Journal of acute medicine最新文献

Gallbladder hemorrhage is a rare medical emergency, often seen in patients with liver or kidney disease, or cancer. Failure to diagnose and treat it early can lead to shock and death. In this article, we present the case of a 64-year-old woman who presented to the emergency room with unstable vital signs and low blood pressure. Physical assessment found epigastric pain and nausea, but no systemic disease. Ultrasound diagnosed a suspected gallbladder hemorrhage, and she underwent immediate resuscitation and emergency computed tomography (CT). She was consulted with general surgery for gallbladder removal and discharged five days later. Interestingly, six months later, she experienced back pain and discomfort. MRI revealed a suspected bone metastasis, and she was eventually diagnosed with stage IVB lung cancer (T4N3M1c).

Necrotizing fasciitis (NF) is an infection of the deep soft tissues that results in progressive destruction of the muscle fascia and overlying subcutaneous fat. These infections can be sudden, vicious, and fast-spreading. If not treated quickly with antibiotics and debridement of the infected tissue, the patient may develop septic shock, which may lead to multiple organ failure and death. NF is difficult to early diagnose due to the overlying tissue can appear unaffected initially. We report an unusual case of NF of the buttock and left thigh that clinically mimics lumbar disc herniation. This patient was successfully treated with emergent fasciotomy and intensive care. We recommend that patients with low back pain and unilateral leg pain should be diagnosed carefully especially keeping NF in differential diagnosis.

Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) constitutes an important part of emergency department (ED) admissions. Therefore, risk scores for evaluating prognosis in COPD patients are valuable. The study aimed to determine the prognostic accuracy of Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) and Ottawa COPD Risk Scale in predicting short-term outcomes in patients presenting to the ED with COPD exacerbation.

Methods: This was a prospective cohort study conducted in a tertiary care hospital. All adult patients who presented to the ED with COPD exacerbation between June 2021 and June 2022 were included. DECAF and Ottawa COPD risk scores were calculated for each patient at ED admission. The primary outcome was all-cause mortality within 30 days of discharge.

Results: The data of 137 patients were analyzed. At the end of the 30-day period, 16 (11.7%) patients died, and 11 (8.0%) were admitted to the ICU. Based on receiver operating characteristic (ROC) curves plotted for mortality, the area under the curve (AUC) for the DECAF score was 0.762 (95% confidence interval [CI]: 0.649-0.876, p = 0.001), while the AUC for the Ottawa score was 0.796 (95% CI: 0.704-0.888, p < 0.001). The scores did not differ for mortality estimation ( p = 0.626). Using a score cut-off value of 3 for both scores for mortality outcome, the sensitivity/specificity values were 63%/78% for DECAF and 100%/34% for Ottawa.

Conclusion: Both risk scores are useful tools for predicting short-term outcomes in patients presenting to the ED after COPD exacerbation and can be used for risk management in the ED.

The evolution of emergency medicine education has been significantly influenced by digital platforms, including blogs, podcasts, and social media. These tools offer accessible, flexible, and interactive learning opportunities that complement traditional methods. Although digital platforms enhance knowledge retention and facilitate peer-to-peer engagement, challenges remain regarding content regulation and misinformation. This article explores the rise of these platforms, their impact on education. Despite limitations, digital tools represent a transformative shift in how healthcare professionals acquire and disseminate knowledge.

Emergency Medicine began as a clinical specialty focused on the provision of pre-hospital and hospital emergency room based care. Fifty years later, it has matured into a new paradigm: it is a complex specialty with a global reach and expansive practice in a variety of geographic and clinical arenas. "E mergency Medicine is a specialty caring for all types of patients, in any place, for any problem, right away, and in the right way ." It is a global population-based specialty, a system of care, has a unique clinical practice compared to other specialties, and is also a management specialty. The curriculum continues to expand to meet community and global needs in a number of areas: emergency pediatric and obstetrical care, emergency critical care, telemedicine, and partnering with public health. The challenges to emergency medicine are global. The most important, and the most pervasive global challenge, is managing stress and burnout which is due to a large number of complex issues. Professional development must be supported and encouraged to produce emergency physicians with cognitive and leadership skills to continue to lead the specialty forward, and to continue to improve the care of the public.

Background: Healthcare workers are at the frontline of the fight against coronavirus disease 2019 (COVID-19). The World Health Organization prioritized healthcare workers to receive COVID-19 vaccination immediately upon availability. This study aims to not only investigate the opinions and willingness of healthcare workers at a tertiary hospital to receive the COVID-19 vaccine but also assess the impact of vaccination on their work-related stress levels, before and after COVID-19 vaccination.

Methods: A cross-sectional survey was conducted using a web-based questionnaire consisting of three sections: "Demographic characteristics of the healthcare workers", "Opinions and willingness to receive the COVID-19 vaccination", and "Psychometric evaluation during the COVID-19 pandemic".

Results: A total of 249 healthcare workers participated in the study and of these 248 (99.6%) completed the three doses of COVID-19 vaccination. The highest stress score was recorded for the subscale "Discomfort caused by the protective equipment". Nurses experienced significantly higher overall stress levels than other categories of healthcare workers, particularly related to the subscale "Workload of caring for patients". Although the stress score for the subscale of "Difficulties and anxiety regarding infection control" obviously decreased after vaccination, there was no significant improvement in the overall stress levels before and after vaccination (47.7 ± 16.8 vs. 47.1 ± 16.7, respectively), and both remained in the severe range.

Conclusions: The willingness of healthcare workers to get COVID-19 vaccination is extremely high. However, receiving the COVID-19 vaccination does not seem obviously to impact work-related stress levels possibly due to the workload and variants of the virus with the potential for repeated infection. Therefore, additional policies aimed at reducing the physical and psychological burdens of healthcare workers, such as increasing staffing levels, should be implemented as soon as possible.

We report a case highlighting the global prevalence of atrial fibrillation (Afib) and the increased use of ablation therapy, underscoring the importance of understanding its complications, especially atrio-esophageal fistula (AEF), a rare but potentially fatal outcome. This case involves a 38-year-old male who underwent radiofrequency ablation for Afib and was subsequently hospitalized with abrupt left-sided weakness. Initially presumed to be a transient ischemic attack (TIA), his condition progressed to seizures and reduced consciousness. The computed tomography scans revealed pneumocranium, leading to a diagnosis of AEF. Despite the rapid identification of this complication, the patient's condition deteriorated quickly, resulting in his death on the 10th day. This case exemplifies that while AEF is an infrequent complication (0.1%-0.2%) following Afib ablation, it is of critical concern. The initial symptoms of AEF can be misleading, which accentuates the necessity for prompt recognition and timely intervention. Employing appropriate diagnostic techniques and ablation strategies are crucial to enhance patient outcomes and reduce the risks associated with AEF.

Background: Acute kidney injury (AKI) is a significant concern in critically ill patients, with mortality and morbidity implications. The serum uric acid-to-albumin ratio has been proposed as a potential prognostic marker for patients with and without AKI. This study aimed to investigate the relationship between this ratio and 28-day mortality in these patient groups.

Methods: A retrospective study was conducted on critically ill patients aged over 18, hospitalized in the internal medicine ICU at Osmangazi University, Eskisehir, Turkey, from May 2020 to November 2021. Patients were categorized based on the presence or absence of AKI. The primary outcome was 28-day mortality. The serum uric acid-to-albumin ratio was calculated, and its prognostic value was assessed using Receiver Operating Curve (ROC) analysis.

Results: Of the 1,016 patients, 449 had AKI. The mean age was 67.1 ± 15.27 years, with 53.9% being male. The serum uric acid-to-albumin ratio was found to have significant prognostic value in predicting 28-day mortality in both groups. In the overall study group, a ratio of 2.32 mg/g predicted 28-day mortality with 71.1% specificity and 58.3% sensitivity. For patients with AKI, a ratio of 3.59 mg/g predicted mortality with 85.3% specificity and 44% sensitivity. For those without AKI, a ratio of 2.28 mg/g predicted mortality with 84.1% specificity and 39.3% sensitivity.

Conclusion: The serum uric acid-to-albumin ratio is a valuable prognostic tool for predicting 28-day mortality in critically ill patients, irrespective of AKI status. Incorporating this low-cost biomarker into scoring systems could enhance patient management and outcome predictions.

Background: This study aimed to assess the diagnostic value and safety of using Pulmonary Embolism Rule-Out Criteria (PERC) in an emergency care setting.

Methods: We conducted a retrospective application of the PERC to the patients suspected of having pulmonary embolism (PE) and who underwent computed tomography pulmonary angiogram (CTPA) Karolinska University Hospital's emergency department (ED) from 2016 to 2017. The patient data, including D-dimer (DD) and ED waiting times were extracted from the Karolinska Venous Thromboembolism cohort (VTE cohort).

Results: Among the 295 patients included in the cohort, 34 (11.5%) were diagnosed with PE. Of these 202 (68.5%) patients were PERC-positive, while 93 (31.5%) were PERC-negative. Among the 93 PERC-negative patients, three had PE; resulting in a sensitivity of 91% (95% CI: 0.77-0.97), a specificity of 34% (95% CI: 0.29-0.40), and a false negative rate (FNR) of 8.8%. Combining positive DD and PERC resulted in a sensitivity of 100% (95% CI: 0.86-1.00), a specificity of 23% (95% CI: 0.15-0.34), and no FNR. When patients classified as high risk for PE (determined by clinical gestalt) were excluded, no PEs were missed. The median total ED stay was 450 minutes in patients who underwent CTPA compared to 203 minutes in the reference group ( p < 0.0001).

Conclusions: Using the PERC rule along with DD testing in low-risk patients effectively rules out PE in ED without the need for further testing. Properly using PERC may significantly reduce patients' waiting time in the ED.