Journal of acute medicine最新文献

Penetrating injuries to the heart often lead to pericardial effusion (PCE) that may result in cardiac tamponade which can be rapidly fatal. Thus, early detection of PCE is extremely important in initial resuscitation. A 37-year-old man without any past medical illness was sent to our emergency department by ambulance due to left chest wall penetrating injury by nail gun 30 minutes ago. Upon presentation, the patient was agitated and diaphoretic. The penetration site was in the region of cardiac box, which raised awareness that possible heart injury has been inflicted. Point-of-care ultrasound (POCUS) was used immediately to screen for PCE which was present. In addition, POCUS revealed a hyper-echoic point in the left ventricle (LV) which we speculate is the foreign body (FB). Non-contrast computed tomography confirmed the presence of PCE and FB in the LV. The patient received emergent blood transfusion and was immediately transferred to a level-1 trauma center where removal of FB and cardiorrhaphy of LV apex was performed. He was discharged one week later under stable condition. Take home Message: The presence of hemopericardium in penetrating thoracic trauma may cause life threatening injuries such as cardiac tamponade which warrants immediate intervention. POCUS is a reliable, repeatable, and readily available tool at bedside for detecting PCE in penetrating thoracic trauma patients. Given its high sensitivity and specificity, POCUS should be used as the initial screening tool for the presence of PCE in all thoracic penetrating trauma patients.

The mechanism of exercise-associated collapse (EAC) is multifactorial. Other diagnoses or serious causes of collapse must be excluded immediately. We report a 45-year-old male runner who collapsed during a half-marathon (21 km). The initial assessment showed he had hyperthermia, tachycardia, and hypotension. In the medical tent, we applied non-invasive hemodynamic monitoring, and the results showed his cardiac index was 3.9 L/min/m ² , total peripheral resistance index (TPRI) was 1,199 dynes × sec/cm ⁵ /m ² (normal range: 1,970-2,390 dynes × sec/cm ⁵ /m ² ), stroke volume variance was 8%. The runner had decreased vascular resistance, likely due to heat-related vasodilation, whereas adequate stroke volume variation indicated a relatively sufficient intravascular fluid status. This suggests the runner experienced exertional heat illness rather than a simple EAC. Initially, vigorous intravenous fluid resuscitation was given within the first 30 minutes. After the hemodynamic data indicated a relatively adequate fluid status, the rate of fluid administration was gradually reduced. External cooling methods were implemented which involving ice packing over the neck, axillae, and groin areas. His body temperature decreased. Tachycardia and hypotension were resolved. One hour later, the sequential hemodynamic monitoring showed an increasing TPRI (1,264 dynes × sec/cm ⁵ /m ² ). In our case, the runner displayed peripheral vasodilation. The goal of treatment EAC is to restore adequate tissue perfusion through fluid resuscitation and restoration of vascular tone. Non-invasive hemodynamic serves as a valuable guide for a comprehensive treatment plan for collapsed runners in the field.

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.