Journal of acute medicine最新文献

Background: Optimal management for trauma-induced coagulopathy (TIC) is a clinical conundrum. In conjunction with the transfusion of fresh-frozen plasma (FFP), additional administration of prothrombin complex concentrate (PCC) was proposed to bring about further coagulative benefit. However, investigations evaluating the efficacy as well as corresponding side effects were scarce and inconsistent. The aim of this study was to systematically review current literature and to perform a meta-analysis comparing FFP+PCC with FFP alone.

Methods: Web search followed by manual interrogation was performed to identify relevant literatures fulfilling the following criteria, subjects as TIC patients taking no baseline anticoagulants, without underlying coagulative disorders, and reported clinical consequences. Those comparing FFP alone with PCC alone were excluded. Comprehensive Meta-analysis software was utilized, and statistical results were delineated with odd ratio (OR), mean difference (MD), and 95% confidence interval (CI). I² was calculated to determine heterogeneity. The primary endpoint was set as all-cause mortality, while the secondary endpoint consisted of international normalized ratio (INR) correction, transfusion of blood product, and thrombosis rate.

Results: One hundred and sixty-four articles were included for preliminary evaluation, 3 of which were qualified for meta-analysis. A total of 840 subjects were pooled for assessment. Minimal heterogeneity was present in the comparisons (I² < 25%). In the PCC + FFP cohort, reduced mortality rate was observed (OR: 0.631; 95% CI: 0.450-0.884, p = 0.007) after pooling. Meanwhile, INR correction time was shorter under PCC + FFP (MD: -608.300 mins, p < 0.001), whilst the rate showed no difference (p = 0.230). The PCC + FFP group is less likely to mandate transfusion of packed red blood cells (p < 0.001) and plasma (p < 0.001), but not platelet (p = 0.615). The incidence of deep vein thrombosis was comparable in the two groups (p = 0.460).

Conclusions: Compared with FFP only, PCC + FFP demonstrated better survival rate, favorable clinical recovery and no elevation of thromboembolism events after TIC.

Gallstone ileus is an infrequent cause of mechanical small bowel obstruction. The mortality rate of gallstone ileus remains relatively high, since gallstone ileus usually presents on elderly patients with multiple underlying diseases. Typically, the way of gallstone migration to small bowel is through biliary-enteric flstula, which is a rare complication of chronic cholecystitis. Patients present with diffuse abdominal pain and vomiting when the gallstone lodges in distal small bowel. The goals of surgical intervention include release of the bowel obstruction and closure of biliary-enteric flstula.

Background: Optimal management for trauma-induced coagulopathy (TIC) is a clinical conundrum. In conjunction with the transfusion of fresh-frozen plasma (FFP), additional administration of prothrombin complex concentrate (PCC) was proposed to bring about further coagulative benefit. However, investigations evaluating the efficacy as well as corresponding side effects were scarce and inconsistent. The aim of this study was to systematically review current literature and to perform a meta-analysis comparing FFP+PCC with FFP alone.

Methods: Web search followed by manual interrogation was performed to identify relevant literatures fulfilling the following criteria, subjects as TIC patients taking no baseline anticoagulants, without underlying coagulative disorders, and reported clinical consequences. Those comparing FFP alone with PCC alone were excluded. Comprehensive Meta-analysis software was utilized, and statistical results were delineated with odd ratio (OR), mean difference (MD), and 95% confidence interval (CI). I² was calculated to determine heterogeneity. The primary endpoint was set as all-cause mortality, while the secondary endpoint consisted of international normalized ratio (INR) correction, transfusion of blood product, and thrombosis rate.

Results: One hundred and sixty-four articles were included for preliminary evaluation, 3 of which were qualified for meta-analysis. A total of 840 subjects were pooled for assessment. Minimal heterogeneity was present in the comparisons (I² < 25%). In the PCC + FFP cohort, reduced mortality rate was observed (OR: 0.631; 95% CI: 0.450-0.884, p = 0.007) after pooling. Meanwhile, INR correction time was shorter under PCC + FFP (MD: -608.300 mins, p < 0.001), whilst the rate showed no difference (p = 0.230). The PCC + FFP group is less likely to mandate transfusion of packed red blood cells (p < 0.001) and plasma (p < 0.001), but not platelet (p = 0.615). The incidence of deep vein thrombosis was comparable in the two groups (p = 0.460).

Conclusions: Compared with FFP only, PCC + FFP demonstrated better survival rate, favorable clinical recovery and no elevation of thromboembolism events after TIC.

The rapid spread of coronavirus disease 2019 (COVID-19) has led to a large number of patients being admitted to hospitals, resulting in a near collapse of the medical system. The shortage of negative pressure isolation rooms and personal protective equipment is a potential problem. It is a pressing challenge to prevent the risk of infection in emergency physicians (EPs) during the endotracheal intubation of patients with COVID-19. We used a large clear plastic bag, cut an opening that covered the patient's head, and created a negative pressure environment inside the plastic bag using the hospital's medical gas pipeline system; thus reducing the amount of virus-containing aerosols leaked out and the risk of infection in the operators performing intubation. The video (http://www.caregiver.com.tw/Article.asp?ID=1258#article) about the detailed preparation of the plastic bag intubation kit (PBIK) has been posted on the website. This technique for safe endotracheal intubation in patients with COVID-19 is being used not only by EPs in Taiwan, but also by physicians and paramedics from other countries. Regarding designing the PBIK, our original intention was to use readily available materials to make tools that can improve the safety of the operators performing the intubations in situations where medical resources are exhausted. However, due to limited time and patients, further research is needed for validation.

Influenza is one of the most common respiratory viral infections, causing annual epidemics of respiratory illnesses characterized by sudden onset of fever, malaise, myalgias, cough, and other respiratory complaints. A spectrum of cardiovascular complications has also been reported in association with influenza infection. Cardiovascular involvement can occur through the direct effects of the virus on the myocardium or through the exacerbation of the existing cardiovascular disease. We report the case of an 86-year-old woman without a history of cardiac disease before admission who developed a transient complete atrioventricular block without myocarditis after acute infection with the influenza A virus.

Angioedema of tongue can be a truly emergency situation and needs rapid evaluation and intervention if airway compromise happens. It is also crucial to recognize the causality of the allergic reaction. Mostly the culprit can be identified if detailed medical regimen and exposure history have been reviewed. A rare case of gabapentin-induced angioedema of tongue is presented.

Lithium intoxication-induced myxedema coma, a rare but dangerous condition of severe hypothyroidism, can be easily misdiagnosed in patients without history of hypothyroidism. The objective of this case report is to describe a lithium-treated patient who presented to emergency department with obtundation and moderate hypothermia and was diagnosed with myxedema coma and lithium toxicity. A 64-year-old female presented to the emergency department with obtundation and hypothermia. The patient had the past history of stage-III chronic kidney disease, bipolar-type schizoaffective disorder, hypertension, and hyperlipidemia, and she had received long-term lithium therapy for the schizoaffective disorder. Bradycardia with hypotension developed after a few hours of admission and thyroid function revealed thyroid-stimulating hormone 53.1 nIU/mL and free T4 (FT4) 0.11 ng/dL, and the serum lithium level was 2.54 mmol/L. Therefore, diagnosis of lithium intoxication-induced myxedema coma was made, and the patient was managed with oral form of levothyroxine (LT4) (loading dose of 400 mcg followed by 100 mcg per day), intensive fluid therapy, empirical antibiotics, mechanical ventilation, and inotropic agents; lithium had been discontinued since admission. The patient weaned from the mechanical ventilation and inotropic support at day 4 of admission and by day 6, the patient's consciousness had fully recovered; on day 9, the serum lithium level was 0.37 mmol/L. The patient's FT4 recovered to the normal range (0.96 ng/dL) on day 15. In patients with no history of hypothyroidism or neck surgery and radiation therapy, lithium intoxication can be the single contributor to myxedema coma, which can be treated with oral form of LT4 as thyroid replacement therapy with instant and intensive supportive care. However, further study is needed to compare the outcomes of the patients with myxedema coma treated by oral and intravenous LT4.