Journal of acute medicine最新文献

Background: Point-of-care ultrasound (POCUS) has become a crucial tool in the emergency department, aiding in rapid patient assessment and diagnosis, particularly in cases of acute dyspnea, which can have life-threatening causes. This study explores the diagnostic accuracy of PoCUS performed by emergency medicine residents, utilizing visual estimation and E-Point Septal Separation (EPSS) methods, in comparison to conventional 2D echocardiograms interpreted by sonographers.

Methods: A total of 112 adult patients with acute dyspnea were included in this non-inferiority study. Visual estimation and EPSS measurements were performed by trained emergency medicine residents, with the results compared to 2D echocardiograms for sensitivity, specificity, positive and negative predictive values, likelihood ratios, receiver operating characteristic curve and diagnostic accuracy.

Results: The study demonstrated a moderate positive correlation between visual estimation and EPSS methods and 2D echocardiography findings, with a Spearman's correlation coefficient of 0.422 and 0.411, respectively. The visual estimation method showed higher positive likelihood ratios (107) and sensitivity (100%) for detecting severely reduced ejection fraction (EF) < 30%, while EPSS displayed slightly lower positive likelihood ratios (13.4) and sensitivity (100%) in the same category. The diagnostic accuracy for both methods was highest in patients with severely depressed EF and lowest in those with moderately depressed EF. The study revealed some discrepancies in classification between methods, with visual estimation and EPSS sometimes underestimating or overestimating EF, potentially due to patient factors and operator-dependent bias.

Conclusion: This study demonstrates that visual estimation and EPSS methods, when performed by emergency medicine residents, exhibit a moderate positive correlation with 2D echocardiography findings. These methods offer a statistically significant diagnostic accuracy in estimating left ventricular ejection fraction, making them valuable tools for initial assessment in time-sensitive situations.

Pneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection that primarily affects immunocompromised individuals, particularly those with acquired immunodeficiency syndrome caused by human immunodeficiency virus (HIV). The clinical presentation of PJP can be atypical, with symptoms such as spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema, complicating diagnosis. In this report, we present a case of a 31-year-old male pharmacist with newly diagnosed HIV and PJP, who presented with persistent cough, dyspnea, intermittent fever, and subcutaneous emphysema. Chest X-ray and CT scans revealed bilateral ground-glass opacities, pneumomediastinum, and subcutaneous emphysema. The patient was diagnosed with HIV and PJP based on clinical findings and laboratory tests. Treatment with levofloxacin, penicillin, Caspofungin, and antiretroviral therapy led to significant improvement. This case highlights the importance of early diagnosis and the need for heightened clinical awareness of PJP in HIV-positive patients presenting with respiratory symptoms, particularly when imaging reveals atypical features.

Background: In Japan, few hospitals have emergency physicians who handle all diseases and trauma, regardless of their specialty, and emergency physicians have to work in a variety of settings. The Emergency Medicine Alliance (EMA) was formed in 2009 to address this gap and enhance emergency room-type (ER-type) emergency medicine, where emergency specialists manage all diseases and trauma akin to the approach in the United States. We aimed to examine the EMA's activities, impact, and contributions over the past 15 years.

Methods: This descriptive study reviewed the EMA's activities and outcomes from its inception in 2009 to 2024. The EMA is a nonprofit organization in Japan that includes 76 physicians and over 4,400 mailing list participants. Data from the EMA's internal records and publications were analyzed using descriptive statistics and qualitative feedback.

Results: The EMA's mission includes developing ER-type emergency medicine, establishing professional identity, supporting networking, providing educational resources, and promoting research. The EMA has successfully increased its mailing list to over 4,200 by 2023 and transitioned to a nonprofit in 2016. It published four books and one journal, created the Choosing Wisely index, and conducted several educational workshops, including 20 EMA meetings and 10 director academies. The EMA's initiatives significantly contributed to the recognition of emergency physicians in Japan. The EMA has also focused on awareness activities, such as surveying burnout among emergency physicians and publishing the results of these surveys.

Conclusions: The EMA has contributed to the advancement of emergency medicine in Japan by establishing a robust network, providing comprehensive educational resources, and advocating for the professional status of emergency physicians. Continued support and innovative strategies are essential to sustaining these achievements and addressing future challenges in emergency medical care.

Background: Brugada syndrome is a rare cardiac condition associated with an increased risk of ventricular arrhythmias and sudden cardiac death. Fever is a recognized trigger that can unmask Brugada patterns on electrocardiography (ECG), yet fever-induced Brugada syndrome remains uncommon and is often underdiagnosed.

Case presentation: We report the case of a 72-year-old man who presented to the emergency department with intermittent fever and lower back pain. Eight hours after admission, during a febrile episode with a body temperature of 39°C, the patient developed chest tightness. ECG revealed ST-segment elevation and an rSR' pattern in leads V1 and V2, consistent with a Type 1 Brugada pattern. Emergent coronary angiography showed normal coronary arteries. With the resolution of fever, the patient's symptoms subsided, and subsequent ECGs returned to normal sinus rhythm. He remained asymptomatic throughout his hospital course and follow-up.

Conclusions: This case highlights the diagnostic challenge of fever-induced Brugada syndrome, which can mimic acute coronary syndromes. Prompt recognition and appropriate evaluation are essential to prevent misdiagnosis and optimize patient outcomes. Further studies are needed to clarify the prevalence and clinical significance of fever-induced Brugada patterns in diverse populations.

Background: The ongoing COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to significant morbidity and mortality worldwide. Identifying the clinical features and factors influencing severe disease and mortality in individuals hospitalized with COVID-19 is essential for informing clinical management strategies and optimizing healthcare resource distribution.

Methods: We conducted a retrospective cohort study of 684 patients hospitalized with COVID-19 at a single center in Taiwan between April and June 2022. Demographic characteristics, comorbidities, vaccination status, and clinical outcomes were compared among different age groups (< 50 years, 50-74 years, and ≥ 75 years). Logistic regression analyses were performed to identify factors associated with critical illness and mortality.

Results: The median age of the cohort was 72 years (interquartile range [IQR]: 58-82), and 59.6% were male. Older patients had a significantly higher prevalence of comorbidities. The overall rates of mortality and critical illness were 15.1% and 30.4%, respectively. There were no significant differences in the occurrence of critical illness among the age groups. However, mortality was significantly higher in patients aged ≥ 50 years. In the multivariate analysis, oral antiviral drug use (adjusted odds ratio [aOR]: 0.5, 95% CI [confidence interval]: 0.3-0.7) and being fully vaccinated (aOR: 0.6, 95% CI: 0.4-0.8) were associated with lower mortality, while having ≥ 3 risk factors (aOR: 1.9, 95% CI: 1.2-3.0) was associated with higher mortality. Additionally, age ≥ 50 years was associated with increased mortality; 50-74 years (aOR: 2.3, 95% CI: 1.1-4.8); ≥ 75 years (aOR: 2.3, 95% CI: 1.1-4.8) compared to age < 50 years. Similar factors were associated with critical illness.

Conclusions: Older age was associated with higher mortality but not with an increased risk of critical illness in patients hospitalized with COVID-19. Oral antiviral drug use and being fully vaccinated were associated with better outcomes, highlighting the importance of early treatment and vaccination in mitigating severe COVID-19.

Trauma is a leading cause of death worldwide, with 25% of cases involving the head and neck region. Among various trauma types, impalement injuries caused by arrows and spearguns pose significant challenges due to their potential for severe damage to critical structures. This case report aims to present a case of a speargun arrow injury to the face and to discuss the mechanisms, implications, and management of such trauma. A 44-year-old male presented with an impaled arrow in the right infraorbital area, accidentally shot by his son. Initial assessment showed a conscious patient with stable vital signs. Imaging revealed the arrow penetrating the nasomaxillary region and extending into the cervical spine. Surgical removal was performed successfully using a retrograde approach with a Foley catheter to avoid further tissue damage. This case underscores the importance of individualized treatment strategies and the critical role of imaging in managing penetrating arrow injuries. A multidisciplinary approach, rapid assessment, and careful surgical planning are essential for positive outcomes. Reporting such cases contributes to medical research and improves safety regulations and treatment protocols.

Neurogenic pulmonary edema (NPE) is a rare, life-threatening condition characterized by the accumulation of fluid in the lungs following acute central nervous system (CNS) injury. This case report discusses a 42-year-old woman who presented to the emergency department with sudden onset of severe headache followed by syncope. She was later found unconscious and experienced multiple episodes of seizures and respiratory distress. Initial chest X-ray (CXR) revealed clear lung fields, but two hours later, bilateral alveolar opacities indicative of pulmonary edema were noted. Brain computed tomography (CT) confirmed the presence of subarachnoid hemorrhage (SAH). NPE typically presents with symptoms similar to other causes of pulmonary edema, including dyspnea, frothy sputum, and wheezing. It often follows conditions such as epileptic seizures, traumatic brain injury, or intracranial hemorrhage. In this case, a significant amount of frothy sputum was observed during endotracheal intubation, further supporting the diagnosis of NPE. The primary focus of treatment for NPE involves managing the underlying CNS injury while providing adequate supportive care, such as oxygenation, mechanical ventilation, and intracranial pressure (ICP) monitoring. This case highlights the importance of rapid diagnosis and management of NPE in patients with acute CNS injuries. Early recognition and intervention are essential to prevent severe respiratory compromise and improve clinical outcomes. Physicians should be mindful of NPE as a potential complication in patients presenting with neurological emergencies.

Background: Enhancing geriatric emergency care is important for the global aging society; however, the current state of collaboration between the government and healthcare professional organizations and its effect on this issue remain unclear. Therefore, this study was conducted for clarification.

Methods: The Taiwan Health Promotion Administration and the Taiwan Society of Emergency Medicine (TSEM) cooperated to lead 13 emergency departments (EDs) in implementing geriatric EDs based on the model of acute care for elders between January 1, 2021 and November 30, 2021. Experts from the Taiwan Association of Gerontology and Geriatrics and the Taiwan Association of Critical Care Nurses were also invited to set up a Taiwan Geriatric Emergency Department Guide (TGED) and individual goals for each ED. Education, benchmarking, regular joint and individual meetings, communication, and discussion were then performed via communication software, and intensive follow-up was conducted using a monthly checklist.

Results: Despite the impact of COVID-19, 10 of the 13 EDs accomplished the overall goals (76.9%). According to the TGED, the achievement rates for the seven domains were as follows: interdisciplinary team (100%), education (92.3%), equipment and supplies (100%), environment (92.3%), care protocol (100%), quality indicator (100%), and monitor indicator (92.3%). A practice guide and an education guide for the subsequent promotion of geriatric EDs were also established based on the experiences and results from the 13 EDs.

Conclusions: A new model for collaboration between the government and healthcare professional organizations was successfully implemented in Taiwan and thus could serve as an important reference for enhancing geriatric emergency care in the future.