Open Access Emergency Medicine最新文献

Introduction: Sudden Out-of-Hospital Cardiac Arrest (OHCA) is a significant global health issue, with considerable regional variations, and is the third leading cause of death in Europe. With approximately 80% of cases being witnessed, immediate initiation of cardiopulmonary resuscitation (CPR) by lay bystanders can increase OHCA survival by a factor of 2-4. In 2007, the European Resuscitation Council (ERC) established the European Registry of Cardiac Arrest (EuReCa) to systematically collect and analyze OHCA data across Europe, identifying gaps in the chain of survival. EuReCa findings highlight the critical impact of bystander CPR and the importance of measurement for evidence-based improvement. However, previous EuReCa studies in Portugal were limited to Madeira and the Azores, representing less than 5% of the population. This exploratory study is the first to provide comprehensive nationwide OHCA data, aiming to characterize the current national context.

Objective: Characterize the current national situation in terms of sudden OHCA survival and bystander CPR.

Methods: A retrospective cohort study was conducted from September 1 to November 30, 2022. All EMS-attended OHCA cases were included, and Utstein-style guidelines were applied to ensure standardized data reporting.

Results: During the study period, 4769 OHCA cases were recorded, including 2128 witnessed by laypeople. Bystander CPR was performed in 555 cases (26%), and ROSC was achieved in 117 victims, corresponding to a 5% survival rate among witnessed OHCAs.

Discussion: The bystander CPR rate in witnessed OHCA was 26%, which is below the average results of EuReCa One (48%) and significantly below the average results of EuReCa Two (58%).

Conclusion: Despite limitations related to the retrospective design and lack of a national OHCA registry, bystander CPR in witnessed OHCA showed a significant positive impact on ROSC (p<0.001). Regional differences were observed, underscoring the need to implement ERC recommendations to increase bystander CPR rates nationwide.

A 20-year-old female patient ingested approximately 1200 mL of antifreeze and was found comatose five hours later, after which she was transported to the hospital. On admission, she was in deep coma with respiratory failure and severe metabolic acidosis (pH 6.82). Laboratory findings revealed a high anion gap, elevated lactate levels, and acute kidney injury. Chest computed tomography (CT) showed aspiration pneumonia. Based on clinical history and examination, a diagnosis of ethylene glycol poisoning complicated by toxic encephalopathy and multiple organ dysfunction syndrome (MODS) was established. The patient received gastric lavage, ethanol antidote therapy, combined hemoperfusion and continuous renal replacement therapy (CRRT), as well as multi-organ supportive treatment. Mechanical ventilation was withdrawn on day 4, she was transferred to a general ward on day 6, and discharged on day 28 after recovery of renal function. This case highlights that early recognition of ethylene glycol poisoning, together with combined detoxification, blood purification, and organ support therapy, is essential for improving patient outcomes.

Purpose: Crisis Resource Management (CRM) is critical in managing code trauma cases, yet remains underemphasized in many medical training programs in Indonesia. This study aimed to develop and evaluate a virtual reality (VR)-based CRM training module tailored for emergency physicians.

Patients and methods: A pilot CRM module was designed through expert focused group discussions (FGDs) and refined using the Delphi method. The module included a lecture, roundtable discussion, and VR simulation. Fifteen emergency physicians participated in the training and were assessed using pre- and post-tests, a checklist based on CRM objectives, the Ottawa General Rating Scale (GRS), and a satisfaction questionnaire.

Results: Participants showed a significant improvement in knowledge (mean pretest 70 vs posttest 95.33; p < 0.001). Checklist completion rates had a median of 81% individually and 80% at the team level. Ottawa GRS scores indicated strong performance in leadership, problem-solving, communication, and situational awareness (overall mean score: 6.2/7). Satisfaction ratings reflected positive participant experiences with the module.

Conclusion: VR-based simulation is an effective, accessible tool for enhancing CRM skills in emergency settings, particularly in low-resource or remote environments. The module demonstrated high participant satisfaction and notable improvements in both individual and team performance and incorporating VR into trauma team CRM training should be considered.

Objective: Despite the numerous studies critiquing the Quick Sequential Organ Failure Assessment (qSOFA) score for sepsis prognosis in the emergency department (ED), there are limited known risk factors that can be missed by qSOFA.

Methods: This is a multicenter retrospective cohort study using ED data from Dr Sulaiman AL-Habib Medical Group Hospitals in Riyadh, Saudi Arabia. We assessed all suspected septic patients who came through the EDs from 1st May 2022 to 30th April 2023 with the qSOFA < 2. Among these patients, we identify those who develop critical outcomes (the requirement for vasopressors/inotropes or mortality) within 72 hours of triage. Additionally, we analyzed the potential risk factors of critical outcomes using a multivariable logistic regression model.

Results: We identified 1011 patients who presented with suspected sepsis and qSOFA < 2. Among them, 70 patients developed critical outcomes within 72 hours. In the multivariable logistic regression model, the potential risk factors for critical outcomes were age ≥65 years (adjusted OR, 3.87 [1.25, 14.9]), lactate ≥ 2.5 mmol/L with adjusted OR 2.04 [1.16, 3.54], and shock index >1 with adjusted OR 3.27 [1.13, 10.3]. There are no specific comorbidities that were independently associated with the critical outcomes.

Conclusion: The study identified potential risk factors for sepsis outcomes that qSOFA overlooks. Integration of risk factors (lactate, shock index, age) with qSOFA could enhance early sepsis recognition and improve patient outcomes. We recommend further studies to validate these risk factors.

Background: Mass casualty incidents present significant challenges to healthcare systems, necessitating effective triage and response from emergency personnel. Unfortunately, emergency medicine residents have reported discomfort with disaster preparation and lack of confidence at the prospect of responding to large-scale mass casualty incidents. Mass casualty preparation exercises are often costly, time-consuming to plan, and resource prohibitive, complicating disaster training initiatives for emergency medicine residency programs. We implemented and evaluated a novel training exercise geared toward improving resident comfort levels in utilizing the START (Simple Triage and Rapid Treatment) and JumpSTART triage algorithms that incorporated easily acquired materials and required limited faculty time commitment.

Methods: We staged two small-scale mass casualty exercises in May 2023 and December 2024 utilizing moulaged dolls and props designed to mimic a disaster scene. Dolls were equipped with QR codes linked to short vignettes including vital signs and relevant clinical information. Residents were instructed to assign a triage designation based on the information provided and input their response into Google Forms. Once submitted, participants received immediate feedback regarding the accuracy of their response, along with an explanation of why they were or were not correct.

Results: A total of thirteen residents for the first, and twelve residents for the second exercise implementation participated, completing pre- and post-intervention surveys to evaluate their comfort with mass casualty scenarios using the START triage system. Results indicated a 66% increase (first implementation) and 55% increase (second implementation) in the likelihood of residents feeling "mostly" or "very" comfortable post-exercise. Participants rated the teaching quality and instructional tools as "excellent".

Conclusion: Resident confidence in responding to mass casualty incidents improved post-exercise via the use of a cost-effective and easily replicable mass casualty triage training model, circumventing the need for costly simulation equipment and extensive faculty involvement.

Duodenal diverticular disease is a common finding in the general population and most individuals, in fact, remain asymptomatic. However, duodenal diverticular perforation is an occasional unfortunate endpoint that carries significant morbidity, and mortality rates and requires a particular attention and a wise judgement whether to liberally interfere surgically or to stay more conservative.In this writing, we describe a case of a 45-year-old male with a perforated duodenal diverticulum that presented in a stable general condition and was successfully managed conservatively, sparing the patient a particularly morbid surgical intervention. Perforated duodenal diverticula, though rare, can be managed conservatively in stable patients without signs of sepsis or generalized peritonitis. Conservative treatment, including intravenous antibiotics, bowel rest, and nasogastric suction, can be effective and avoid the morbidity associated with surgery. In our case, conservative management led to significant improvement, underscoring the importance of individualized treatment plans and close monitoring to decide on the necessity of surgical intervention.Conservative management of perforated duodenal diverticula should be considered in selected patients who fulfill the general settled criteria. Nevertheless, an individualized approach is recommended and escalating up the invasiveness of interventions may seem vital at any time during treatment.

Prehospital geriatric falls account for approximately a fifth of emergency medical services (EMS) call volumes nationwide, with a significant proportion involving head injuries and lacerations. Managing these injuries and associated hemorrhage requires substantial resource utilization, including personnel, time, and supplies. Complicating care is that many geriatric patients are maintained on long-term oral anticoagulant or antiplatelet therapy, making hemorrhage control more difficult. Failure to achieve adequate hemostasis in the field can delay critical assessments and further intervention. This case report describes the prehospital use of a novel hemostatic gel (Traumagel) in managing a complex head laceration. Traumagel achieves rapid and reliable hemostasis in complex wounds that may not be amenable to other hemostatic techniques. Deploying this gel alone or in combination with traditional methods enables emergency medical providers in the field to shift their focus to advanced patient care, allowing for earlier transport to definitive care. In this case, an elderly patient on chronic antiplatelet therapy (Clopidogrel) sustained a complex, open scalp laceration following a ground-level fall. EMS controlled a mixed venous-arterial hemorrhage unresponsive to direct pressure and traditional hemostatic interventions using Traumagel. Effective field hemostasis helped avoid trauma activation and potential operative intervention. The wound was successfully repaired in the emergency department without complication. This report underscores the importance of EMS providers integrating traditional techniques with emerging hemostatic technologies to optimize outcomes in moderate to severe trauma-related hemorrhage.

Background: Arrhythmia is a common complication among trauma patients and is frequently encountered in clinical practice. It is highly prevalent in this population and is associated with an elevated risk of adverse outcomes, including myocardial infarction, cerebrovascular events, and prolonged hospitalization.

Methods: We conducted a bibliometric analysis using CiteSpace and VOSviewer to perform both qualitative and quantitative assessments of the literature, including publication volume, contributing countries and institutions, leading authors, and keyword co-occurrence patterns.

Results: A comprehensive search of the Web of Science Core Collection database was performed for publications on trauma and arrhythmia from January 2014 to December 2024, yielding 5,840 relevant articles. The annual number of publications increased steadily, peaking in 2021 (764 articles), followed by a slight decline in 2022 (756 articles). The United States was the most productive country, accounting for 2,056 articles (35.2%). The Mayo Clinic emerged as the leading institution (107 articles), and Dr. Shinsuke Miyazaki was the most prolific author (34 articles, 0.58%). Frequently occurring keywords included atrial fibrillation, spinal cord injury, post-traumatic stress disorder, blunt chest trauma, traumatic brain injury, hip fracture, head trauma, chest trauma, pelvic fracture, and spinal cord injury. Among trauma types, spinal cord injury, traumatic brain injury, chest trauma, pelvic fracture, and post-traumatic stress disorder were most strongly associated with arrhythmia development, with atrial fibrillation being the predominant arrhythmic subtype.

Conclusion: This study represents the first bibliometric analysis to map the global research landscape of trauma-related arrhythmia. It delineates current research trends, identifies key contributors and thematic foci, and offers novel insights to guide future investigations into the mechanisms, prevention, and management of trauma-induced arrhythmias, while also forecasting emerging research hotspots.

Background: The emergency department (ED) plays a vital role in providing life-saving services in hospitals worldwide. In Jeddah province, Saudi Arabia, the Ministry of Health introduced the "Door to Disposition" key performance indicator (KPI) to enhance ED service quality by addressing overcrowding, limited bed capacity, delays in patient transfer, and complex logistical inefficiencies. However, little is known about how this initiative has affected the quality of ED care from the perspectives of patients and healthcare professionals.

Aim: To evaluate the quality of health services in the ED from the patients' and health professional's perspectives.

Methods: A qualitative design was employed using purposive sampling. Semi-structured interviews were conducted with 32 patients and 24 health professionals across 11 public hospitals (three rural and eight urban) in Jeddah between November 2023 and January 2024. Interviews were conducted face-to-face or by phone in Arabic or English, recorded with consent, and analyzed thematically.

Findings: Participants highlighted the importance of the "Door to Disposition" initiative and its valuable implementation. On the other hand, the primary reported barriers to emergency quality care provision are the absence of an effective triage system, shortage of medical practitioners, long waiting times, lack of dedicated urgent care centers, and lack of resources and logistical support. Thus, participants suggested improving emergency department services by focusing on primary and secondary care centers in terms of essential services and supplies, increasing the physical and human capacity of hospitals, establishing affiliated urgent care centers, providing effective and efficient means of communication between primary and secondary care centers, and finally, continually developing the healthcare providers capabilities.

Conclusion: The study helped to identify the barriers and facilitators encountered by patients and health professionals when accessing and utilizing emergency care in Jeddah.

Background: Road traffic injuries pose a significant public health challenge in Sub-Saharan Africa, particularly Uganda. Due to limited emergency medical services, police officers and bystanders provide inadequate prehospital care, contributing to high mortality rates of road traffic accident victims. The study evaluated the effect of an educational intervention on the knowledge and skills of police officers towards prehospital care for RTA victims in Southwestern Uganda.

Methodology: The study was conducted at Mbarara Central Police Station using a quasi-experimental design. We recruited a convenience sample of 45 participants who had served for at least 6 months and provided informed consent to participate. Data were collected using a validated structured questionnaire and checklist. Analysis was done using Stata version 17, with variables scoring a p-value of 0.001, which was considered significant utilizing a t-test.

Results: The majority (80%) of the participants were men, mean age was 41.2±11.3 years. Baseline knowledge and skills in prehospital care were low, with mean scores of 50.7%±16.8 and 34.0%±8.1 respectively. Post-intervention, there was a significant improvement in knowledge by 15.4% and skills by 46.4%, which was statistically significant (P<0.001). Improvement was most notable in the secondary survey by 67% for skills and least in the assessment for major bleeding by 18.5% for knowledge.

Conclusion and recommendations: The study found that an educational intervention greatly enhanced police officers' prehospital care skills for RTA victims, recommending regular training for Police officers as first responders.