International Journal of Emergency Medicine最新文献

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.

Background: Since 1930 it has been accepted that intravenous injection of iodinated contrast agent as part of contrast-enhanced computed tomography (CE-CT) imaging can induce a contrast-associated acute kidney injury (CA-AKI). For the last 10 years, studies have investigated this iatrogenia. However, those works didn't concern patient hospitalised after emergency department (ED) visit. This study assessed the CA-AKI incidence and risk factors in patients hospitalised after a CE-CT in ED.

Materials and methods: This was a monocentric retrospective study, conducted in a University Hospital ED (Beaujon Hospital) between 2019 and 2022. Patients over 16 years old who received a CE-CT and two serum creatinine dosages, one pre-CT and one post-CT (2 to 7 days later), were included. Risk factors and protective factors of CA-AKI as well as population characteristics were analysed.

Results: After studying 5079 enhanced CT-scans, 1463 patients fulfilled the inclusion criteria. The incidence of CA-AKI was 4.1%. The associated risk factors were: hypertension (adjusted odds ratio (aOR) = 3.36, 95% confidence interval (CI) (1.76-6.43)), CKD grade 4-5 (aOR = 5.89, 95% CI (1.39-24.95)), waiting time before CT (aOR = 3.36, 95% CI (1.76-6.43)). Ongoing treatment by metformin was found to be a protective factor (aOR = 0.26, 95% CI (0.06-1.12)).

Conclusion: Our findings suggest that only hypertension and stage 4-5 CKD significantly increase the risk of CA-AKI. Consequently, CT imaging should not be unnecessarily delayed when clinically justified, as prompt diagnosis could help limit morbidity and mortality.

Clinical trial number: The study was registered at ClinicalTrials.gov on 22 July 2025 (NCT07091656).

Background: Hypertension is a major global health problem that affects approximately 1.4 billion people worldwide, and 1-2% of this population experience hypertensive crisis. Hypertensive emergency is a subtype of hypertensive crisis associated with target organ damage and is linked with increased morbidity and mortality. In our setting, the prevalence of hypertensive emergencies and the characteristics of patients with a hypertensive crisis are not certainly known yet. This study aimed to assess the prevalence and associated factors of hypertensive emergency among hypertensive crisis patients admitted to the emergency department at Hawassa University Comprehensive Specialized Hospital, Ethiopia.

Methods: An institution-based cross-sectional study was conducted among 379 randomly selected medical records of hypertensive crisis patients admitted at Hawassa University Comprehensive Specialized Hospital from July 2021 to July 2024. Data were extracted from September 1 to 30, 2024. A structured checklist was used to collect the data from charts through the Kobo toolbox. The descriptive statistics were presented in tables, frequencies, percentages, and graphs. Binary logistic regression analysis was used to identify factors associated with hypertensive Emergency. An adjusted odds ratio along with a 95% confidence interval was reported. The statistical significance level was declared at a p-value ≤ 0.05.

Results: A total of 369 patients with hypertensive crisis were included in the study. The prevalence of hypertensive Emergency was 40.7% (95% CI: 36, 46%). In patients with hypertensive emergencies, cerebrovascular injuries accounted for 25.7% of the hypertension-mediated organ damage, followed by acute renal failure (22%), and cardiovascular emergencies (15.4%). New-onset hypertension [AOR:2.5; 95%CI: 1.52, 4.15] and diabetes mellitus [AOR: 2.92; 95% CI: 1.63, 5.24] were independently associated with a hypertensive emergency.

Conclusion: The study found that in four out of ten hypertensive crises, patients experienced hypertensive emergencies. Cerebrovascular injuries were the most commonly identified target organ damage. New-onset hypertension and diabetes mellitus were independently associated with hypertensive emergency. Routine hypertension screening, monitoring, and counseling of hypertensive individuals could reduce the risk of target organ damage.