Pub Date : 2024-10-08DOI: 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.
{"title":"Utility of smart watch in expediting diagnosis of cold drink-triggered atrial fibrillation: a case report.","authors":"Grace V Heringer, David R Vinson","doi":"10.1186/s12245-024-00716-z","DOIUrl":"10.1186/s12245-024-00716-z","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"148"},"PeriodicalIF":2.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390419","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 : 2024-10-08DOI: 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.
{"title":"The polk county screening tool screening for detecting subarachnoid hemorrhage.","authors":"Krish Patel, Sanjana Konda, Latha Ganti, Anjali Banerjee, Paul Banerjee","doi":"10.1186/s12245-024-00722-1","DOIUrl":"10.1186/s12245-024-00722-1","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"146"},"PeriodicalIF":2.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390418","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 : 2024-10-07DOI: 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.
{"title":"Elevated high-sensitive cardiac troponin T in emergency department patients: insights from a retrospective descriptive cohort study.","authors":"Finn Syryca, Bernhard Haller, Lisa Schmid, Christiane Kallweit, Philipp Nicol, Teresa Trenkwalder, Karl-Georg Kanz, Anja Haas, Michael Dommasch","doi":"10.1186/s12245-024-00735-w","DOIUrl":"https://doi.org/10.1186/s12245-024-00735-w","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"141"},"PeriodicalIF":2.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11457446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390403","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 : 2024-10-07DOI: 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.
{"title":"A diagnosis that's hard to swallow: case report of delayed onset lateral medullary syndrome presenting with only dysphagia.","authors":"Jose Ernesto Gomez, Eric Justin Ho","doi":"10.1186/s12245-024-00709-y","DOIUrl":"https://doi.org/10.1186/s12245-024-00709-y","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case presentation: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"144"},"PeriodicalIF":2.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390400","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 : 2024-10-07DOI: 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.
{"title":"Recruitment of emergency department patients to a prospective observational study.","authors":"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","doi":"10.1186/s12245-024-00717-y","DOIUrl":"https://doi.org/10.1186/s12245-024-00717-y","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"142"},"PeriodicalIF":2.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390415","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 : 2024-10-07DOI: 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.
{"title":"Sex and 30-day survival following out-of-hospital cardiac arrest in Scotland 2011-2020.","authors":"Laura A E Bijman, Sarah H Wild, Gareth Clegg, Nynke Halbesma","doi":"10.1186/s12245-024-00731-0","DOIUrl":"https://doi.org/10.1186/s12245-024-00731-0","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"143"},"PeriodicalIF":2.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390417","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 : 2024-10-04DOI: 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.
{"title":"Bibliometric analysis of depression in post-stroke patients.","authors":"Dehao Zheng, Sydney Vaughn, Murdoc Gould, Latha Ganti","doi":"10.1186/s12245-024-00725-y","DOIUrl":"10.1186/s12245-024-00725-y","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"139"},"PeriodicalIF":2.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375426","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 : 2024-10-04DOI: 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.
{"title":"Emergency department physiotherapists: consideration of perceived barriers and facilitators to help optimise their role in the Australian emergency department.","authors":"Tina Vickery, Lindsey Brett, Taryn Jones","doi":"10.1186/s12245-024-00714-1","DOIUrl":"10.1186/s12245-024-00714-1","url":null,"abstract":"<p><strong>Questions: </strong>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?</p><p><strong>Design: </strong>Mixed methods study using a cross sectional survey.</p><p><strong>Participants: </strong>Australian physiotherapists currently providing services to patients within an Australian emergency department.</p><p><strong>Intervention: </strong>N/A.</p><p><strong>Outcome measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Trial registration: </strong>N/A.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"136"},"PeriodicalIF":2.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375427","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 : 2024-10-04DOI: 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。
{"title":"Airway obstruction due to ingestion of sodium polyacrylate: a case report.","authors":"Andreas Stalder, Youcef Guechi, Claire-Lise Bonnemain, Thomas Schmutz","doi":"10.1186/s12245-024-00730-1","DOIUrl":"10.1186/s12245-024-00730-1","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"137"},"PeriodicalIF":2.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375425","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 : 2024-10-04DOI: 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.
{"title":"Large right middle cerebral artery stroke with hemorrhagic transformation.","authors":"Jack Niles, Garv Bhasin, Latha Ganti","doi":"10.1186/s12245-024-00739-6","DOIUrl":"10.1186/s12245-024-00739-6","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"138"},"PeriodicalIF":2.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11453048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375428","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}