International Journal of Emergency Medicine最新文献

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.

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.

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.

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.

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.

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.

Background: Acute flank pain is a common presentation in the Emergency Department (ED). Point-of-care ultrasound (PoCUS) has emerged as an invaluable tool in the evaluation of acute flank pain and provides real-time images resulting in the early identification of the underlying pathology.

Case report: Here we report a case of a young lady presented to the ED with a complaint of right flank pain followed by a syncopal episode. The diagnosis of ruptured angiomyolipoma was made using a PoCUS and an immediate consult to interventional radiology and urology was provided.

Conclusion: This case highlights the importance of PoCUS in assessing patients presented to the ED with acute flank pain. Its incorporation into clinical practice promises to revolutionize the approach to renal emergencies, emphasizing its important role in delivering timely and effective care.

Background: Congenital diaphragmatic hernia(CDH) is a rare congenital anomaly characterized by herniation of abdominal contents into thoracic cavity through a defect in diaphragm. While commonly diagnosed prenatally or in neonatal period, late-presenting CDH can occur and may mimic other thoracic emergencies such as tension pneumothorax, complicating diagnosis and management.

Case presentation: A two-year old male black child from Ethiopia presented to the emergency department with sudden onset of acute respiratory distress. Initial clinical assessment and chest radiography suggested a diagnosis of tension pneumothorax due to the presence of significant mediastinal shift and apparent pleural air. Despite insertion of chest tube, the child's condition did not improve, raising suspicion of alternative diagnosis. Careful observation of initial chest x-ray and subsequent chest ultrasound revealed a left sided congenital diaphragmatic hernia with herniation of stomach and intestine into thoracic cavity compressing the left lung and causing mediastinal shift. After the diagnosis of CDH was confirmed, the child was stabilized and emergent surgical repair performed. Postoperative recovery was uneventful, and the child was discharged with no significant long-term complications.

Conclusion: This case underscores the importance of considering CDH in the differential diagnosis of acute respiratory distress in a child. It highlights the diagnostic challenges and potential risks of emergency interventions based on initial misdiagnosis. Even if x -ray looks like typical of tension pneumothorax, it showed giant cystic air filled structure pushing the mediastinal structure to contralateral side with loss of left diaphragmatic outline which raised suspicion of congenital cystic lung mass or congenital diaphragmatic hernia. Advanced imaging and high index of suspicion are crucial for accurate diagnosis and timely management, ultimately improving patient outcomes. Consideration of alternative diagnosis when our initial intervention with insertion of chest tube fail to provide symptom improvement in suspected pneumothorax should raise suspicion of congenital diaphragmatic hernia like in our case.

Introduction: The use of portable ultrasound equipment in emergency medicine has shown the capacity to greatly improve patient care in the swiftly changing field. This research evaluates the influence of the Butterfly POCUS device on patient contentment in the Emergency Department at Jordan University Hospital.

Materials and methods: We conducted a cross-sectional survey of 98 patients to examine their satisfaction levels after undergoing an ultrasound examination. We then evaluated these levels in relation to demographic and clinical characteristics.

Results: Seventy eight percent of the patients expressed a high level of satisfaction with their evaluation. This satisfaction level was consistent across all patient demographics, with no notable differences. Significantly, there was a clear correlation between greater satisfaction levels and higher first pain ratings, indicating that the technology effectively addresses patient concerns and enhances the diagnostic experience.

Conclusion: The findings of our study support the wider use of portable ultrasound technology in emergency care settings, emphasizing its ability to greatly enhance patient satisfaction and outcomes. Further investigation should include multicenter trials to authenticate these results and investigate the long-term effects on clinical practice.

Background: Penetrating aortic ulcers (PAU) are life-threatening conditions which derive from severely advanced atherosclerotic lesions of the aorta. The clinical course is unpredictable; thus clinical vigilance should be maintained. It is very challenging to separate PAU from co-existing AAS as predisposing factors and findings overlap.

Case presentation: Case of 58-year-old gentleman, who presented for atypical chest pain in the setting of respiratory tract infection. Computed Tomographic angiography (CTA) of the chest showed a large PAU and intramural hematoma which rapidly progressed into an acute aortic dissection in the emergency department. Close follow up with cardiac point of care ultrasound one hour later detected an intimal flap which was not initially present on CTA. Patient underwent surgical aortic graft replacement and had an uneventful in-hospital stay.

Discussion: This case underlines the importance of broadening differential diagnoses in atypical presentations in patients with risk factors. Prompt intervention and careful management are imperative to optimize patient outcomes and prevent complications of aortic lesions. Cardiac point of care ultrasound can help in detecting progression of dynamic atherosclerotic diseases such as acute aortic syndrome.