Journal of acute medicine最新文献

Background: The prevalence and antimicrobial susceptibility of uropathogens can vary with time and geographical location. Empirical antibiotic treatment is frequently started before the urine culture reports are received; thus, the correct selection of antibiotics is imperative, as inappropriate use could increase resistance rates. This study evaluates the distribution trends and antimicrobial susceptibility of common uropathogens in Taiwan to help predict causative pathogens, prevent overly broad antibiotic use, and guide the optimal prescription of empirical antibiotic therapy to improve prognosis. Methods: This retrospective study extracted 5,672,246 urine culture sample data, including outpatient, emergency, and inpatient departments, during 2007-2017 from the Chang Gung Research Database. We examined the trend and susceptibility of uropathogens. Results: The three leading microorganisms were Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), and Pseudomonas aeruginosa (P. aeruginosa). E. coli. was more common among females (42.7%) than males (24.7%), while P. aeruginosa was more common among males (10.2%) than females (4.42%). E. coli and K. pneumoniae were highly susceptible to carbapenems, followed by aminoglycosides. Nevertheless, an increased antimicrobial resistance trend was observed in cephalosporins and quinolones. Conclusions: This study establishes E. coli and K. pneumoniae as the predominant uropathogens. Age and gender of patients result in distribution variations of uropathogens, but geographical location does not. In addition, P. aeruginosa occurs more in the sample of elderly and that too among males. Overall, this study could help clinicians choose appropriate antibiotics to treat urinary tract infections per the prevalent uropathogens and local antimicrobial susceptibility patterns.

Rhabdomyolysis is an uncommon complication in patients with severe SARS CoV-2 infection. This report presents a case of rhabdomyolysis in a critically ill patient with acute respiratory distress syndrome owing to COVID-19. The clinical manifestations included fever, tea-colored urine because of myoglobinuria, and elevated serum creatine kinase (CK). Muscle weakness was present and hindered successful weaning from mechanical ventilation. Prompt and aggressive fluid resuscitation was initiated in combination with alkalization of urine and furosemide administration. Treatment was titrated to maintain an adequate urine output with excellent clinical response. Severe COVID-19 infection may be accompanied by the late occurrence of rhabdomyolysis. CK levels should be monitored regularly and patients should be treated promptly with the adequate expansion of the extracellular volume. In our case, the intensive treatment proved to be effective in preventing acute kidney injury and related metabolic complications.

Background: Mass casualties caused by natural disasters and man-made events may overwhelm local emergency medical services and healthcare systems. Logistics is essential to a successful emergency medical response. Drills have been used in disaster preparedness to validate plans, policies, procedures, and agreements, and identify resource gaps. The application of the internet to facilitate the conduct of exercise was still limited. This study aimed to investigate the optimal preparation of medical supplies by medical emergency response teams (MERTs) during emergencies and disasters using an internet-based drill.

Methods: An internet-based drill based on real-life mass casualty incidents (MCIs) was developed and conducted in Taiwan from June 2017 to July 2018. The drill involved an MCI with 50 events delivered under two scenarios: (1) reduced transfer capacity and well-functioning local healthcare facilities (emergency module); (2) severely reduced transfer capacity and dysfunctional local healthcare facilities (disaster module). For each event, medical supplies commonly prepared by local MERTs in Taiwan were listed in structured questionnaires and participants selected the supplies they would use.

Results: Forty-three senior medical emergency responders participated in the survey (responding rate of 47.3%). Resuscitation-related supplies increased from emergency to disaster module (e.g., intubation from 9.1% to 13.9%; dopamine from 3.2% to 5.0%; all p < 0.001). In the subgroup analysis of events with life-threatening injuries, the utilization of resuscitation-related supplies (e.g., intubation from 46.6% to 65.3%; p < 0.001) remained higher in the disaster than in the emergency module. Compared to emergency medical technicians, physicians and nurses are more likely to use intravenous/intramuscular analgesics.

Conclusions: The severity of scenarios and the professional background of emergency responders have a different utilization of medical supplies in the simulation drill. The internet-based drill may contribute to optimizing the preparedness of medical response to prehospital emergencies and disasters.

Estimation of crowd size for large gatherings is an indispensable metric for event planners, local authorities, and emergency management. Currently, most crowd counting relies on dated methods such as people counters, entrance sensors, and ticket sales. Over the past decade, there has been rapid development in crowd counting techniques and related technology. Despite progress, theoretical advances in crowd counting technology have outpaced practical applications. The emergence of the vast array of crowd counting techniques has added to the challenge of determining those advances that can be most readily implemented. This article aims to provide an overview of promising crowd counting strategies and recent developments applied within the disaster medicine context along with the best use cases and limitations.

Background: Spinal epidural abscess (SEA) is an uncommon but serious differential diagnosis of acute spinal pain with high paralysis and mortality rate. This study aims to provide local data on its bioclinical characteristics and evaluate potential strategies to enhance its diagnostic rate in accident and emergency department (AED).

Methods: A retrospective case study from 2013 to 2019 was conducted in United Christian Hospital. SEA cases were classified as study group, spinal pain due to non-SEA cases were classified as control group. Data collected from study group included symptoms, radiological diagnosis, microbiological culture, treatment, and outcome. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) of both groups were compared to analyze their diagnostic power.

Results: In the study group (n = 42), 93% of patients had spinal pain, 55% had fever, 60% had neurological deficits, and only 26% had the classic triad on presentation. Seventy-four percent of patients presented with spinal cord or cauda equina compression in their first magnetic resonance imaging. Mortality rate was 23.8%, and paralysis rate was 7.1%. Diagnostic accuracy in AED was 12%. Admission to orthopedic ward (n = 23) resulted in a significantly lower mean time-to-imaging (4.39 days vs. 14.58 days) and mean time-to-treatment (6.56 days vs. 16.9 days) as compared to other specialties. The area under curves of CRP and ESR were 0.893 and 0.874 respectively, the optimal threshold levels were 45.9 mg/L (sensitivity 82.9%, specificity 79%) and 59.5 mm/hr (sensitivity 87.2%, specificity 80.4%), respectively.

Conclusion: Diagnosis of SEA in emergency department based on clinical symptomatology is not reliable due to low incidence of the classic triad, despite a more advanced disease on presentation. We proposed incorporating CRP and ESR tests into evaluation of patients with spinal pain since both tests demonstrated excellent discriminative power in diagnosing SEA.

This case involves a 41-year-old male experiencing agitation and confusion due to betel nut intoxication. The diagnosis was made by identifying the toxidrome through physical examination. Removing the residual betel nut with a finger and brushing it with water resulted in a significant improvement in consciousness and orientation within one hour. In addition to recognizing the toxidrome, prompt and effective treatment for the intoxicated patient is essential. Given the prevalence of betel nut chewing in Taiwan, emergency physicians should be particularly vigilant of arecoline toxicity.

Background: High-quality cardiopulmonary resuscitation (HQ-CPR) focuses on improving heart and brain blood perfusion. The evaluation of HQ-CPR included depth, frequency, rate of chest compressions, and the occurrence of chest recoil between two chest compressions. Staff performing CPR may not be performing HQ-CPR since it is influenced by individual stamina, physical strength, and lack of target marker. We aimed to study the impact of 100 times per minute rate vs. 120 times per minute CPR rate on the depth and percentage of depth-on-target done by trained staff on a manikin.

Methods: This was a cross-over randomized control study. The subjects were anesthesiology and intensive care residents in a tertiary teaching hospital in Indonesia, all certified to perform advanced life support. The subject was asked to perform both CPR of 100 and 120 times per minute after a period of one-day rest. The standardized adult manikin was used, and the depth of CPR was measured using a pad-sensor attached to the manikin, and the results were transferred to recording software. Analysis was done using the chi-square analysis, and p < 0.05 was considered statistically significant.

Results: A total of 35 subjects were included. The results showed that the average compression depth at 100 times/minute was more statistically superficial than the 120 times/minute treatment (5.210 ± 0.319 vs. 5.430 ± 0.283, p = 0.007). In contrast, the compression depth-on-target percentage was significantly higher at a speed of 100 times per minute (37.130 ± 10.233 vs. 18.730 ± 7.224, p = 0.0001).

Conclusion: One hundred times per minute CPR resulted in a statistically significant lower compression depth, although not clinically significant, with a statistically significant higher percentage of compression depth-on-target than 120 times per minute CPR.