International Journal of Emergency Medicine最新文献

Background: Lower gastrointestinal perforation (LGP) is an acute abdominal condition associated with a high mortality rate. Timely and accurate diagnosis is crucial. Nevertheless, a diagnostic delay has been estimated to occur in approximately one-third of the cases, and the factors contributing to this delay are yet to be clearly understood. This study aimed to evaluate the diagnostic process for appropriate clinical reasoning and availability of image interpretation in cases of delayed diagnosis of LGP.

Methods: A secondary data analysis of a large multicenter retrospective study was conducted. This descriptive study analyzed data from a multicenter, observational study conducted across nine hospitals in Japan from January 2015 to December 2019. Out of 439 LGP cases, we included 138 cases of delayed diagnosis, excluding patients with traumatic or iatrogenic perforations, or those secondary to mesenteric ischemia, appendicitis, or diverticulitis. Clinical history and computed tomography (CT) imaging information were collected for 138 cases. Additionally, information on the clinical course of 50 cases, which were incorrectly diagnosed as gastroenteritis, constipation, or small bowel obstruction, was also collected.

Results: In 42 (30.4%) cases of delayed diagnosis of LGP, CT imaging was performed before diagnosis, indicating a missed opportunity for timely diagnosis. Moreover, 33 of the 50 patients initially diagnosed with gastroenteritis, constipation, or small bowel obstruction at the time of initial examination had atypical findings that were not consistent with the initial diagnosis. Of the 138 cases with delayed diagnosis in our study, 67 cases (48.6%) showed problems with either the interpretation of CT scans or with the process of clinical reasoning.

Conclusion: Our retrospective study results indicate that approximately half of the cases with delayed diagnosis of LGP were due to problems in interpreting CT images or in clinical reasoning. This finding suggests that clinical reasoning and image interpretation by radiologists are important in improving the diagnostic process for LGP.

Thromboembolic disorders, including deep vein thrombosis (DVT) and pulmonary embolism (PE), are major global health concerns, causing significant morbidity and mortality. Early diagnosis is crucial for effective treatment and improved patient outcomes. Recent research has identified Apelin-13, a bioactive peptide in the apelin family, as a promising diagnostic biomarker for Thromboembolic disorders. Apelin-13 supports vascular health by regulating protease balance through plasminogen activator inhibitors and modulating endothelial cell function. Additionally, it plays a vital role in coagulation, with elevated levels associated with an increased risk of clot formation, suggesting its utility in predicting thrombosis risk, particularly in preoperative evaluations. Findings indicate that the Apelin-13 pathway shows significant promise as a biomarker for Thromboembolic disorders, underscoring its potential therapeutic applications and the need for further investigation. This review synthesizes current literature on thromboembolic disorders and associated laboratory biomarkers, with a particular focus on Apelin-13. It examines Apelin-13's role in disease mechanisms, its physiological functions, and its potential as a diagnostic biomarker in thromboembolic conditions.

Background: Carbon monoxide (CO) poisoning is a serious yet frequently overlooked condition with diverse and nonspecific clinical presentations. The analysis of Lithuanian statistics reveals fluctuations in patient admissions and consultations through the poisoning center over a four-year period, with notable variations in fatality rates. Despite these trends, CO poisoning remains a significant public health concern due to its potential for severe long-term sequelae or death.

Case: This case report focuses on two distinct presentations of CO poisoning in a young couple, illustrating the varied manifestations and outcomes of this toxic exposure. The first case describes a 23-year-old male presenting with altered consciousness and neurological symptoms, while the second case involves a 21-year-old pregnant female presenting with cardiovascular symptoms, including Takotsubo cardiomyopathy.

Discussion: Highlights include the challenges in diagnosing CO poisoning; factors influencing the severity and symptoms of CO poisoning; potential complications; and considerations for hyperbaric oxygen therapy (HBO) in severe cases and pregnancy.

Conclusion: These cases illustrate the importance of recognizing CO poisoning, advocating for oxygen therapy as the first-line treatment, and calling for further research to improve understanding, treatment, and prevention of this potentially fatal condition.

Background: Sudden cardiac death (SCD) is a leading cause of cardiovascular-related deaths, often occurring outside hospitals in undiagnosed individuals. Our study aims to assess the baseline awareness and skills in performing CPR among the population in Palestine.

Methods: A cross-sectional study was conducted using an online questionnaire to assess CPR knowledge among residents of the West Bank, Palestine. Convenience sampling targeted 300 participants via social media. Data were analyzed using descriptive statistics and chi-square tests to examine associations.

Results: The study surveyed 555 participants, revealing that 58.2% lacked CPR training. Awareness of cardiac arrest signs varied, with chest pain being the most recognized 19%. CPR training significantly improved participants' recognition and response to cardiac emergencies.

Conclusion: Addressing the fear of legal consequences is crucial to encourage bystander assistance. We recommend increasing first aid awareness through scientific conferences, free training courses, media campaigns, and incentivized competitions.

Introduction: In today's societies, the threats caused by chemical, biological, radiological and nuclear accidents, whether accidental or intentional, have become a great concern. Acquiring knowledge about how to respond to the management of these incidents and the complications caused by them in order to preserve societies and ensure stability is essential. Due to the fact that hospitals play an important role in dealing with the victims of biological threats, this study was conducted with the aim of auditing the preparedness of selected military Hospital in facing biological threats in 2023-2024.

Methods: This applied research was conducted with the participatory action research method in all departments of selected military Hospital during one year from July 2023 to July 2024. The level of biological preparedness of the hospital was investigated using the hospital's preparedness tool in biological events with 147 items in 8 main dimensions and 20 sub-dimensions, and the weak areas of the hospital (9 areas) were identified. Then, in the hospital audit cycle, using the FOCUS-PDCA model, a program to improve work processes and improve the biological preparedness of different departments of the hospital in the face of accidents and disasters was implemented. The level of biological preparedness of the hospital before and after the implementation of the change was compared and analyzed using SPSS. version 22 software.

Results: The preparedness in the studied hospital in facing biological threats before the change was 196 out of 294 and the hospital's biological preparedness percentage was 66.66%, which was in the average range, and after the change, the preparedness score reached 228 and the hospital's preparedness percentage was 77.55%, which was in the range Well classified. In 9 fields where the level of biological preparedness was moderate and weak, the highest preparedness was created in the field of employees and volunteers with 86.36% and the lowest preparedness was related to the field of corpse management with 50%.

Conclusion: Considering the impact of training in improving the hospital's preparedness program in the face of biological threats, it is suggested that other medical centers include audits in their work plan.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been utilized to treat massive pulmonary embolism (PE) accompanied by cardiac arrest or refractory cardiogenic shock. Our team opted for a femoral-femoral approach for vascular cannulation, using drainage and return cannulas in the common femoral vein and artery, respectively. However, femoral venous cannulation can be limited or challenging due to the presence of thrombus in the inferior vena cava (IVC), making the insertion of the drainage cannula via the femoral vein difficult. We present the case of a patient with massive PE who underwent aspiration thrombectomy and insertion of an IVC filter, followed by the initiation of VA-ECMO for cardiac arrest. We successfully inserted a femoral venous return ECMO cannula through the inferior vena cava filter during extracorporeal cardiopulmonary resuscitation. The patient stabilized with these interventions and ultimately achieved a favorable outcome with normal neurological status.

Introduction: Chenopodium album, commonly known as "lambsquarters," is a plant consumed as food and used in traditional medicine. Its popularity is increasing due to the belief that it has fewer side effects compared to synthetic drugs. However, its use can lead to acute or chronic poisoning. The growing interest in herbal remedies, along with uncontrolled usage and disregard for expert recommendations, contributes to adverse effects.

Case presentation: A 68-year-old female patient presented to the emergency department with nausea, vomiting, and flank pain following the use of lambsquarters. Impaired kidney function was detected in the patient. A biopsy performed after Chenopodium album usage led to the diagnosis of tubulointerstitial nephritis (TIN). The patient responded positively to corticosteroid and hemodialysis treatment.

Discussion: Caution is necessary in the use of herbal medicines and traditional treatments. A thorough evaluation of factors such as patients' nutritional status, herbal product usage, medication history, and genetic background is crucial. Chenopodium album can cause tubulointerstitial nephritis, resulting in kidney damage. Similarly, heavy metal poisoning through herbal products can lead to kidney damage. Adopting a multidisciplinary approach in the diagnosis and treatment process can contribute to better patient management.

Conclusion: This case presents a rare instance of tubulointerstitial nephritis developed due to the use of herbal products. Physicians should inquire about patients' history of exogenous substance use and conduct a comprehensive assessment, keeping such situations in mind. Conscious use of herbal medicines and traditional treatments can help prevent serious complications like kidney damage.

Background: Upper gastrointestinal bleeding (UGIB) is a critical emergency with substantial morbidity and mortality. Outcomes depend on bleeding severity, patient risk factors, and comorbidities. This study evaluated clinical patterns and factors influencing disease severity and hospital stay among patients present with UGIB symptoms at two major Ethiopian hospitals.

Methods: A retrospective, cross-sectional review was conducted on 199 UGIB patients admitted to Yekatit 12 Hospital Medical College (Y12HMC) and Tikur Anbesa Specialized Hospital (TASH) from September 2022 to September 2023. Data on demographics, clinical presentations, endoscopic findings, and outcomes were analyzed using SPSS version 26. Binary logistic regression assessed associations, with statistical significance set at P < 0.05.

Results: Of 199 patients, 70.9% were male, predominantly aged 18-40. Hematemesis (63.8%) and hematemesis with melena (27.6%) were common presentations. Endoscopy was not performed on more than half of the participants, with 116 patients (58.3%) not undergoing this procedure. Among the 83 cases who did have endoscopy, esophageal varices emerged as the most common condition, observed in 43.3% (36 cases. Smoking (AOR = 1.77), alcohol intake (AOR = 1.89), and drug use (AOR = 1.34) were linked to higher severity scores. Alcohol use, comorbidities, liver disease, and previous drug use correlated with prolonged hospital stays.

Conclusion: UGIB predominantly affects younger males, with hematemesis as the primary presentation. Key factors like smoking, alcohol intake, and drug use were associated with greater disease severity and longer hospital stays. These findings suggest the importance of lifestyle interventions, particularly in resource-limited settings.

Background: Family presence during resuscitation is a controversial issue worldwide. The aim of this study was to investigate the self-confidence and attitudes of Emergency Medical Technicians (EMTs) towards family presence during resuscitation (FPDR).

Methods: In this cross-sectional study, a random sample of 252 EMTs were selected from 110 prehospital emergency centers. Two main questionnaires were used to collect data on the EMTs' self-confidence and attitudes towards FPDR.

Results: The results showed that the EMTs' attitudes towards FPDR were lower than the mean (43.69 ± 19.40). In addition, more than 85% of them stated that the resuscitation process was stressful for the patient's companions. There was a positive correlation between EMTs' self-confidence and attitudes towards FPDR (r = 0.52, p < 0.01). The results showed that the smaller number of family members present during resuscitation was associated with higher EMTs' self-confidence and more positive attitudes towards FPDR. Moreover, personnel with more experience, liability insurance, and advanced resuscitation training were significantly more self-confident than other personnel.

Conclusion: A large number of the EMS personnel have a negative attitude towards FPDR, but EMTs, with higher self-confidence, have a more positive attitude. Therefore, it is possible to improve the EMTs attitudes towards FPDR and increase their self-confidence by training them to perform resuscitation in the presence of the family and by preventing people from gathering at resuscitation scenes.

Background: Effective management of pulmonary edema in the emergency department (ED) is crucial given its significant global impact on health. This study aimed to investigate the hypothesis: "Does the utilization of Automatic B-lines via ultrasonography in patients with pulmonary edema facilitate faster diuretic administration in a developing country?"

Methods: This retrospective observational study was conducted at a tertiary academic center in Thailand. Patients with pulmonary edema admitted to the ED between January 2023 and June 2024 were enrolled. Ultrasound documentation and electronic ED medical records were compared to assess the time of diuretic administration between patients who had lung ultrasounds utilizing automatic B-lines and those who had manual B-lines counted by physician eye inspection. Multivariate logistic regression was employed to examine the relationship between the use of automatic B-lines and early diuretic administration.

Results: The study included 134 patients with pulmonary edema. The time to diuretic administration was significantly shorter in the automatic B-lines group (median time [Q1-Q3], 55 min; range, 35-110 min) compared to the non-automatic B-lines group (median time, 100 min; range, 75-145 min). In the multivariable logistic regression analysis, early diuretic administration within 60 min of triage was significantly more likely in the automatic B-lines group (adjusted odds ratio, 1.45; 95% confidence interval, 1.10-2.45) than in the non-automatic B-lines group.

Conclusions: In a developing country, patients with pulmonary edema who had lung ultrasound evaluation with automated B lines experienced a fastest diuresis compared to those who utilized ultrasonography without automatic B lines. Implementing automatic B-lines as an early screening protocol could enhance clinical practice in the ED.