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Utility of smart watch in expediting diagnosis of cold drink-triggered atrial fibrillation: a case report. 智能手表在加速诊断冷饮引发的心房颤动中的作用:一份病例报告。
IF 2 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-08 DOI: 10.1186/s12245-024-00716-z
Grace V Heringer, David R Vinson

Background: Patients presenting to the emergency department with recent palpitations are a diagnostic challenge when the arrhythmia and its symptoms have resolved prior to arrival. Newer smart watch technology, adept at detecting atrial fibrillation, can assist in the diagnostic evaluation of transitory palpitations. We report a case of cold drink-triggered atrial fibrillation whose diagnosis would not have been possible without the assistance of the patient's smart watch.

Case presentation: A middle-aged man without cardiac history developed sudden rapid, irregular palpitations with shortness of breath while drinking a glass of cold juice. He activated his smart watch with 1-lead electrocardiography technology which detected rapid atrial fibrillation. He sought medical care, but while waiting, his symptoms-then 90 min in duration-spontaneously resolved. His initial diagnostic evaluation documented only sinus rhythm, as did several follow-up evaluations with cardiology the next several weeks. Had it not been for his smart watch, the etiology of his transitory palpitations would have remained undiagnosed. His physicians encouraged trigger avoidance. In the following months, he avoided rapid ingestion of cold drink, taking instead small sips. The atrial fibrillation has not recurred.

Conclusions: The case illustrates the valuable contribution of smart watch technology in the diagnostic evaluation of patients with short-lived palpitations. The case also educates clinicians about cold drink and food as a trigger of paroxysmal atrial fibrillation. This trigger, like alcohol, can be modified. Cold drink trigger avoidance has been reported by patients to reduce atrial fibrillation recurrence and is a low-risk, cost-effective strategy that is often successful.

背景:当心律失常及其症状在到达急诊科之前已经缓解时,因近期心悸而到急诊科就诊的患者在诊断方面是一个难题。较新的智能手表技术擅长检测心房颤动,可协助对短暂性心悸进行诊断评估。我们报告了一例冷饮诱发的心房颤动病例,如果没有患者智能手表的协助,诊断是不可能实现的:一名无心脏病史的中年男子在饮用一杯冷果汁时突然出现快速、不规则的心悸,并伴有气短。他启动了智能手表的一导联心电图技术,检测到快速心房颤动。他寻求医疗护理,但在等待期间,他的症状(当时持续了 90 分钟)自发缓解了。他的初步诊断评估仅显示为窦性心律,接下来几周,心脏科也对他进行了多次随访评估。如果不是他的智能手表,他的短暂性心悸的病因可能仍然无法确诊。他的医生鼓励他避免诱发因素。在随后的几个月里,他避免快速喝冷饮,而是小口小口地喝。心房颤动没有再复发:本病例说明了智能手表技术在诊断评估短时心悸患者方面的宝贵贡献。该病例还让临床医生了解到冷饮和冷食是阵发性心房颤动的诱因。这种诱发因素和酒精一样,是可以改变的。据患者报告,避免冷饮触发可减少心房颤动的复发,是一种风险低、成本效益高的策略,通常都能取得成功。
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引用次数: 0
The polk county screening tool screening for detecting subarachnoid hemorrhage. 用于检测蛛网膜下腔出血的波尔克县筛查工具。
IF 2 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-08 DOI: 10.1186/s12245-024-00722-1
Krish Patel, Sanjana Konda, Latha Ganti, Anjali Banerjee, Paul Banerjee

Introduction: The subarachnoid space in the brain contains crucial blood vessels and cerebrospinal fluid. Aneurysms in these vessels can lead to subarachnoid hemorrhage (SAH), a serious stroke subtype with high morbidity and mortality rates. SAH treatment includes procedures like coiling and clipping, but these are available only at comprehensive stroke centers (CSCs), necessitating urgent diagnosis and transfer to specialized facilities.

Methods: This IRB-approved study was conducted by Polk County Fire Rescue (PCFR) in Florida. PCFR, serving an 850,000-person population, implemented a three-step SAH protocol. The protocol uses both Ottawa SAH criteria and recurring symptoms, such as new-onset seizures and high systolic blood pressure, that were identified by EMS. Acute management included administering labetalol, levetiracetam, and ondansetron.

Results: Of 2175 stroke patients, 80 screened positive for SAH and were eligible for transfer. Patients had a median age of 66, and 33% had an initial systolic BP over 220 mmHg. The interfacility transfer rate dropped from 12.9 to 3.6% after implementing the protocol.

Conclusion: The PCFR protocol's effectiveness suggests its potential for nationwide implementation. Early SAH recognition and prompt transfer to CSCs reduce complications and improve outcomes. Accurate field diagnosis by EMTs can prevent unnecessary transfers and enhance patient care. Future improvements may include portable diagnostic tools and enhanced EMT training to further improve SAH patients' pre-hospital care.

简介大脑蛛网膜下腔包含重要的血管和脑脊液。这些血管中的动脉瘤可导致蛛网膜下腔出血(SAH),这是一种严重的中风亚型,发病率和死亡率都很高。蛛网膜下腔出血的治疗包括卷曲和剪切等手术,但这些手术只有综合卒中中心(CSCs)才能提供,因此必须进行紧急诊断并转至专业机构:佛罗里达州波尔克县消防救援队(PCFR)开展了这项经 IRB 批准的研究。PCFR 服务于 85 万人口,实施了三步 SAH 方案。该方案采用了渥太华 SAH 标准和急救中心发现的反复出现的症状,如新出现的癫痫发作和收缩压过高。急性处理包括使用拉贝洛尔、左乙拉西坦和昂丹司琼:在 2175 名中风患者中,有 80 人筛查出 SAH 阳性,符合转院条件。患者的中位年龄为 66 岁,33% 的患者初始收缩压超过 220 mmHg。实施该方案后,医院间转院率从 12.9% 降至 3.6%:PCFR方案的有效性表明其有可能在全国范围内实施。早期识别 SAH 并及时转送至 CSC 可减少并发症并改善预后。由急救医生进行准确的现场诊断可以避免不必要的转院,并加强对患者的护理。未来的改进措施可能包括便携式诊断工具和加强 EMT 培训,以进一步改善 SAH 患者的院前护理。
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引用次数: 0
Elevated high-sensitive cardiac troponin T in emergency department patients: insights from a retrospective descriptive cohort study. 急诊科患者高敏心肌肌钙蛋白 T 升高:一项回顾性描述性队列研究的启示。
IF 2 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-07 DOI: 10.1186/s12245-024-00735-w
Finn Syryca, Bernhard Haller, Lisa Schmid, Christiane Kallweit, Philipp Nicol, Teresa Trenkwalder, Karl-Georg Kanz, Anja Haas, Michael Dommasch

Background: High-sensitive cardiac troponin T (hs-cTnT) assessments are routinely conducted in German emergency departments (EDs). However, data describing a large number of ED patients with pathological hs-cTnT levels and subsequent clinical outcomes are limited.

Methods: This retrospective descriptive analysis included 141.892 patients who presented to the interdisciplinary ED at Klinikum rechts der Isar in Munich, Germany, between January 2019 and December 2021. Patients with trauma diagnoses were excluded, focusing on those with elevated hs-cTnT levels. These patients were categorized into three groups based on the International Classification of Procedures in Medicine (ICPM): those with elevated hs-cTnT who received no coronary angiography (NCA), those who underwent diagnostic coronary angiography (DCA), and those who received percutaneous coronary intervention (PCI). The objective of this study was to characterize a large emergency department patient cohort and assess their subsequent clinical outcomes.

Results: After initial Manchester Triage Sytem (MTS) categorization, 32.6% (46.307/141.892) of patients were identified as non-trauma cases. Of these, 9.9% (4.587/46.307) had hs-cTnT levels exceeding 14 ng/L. Within this subset, 70.4% (3.230/4.587) did not undergo coronary angiography, 15.4% (705/4.587) underwent DCA and 14.2% (652/4.587) received PCI. Chest pain occurred more frequently in the PCI group (28.0%, 160/652) compared to the DCA group (18.3%, 113/705) or NCA group (5.7%, 159/3230), p < 0.001. However, breathing problems occurred more frequently in the NCA group (23.2%, 647/3230) compared to the PCI group (17.7%, 101/652) or DCA group (21.8%, 135/705), p < 0.001. Also, collapse was more frequent in patients in the NCA group (4.0%, 112/3230) compared to the DCA group (3.4%, 21/705) or PCI group (3.5%, 20/652), p < 0.001. Overall, in-hospital mortality was significantly higher in the NCA group (7.9%, 256/3230) compared to the DCA group (2.3%, 16/705) or PCI group (4.1%, 27/652), p < 0.001.

Conclusion: Emergency patients with elevated hs-cTnT who did not undergo coronary angiography faced a higher risk of in-hospital mortality in our retrospective descriptive study. Given the heterogeneous nature of presenting complaints in emergency departments, identifying at-risk patients can pose challenges for treating physicians.

背景:高敏心肌肌钙蛋白 T(hs-cTnT)评估是德国急诊科(ED)的常规检查项目。然而,关于大量急诊科患者的病理 hs-cTnT 水平及其后续临床结果的数据却很有限:这项回顾性描述性分析纳入了 2019 年 1 月至 2021 年 12 月期间在德国慕尼黑 Klinikum rechts der Isar 跨学科急诊科就诊的 141 892 名患者。排除了诊断为外伤的患者,重点关注 hs-cTnT 水平升高的患者。根据国际医学程序分类法(ICPM),这些患者被分为三组:未接受冠状动脉造影术(NCA)的 hs-cTnT 升高患者、接受诊断性冠状动脉造影术(DCA)的患者和接受经皮冠状动脉介入治疗(PCI)的患者。这项研究的目的是描述大型急诊科患者队列的特征,并评估他们随后的临床结果:经过最初的曼彻斯特分诊系统(MTS)分类后,32.6%(46.307/141.892)的患者被确定为非创伤病例。其中,9.9%(4.587/46.307)的 hs-cTnT 水平超过 14 纳克/升。在这个子集中,70.4%(3.230/4.587)的患者没有接受冠状动脉造影术,15.4%(705/4.587)的患者接受了DCA,14.2%(652/4.587)的患者接受了PCI。与 DCA 组(18.3%,113/705)或 NCA 组(5.7%,159/3230)相比,PCI 组(28.0%,160/652)胸痛发生率更高:在我们的回顾性描述性研究中,hs-cTnT 升高且未接受冠状动脉造影术的急诊患者面临较高的院内死亡风险。鉴于急诊科主诉的异质性,识别高危患者可能会给治疗医生带来挑战。
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引用次数: 0
A diagnosis that's hard to swallow: case report of delayed onset lateral medullary syndrome presenting with only dysphagia. 难以下咽的诊断:仅表现为吞咽困难的迟发性侧髓综合征病例报告。
IF 2 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-07 DOI: 10.1186/s12245-024-00709-y
Jose Ernesto Gomez, Eric Justin Ho

Background: Lateral Medullary Syndrome (LMS) is a posterior circulation stroke (PCS) that has a broad array of manifestations but most classically presents with Horner's syndrome, ipsilateral ataxia, and ipsilateral hyperalgesia. Although dysphagia is also common, isolated and single presentation of this alone is rare and there are only a few case reports of this in the literature. This presentation can bias a clinician's differential diagnosis and delay diagnosis.

Case presentation: A previously healthy 53-year-old-male presented with a complaint of dysphagia. He had no PCS symptoms, a National Institute of Health Stroke Scale (NIHSS) of zero, and an otherwise unremarkable neurological exam. Stroke imaging including non-contrast computed tomography (NCCT) scan of his head and computed tomography angiography (CTA) scan of his head and neck revealed no acute abnormalities. He was found to be positive for Influenza A, but otherwise all other etiologies for his dysphagia were worked up, including consultation with other specialty services, without resolve. Two days later, the patient subsequently developed new right sided sensory deficits and left sided Horner's syndrome, in which a magnetic resonance imaging (MRI) scan of his head revealed an acute infarct of the left lateral medulla with likely thrombus in the left posterior inferior cerebellar artery (PICA).

Conclusions: PCS is frequently missed due to the often-vague symptoms and reassuring negative imaging. This case highlights the variability of presentations that ED physicians may encounter. Nonetheless, a high index of suspicion for PCS should be maintained even in young patients without risk factors. Lastly, dysphagia is never normal, and this case demonstrates the need to reconsider neurogenic origin when other causes have been ruled out.

背景:延髓外侧综合征(LMS)是一种后循环卒中(PCS),有多种表现,但最常见的是霍纳综合征、同侧共济失调和同侧痛觉减退。虽然吞咽困难也很常见,但单独出现吞咽困难的情况并不多见,文献中也只有少数病例报告。这种表现会给临床医生的鉴别诊断带来偏差,延误诊断:病例介绍:一名 53 岁的男性患者因吞咽困难前来就诊。他没有 PCS 症状,美国国立卫生研究院卒中量表(NIHSS)为零,其他神经系统检查无异常。脑卒中成像检查包括头部非对比计算机断层扫描(NCCT)和头颈部计算机断层扫描(CTA),均未发现急性异常。他的甲型流感检测结果呈阳性,除此之外,还检查了导致其吞咽困难的所有其他病因,包括咨询其他专科服务机构,但均未解决问题。两天后,患者出现新的右侧感觉障碍和左侧霍纳综合征,头部磁共振成像(MRI)扫描显示左侧延髓急性梗死,左侧小脑后下动脉(PICA)可能有血栓:结论:PCS 常因症状模糊和影像学检查阴性而被漏诊。本病例凸显了急诊科医生可能会遇到的不同表现。然而,即使是没有危险因素的年轻患者,也应高度怀疑 PCS。最后,吞咽困难从来都不是正常现象,本病例表明,在排除了其他病因后,有必要重新考虑神经源性吞咽困难。
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引用次数: 0
Recruitment of emergency department patients to a prospective observational study. 招募急诊科患者参与前瞻性观察研究。
IF 2 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-07 DOI: 10.1186/s12245-024-00717-y
Claire Shubeck, Hans Reyes Garay, Bret P Nelson, Marcee Wilder, Aleksandra Degtyar, Megan Lukas, Lauren Gordon, George T Loo, Bernice Coleman, Lynne D Richardson, Kimberly Souffront

Background: The dynamic environment of the emergency department (ED) poses unique challenges to the execution of well-designed research. There is limited investigation into the viability of studies conducted in the ED. This paper offers a systematic evaluation of our recruitment of emergency patients for a prospective observational research study, shedding light on the intricate landscape of research feasibility within the ED setting.

Results: Research coordinators dedicated 2816.83 h to screening, recruiting, and enrolling patients between June 2018 and September 2023, having to stop recruitment twice due to financial constraints and the COVID-19 pandemic. 485 patients were approached and 84 of them were enrolled, resulting in a 31.94% enrollment rate, with approximately 2.8 participants recruited per month. Of those enrolled, 77 completed all study endpoints. Most participants were Hispanic (n = 44; 52.3%) and/or Black (n = 37; 44%), middle-aged (µ = 51.7 years), and female (n = 48; 57.1%). Participant recruitment was challenged by competing mindsets, the COVID-19 pandemic, and high staff turnover.

Conclusions: Recruiting emergency patients for a prospective observational study is feasible given adequate staffing and financial resources. Standardizing feasibility assessments for the recruitment of patients in the emergency department is important to the success of future study.

背景:急诊科(ED)的动态环境为开展精心设计的研究带来了独特的挑战。关于在急诊科开展研究的可行性调查十分有限。本文对我们为一项前瞻性观察研究招募急诊患者的情况进行了系统评估,揭示了急诊室环境中研究可行性的复杂情况:研究协调员在 2018 年 6 月至 2023 年 9 月期间共投入 2816.83 小时用于筛选、招募和注册患者,由于资金紧张和 COVID-19 大流行,不得不两次停止招募。共接触了 485 名患者,其中 84 人被招募,招募率为 31.94%,每月招募约 2.8 名参与者。其中 77 人完成了所有研究终点。大多数参与者为西班牙裔(n = 44;52.3%)和/或黑人(n = 37;44%)、中年(µ = 51.7 岁)和女性(n = 48;57.1%)。参与者的招募受到了竞争心态、COVID-19大流行和人员流动率高的挑战:结论:在人员和资金充足的情况下,招募急诊患者参与前瞻性观察研究是可行的。对急诊科患者招募的可行性评估进行标准化对未来研究的成功非常重要。
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引用次数: 0
Sex and 30-day survival following out-of-hospital cardiac arrest in Scotland 2011-2020. 2011-2020 年苏格兰院外心脏骤停患者的性别和 30 天存活率。
IF 2 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-07 DOI: 10.1186/s12245-024-00731-0
Laura A E Bijman, Sarah H Wild, Gareth Clegg, Nynke Halbesma

Background: Differences in 30-day survival between males and females following out-of-hospital cardiac arrest (OHCA) are well documented. Biological sex does not appear to be responsible for this survival gap independently of potential mediating factors. We investigated the role of potential mediating factors in the association between sex and 30-day survival after OHCA in Scotland.

Methods: A retrospective cohort study of adult non-emergency medical services (EMS)-witnessed OHCA cases was conducted. We included incidents from the whole of Scotland where resuscitation was attempted by the Scottish Ambulance Service (SAS) between April 1, 2011 and March 1, 2020. Logistic regression was used to assess the contribution of age, socioeconomic status, urban-rural location of the incident, initial cardiac rhythm, bystander cardiopulmonary resuscitation (CPR) and location of the arrest (home or away from home).

Results: The cohort consisted of 20,585 OHCA cases (13,130 males and 7,455 females). Median (IQR) age was 69 years (22) for males versus 72 years (23) for females. A higher proportion of males presented with initial shockable rhythm (29.4% versus 12.4%) and received bystander CPR (56.7% versus 53.2%) compared with females. A higher proportion of females experienced OHCA at home (78.8% versus 66.8%). Thirty-day survival after OHCA was higher for males compared with females (8.2% versus 6.2%). Males had higher age-adjusted odds for 30-day survival after OHCA than females (OR, 1.26; (95% CI), 1.12-1.41). Mediation analyses suggested a role for initial cardiac rhythm and location of the arrest (home or away from home).

Conclusion: Males had higher age-adjusted 30-day survival after OHCA than females. However, after adjusting for confounding/mediating variables, sex was not associated with 30-day survival after OHCA. Our findings suggest that initial cardiac rhythm and location of the arrest are potential mediators of higher 30-day OHCA survival in males than females. Improving proportions of females who present with initial shockable rhythm may reduce sex differences in survival after OHCA.

背景:院外心脏骤停(OHCA)后,男性和女性的 30 天存活率存在差异,这一点有据可查。除了潜在的中介因素外,生理性别似乎并不是造成这种存活率差距的原因。我们研究了苏格兰院外心脏骤停患者性别与 30 天存活率之间潜在中介因素的作用:我们对非紧急医疗服务(EMS)目击的成人 OHCA 病例进行了回顾性队列研究。我们纳入了 2011 年 4 月 1 日至 2020 年 3 月 1 日期间苏格兰救护服务机构(SAS)在全苏格兰尝试进行复苏的事件。我们使用逻辑回归法评估了年龄、社会经济地位、事件发生地的城乡差异、初始心律、旁观者心肺复苏(CPR)和停搏地点(在家或离家)等因素的影响:队列中有 20,585 例 OHCA(男性 13,130 例,女性 7,455 例)。男性的中位(IQR)年龄为 69 岁(22),女性为 72 岁(23)。与女性相比,男性出现初始可电击心律(29.4% 对 12.4%)和接受旁观者心肺复苏(56.7% 对 53.2%)的比例更高。在家中发生 OHCA 的女性比例更高(78.8% 对 66.8%)。与女性相比,男性在发生 OHCA 后的 30 天存活率更高(8.2% 对 6.2%)。经年龄调整后,男性在 OHCA 后 30 天存活率高于女性(OR,1.26;(95% CI),1.12-1.41)。中介分析表明,最初的心律和心跳骤停的地点(在家或离家)起了作用:结论:经年龄调整后,男性在心脏骤停后30天的存活率高于女性。然而,在对混杂/中介变量进行调整后,性别与 OHCA 后的 30 天存活率无关。我们的研究结果表明,最初的心律和心跳骤停的位置是导致男性 OHCA 30 天存活率高于女性的潜在因素。提高初始心律可电击的女性比例可能会缩小 OHCA 后存活率的性别差异。
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引用次数: 0
Bibliometric analysis of depression in post-stroke patients. 中风后患者抑郁症的文献计量分析。
IF 2 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-04 DOI: 10.1186/s12245-024-00725-y
Dehao Zheng, Sydney Vaughn, Murdoc Gould, Latha Ganti

Introduction: Stroke is a life-threatening condition that increasingly damages cerebral tissue over time and can lead to serious post-effects, including depression, which can hinder a patient's recovery from stroke and reduce quality of life. This paper aims to analyze the global research landscape of post-stroke depression (PSD) between the years 1900 to 2024 using bibliometric analysis.

Methods: The data used in this analysis was collected from the Web of Science Core Collection (WoSCC). An advanced search was performed using the keywords, "stroke" and "depression," on July 8th, 2024. From the Web of Science, bibliometric data was then extracted and analyzed in VOSviewer through four categories: countries, number of publications, keywords, and journals.

Results: The bibliometric analysis resulted in 2,289 publications from the year 1900 to 2024. A gradual increase in the number of publications on post-stroke depression over the study period was observed. China was found to be the leading country for publications and funding on PSD, with the United States following in second. The top keywords included: "stroke," "depression," and "poststroke depression." The Journal of Stroke had the highest number of publications on depression in post-stroke patients.

Conclusion: This study provides an overview of the current trends in articles published on PSD. Depression is an important topic to be considered in post-stroke patients due to its negative effects on post-stroke recovery and reduced quality of life, necessitating a call to attention and support for future research in this field. With continued research efforts led by the United States and China, improved treatments for patients with post-stroke depression can be implemented.

导言:脑卒中是一种危及生命的疾病,随着时间的推移,脑组织会受到越来越严重的损害,并可能导致严重的后遗症,其中包括抑郁症,它会阻碍患者从脑卒中中恢复并降低生活质量。本文旨在利用文献计量学分析方法,分析 1900 年至 2024 年间全球脑卒中后抑郁症(PSD)的研究状况:分析所用数据来自科学网核心文献集(WoSCC)。在 2024 年 7 月 8 日使用关键词 "中风 "和 "抑郁症 "进行了高级检索。然后从科学网中提取文献计量数据,并在 VOSviewer 中通过四个类别进行分析:国家、出版物数量、关键词和期刊:文献计量分析结果显示,从 1900 年到 2024 年,共有 2289 篇出版物。在研究期间,有关卒中后抑郁症的论文数量逐渐增加。研究发现,在有关卒中后抑郁的出版物和资金方面,中国居首位,美国紧随其后。热门关键词包括"卒中"、"抑郁 "和 "卒中后抑郁"。卒中杂志》上关于卒中后抑郁的论文数量最多:本研究概述了当前有关 PSD 的文章发表趋势。抑郁症对脑卒中后的康复和生活质量的降低有负面影响,因此是脑卒中后患者需要考虑的一个重要课题。在中美两国的持续研究努力下,卒中后抑郁症患者的治疗方法将得到改善。
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引用次数: 0
Emergency department physiotherapists: consideration of perceived barriers and facilitators to help optimise their role in the Australian emergency department. 急诊科理疗师:对澳大利亚急诊科理疗师角色优化的障碍和促进因素进行思考。
IF 2 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-04 DOI: 10.1186/s12245-024-00714-1
Tina Vickery, Lindsey Brett, Taryn Jones

Questions: What are the current barriers and facilitators to the role of ED physiotherapists? How do ED physiotherapists believe their role may be optimised within the context of the ED?

Design: Mixed methods study using a cross sectional survey.

Participants: Australian physiotherapists currently providing services to patients within an Australian emergency department.

Intervention: N/A.

Outcome measures: The survey included questions related to the level of integration of ED physiotherapy into emergency department teams and wider health system, and open answer questions to identify the factors which impact and influence ED physiotherapy practice, and the future of ED physiotherapy.

Results: 1 - Organisational culture, 2 - training and credentialling, 3 - governance, legislation and policies, 4 - funding, and 5 - advocacy and research were the five major themes generated from participant comments on existing facilitators and barriers to their role and the role of ED physiotherapists nationally. Six themes were generated from participant comments regarding the strategies to overcome barriers and facilitate an increased contribution by ED physiotherapists in the future: 1 - Training opportunities and specialisation pathways, 2 - Organisational culture, 3 - Governance, legislation and policies, 4 - Funding, 5 - Advocacy, 6 - Medicolegal Risks.

Conclusion: Australian emergency department physiotherapists perceive their roles and emergency physiotherapy service provision to be impacted by complex and multi-factorial influences. The overall contribution of ED physiotherapy is susceptible to influence from non-linear interactions of various agents and factors which span all levels of the health system.

Trial registration: N/A.

问题目前急诊室物理治疗师发挥作用的障碍和促进因素是什么?急诊室物理治疗师认为如何在急诊室环境中优化他们的角色?混合方法研究,采用横断面调查:干预措施: 不适用:结果测量:调查内容包括有关急诊科物理治疗与急诊科团队和更广泛的医疗系统的整合程度的问题,以及旨在确定影响急诊科物理治疗实践的因素和急诊科物理治疗的未来的开放式答案问题:1 - 组织文化;2 - 培训和认证;3 - 管理、立法和政策;4 - 资金;5 - 宣传和研究是参与者就其角色和全国急诊科物理治疗师角色的现有促进因素和障碍所发表的评论中产生的五大主题。与会者就克服障碍和促进急诊室物理治疗师在未来做出更大贡献的策略提出了六个主题:1 - 培训机会和专业化途径,2 - 组织文化,3 - 治理、立法和政策,4 - 资金,5 - 宣传,6 - 医疗法律风险:澳大利亚急诊科物理治疗师认为,他们的角色和急诊物理治疗服务的提供受到了复杂的多因素影响。急诊科物理治疗的整体贡献很容易受到跨越各级医疗系统的各种媒介和因素的非线性相互作用的影响:不适用。
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引用次数: 0
Airway obstruction due to ingestion of sodium polyacrylate: a case report. 摄入聚丙烯酸钠导致气道阻塞:一份病例报告。
IF 2 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-04 DOI: 10.1186/s12245-024-00730-1
Andreas Stalder, Youcef Guechi, Claire-Lise Bonnemain, Thomas Schmutz

Background: Super-absorbent polymers (SAPs) possess the ability to absorb large amounts of water and are widely used in medical settings. Commonly used in vomit bags to contain fluids, reduce spillage, and enhance bedside hygiene, SAPs are generally regarded as safe and non-toxic. However, we report a tragic incident where the accidental ingestion of SAPs led to fatal asphyxiation, highlighting a critical safety concern.

Case presentation: A 76-year-old female suffering from advanced Alzheimer's dementia was brought to the emergency department following a fall with cervical trauma. Following a complaint of nausea, she was given a vomit bag containing a sachet of approximately 9 g of SAP. Thirty minutes later, she was found deceased in the waiting area, with a grayish, half-hardened gel blocking her oropharynx and remnants of a chewed SAP sachet. Pathological analysis confirmed death by asphyxiation caused by the SAP expanding in her oropharynx upon contact with saliva.

Conclusions: This case emphasizes the potential dangers of SAPs when accidentally ingested and it is imperative that such products are kept out of reach of vulnerable populations. In cases of airway obstruction, there are no specific treatments available. Laryngoscopy may be impossible, necessitating the prompt consideration of an emergency tracheotomy. Experimental data suggest the use of an aerosol of warm alkaline hydrogen peroxide solution to dissolve these obstructive foreign bodies, but further studies are needed to validate its use in emergency situations.

背景:超吸水性聚合物(SAP)具有吸收大量水分的能力,被广泛应用于医疗领域。SAP 通常用于呕吐袋,以盛装液体、减少溢出并改善床边卫生,通常被认为是安全无毒的。然而,我们报告了一起意外摄入 SAP 导致致命窒息的悲惨事件,凸显了一个重要的安全问题:一名患有晚期阿尔茨海默氏症的 76 岁女性在摔倒并造成颈椎外伤后被送到急诊科。在主诉恶心后,医生给她使用了一个装有一袋约 9 克 SAP 的呕吐袋。30 分钟后,人们在候诊区发现她已经死亡,口咽部被灰色半硬化凝胶堵塞,并有咀嚼过的 SAP 小袋残留物。病理分析证实,她死于窒息,原因是 SAP 在口咽部与唾液接触后膨胀:本病例强调了误食 SAP 的潜在危险,因此必须将此类产品放在易受感染人群接触不到的地方。在气道阻塞的情况下,目前还没有具体的治疗方法。喉镜检查可能无法进行,因此必须立即考虑进行紧急气管切开术。实验数据表明,使用温碱性过氧化氢溶液气雾剂可以溶解这些阻塞性异物,但还需要进一步的研究来验证其在紧急情况下的应用。
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引用次数: 0
Large right middle cerebral artery stroke with hemorrhagic transformation. 大面积右侧大脑中动脉中风伴出血性转化。
IF 2 Q2 EMERGENCY MEDICINE Pub Date : 2024-10-04 DOI: 10.1186/s12245-024-00739-6
Jack Niles, Garv Bhasin, Latha Ganti

The authors present a case of an acute right middle cerebral artery infarct in a 65-year-old male with a history of diabetes, hypertension, and cardiovascular disease. The timeline of treatment and the evolution of the stroke is described. This case highlights the significant burden of right-sided cerebral artery stroke, even when intervention is swift.

作者介绍了一例急性右侧大脑中动脉梗死病例,患者为一名 65 岁男性,有糖尿病、高血压和心血管疾病病史。文中描述了治疗的时间表和中风的演变过程。该病例突出了右侧大脑动脉卒中的巨大负担,即使干预迅速。
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引用次数: 0
期刊
International Journal of Emergency Medicine
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