Journal of acute medicine最新文献

This study involved a simulation of transportation and basic life support on ambulances carrying coronavirus disease 2019 (COVID-19) patients, using a specially modified mannequin. The mannequin used can spew a fluorescent solution from its mouth to simulate the droplets or vomitus made by the patient and can be detected using ultraviolet light illumination. We determined that the most frequently contaminated areas of an ambulance in the driver's cabin are the left front door's outer handle, driver's handler, gear lever, and mat. The most frequently contaminated area in the rear patient's cabin is the rear door, rear door lining, and handle over the roof. The most frequently contaminated areas before the removal of personal protective equipment (PPE) are the lower chest to the belly area, bilateral hands, lower rim of the gown, and shoes. After the removal of PPE, traces of fluorescence were observed over the neck, hands, and legs. We therefore suggest taking a bath immediately after PPE removal.

Backgorund: Previous studies conducted on critical patients in intensive care units have shown that fluid balance disorder (FBD) increases mortality. The purpose of this study is to investigate the effect of FBD on mortality of patients hospitalized in internal medicine ward.

Methods: The present study was designed as an observational study and follow-up period of the patients began in the first 8 hours of admission to the emergency room who had hypervolemia findings in physical examination were included in the fluid balance FB (+) group; those who had any of the dehydration findings were included in FB (-) group, those who had both hypervolemia and dehydration findings were included in FB (mix) group, and those with normal examination findings were included in FB (N) group.

Results: A total of 303 patients, mean age of 66.4 ± 15.9 years, 54.5% male, were included in the study, which covered the period between May 1, 2019 and September 30, 2019. In-hospital, monthly and quarterly cumulative survival rates of the patients were respectively; 91.7 ± 2.7%, 89.2 ± 2.8%, 81.7 ± 3.5% in FB (N) group; 86.3 ± 5.2%, 82.2 ± 5.7%, and 57.8 ± 7.4% in FB (-) group; 70.9 ± 4.4%, 68.1 ±4.4%, and 54.9 ± 4.7% in FB (+) group; 57.6 ± 10.2%, 56.0 ± 9.9%, 44.0 ± 9.9% in FB (mix) group. It was determined that there was an approximately 3-fold increase in both monthly and quarterly mortality risks in those who had FBD compared to those who were not (HR: 3.077 and 3.031, respectively). It was shown with the multivariate Cox regression analyses that this risk increases independently from both preliminary diagnosis, concomitant diseases, vital disorders (30-day and 90-day AHR 2.541 and 2.517, respectively), and from the biochemical disorders (30-day and 90-day AHR 2.132 and 2.124, respectively).

Conclusions: Our study is important in terms of emphasizing the value of physical examination which lost its popularity with the development of technology and many medical instruments, but still simple and cheap.

Background: This study adopts the Situation-Behavior-Impact-Action (SBIA) model to examine the compliance of narrative feedback in the Entrustable Professional Activities (EPAs)-based e-Portfolio system for clinical preceptors in the emergency department of a regional teaching hospital, and analyzes the applicability of its application in emergency clinical training to increase the feasibility of improving the quality of clinical preceptors' feedback content.

Methods: Application of data mining technique to analyze 928 data points was recorded by 14 clinical teachers from April 2017 to May 2019. These data points were narrative feedback from workplace direct observation, which was recorded in the EPAs-based e-Portfolio.

Results: The majority of the narrative feedback consisted of only one component, behavior observed (53.99%) and action suggestion (17.24%). Some feedback consisted of two to three components; which were behavior observed-action suggestion (20.37%) and situation description-behavior observed- action suggestion (1.29%). Only a few feedbacks consisted of all four components: situation description- behavior observed-possible impact-action suggestion (0.75%).

Conclusions: The current narrative feedback is from the basic appearance of SBIA, but there still got room for improvement. The narrative feedback should be given according to SBIA model in order to provide a comprehensive and constructive learning outcome. The narrative feedback recorded in EPAsbased e-Portfolio provides the delay of feedback effect. Thus, multiple feedbacks from various clinical teachers could make the assessments more concrete and outline the authentic clinical condition of the trainees.

[This corrects the article on p. 20 in vol. 10.].

Background: Traumatic diaphragm injuries are rare. After blunt trauma, injuries occur with a 1-7% rate. This rate increases up to 15% in penetrating injuries. Diagnosis may be diffi cult and imaging tests may be misleading. The misdiagnosis may lead to herniated abdominal organs towards the intrathoracic cavity, with a mortality rate between 30% and 60%. This study was designed to investigate the data of patients operated for diaphragmatic injury in our clinic.

Methods: The files of trauma patients admitted to our hospital between 2014-2019 were reviewed retrospectively. The files of cases with diaphragmatic injury were examined. Patients were evaluated in terms of age, sex, type of injury, localization, additional organ injuries, grade, surgical method, and mortality. Values were statistically analyzed.

Results: A total of 20 patients were included in the study. Of the patients, 7 were female and 13 were male. The mean age was 32.7 (17-52) years. Of the cases, 10 were with stab wounds while 4 were incar traffi c accidents and 6 were gunshot wounds. Although all patients had thoracoabdominal injuries, 4 patients had additional pelvic injuries. Of the cases, 14 were accompanied with lung injury while 5 with intestinal, 4 with the spleen, 3 with liver, and 2 with cardiovascular injury. Patients with intestinal resection performed had a longer hospitalization period than others. When the severity of the injury was evaluated, grade 3 injuries were detected most commonly, whereas 3 patients had grade 1, 2, and 4 injuries. Grade 5 injury was detected in 1 patient. Primary repair was performed in 18 patients and mesh repair was performed in 2 patients. In three cases, the repair was performed with a thoracic way. One patient died on the postoperative fi rst day.

Conclusions: Diaphragmatic injuries that may be missed during imaging may be damaged with many organs. Diaphragmatic injuries should be kept in mind in the upper abdominal and thoracic injuries.

To improve the clinical outcomes of patients with acute ischemic stroke, the public, pre-hospital care system, and hospitals should cooperate to achieve quick assessment and management for such patients and to start treatment as soon as possible. To reach the goal, the Consensus Group, including emergency physicians and neurologists in the Taiwan Society of Emergency Medicine and Taiwan Stroke Society, performed an updated review and discussion for the local guidelines. The guidelines consist of 12 parts, including public education program, evaluation and management in the emergency medical system, emergency medical system, assessment of stroke care capability of the hospital by independent parties, stroke team of the hospital, telemedicine, organization, and multifaceted integration, improvement of quality of care process of stroke system, initial clinical and imaging evaluations after arriving at the hospital, imaging evaluation for indications of intravenous thrombolysis, imaging evaluation for indications of endovascular thrombectomy, and other diagnostics. For detailed contents in Chinese, please refer to the Taiwan Stroke Society Guideline and Taiwan Emergency Medicine Bulletin.

Hollow organ perforation is a serious and common abdominal emergency. The diagnosis depends on history taking, physical examination, and radiological fi ndings. We reported a hollow organ perforation patient with only indirect radiological signs of the heterogenous enhanced lesion between the stomach, duodenum, and liver over initial abdominal computed tomography. Pneumoperitoneum occurred in follow-up chest X-ray 5 hours after the emergency department visit. The reason for the delayed occurrence of pneumoperitoneum, direct/indirect radiological signs of hollow organ perforation, and ways to avoid this pitfall are discussed.

Injury is a leading cause of death among young adults. An accurately implemented fi led triage scheme (FTS) by emergency medical technicians (EMTs) is the first step for delivering right patients to the right hospital. However, the training effect of FTS on EMTs with different levels and backgrounds has scarcely been reported. We evaluated training effects of FTS among EMTs in Taipei. Standard FTS contains physiologic status, anatomical sites of injury, and mechanism of injury criteria. The intervention was a 30-minute lecture and pre-and-post tests, each containing five questions about trauma severity judgment (i.e., mechanism of injury [2 questions], anatomic sites of injury [2 questions], and physiological status [1 question]). The change in EMT accuracy was measured before and after training. Subgroup analyses were performed across EMTs with different levels and seniorities. From September 1, 2015 to March 31, 2016, 821 EMTs were enrolled, including 740 EMT-intermediates and 81 paramedics. Overall, EMT accuracy improved after the intervention in the intermediate (73.2% vs. 85.5%, p < 0.05) and paramedic (76.0% vs. 85.7%, p <0.01) groups. All trainees showed improvements in physiology and mechanism criteria, but paramedics showed decreased accuracy in anatomic criteria. The subgroup analysis showed that accuracy positively associated with prehospital care experience for major trauma cases 1 year before the training course, and the anatomical criterion accuracy was adversely associated with paramedic seniority. Field triage training can improve EMT accuracy for FTS. The anatomical aspect is more diffi cult to improve and should be emphasized in FTS training courses.