International Journal of Emergency Medicine最新文献

Background: Spontaneous spinal epidural hematoma (SSEH) is an exceedingly rare clinical entity often associated with neurological deficits, for which surgical intervention remains the mainstay of treatment. We report a case successfully managed through complete conservative therapy.

Case presentation: A 59-year-old Chinese male with a medical history of hypertension, chronic smoking, and alcohol use presented to our institution with acute-onset low back pain accompanied by bilateral lower limb weakness and hypoesthesia persisting for 30 min. Diagnostic imaging (CT and MRI) revealed a thoracolumbar epidural hematoma (T11-L1 distribution). Contrary to conventional surgical management paradigms, we implemented a comprehensive conservative management protocol. Remarkably, complete resolution of symptoms and spontaneous hematoma absorption were achieved within 20 days.

Conclusion: This case demonstrates that select SSEH cases may achieve favorable outcomes through conservative management without surgical decompression.

Background: Ranitidine, a histamine-2 (H2) receptor antagonist, is widely used for acid-peptic disorders. Although generally safe, it is a rare but recognized cause of drug-induced anaphylaxis, with an estimated incidence of 0.2-0.7% for H2 receptor blockers and proton pump inhibitors. We report a near-fatal case of ranitidine-induced anaphylactic shock successfully managed in a rural hospital.

Case presentation: A 35-year-old female developed sudden shortness of breath, hypotension, and drowsiness within minutes of receiving a 50 mg intravenous (IV) dose of ranitidine for epigastric discomfort at a local clinic. She had no prior exposure to ranitidine or known allergies. On arrival, her blood pressure was 60 mmHg systolic, pulse 130/min, and SpO₂ 60%. She had diffused urticaria and wheezing. A diagnosis of anaphylactic shock was made. Immediate management included high-flow oxygen, intramuscular epinephrine (0.5 mg, 1:1000), followed by intravenous hydrocortisone. Significant improvement occurred within 10 minutes and she was discharged after 24 hours of observation.

Conclusion: This case highlights that ranitidine, although commonly used, can rarely trigger severe anaphylactic shock even in patients without prior exposure or known allergies. Early recognition of the reaction and timely administration of intramuscular epinephrine were key to the patient's rapid recovery. Awareness of this potential adverse reaction is important for all clinicians who administer H2-receptor antagonists.

Introduction: Traffic-related injury is a leading cause of morbidity and mortality globally, especially among children. In Armenia, traffic-related mortality rates are the second highest among European Union and former Soviet countries. Currently, there are no published studies on pedestrian safety in Armenia and no notable examinations of pedestrian safety infrastructure. This manuscript describes an audit of Armenia's infrastructure using a modified Inventory for Pedestrian Safety Infrastructure (IPSI) in the Yerevan city center, focusing on areas surrounding schools.

Methods: Intersections (n = 379) and roadways (n = 623) shared by pedestrians and drivers in Yerevan's center were audited using a 36-item modified ISPI and paired with cloud-based smartphone application QField between October 2023 and February 2024. Visual analysis of data was conducted using the open-source software QGIS with statistical analysis in R. Inter-rater reliability of the audit was calculated using Cohen's Kappa and intra-class correlation coefficients. Incidence of each feature surrounding schools was compared to incidence overall using a one-sample z-test for continuous variables and a two-sample test of proportions for binary variables.

Results: Many of the features audited were not observed consistently across the audited area and were not more prevalent near schools. Lower inter-rater reliability was found with roadway and midblock data, resulting in analysis of primarily intersection features. Speed limits surrounding schools varied from 20 to 60 km/hr (12.5-37 mph). When compared to the overall audited area, crosswalks near schools demonstrated similar occurrence for traffic lights with crosswalk markings (23.3%, 95% CI: 0.157-0.309), speed bumps (11.9%, 95% CI: -0.139- 0.0338), and pedestrian signals (12.9%, 95% CI: 0.0709-0.194). Of the analyzed items, only bus stops were observed significantly more often near schools (19%, 95% CI: 0.00930-0.220).

Conclusions: The audit revealed an inconsistent presence of safety infrastructure, with infrastructure near schools largely reflecting the overall audited area. However, analysis was limited by low inter-rater reliability for many roadway and midblock features audited. Based on these results, infrastructure changes targeting lower speed limits and increased traffic calming measures are recommended to improve safety in school zones. Given a paucity of studies in LMICs, further work must be done to identify which high-yield features should be targeted in LMICs to prevent injury.

Haemorrhagic stroke, caused by bleeding in the brain, is one of the most dangerous types of stroke. It kills many people and leaves others with lifelong disabilities. In the Democratic Republic of the Congo (DRC), this problem is serious but often ignored. While most strokes in wealthy countries are caused by blocked blood vessels, in Africa, a much larger number are caused by bleeding. In the DRC, the problem is that stroke patients often arrive late at hospitals, and most hospitals do not have brain imaging or enough specialised stroke staff to treat them promptly. The country has fewer than 20 neurosurgeons for more than 100 million people, and most of them work in major cities. People living in rural areas usually cannot access proper care. Even when patients arrive at a hospital, surgery and intensive care are often unavailable. Stroke is usually managed as part of general health programmes, but the surgical aspect of haemorrhagic stroke is rarely included. This results in many deaths that could be prevented. This paper examines haemorrhagic stroke in the DRC from a neurosurgical perspective. We highlight how the lack of specialists, equipment, and clear treatment protocols worsens the situation. Simultaneously, there are opportunities for improvement: training general doctors and nurses in basic neurosurgical care, utilising telemedicine for advice, and developing national policies that include surgery. Collecting better data and establishing global partnerships will also be beneficial. Increasing focus on haemorrhagic stroke can save lives and reduce disabilities in the DRC.

Introduction: Disasters and public health emergencies can overwhelm healthcare systems, requiring rapid increase in capacity, inter-agency collaboration, and the quick deployment of emergency medical teams. An effective response to these crises requires a structured approach that integrates multiple entities, including healthcare, military, and community organizations. Current frameworks often lack structured methods for optimizing collaboration, which can lead to redundancy and inefficiency. This study aims to address this gap by developing a conceptual framework combining collaboration and integration theories to improve inter-organizational partnerships in emergency management.

Methods: To develop this framework, a comprehensive literature review was conducted identifying gaps in existing theoretical models of integration and collaboration. We examined integration theory at five distinct levels: structural, functional, normative, interpersonal, and process. Simultaneously, we explored collaboration theory, focusing on socio-cognitive, intersubjectivity, and distributed cognition frameworks. The study then synthesized these theories into a new, combined framework. This framework aligns integration components with key collaborative principles such as shared decision-making, effective communication, and adaptability. To make this framework a practical tool, we incorporated the CSCATTT model (Command and Control, Safety, Communication, Assessment, Triage, Treatment, Transport). This model typically used in collaborative exercises, serves as a practical guide for implementing and evaluating collaboration in real-world scenarios.

Results: The proposed framework provides a structured approach for responding to disasters and public health emergencies by identifying key points where integration and collaboration can effectively be combined. It demonstrates that integration theory ensures system cohesion and operational efficiency, while collaboration theory fosters adaptability and stakeholder engagement. By aligning these two theories, the framework facilitates more effective multi-agency partnerships. The inclusion of the CSCATTT model enhances structured decision-making, enabling coordinated and efficient action during emergencies.

Conclusion: By integrating collaboration and integration theories, this study offers a robust model for enhancing partnerships during disasters and public health emergencies. The proposed framework improves resource utilization, inter-agency coordination, cooperation, and overall effectiveness of collaborative responses, all while maintaining system flexibility. Future research should focus on validating this framework through practical applications, such as simulation exercises and real-world deployments.

Background: Emergency ambulances are vital in prehospital care but carry a high risk of healthcare-associated infections due to confined spaces, high patient turnover, and brief cleaning intervals. Routine disinfection protocols are in place; however, their effectiveness in South Korean ambulances has not been formally evaluated.

Methods: This pre-post observational study examined bacterial contamination on six high-touch surfaces across five operational ambulances in Province G, South Korea. Swabs were collected immediately before and after daily disinfection performed by paramedics. Bacterial load was quantified using colony-forming units (CFUs), and species identification was conducted via 16 S rRNA sequencing. Statistical analyses included paired t-tests, ANOVA, Cohen's d, and MANOVA to evaluate the cleaning efficacy and contamination patterns.

Results: All six surfaces were contaminated before cleaning, with the highest CFUs recorded on the ventilation outlet (182.6 ± 48.3), SpO₂ sensor (145.2 ± 35.7), and stretcher handle (122.4 ± 22.6). Disinfection significantly reduced bacterial load across all surfaces (p < 0.05), yet residual contamination remained on the SpO₂ sensor (Bacillus velezensis) and stretcher handle (Williamsia muralis). ANOVA revealed significant differences in baseline contamination (F(5,24) = 78.52, p < 0.001), and MANOVA confirmed that cleaning effectiveness varied by surface geometry (Wilks' Λ = 0.202, p < 0.001).

Conclusions: Manual disinfection significantly lowers bacterial load in ambulances, but residual contamination on complex, high-touch surfaces remains problematic. These findings underscore the need for multimodal disinfection approaches, improved equipment design, and systematic microbial surveillance to enhance EMS infection control standards.