World journal of emergency medicine最新文献

Background: Serum osmolality is a prognostic indicator in critically ill patients. This study aimed to evaluate the association between high osmolality and 28-day mortality in patients with cardiac arrest (CA) admitted to the intensive care unit (ICU).

Methods: Baseline data of adult patients with CA who were admitted to the ICU from 2008 to 2019 were collected from the Medical Information Mart for Intensive Care (MIMIC)-IV. Patients were divided into survivor and non-survivor groups according to the 28-day prognosis. Serum concentrations of sodium, potassium, glucose, and urea nitrogen on the first day of ICU admission were used to determine serum osmolarity. The primary endpoint of this study was 28-day all-cause mortality. Propensity score matching (PSM) analysis was performed to reduce bias between the survivor and non-survivor groups.

Results: Among the 798 included CA patients, the high osmolarity on the first day of ICU admission remained significantly associated with increased 28-day mortality (62.0% vs. 35.5%, P<0.001) and reduced cumulative survival (log-rank P<0.05) after PSM. Cox regression identified the high osmolarity on the first day of ICU admission as an independent predictor. High serum osmolarity on the first day of ICU admission effectively predicted 1-, 3-, 7-, and 28-day all-cause mortality, with the strongest predictive performance for 1-day mortality both before and after PSM (all P<0.05).

Conclusion: In this study, elevated serum osmolarity on the first day of ICU admission was independently associated with increased 28-day mortality in CA patients and could serve as a prognostic marker.

Background: This study is to evaluate clearance effects of hemoperfusion (HP), continuous renal replacement therapy (CRRT), and plasma exchange (PE) for chlorfenapyr and its metabolite tralopyril in patients with acute poisoning.

Methods: This retrospective study included 18 patients with acute oral chlorfenapyr poisoning treated at our department between January 2022 and January 2024. All patients received conventional therapies combined with blood purification, including HP, CRRT, and PE. HP was performed three sessions within the first 24 h, followed by CRRT and PE. Serial blood samples were collected to measure plasma concentrations of chlorfenapyr and tralopyril using gas chromatography/liquid chromatography-mass spectrometry (GC/LC-MS). The toxin-clearance effects were assessed using a linear mixed-effects (LME) model.

Results: The hourly decline rate of the plasma chlorfenapyr concentration (median [IQR]) was 8.83% (1.79%) for HP, 4.12% (1.26%) for CRRT, and 6.85% (1.44%) for PE. LME analysis showed higher decline rate in the plasma concentration with HP (β=5.00; P<0.001) and PE (β=2.15; P=0.003) compared to CRRT. For tralopyril, the hourly decline rates were 3.04% (0.62%) for HP, 1.82% (0.48%) for CRRT, and 3.01% (0.37%) for PE. LME analysis showed that the clearance effects of HP (β=0.027; P<0.001) and PE (β=0.022; P=0.001) were superior to CRRT. Pre-treatment toxin levels and the interval from hospital admission to blood purification showed no significant interaction with clearance outcomes.

Conclusion: In our study, HP was associated with a higher decline rate in plasma chlorfenapyr concentration compared to CRRT and PE, supporting HP as a preferred early intervention. However, all three methods showed limited efficacy in reducing tralopyril levels. Further research into the toxicokinetics and mechanisms of chlorfenapyr is warranted to optimize purification strategies.

Background: Maxillofacial trauma represents a significant challenge in emergency medicine, requiring both diagnostic accuracy and prompt intervention while balancing immediate life-saving interventions with preservation of function and aesthetics. The complex anatomy of this region, with its proximity to critical structures, demands a thorough understanding of assessment and management principles. This narrative review aims to provide evidence-based guidelines for emergency physicians managing maxillofacial trauma, with particular emphasis on early recognition of critical injuries, airway management strategies, and special population considerations.

Methods: A narrative review was conducted via a comprehensive literature search of the PubMed and Scopus databases, which focused on maxillofacial trauma management in emergency settings. Articles were selected based on relevance to clinical practice, methodological quality, and current management guidelines. The review synthesized evidence from multiple study types, including original research, systematic reviews, and clinical practice guidelines, to provide practical guidance for emergency physicians.

Results: Initial assessment following Advanced Trauma Life Support (ATLS) principles is crucial, with airway management being a primary concern due to the risk of dynamic obstruction. Critical time-sensitive emergencies include orbital compartment syndrome, trapdoor fractures (in pediatric patients), and facial nerve injuries. Computed tomography (CT) imaging remains the gold standard for diagnosis. Special considerations are required for pediatric patients, who present unique anatomical challenges and injury patterns, and for elderly patients, who often have complex medical comorbidities and increased complication risks. Management strategies range from conservative treatment to urgent surgical intervention, with decisions based on the injury pattern and associated complications.

Conclusion: Emergency physicians must maintain a structured yet flexible approach to maxillofacial trauma, focusing on early recognition of critical injuries, appropriate airway management, and timely specialist consultation. Understanding injury patterns and their potential complications allows for effective risk stratification and treatment planning, ultimately improving patient outcomes.

BACKGROUND: Iron metabolism dyshomeostasis is associated with ferroptosis and ischemia-reperfusion injury. We aim to investigate post-cardiac arrest changes in plasma iron metabolism-related parameters and their prognostic value for 28-day neurological outcomes. METHODS: In this prospective observational cohort study, plasma iron metabolism-related parameters (iron, ferritin, hepcidin, soluble transferrin receptor [sTfR], total iron binding capacity [TIBC], and transferrin saturation), interleukin-6, and neuron-specific enolase (NSE) were assessed in 120 patients after restoration of spontaneous circulation (ROSC) on days 1 and 3 of intensive care unit (ICU) admission and in 40 healthy controls. The primary outcome was poor 28-day neurological prognosis. RESULTS: Compared to controls, post-ROSC patients exhibited significant plasma iron metabolism disturbances, including decreased iron, TIBC, transferrin saturation, with elevated hepcidin, ferritin, sTfR, interleukin-6, and NSE on day 1 after ICU admission (P<0.05 for all). On day 28 post-ROSC, patients with poor neurological outcomes (71/120) presented more pronounced alterations than those with good neurological outcomes. Binary logistic analysis revealed that a plasma iron concentration ≤11.2 µmol/L (odds ratio [OR] 0.607, 95% confidence interval [CI] 0.455-0.808) and an NSE concentration ≥20.5 ng/mL (OR 1.020, 95% CI 1.005-1.035) on day 1 of ICU admission were associated with 28-day poor neurological outcomes. The plasma iron-NSE combination showed better predictive performance (area under the curve=0.935, sensitivity 89.8%, specificity 84.5%). CONCLUSION: Early post-ROSC plasma iron metabolism disturbances combined with NSE elevation were associated with the 28-day neurological prognosis, suggesting the therapeutic potential of targeting the iron metabolism pathway.

BACKGROUND: Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology. We aimed to investigate the relationships between liver function indicators at hospital admission and mortality in children receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support following cardiac surgery. METHODS: We retrospectively analysed the clinical data of pediatric patients who received postcardiotomy VA-ECMO support at Fuwai Hospital between January 2010 and June 2020. Univariable and multivariable-adjusted Cox proportional hazard models were constructed to evaluate the risk factors associated with 30-day and 180-day mortality. The cut-off values for the liver function variables measured at hospital admission were categorized into high and low groups and then compared using Kaplan-Meier survival curves and log-rank tests. RESULTS: Our study included 96 pediatric patients who received VA-ECMO support after cardiotomy. Among the patients receiving VA-ECMO, the 30-day and 180-day mortality rates were 37.5% and 52.1%, respectively. The level of aspartate aminotransferase (AST) at admission was associated with 30-day mortality (hazard ratios [HRs]=1.852, 95%CI 1.010-3.398, P=0.046). The AST and alkaline phosphatase (ALP) levels were predictors of 180-day mortality, with adjusted HRs of 1.799 (95%CI 1.074-3.014; P=0.025) and 1.384 (95%CI 1.050-1.825; P=0.021), respectively. The cut-off value for AST to predict mortality at 30 d was 77 U/L, and that for ALP to predict mortality at 180 d was 269 U/L. CONCLUSION: Liver function indicators, including AST and ALP, at hospital admission are associated with mortality risk in children with congenital heart disease receiving VA-ECMO after cardiac surgery.

BACKGROUND: BRASH syndrome (Bradycardia, Renal failure, AV nodal blockade, Shock, and Hyperkalemia) is a recently described clinical entity characterized by synergistic interaction between AV nodal blocking medications and hyperkalemia. Despite increasing recognition, its clinical characteristics, risk factors, and outcomes remain poorly defined. The rationale of this review is to provide clinicians an up-to-date overview of the most commonly encountered risk factors, triggers, clinical pictures, usual lab values, complications and outcomes, via the systemic analysis of currently published cases. METHODS: A systematic review was conducted using MEDLINE, Web of Science, and Cochrane Library databases through December 2024. Case reports, case series, and conference abstracts involving adult patients with BRASH syndrome were included. Data extraction focused on demographics, clinical presentations, laboratory findings, management strategies, and outcomes. RESULTS: Analysis included 131 patients from 111 published cases. Mean age was (71±13) years, with female predominance (58.1%). Hypertension (77.0%), chronic kidney disease (48.4%), and diabetes mellitus (46.7%) were the most common comorbidities. Beta-blockers were the predominant medication (76.5%). Most common presenting symptoms were syncope (17.9%), generalized weakness (16.2%), and altered mental status (11.9%). Mean potassium level was 6.6 mEq/L, with more than half of cases presenting with non-severe hyperkalemia (<6.5 mEq/L). Management often required multimodal therapy, with 50.8% of patients requiring vasopressors and 31.6% requiring hemodialysis. CONCLUSION: This systematic review provides the most comprehensive analysis of BRASH syndrome to date, demonstrating that while potentially serious, outcomes are generally favorable with appropriate recognition and management. The syndrome can develop even with modest hyperkalemia, particularly in elderly patients with multiple comorbidities. Early recognition and systematic management addressing all components of the syndrome appear crucial for optimal outcomes.