintain "ABCs", INfuse vasopressors and/or fluids (to support hemodynamic/perfusion) and INvestigate with simple blood tests, Ultrasound to detect the type of shock, Treat the underlying Etiology, and Stabilize organ perfusion.
{"title":"The MINUTES bundle for the initial 30 min management of undifferentiated circulatory shock: an expert opinion.","authors":"Ahmed Hasanin, Filippo Sanfilippo, Martin W Dünser, Hassan M Ahmed, Laurent Zieleskiewicz, Sheila Nainan Myatra, Maha Mostafa","doi":"10.1186/s12245-024-00660-y","DOIUrl":"10.1186/s12245-024-00660-y","url":null,"abstract":"<p><p>Acute circulatory shock is a life-threatening emergency requiring an efficient and timely management plan, which varies according to shock etiology and pathophysiology. Specific guidelines have been developed for each type of shock; however, there is a need for a clear timeline to promptly implement initial life-saving interventions during the early phase of shock recognition and management. A simple, easily memorable bundle of interventions could facilitate standardized management with clear targets and specified timeline. The authors propose the \"MINUTES\" acronym which summarizes essential interventions which should be performed within the first 30 min following shock recognition. All the interventions in the MINUTES bundle are suitable for any patient with undifferentiated shock. In addition to the acronym, we suggest a timeline for each step, balancing the feasibility and urgency of each intervention. The MINUTES acronym includes seven sequential steps which should be performed in the first 30 min following shock recognition: Maintain \"ABCs\", INfuse vasopressors and/or fluids (to support hemodynamic/perfusion) and INvestigate with simple blood tests, Ultrasound to detect the type of shock, Treat the underlying Etiology, and Stabilize organ perfusion.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-18DOI: 10.1186/s12245-024-00676-4
João Isuk Suh, Daiane Leite da Roza, Filipe Matheus Cadamuro, Luiz Marcelo Sá Malbouisson, Talita Rojas Sanches, Lúcia Andrade
Background: Trauma and emergency surgery are major causes of morbidity and mortality. The objective of this study was to determine whether serum levels of epinephrine and norepinephrine are associated with aging and mortality.
Methods: This was a prospective observational cohort study conducted in a surgical critical care unit. We included 90 patients who were admitted for postoperative care, because of major trauma, or both. We collected demographic and clinical variables, as well as serum levels of epinephrine and norepinephrine.
Results: For patients in the > 60-year age group, the use of vasoactive drugs was found to be associated with an undetectable epinephrine level (OR [95% CI] = 6.36 [1.12, 36.08]), p = 0.05). For the patients with undetectable epinephrine levels, the in-hospital mortality was higher among those with a norepinephrine level ≥ 2006.5 pg/mL (OR [95% CI] = 4.00 [1.27, 12.58]), p = 0.03).
Conclusions: There is an association between age and mortality. Undetectable serum epinephrine, which is more common in older patients, could contribute to poor outcomes. The use of epinephrine might improve the clinical prognosis in older surgical patients with shock.
{"title":"Catecholamine concentration as a predictor of mortality in emergency surgical patients.","authors":"João Isuk Suh, Daiane Leite da Roza, Filipe Matheus Cadamuro, Luiz Marcelo Sá Malbouisson, Talita Rojas Sanches, Lúcia Andrade","doi":"10.1186/s12245-024-00676-4","DOIUrl":"10.1186/s12245-024-00676-4","url":null,"abstract":"<p><strong>Background: </strong>Trauma and emergency surgery are major causes of morbidity and mortality. The objective of this study was to determine whether serum levels of epinephrine and norepinephrine are associated with aging and mortality.</p><p><strong>Methods: </strong>This was a prospective observational cohort study conducted in a surgical critical care unit. We included 90 patients who were admitted for postoperative care, because of major trauma, or both. We collected demographic and clinical variables, as well as serum levels of epinephrine and norepinephrine.</p><p><strong>Results: </strong>For patients in the > 60-year age group, the use of vasoactive drugs was found to be associated with an undetectable epinephrine level (OR [95% CI] = 6.36 [1.12, 36.08]), p = 0.05). For the patients with undetectable epinephrine levels, the in-hospital mortality was higher among those with a norepinephrine level ≥ 2006.5 pg/mL (OR [95% CI] = 4.00 [1.27, 12.58]), p = 0.03).</p><p><strong>Conclusions: </strong>There is an association between age and mortality. Undetectable serum epinephrine, which is more common in older patients, could contribute to poor outcomes. The use of epinephrine might improve the clinical prognosis in older surgical patients with shock.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11264696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-18DOI: 10.1186/s12245-024-00665-7
Natalija Aleksandrova, Jonas De Rop, Frederic Camu, Ives Hubloue, Katleen Devue
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity reaction characterized by cutaneous rash, lymphadenopathy, fever, eosinophilia, leukocytosis, and life-threatening organ dysfunctions. We describe the case of a 26 year old patient admitted to the Emergency Department for DRESS syndrome after sulfasalazine treatment for rheumatoid arthritis in the right knee. Whole body computer tomography showed multiple neck, chest, and abdominal lymphadenopathy with splenomegaly, massive ascites and severe hepatic cytolysis. Serology results for Epstein-Barr Virus (EBV), influenza, measles, rubella, hepatitis A and B were negative. The histologic analysis of skin, lymph node and bone marrow biopsies could not indicate a classical Hodgkin's Disease or iatrogenic immunodeficiency/EBV-associated lymphoproliferative disorder (LPD), Hodgkin type. The relatively small caliber of the CD30 + immunoreactive blastoid cells in the lymph nodes suggested reactive immunoblasts rather than Hodgkin cells. The morphologic aspects of the lymph node biopsies with predominance of T-cells were compatible with the diagnosis of a sulfasalazine-induced DRESS syndrome as the patient had a high RegiSCAR score for DRESS. [DRESS Syndrome Foundation: Diagnosis and Treatment. (2023)] The patient's complex clinical course, marked by two hospital admissions, highlights the challenges in diagnosing and managing DRESS. This case underscores the need for individualized care, close patient monitoring, and further research to better understand DRESS's underlying mechanisms and optimal therapeutic strategies.
{"title":"A diagnostic dilemma: distinguishing a sulfasalazine induced DRESS hypersensitivity syndrome from a CD30 + lymphoma in a young patient.","authors":"Natalija Aleksandrova, Jonas De Rop, Frederic Camu, Ives Hubloue, Katleen Devue","doi":"10.1186/s12245-024-00665-7","DOIUrl":"10.1186/s12245-024-00665-7","url":null,"abstract":"<p><p>Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity reaction characterized by cutaneous rash, lymphadenopathy, fever, eosinophilia, leukocytosis, and life-threatening organ dysfunctions. We describe the case of a 26 year old patient admitted to the Emergency Department for DRESS syndrome after sulfasalazine treatment for rheumatoid arthritis in the right knee. Whole body computer tomography showed multiple neck, chest, and abdominal lymphadenopathy with splenomegaly, massive ascites and severe hepatic cytolysis. Serology results for Epstein-Barr Virus (EBV), influenza, measles, rubella, hepatitis A and B were negative. The histologic analysis of skin, lymph node and bone marrow biopsies could not indicate a classical Hodgkin's Disease or iatrogenic immunodeficiency/EBV-associated lymphoproliferative disorder (LPD), Hodgkin type. The relatively small caliber of the CD30 + immunoreactive blastoid cells in the lymph nodes suggested reactive immunoblasts rather than Hodgkin cells. The morphologic aspects of the lymph node biopsies with predominance of T-cells were compatible with the diagnosis of a sulfasalazine-induced DRESS syndrome as the patient had a high RegiSCAR score for DRESS. [DRESS Syndrome Foundation: Diagnosis and Treatment. (2023)] The patient's complex clinical course, marked by two hospital admissions, highlights the challenges in diagnosing and managing DRESS. This case underscores the need for individualized care, close patient monitoring, and further research to better understand DRESS's underlying mechanisms and optimal therapeutic strategies.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11256461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Disaster preparedness is one of the critical strategies for effectively managing disasters and has been an area of high focus in the healthcare sector over the past few decades. The current Indian medical undergraduate curriculum does not describe any novel methods for disaster preparedness training. There is a need for a better understanding of novel teaching-learning methods and modes for administering disaster preparedness training among Indian medical students.
Objectives: Describe the undergraduate medical students' baseline knowledge and confidence level of disaster preparedness. Compare undergraduate medical students' knowledge scores and confidence levels on disaster preparedness after online and onsite delivery of the disaster preparedness module.
Methods: In this educational interventional study, 103 medical students were divided into two groups and subjected to an online or onsite session of the validated disaster preparedness module (based on the COVID-19 pandemic), encompassing a simulation-based tabletop exercise. Baseline testing was done for 52 participants in the online group and 51 in the onsite group of the study. Post-intervention, they were assessed with single-response type MCQs for knowledge and Likert scale-based questions for confidence scores. The pretest and posttest scores were collected, and the data were analysed using two-tailed t-tests for paired analysis of within-group (online group or onsite group) and heteroscedastic analysis of between-group datasets.
Results: One hundred and three participants completed the exercise-52 participants were from the online group, and 51 were from the onsite group. After the intervention, there was a statistically significant increase in knowledge and confidence in both online and onsite groups. There is, however, no significant difference in the 'percentage change' in 'knowledge' or 'confidence' between the groups.
Conclusions: Our study indicates that the disaster preparedness module, delivered online and onsite, improves knowledge and confidence among undergraduate medical students. However, there is no superiority between one mode of delivery and the other. We conclude that online training can facilitate disaster preparedness training as a corollary to the prescribed traditional training methods for undergraduate medical students in India.
{"title":"Comparing online and onsite simulation modules for improving knowledge and confidence in disaster preparedness among undergraduate medical students.","authors":"Vimal Krishnan S, Aaditya Katyal, Soumya S Nair, Kirtana Raghurama Nayak","doi":"10.1186/s12245-024-00667-5","DOIUrl":"10.1186/s12245-024-00667-5","url":null,"abstract":"<p><strong>Background: </strong>Disaster preparedness is one of the critical strategies for effectively managing disasters and has been an area of high focus in the healthcare sector over the past few decades. The current Indian medical undergraduate curriculum does not describe any novel methods for disaster preparedness training. There is a need for a better understanding of novel teaching-learning methods and modes for administering disaster preparedness training among Indian medical students.</p><p><strong>Objectives: </strong>Describe the undergraduate medical students' baseline knowledge and confidence level of disaster preparedness. Compare undergraduate medical students' knowledge scores and confidence levels on disaster preparedness after online and onsite delivery of the disaster preparedness module.</p><p><strong>Methods: </strong>In this educational interventional study, 103 medical students were divided into two groups and subjected to an online or onsite session of the validated disaster preparedness module (based on the COVID-19 pandemic), encompassing a simulation-based tabletop exercise. Baseline testing was done for 52 participants in the online group and 51 in the onsite group of the study. Post-intervention, they were assessed with single-response type MCQs for knowledge and Likert scale-based questions for confidence scores. The pretest and posttest scores were collected, and the data were analysed using two-tailed t-tests for paired analysis of within-group (online group or onsite group) and heteroscedastic analysis of between-group datasets.</p><p><strong>Results: </strong>One hundred and three participants completed the exercise-52 participants were from the online group, and 51 were from the onsite group. After the intervention, there was a statistically significant increase in knowledge and confidence in both online and onsite groups. There is, however, no significant difference in the 'percentage change' in 'knowledge' or 'confidence' between the groups.</p><p><strong>Conclusions: </strong>Our study indicates that the disaster preparedness module, delivered online and onsite, improves knowledge and confidence among undergraduate medical students. However, there is no superiority between one mode of delivery and the other. We conclude that online training can facilitate disaster preparedness training as a corollary to the prescribed traditional training methods for undergraduate medical students in India.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11256551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1186/s12245-024-00677-3
Rafik Matbouli, Olivier Pantet, Julien Castioni, Nima Vakilzadeh, Lorenzo Alberio, Olivier Hugli
Dabigatran is an oral anticoagulant that is mainly renally excreted. Despite its efficacy in preventing thromboembolic events, concerns arise regarding bleeding complications in patients with acute kidney injury. Idarucizumab is its specific antidote and reverses quickly and effectively dabigatran anticoagulation effects in situations of severe bleeding or pending surgical procedures, but its benefit beyond these two indications remains uncertain. We present a case of a woman with atrial fibrillation anticoagulated by dabigatran and admitted with Streptococcus agalactiae meningitis, acute kidney injury and dabigatran accumulation. Idarucizumab was not administered initially as she did not meet its current strict indications. However, subsequently, significant bleeding necessitated its use. A rebound increase in dabigatran concentration was associated with an intracranial hemorrhage, but the combination of additional doses of idarucizumab with hemodialysis lowered the dabigatran concentration and prevented significant rebound increases. Further investigation into the optimal management of dabigatran accumulation and acute kidney injury-associated bleeding is needed to enhance patient outcomes and safety. Early initiation of hemodialysis together with idarucizumab administration may be crucial in preventing life-threatening bleeding events in these patients.
{"title":"Dabigatran accumulation in acute kidney injury: is more better than less to prevent bleeding? A case report.","authors":"Rafik Matbouli, Olivier Pantet, Julien Castioni, Nima Vakilzadeh, Lorenzo Alberio, Olivier Hugli","doi":"10.1186/s12245-024-00677-3","DOIUrl":"10.1186/s12245-024-00677-3","url":null,"abstract":"<p><p>Dabigatran is an oral anticoagulant that is mainly renally excreted. Despite its efficacy in preventing thromboembolic events, concerns arise regarding bleeding complications in patients with acute kidney injury. Idarucizumab is its specific antidote and reverses quickly and effectively dabigatran anticoagulation effects in situations of severe bleeding or pending surgical procedures, but its benefit beyond these two indications remains uncertain. We present a case of a woman with atrial fibrillation anticoagulated by dabigatran and admitted with Streptococcus agalactiae meningitis, acute kidney injury and dabigatran accumulation. Idarucizumab was not administered initially as she did not meet its current strict indications. However, subsequently, significant bleeding necessitated its use. A rebound increase in dabigatran concentration was associated with an intracranial hemorrhage, but the combination of additional doses of idarucizumab with hemodialysis lowered the dabigatran concentration and prevented significant rebound increases. Further investigation into the optimal management of dabigatran accumulation and acute kidney injury-associated bleeding is needed to enhance patient outcomes and safety. Early initiation of hemodialysis together with idarucizumab administration may be crucial in preventing life-threatening bleeding events in these patients.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11253475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.1186/s12245-024-00668-4
Caleb Weihao Huang, Mathew Yi Wen Yeo
Background: Iliacus muscle abscess is an uncommon but potentially life-threatening condition that can present with nonspecific symptoms, posing diagnostic challenges. This case report highlights the importance of considering iliopsoas abscess in patients presenting with fever and hip pain, especially in the absence of obvious risk factors or penetrating trauma. The novelty of this case lies in its atypical presentation mimicking a respiratory viral infection and musculoskeletal injury, impeding accurate diagnosis and appropriate management.
Case presentation: A previously healthy 21-year-old female who had a mechanical fall 3 weeks prior presented with fever, right hip pain, and respiratory symptoms, initially suggestive of a respiratory infection and musculoskeletal injury. However, initial investigations revealing a markedly high C-reactive protein (CRP) concentration prompted further computed tomography (CT) imaging of her abdomen and pelvis, which uncovered an iliopsoas abscess presumably stemming from antecedent trauma. Subsequent CT guided aspiration along with culture-sensitive antibiotics led to successful treatment and resolution of her symptoms.
Conclusions: This case emphasizes the importance of considering iliopsoas abscess as a possible differential, even in young patients without typical risk factors. Markedly elevated inflammatory markers such as CRP concentrations can serve as a vital indicator, directing attention towards the possibility of septicemia or the presence of an occult abscess, facilitating prompt imaging and accurate diagnosis.
背景:髂腰肌脓肿是一种不常见但可能危及生命的疾病,可表现为非特异性症状,给诊断带来困难。本病例报告强调了在患者出现发热和髋部疼痛时考虑髂腰肌脓肿的重要性,尤其是在没有明显危险因素或穿透性创伤的情况下。本病例的新颖之处在于其非典型表现模仿了呼吸道病毒感染和肌肉骨骼损伤,妨碍了准确诊断和适当处理:病例介绍:一名 21 岁的女性,此前身体健康,3 周前曾因机械性摔倒而出现发热、右髋部疼痛和呼吸道症状,最初提示为呼吸道感染和肌肉骨骼损伤。然而,初步检查发现她的 C 反应蛋白(CRP)浓度明显偏高,这促使她对腹部和骨盆进行了进一步的计算机断层扫描(CT)成像,结果发现她的髂腰肌脓肿可能源于之前的外伤。随后在 CT 引导下进行了抽吸,并使用了对培养敏感的抗生素,最终成功治疗并消除了她的症状:本病例强调了将髂腰肌脓肿作为可能的鉴别病例的重要性,即使是没有典型风险因素的年轻患者。CRP 浓度等炎症指标的明显升高可作为一个重要指标,引导人们关注脓毒血症或隐匿性脓肿存在的可能性,有助于及时进行影像学检查和准确诊断。
{"title":"\"Iliacus muscle abscess as an unexpected cause of posterior hip pain in a healthy young adult female\": a case report.","authors":"Caleb Weihao Huang, Mathew Yi Wen Yeo","doi":"10.1186/s12245-024-00668-4","DOIUrl":"10.1186/s12245-024-00668-4","url":null,"abstract":"<p><strong>Background: </strong>Iliacus muscle abscess is an uncommon but potentially life-threatening condition that can present with nonspecific symptoms, posing diagnostic challenges. This case report highlights the importance of considering iliopsoas abscess in patients presenting with fever and hip pain, especially in the absence of obvious risk factors or penetrating trauma. The novelty of this case lies in its atypical presentation mimicking a respiratory viral infection and musculoskeletal injury, impeding accurate diagnosis and appropriate management.</p><p><strong>Case presentation: </strong>A previously healthy 21-year-old female who had a mechanical fall 3 weeks prior presented with fever, right hip pain, and respiratory symptoms, initially suggestive of a respiratory infection and musculoskeletal injury. However, initial investigations revealing a markedly high C-reactive protein (CRP) concentration prompted further computed tomography (CT) imaging of her abdomen and pelvis, which uncovered an iliopsoas abscess presumably stemming from antecedent trauma. Subsequent CT guided aspiration along with culture-sensitive antibiotics led to successful treatment and resolution of her symptoms.</p><p><strong>Conclusions: </strong>This case emphasizes the importance of considering iliopsoas abscess as a possible differential, even in young patients without typical risk factors. Markedly elevated inflammatory markers such as CRP concentrations can serve as a vital indicator, directing attention towards the possibility of septicemia or the presence of an occult abscess, facilitating prompt imaging and accurate diagnosis.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11253457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.1186/s12245-024-00673-7
Bui Hai Hoang, Thomas Vu Tang, Nguyen Dai Nghia Phan, Anh Dung Nguyen, Michael Minh Quoc Dinh
Background: Dengue is the most common arboviral illness reported globally, endemic to most tropical and sub-tropical regions of the world. Dengue Shock Syndrome is a rare complication of severe Dengue infection resulting in haemorrhagic complications and refractory hypotension. We report on a case of severe dengue diagnosed in a patient with major trauma and illustrate some of the potential challenges and considerations in the clinical management of such cases.
Case presentation: A 49-year-old female presented following a road trauma incident with multiple abdominal injuries requiring urgent laparotomy. Her recovery in Intensive Care Unit was complicated by the development of Dengue Shock Syndrome characterised by a falling haemoglobin and platelet count, multiorgan dysfunction and prolonged hospital stay.
Conclusions: Dengue Shock Syndrome may complicate fluid management and bleeding control in major trauma cases. Awareness of Dengue, particularly in endemic areas and returned travellers may help facilitate early diagnosis and management of complications.
{"title":"Airway breathing circulation dengue: a case of multifactorial shock due to major trauma and severe dengue infection.","authors":"Bui Hai Hoang, Thomas Vu Tang, Nguyen Dai Nghia Phan, Anh Dung Nguyen, Michael Minh Quoc Dinh","doi":"10.1186/s12245-024-00673-7","DOIUrl":"10.1186/s12245-024-00673-7","url":null,"abstract":"<p><strong>Background: </strong>Dengue is the most common arboviral illness reported globally, endemic to most tropical and sub-tropical regions of the world. Dengue Shock Syndrome is a rare complication of severe Dengue infection resulting in haemorrhagic complications and refractory hypotension. We report on a case of severe dengue diagnosed in a patient with major trauma and illustrate some of the potential challenges and considerations in the clinical management of such cases.</p><p><strong>Case presentation: </strong>A 49-year-old female presented following a road trauma incident with multiple abdominal injuries requiring urgent laparotomy. Her recovery in Intensive Care Unit was complicated by the development of Dengue Shock Syndrome characterised by a falling haemoglobin and platelet count, multiorgan dysfunction and prolonged hospital stay.</p><p><strong>Conclusions: </strong>Dengue Shock Syndrome may complicate fluid management and bleeding control in major trauma cases. Awareness of Dengue, particularly in endemic areas and returned travellers may help facilitate early diagnosis and management of complications.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11251368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Compartment syndrome commonly occurs in patients with forearm and lower leg fractures. Compartment syndromes of the gluteal and thigh muscles are less common. It is imperative that compartment syndrome be diagnosed and treated with fasciotomy as soon as possible. However, there are few reports on the diagnosis and treatment strategies for compartment syndromes that occur simultaneously in multiple anatomical regions or in the ipsilateral gluteal region and thigh.
Case presentation: We report on a 76-year-old man who was obliquely crushed under a tree extending from the right forearm to the left groin. He was brought to our emergency room, where he was diagnosed with compartment syndrome of the right forearm and left lower leg and crush syndrome. Emergency fasciotomy was performed. On the day after admission, swelling and tightness of the left gluteal thigh became apparent, and intracompartmental pressures were elevated, which led to an additional diagnosis of these compartment syndromes. A fasciotomy was performed, the gluteal skin incision was made according to the Kocher-Langenbeck approach (one of the posterior approaches for hip fractures), and the thigh was approached by extending the incision laterally. This surgical approach enabled the decompression of the compartments through a single incision and allowed for easier wound treatment and closure.
Conclusion: This case highlights the diagnosis and treatment of compartment syndrome in four anatomical regions. Extension of the Kocher-Langenbeck approach to the lateral thigh can be a useful surgical approach for ipsilateral gluteal and thigh compartment syndrome.
{"title":"Treatment strategy for compartment syndrome at multiple regions due to injuries caused by a tree fall: a case report.","authors":"Tomotaka Miura, Takahito Miyake, Hideshi Okada, Hideaki Oiwa, Yosuke Mizuno, Yuichiro Kitagawa, Tetsuya Fukuta, Haruka Okamoto, Masato Shiba, Norihide Kanda, Takahiro Yoshida, Shozo Yoshida, Shinji Ogura","doi":"10.1186/s12245-024-00675-5","DOIUrl":"10.1186/s12245-024-00675-5","url":null,"abstract":"<p><strong>Background: </strong>Compartment syndrome commonly occurs in patients with forearm and lower leg fractures. Compartment syndromes of the gluteal and thigh muscles are less common. It is imperative that compartment syndrome be diagnosed and treated with fasciotomy as soon as possible. However, there are few reports on the diagnosis and treatment strategies for compartment syndromes that occur simultaneously in multiple anatomical regions or in the ipsilateral gluteal region and thigh.</p><p><strong>Case presentation: </strong>We report on a 76-year-old man who was obliquely crushed under a tree extending from the right forearm to the left groin. He was brought to our emergency room, where he was diagnosed with compartment syndrome of the right forearm and left lower leg and crush syndrome. Emergency fasciotomy was performed. On the day after admission, swelling and tightness of the left gluteal thigh became apparent, and intracompartmental pressures were elevated, which led to an additional diagnosis of these compartment syndromes. A fasciotomy was performed, the gluteal skin incision was made according to the Kocher-Langenbeck approach (one of the posterior approaches for hip fractures), and the thigh was approached by extending the incision laterally. This surgical approach enabled the decompression of the compartments through a single incision and allowed for easier wound treatment and closure.</p><p><strong>Conclusion: </strong>This case highlights the diagnosis and treatment of compartment syndrome in four anatomical regions. Extension of the Kocher-Langenbeck approach to the lateral thigh can be a useful surgical approach for ipsilateral gluteal and thigh compartment syndrome.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.1186/s12245-024-00678-2
Ortal Schaffer, Adi Kenoshi, Osnat Zmora
Background: Ingestion of magnets carries risks for significant morbidity. We propose a new protocol designed to reduce the need for surgery, shorten length of stay, and decrease morbidity.
Methods: The Early Colonic-preparation and Salvage Laparoscopic Appendectomy (ECSLA) protocol includes initiating colonoscopy preparation upon admission in asymptomatic patients if magnets are not amenable to removal by gastroscopy, and laparoscopic magnets retrieval via appendectomy if surgery is eventually needed. The protocol was initiated in May 2023. A retrospective study of all cases of ingested magnets in children in our institution during July 2020 - January 2024 was conducted to retrieve and analyze demographic, clinical, imaging, management, and outcome data.
Results: During the 3.5-year study period, 13 cases of ingested multiple magnets were treated, including 7 cases since initiation of ECLSA protocol, with no complications. Since initiation of ECSLA protocol, Early colonic preparation resulted in spontaneous passage of magnets (two cases) and successful colonocsopic removal (three cases), with two cases in which magnets were retrieved via gastroscopy upon admission, and no patients needing surgical intervention. Length of stay (LOS) was short (1-3 days).
Conclusions: The ECSLA protocol is a promising tool for preventing surgical intervention and complications and for possibly shortening LOS in children who have ingested multiple magnets.
{"title":"Early colonic-preparation and salvage laparoscopic appendectomy (ECSLA)- innovative protocol for the management of magnets ingestion.","authors":"Ortal Schaffer, Adi Kenoshi, Osnat Zmora","doi":"10.1186/s12245-024-00678-2","DOIUrl":"10.1186/s12245-024-00678-2","url":null,"abstract":"<p><strong>Background: </strong>Ingestion of magnets carries risks for significant morbidity. We propose a new protocol designed to reduce the need for surgery, shorten length of stay, and decrease morbidity.</p><p><strong>Methods: </strong>The Early Colonic-preparation and Salvage Laparoscopic Appendectomy (ECSLA) protocol includes initiating colonoscopy preparation upon admission in asymptomatic patients if magnets are not amenable to removal by gastroscopy, and laparoscopic magnets retrieval via appendectomy if surgery is eventually needed. The protocol was initiated in May 2023. A retrospective study of all cases of ingested magnets in children in our institution during July 2020 - January 2024 was conducted to retrieve and analyze demographic, clinical, imaging, management, and outcome data.</p><p><strong>Results: </strong>During the 3.5-year study period, 13 cases of ingested multiple magnets were treated, including 7 cases since initiation of ECLSA protocol, with no complications. Since initiation of ECSLA protocol, Early colonic preparation resulted in spontaneous passage of magnets (two cases) and successful colonocsopic removal (three cases), with two cases in which magnets were retrieved via gastroscopy upon admission, and no patients needing surgical intervention. Length of stay (LOS) was short (1-3 days).</p><p><strong>Conclusions: </strong>The ECSLA protocol is a promising tool for preventing surgical intervention and complications and for possibly shortening LOS in children who have ingested multiple magnets.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}