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Factors Associated with Postintubation Hypotension Among Patients with Suspected Sepsis in Emergency Department 急诊疑似脓毒症患者插管后低血压的相关因素分析
Q3 EMERGENCY MEDICINE Pub Date : 2023-11-01 DOI: 10.2147/oaem.s426822
Panvilai Tangkulpanich, Chuenruthai Angkoontassaneeyarat, Thavinee Trainarongsakul, Chetsadakon Jenpanitpong
Purpose: Postintubation hypotension (PIH) is a recognized complication that increases both in-hospital mortality and hospital length of stay. Sepsis is reportedly a factor associated with PIH. However, no study to date has examined which factors, including the intubation method, may be clinical predictors of PIH in patients with sepsis. This study aims to investigate factors associated with the occurrence of PIH in patients with suspected sepsis in emergency department. Patients and Methods: This retrospective cross-sectional study was performed over a 5-year period (January 2013–December 2017) and involved patients with suspected sepsis who underwent endotracheal intubation in the emergency department of Ramathibodi Hospital. The patients were divided into those with and without PIH, and factors associated with the occurrence of PIH were analyzed. PIH was defined as any recorded systolic blood pressure of < 90 mmHg within 60 minutes of intubation. Results: In total, 394 patients with suspected sepsis were included. PIH occurred in 106 patients (26.9%) and was associated with increased in-hospital mortality (43.00% in the PIH group vs 31.25% in the non-PIH group, P = 0.034). Multivariable logistic regression showed that the factors associated with PIH were an age of ≥ 61 years (adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.14– 4.43; P = 0.019) and initial serum lactate concentration of > 4.4 mmol/L (aOR 2.00; 95% CI 1.16– 3.46; P = 0.013). Rapid sequence intubation and difference types of induction agents was unrelated to PIH. Conclusion: Monitoring the development of PIH in patients with sepsis is essential because of its correlation with higher in-hospital mortality. This is particularly critical for older individuals and those with severe infections and high initial lactate concentrations. Keywords: postintubation hypotension, sepsis, emergency department intubation
目的:插管后低血压(PIH)是一种公认的并发症,可增加住院死亡率和住院时间。脓毒症是PIH的一个相关因素。然而,迄今为止还没有研究检查哪些因素(包括插管方法)可能是脓毒症患者PIH的临床预测因素。本研究旨在探讨急诊疑似脓毒症患者发生PIH的相关因素。患者和方法:这项回顾性横断面研究进行了5年时间(2013年1月- 2017年12月),涉及在Ramathibodi医院急诊科接受气管插管的疑似脓毒症患者。将患者分为有PIH组和无PIH组,分析发生PIH的相关因素。PIH定义为插管后60分钟内任何记录的收缩压< 90mmhg。结果:共纳入疑似脓毒症患者394例。106例(26.9%)患者发生PIH,并与住院死亡率增加相关(PIH组43.00% vs非PIH组31.25%,P = 0.034)。多变量logistic回归显示,与PIH相关的因素为年龄≥61岁(校正优势比[aOR] 2.25;95%置信区间[CI] 1.14 - 4.43;P = 0.019),初始血清乳酸浓度> 4.4 mmol/L (aOR 2.00;95% ci 1.16 - 3.46;P = 0.013)。快速序贯插管和不同类型诱导剂与PIH无关。结论:监测脓毒症患者PIH的发展是必要的,因为它与较高的住院死亡率相关。这对老年人和严重感染和初始乳酸浓度高的人尤其重要。关键词:插管后低血压,败血症,急诊科插管
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引用次数: 0
Impact of Different Treatments for Disseminated Intravascular Coagulation on Patients with or without Biliary Drainage for Severe Biliary Tract Infection 播散性血管内凝血不同治疗方法对重症胆道感染患者行或不行胆道引流的影响
Q3 EMERGENCY MEDICINE Pub Date : 2023-11-01 DOI: 10.2147/oaem.s423097
Makoto Kobayashi, Shun Takai, Kyohei Sakurai, Yoshimatsu Ehama
Objective: Sepsis caused by severe acute cholangitis requires biliary drainage to decrease the intra-biliary pressure. Furthermore, several studies showed that anticoagulant treatment can improve the outcomes of patients with sepsis-associated disseminated intravascular coagulation (DIC). There were reports examining the efficacy of anti-DIC drugs in patients undergoing biliary drainage with sepsis-associated DIC, and no reports compared the efficacy of DIC treatments when no drainage is performed. In this study, the influence of antithrombin (AT) replacement therapy and recombinant thrombomodulin (rTM) preparations on the overall survival (OS) of patients with and without biliary drainage was analyzed. Patients and Methods: This retrospective cohort study in a single institution involved patients with sepsis-associated DIC caused by severe biliary tract infection. In total, 71 patients treated by either AT replacement therapy or rTM preparation were assessed for inclusion. The two groups were patients with biliary drainage (n = 45) and without drainage (n = 26). To assess the clinical efficacy of anti-DIC drugs in each group, the 60-day OS was determined through estimated survival analysis. Results: Focusing on the effects of different therapeutic agents for DIC, in the group of patients with biliary drainage, OS showed no difference between patients treated by rTM and AT. However, in patients without biliary drainage, the survival curves of patients treated with AT replacement were lower than those of patients with rTM preparation. Conclusion: This study revealed that the OS of patients without biliary drainage differed depending on the DIC therapeutic agent for sepsis-associated DIC caused by acute cholangitis. We would recommend the use of rTM preparation over AT replacement therapy for patients who cannot undergo biliary drainage. Keywords: sepsis, antithrombin, recombinant thrombomodulin, DIC treatment, acute cholangitis
目的:重症急性胆管炎致脓毒症需要胆道引流以降低胆道内压。此外,一些研究表明抗凝治疗可以改善脓毒症相关弥散性血管内凝血(DIC)患者的预后。有报道研究了抗DIC药物对胆道引流合并脓毒症相关性DIC患者的疗效,但没有报道比较不引流时DIC治疗的疗效。本研究分析了抗凝血酶(AT)替代治疗和重组凝血调节素(rTM)制剂对胆道引流和非胆道引流患者总生存期(OS)的影响。患者和方法:该回顾性队列研究在单一机构中纳入了由严重胆道感染引起的脓毒症相关DIC患者。共有71名接受AT替代疗法或rTM制剂治疗的患者被纳入评估。两组分别为行胆道引流(n = 45)和不行胆道引流(n = 26)。为了评估各组抗dic药物的临床疗效,通过估计生存分析确定60天生存期。结果:关注不同治疗药物对DIC的影响,在胆道引流组,rTM与AT治疗组的OS无差异。然而,在没有胆道引流的患者中,AT替代治疗患者的生存曲线低于rTM制剂患者。结论:本研究显示,急性胆管炎所致脓毒症相关性DIC患者无胆道引流的OS随DIC治疗剂的不同而不同。对于不能行胆道引流的患者,我们建议使用rTM制剂而不是AT替代疗法。关键词:脓毒症,抗凝血酶,重组凝血调节蛋白,DIC治疗,急性胆管炎
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引用次数: 0
The Clinical Value of Comprehensive Nursing Intervention in Preventing Severe Lymphopenia and Improving the Survival Rate Among Patients with Sepsis. 综合护理干预对预防脓毒症患者严重淋巴细胞减少及提高生存率的临床价值。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2023-10-21 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S433980
Lin Zhang, Chao Xu, Lin Bai, Lin Li, Jinyan Guo, Yanyi Li

Background: Intensive care unit (ICU) patients with sepsis who experience severe lymphopenia are at a higher risk of mortality, and they serve as a more accurate indicator of bacteremia compared to traditional infection markers.

Aim: Our study aimed to examine the influence of severe lymphopenia on ICU mortality and outcomes in sepsis patients, while also evaluating the clinical significance of comprehensive nursing intervention in preventing severe lymphopenia.

Methods: Patients with sepsis in the ICU at our hospital between January 2015 and January 2021 were split into a control group and a test group.The control group received regular nursing care, while the test group was provided with comprehensive nursing care in addition to the control group. The results encompassed mortality rates of 28 days, mortality rates of 1 year, and lengths of stay in the ICU.

Results: Our attention was directed towards day 4 absolute lymphocyte counts, taking into account the receiver operating characteristic (ROC) outcome. Patients with severe lymphopenia were older, more patients with 2 above comorbidities, higher co-infection rates and SOFA score. In addition, patients with severe lymphopenia required longer days stay in ICU (P<0.001), and presented with higher 28-day mortality (P=0.038) and 1-year mortality (P=0.004). Patients in control group have a higher incidence of severe lymphopenia (P=0.006), 28-day mortality (P=0.015) and 1-year mortality (P=0.019) compared with the test group.

Conclusion: Comprehensive nursing intervention can prevent the occurrence of severe lymphopenia, improve patients satisfaction and reduce mortality.

背景:重症监护室(ICU)脓毒症患者经历严重淋巴细胞减少症的死亡率更高,与传统的感染标志物相比,它们是更准确的菌血症指标。目的:我们的研究旨在探讨严重淋巴细胞减少症对败血症患者ICU死亡率和预后的影响,同时评估综合护理干预在预防严重淋巴细胞减少病中的临床意义。方法:将2015年1月至2021年1月在我院ICU的败血症患者分为对照组和试验组。对照组接受常规护理,试验组在对照组的基础上进行综合护理。结果包括28天的死亡率、1年的死亡率和在ICU的住院时间。结果:我们的注意力集中在第4天的绝对淋巴细胞计数上,考虑到受试者的操作特征(ROC)结果。严重淋巴细胞减少症患者年龄较大,有2种以上合并症的患者较多,合并感染率和SOFA评分较高。此外,严重淋巴细胞减少症患者需要更长的ICU住院天数(P=0.038)和1年死亡率(P=0.004)。与试验组相比,对照组患者的严重淋巴细胞减少病发生率(P=0.006)、28天死亡率(P=0.015)和1周死亡率(P=0.019)更高。结论:综合护理干预可预防严重淋巴细胞减少症的发生,提高患者满意度,降低死亡率。
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引用次数: 0
Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study. 乙状结肠扭转患者急诊剖腹手术后围手术期不良结局及其预测因素:回顾性随访研究。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2023-10-19 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S430193
Tilahun Deresse, Esubalew Tesfahun, Zenebe Abebe Gebreegziabher, Mandante Bogale, Dawit Alemayehu, Megbar Dessalegn, Tewodros Kifleyohans, George Eskandar

Background: Acute sigmoid volvulus is a surgical emergency with closed-loop obstruction of the colon that often requires emergency laparotomy, which is associated with a multitude of post-operative complications. Although sigmoid volvulus is the main cause of intestinal obstruction in Ethiopia, local studies of its management outcomes are limited.

Objective: To assess the magnitude and predictors of adverse perioperative outcomes of emergency laparotomy for acute sigmoid volvulus in the Debre Markos Comprehensive Specialized Hospital (DMCSH), Amhara region, Ethiopia in 2023.

Methods: This was a retrospective follow-up study. Descriptive statistics were used to measure perioperative outcomes and other study variables. Bivariable and multivariable logistic regression models were used to identify the predictors of adverse surgical outcomes. Associations were considered significant at p < 0.05 (95% confidence interval).

Results: In total, 170 study participants were enrolled, with a response rate of 91.4%. Forty-nine patients (28.8%) developed perioperative adverse outcomes. Pneumonia (29 patients, 28.1%), surgical site infection (19 patients, 18.4%), and wound dehiscence (10 patients, 9.7%) were the most common complications. Pre-operative shock [AOR: 3.87 (95% CI: (1.22, 12.28))], pus or fecal matter contamination of the peritoneum [AOR: 4.43 (95% CI: (1.35, 14.47)], and a higher American Society of Anesthesiologists (ASA) score [AOR: 2.37 (95% CI: (1.05, 5.34))] were identified as predictors of perioperative adverse events.

Conclusion: The perioperative adverse outcomes in this study were higher than those reported in Ethiopian national and global reports following emergency laparotomies. Hypotension at presentation, pus and/or fecal matter contamination of the peritoneum, and higher ASA scores are strong predictors of increased perioperative adverse outcomes. Therefore, healthcare providers and institutions involved in the delivery of emergency surgical care should emphasize the importance of early surgical intervention, adequate resuscitation, and patient monitoring to improve perioperative outcomes.

背景:急性乙状结肠扭转是一种结肠闭环梗阻的外科紧急情况,通常需要紧急剖腹手术,这与许多术后并发症有关。尽管乙状结肠扭转是埃塞俄比亚肠梗阻的主要原因,但当地对其治疗结果的研究有限。目的:评估2023年埃塞俄比亚阿姆哈拉地区Debre Markos综合专科医院(DMCSH)急诊剖腹治疗乙状结肠扭转的围手术期不良后果的程度和预测因素。方法:这是一项回顾性随访研究。描述性统计用于测量围手术期结果和其他研究变量。使用双变量和多变量逻辑回归模型来确定不良手术结果的预测因素。在p<0.05(95%置信区间)时,相关性被认为是显著的。结果:总共有170名研究参与者入选,有效率为91.4%。49名患者(28.8%)出现围手术期不良结果。肺炎(29例,28.1%)、手术部位感染(19例,18.4%)和伤口裂开(10例,9.7%)是最常见的并发症。术前休克[AOR:3.87(95%CI:(1.22,12.28))]、腹膜脓液或粪便污染[AOR:4.43(95%CI:(1.35,14.47)]和较高的美国麻醉师协会(ASA)评分[AOR:2.37(95%CI:(1.05,5.34)]被确定为围手术期不良事件的预测因素。结论:本研究中的围手术期不良结果高于埃塞俄比亚国家和全球报告中报道的紧急剖腹产术后的不良结果。表现时的低血压、腹膜的脓液和/或粪便污染以及较高的ASA评分是围手术期不良结果增加的有力预测因素。因此,参与提供紧急手术护理的医疗保健提供者和机构应强调早期手术干预、充分复苏和患者监测的重要性,以改善围手术期结果。
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引用次数: 0
Evaluating the Triage of Suspected COVID-19 Cases in Sudan's Emergency Settings: A Clinical Audit. 评估苏丹紧急情况下新冠肺炎疑似病例的分类:临床审计。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2023-10-18 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S433240
Bayan E Ibrahim, Rahba Osman El-Amin, Safia Tarig Adam Abdulla

Background: The inevitable coronavirus disease 2019 global pandemic has severely affected Sudan's fragile healthcare system. The authors share the experience of COVID-19 triage in the emergency departments of five public hospitals in Khartoum state, Sudan.

Methods: A clinical audit was conducted in December 2020 using the Centers for Disease Control and Prevention Checklist and Monitoring Tool for Triage of Suspected COVID-19 Cases. The tool was categorised into 5 domains and 38 indicators.

Results: Only three hospitals had hand hygiene stations in their triage areas: Ibrahim Malik, Omdurman, and Al-Nau. Omdurman Teaching Hospital was the sole hospital with a designated respiratory waiting area. At Al-Nau and Omdurman Hospitals, all respiratory symptomatic patients wore a facemask or alternative. Ibrahim Malik and Bahri Teaching Hospitals had 60% and 50% compliance, respectively, while none at El-Tamayouz Hospital did. No posters or job aids were present in donning and doffing areas. Heavy duty gloves were worn only at Ibrahim Malik (50%) and Omdurman (20%). 100% of staff wore closed-toe footwear at Ibrahim Malik and Omdurman, 75% at El-Tamayouz, 63% at Bahri, and none at Al-Nau.

Conclusion: The healthcare facilities displayed significant shortcomings in preparedness and response to COVID-19, with variations across hospitals in infrastructure, human resources, and procedures. To better combat future outbreaks, systemic improvements and a focused approach on consistent staff training, standard triage algorithms, and adequate PPE availability are imperative.

背景:不可避免的2019冠状病毒病全球大流行严重影响了苏丹脆弱的医疗系统。作者分享了苏丹喀土穆州五家公立医院急诊科新冠肺炎分诊的经验。方法:2020年12月,使用疾病控制和预防中心新冠肺炎疑似病例分诊检查表和监测工具进行临床审计。该工具分为5个领域和38个指标。结果:只有三家医院在其分诊区设有手部卫生站:易卜拉欣·马利克、乌姆杜尔曼和阿尔瑙。乌姆杜尔曼教学医院是唯一一家设有指定呼吸候诊区的医院。在Al Nau和Omdurman医院,所有有呼吸道症状的患者都戴着口罩或其他口罩。Ibrahim Malik和Bahri教学医院的合规率分别为60%和50%,而El Tamayouz医院没有。穿脱区没有张贴海报或工作辅助用具。只有易卜拉欣·马利克(50%)和乌姆杜尔曼(20%)佩戴了重型手套。Ibrahim Malik和Omdurman医院100%的员工穿着封闭式鞋类,El-Tamayouz医院75%,Bahri医院63%,Al-Nau医院没有。为了更好地应对未来的疫情,必须进行系统性改进,并对员工进行一致的培训、标准的分诊算法和充足的个人防护装备。
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引用次数: 0
Reducing Door-In to Door-Out Time for Patients Receiving a Mechanical Thrombectomy Using AutoLaunch Protocol. 使用AutoLaunch协议减少接受机械血栓切除术的患者门到门的时间。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2023-10-17 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S427945
Devin M Howell, Timmy Li, Elizabeth Quellhorst, Jeffrey M Katz, Rohan Arora, Jonathan Berkowitz

Background: Door-in to door-out (DIDO) time for large vessel occlusion (LVO) stroke is an emerging stroke performance measure. Initial presentation at a non-Comprehensive Stroke Center (CSC) requires a transfer process that minimizes delays. Our objective was to assess whether DIDO time for stroke patients was reduced after implementation of an AutoLaunch protocol for interfacility transfers.

Methods: This was a pre-post analysis of an AutoLaunch protocol for all acute stroke patients transferred to a CSC for mechanical thrombectomy. The distribution of DIDO times between patients transferred via the AutoLaunch and traditional dispatch protocols were compared.

Results: We evaluated 92 interfacility transfers, with 22 utilizing the AutoLaunch protocol and 70 utilizing traditional dispatch. Among AutoLaunch transfers, the median DIDO time was 85 minutes (IQR: 71, 133), while the median DIDO time among the traditional transfers was 109 minutes (IQR, 84, 144) (p=0.044).

Conclusion: Implementation of an AutoLaunch protocol for patients with suspected LVO was associated with a reduction in DIDO time to CSCs. Further studies should evaluate patient outcomes based on transfer strategies.

背景:大血管闭塞(LVO)卒中的门进门出(DIDO)时间是一种新兴的卒中表现指标。在非综合性中风中心(CSC)的首次演示需要一个最大限度地减少延误的转移过程。我们的目的是评估在实施设施间转移的AutoLaunch协议后,中风患者的DIDO时间是否减少。方法:这是对所有转移到CSC进行机械血栓切除术的急性中风患者的AutoLaunch方案的前后分析。比较了通过AutoLaunch和传统调度协议转移的患者之间的DIDO时间分布。结果:我们评估了92个设施间传输,其中22个使用AutoLaunch协议,70个使用传统调度。在自动启动转移中,DIDO时间中位数为85分钟(IQR:71133),而传统转移中的DIDO时间中值为109分钟(IQR,84144)(p=0.044)。进一步的研究应该基于转移策略来评估患者的结果。
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引用次数: 0
Predictive Factors of Oxygen Therapy Failure in Patients with COVID-19 in the Emergency Department. 急诊科新冠肺炎患者氧疗失败的预测因素。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2023-10-04 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S430600
Karn Suttapanit, Peeraya Lerdpaisarn, Pitsucha Sanguanwit, Praphaphorn Supatanakij

Background: Most patients with coronavirus disease 2019 (COVID-19) pneumonia require oxygen therapy, including standard oxygen therapy and a high-flow nasal cannula (HFNC), in the Emergency Department (ED), and some patients develop respiratory failure. In the COVID-19 pandemic, the intensive care unit (ICU) was overburdening. Therefore, prioritizing patients who require intensive care is important. This study aimed to find predictors and develop a model to predict patients at risk of requiring an invasive mechanical ventilator (IMV) in the ED.

Methods: We performed a retrospective, single-center, observational study. Patients aged ≥18 years who were diagnosed with COVID-19 and required oxygen therapy in the ED were enrolled. Cox regression and Harrell's C-statistic were used to identifying predictors of requiring IMV. The predictive model was developed by calculated coefficients and the ventilator-free survival probability. The predictive model was internally validated using the bootstrapping method.

Results: We enrolled 333 patients, and 97 (29.1%) had required IMV. Most 66 (68.0%) failure cases were initial oxygen therapy with HFNC. Respiratory rate-oxygenation (ROX) index, interleukin-6 (IL-6) concentrations ≥20 pg/mL, the SOFA (Sequential Organ Failure Assessment) score without a respiratory score, and the patient's age were independent risk factors of requiring IMV. These factors were used to develop the predictive model. ROX index and the predictive model at 2 hours showed a good performance to predict oxygen therapy failure; the c-statistic was 0.814 (95% confidence level [CI] 0.767-0.861) and 0.901 (95% CI 0.873-0.928), respectively. ROX index ≤5.1 and the predictive model score ≥8 indicated a high probability of requiring IMV.

Conclusion: The COVID-19 pandemic was limited resources, ROX index, IL-6 ≥20 pg/mL, the SOFA score without a respiratory score, and the patient's age can be used to predict oxygen therapy failure. Moreover, the predictive model is good at discriminating patients at risk of requiring IMV and close monitoring.

背景:大多数2019冠状病毒病(新冠肺炎)肺炎患者需要在急诊科(ED)接受氧气治疗,包括标准氧气治疗和高流量鼻插管(HFNC),一些患者会出现呼吸衰竭。在新冠肺炎大流行期间,重症监护室(ICU)负担过重。因此,优先考虑需要重症监护的患者非常重要。本研究旨在寻找预测因素,并开发一个模型来预测ED中有需要有创机械通气机(IMV)风险的患者。方法:我们进行了一项回顾性、单中心、观察性研究。入选年龄≥18岁的诊断为新冠肺炎并需要在急诊室接受氧气治疗的患者。Cox回归和Harrell C统计量用于确定需要IMV的预测因素。通过计算系数和无呼吸机生存概率建立预测模型。使用自举方法对预测模型进行了内部验证。结果:我们招募了333名患者,其中97名(29.1%)需要IMV。大多数66例(68.0%)失败病例是HFNC的初始氧气治疗。呼吸速率氧合(ROX)指数、白细胞介素-6(IL-6)浓度≥20 pg/mL、无呼吸评分的SOFA(序贯器官衰竭评估)评分和患者年龄是需要IMV的独立危险因素。这些因素被用于开发预测模型。ROX指数和2小时预测模型在预测氧疗失败方面表现良好;c统计量分别为0.814(95%置信水平[CI]0.767-0.861)和0.901(95%CI 0.873-0.928)。ROX指数≤5.1,预测模型评分≥8表明需要IMV的概率较高。结论:新冠肺炎大流行资源有限,ROX指数、IL-6≥20pg/mL,SOFA评分无呼吸评分,患者年龄可用于预测氧疗失败。此外,该预测模型能够很好地区分有需要IMV和密切监测风险的患者。
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引用次数: 0
A Systematic Review on Outcomes of Patients with Heatstroke and Heat Exhaustion. 中暑和热衰竭患者预后的系统评价。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2023-09-22 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S419028
Hassan Adnan Bukhari

Introduction: Heatstroke (HS) is a severe form of heat-related illness (HRI) associated with high morbidity and mortality, representing a condition that includes long-term multiorgan dysfunction and susceptibility to further heat illness.

Methods: In a systematic review searching Medline PubMed from the studies conducted between 2009 and 2020, 16 papers were identified.

Results: A hallmark symptom of heat stroke is CNS dysfunction (a hallmark sign of HS) which manifests as mental status changes, including agitation, delirium, epilepsy, or coma at the time of the collapse. Acute kidney injury (AKI), gut ischemia, blood clots in the stomach and small intestine, cytoplasmic protein clumps in the spleen, and injury of skeletal muscle (rhabdomyolysis) are all characteristics of peripheral tissue damage. Severe heat stroke tends to be complicated by rhabdomyolysis, especially in patients with exertional heat stroke. Rhabdomyolysis may lead to systemic effects, including the local occurrence of compartment syndrome, hyperkalemic cardiac arrest, and/or lethal disseminated intravascular coagulopathy. Untreated heat stroke might exacerbate psychosis, lactic acidosis, consumptive coagulopathy, hematuria, pulmonary edema, renal failure, and other metabolic abnormalities. Core body temperature and level of consciousness are the most significant indicators to diagnose the severity of heat stroke and prevent unfavorable consequences. Heatstroke is a life-threatening illness if not promptly recognized and effectively treated.

Discussion: This review highlighted that core body temperature and white blood cell count are significant contributing factors affecting heat stroke outcomes. Other factors contributing to the poor outcome include old age, low GCS, and prolonged hospital stay. The prevalence of both classic and exertional heatstroke can be reduced by certain simple preventive measures, such as avoiding strenuous activity in hot environments and reducing exposure to heat stress.

引言:中暑(HS)是一种严重的热相关疾病(HRI),发病率和死亡率较高,代表一种包括长期多器官功能障碍和易患进一步热疾病的疾病。方法:在一项系统综述中,从2009年至2020年间进行的研究中检索Medline PubMed,共发现16篇论文。结果:中暑的标志性症状是中枢神经系统功能障碍(HS的标志性体征),表现为精神状态的变化,包括激动、谵妄、癫痫或崩溃时的昏迷。急性肾损伤(AKI)、肠道缺血、胃和小肠中的血块、脾脏中的细胞质蛋白块以及骨骼肌损伤(横纹肌溶解症)都是外周组织损伤的特征。严重中暑往往并发横纹肌溶解症,尤其是在运动性中暑患者中。横纹肌溶解症可能导致全身性影响,包括局部发生隔室综合征、高钾性心脏骤停和/或致命的弥散性血管内凝血病。未经治疗的中暑可能会加剧精神病、乳酸酸中毒、消耗性凝血障碍、血尿、肺水肿、肾衰竭和其他代谢异常。核心体温和意识水平是诊断中暑严重程度和预防不良后果的最重要指标。如果不能及时发现和有效治疗,中暑是一种危及生命的疾病。讨论:这篇综述强调,核心体温和白细胞计数是影响中暑结果的重要因素。导致不良结果的其他因素包括年龄大、GCS低和住院时间长。通过某些简单的预防措施,如避免在炎热环境中进行剧烈活动和减少暴露在热应激下,可以降低经典性和运动性中暑的患病率。
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引用次数: 0
Diagnostic Impact of Hs-CRP and IL-6 for Acute Coronary Syndrome in Patients Admitted to the ED with Chest Pain: Added Value to the HEART Score? Hs-CRP和IL-6对因胸痛入院的急诊科患者急性冠状动脉综合征的诊断作用:心脏评分的附加值?
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2023-09-21 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S425319
Khalil Rafiqi, Camilla Bang Hoeks, Bo Løfgren, Martin Bødtker Mortensen, Jens M Bruun

Objective: To investigate whether hs-CRP and IL-6 provide additional diagnostic value beyond that achieved by the HEART score in patients with chest pain suggestive of acute coronary syndrome (ACS) admitted to the emergency department (ED).

Methods: This was a post hoc analysis using data from the RACING-MI study. Baseline data, including hs-CRP and IL-6 levels, were analyzed using the plasma from the biobank. A total of 818 patients with chest pain suggestive of ACS were included in this analysis. Of these, 98 were diagnosed with ACS (12%). Logistic regression was used to identify the independent predictors of ACS development in patients with chest pain.

Results: hs-CRP levels >2 mg/L were observed in 50% of all ACS cases. IL-6 levels >1.3 pg/mL were observed in 71% of all ACS cases. hs-CRP had a sensitivity of 50% and specificity of 51% for the diagnosis of ACS, whereas IL-6 had a sensitivity of 71% and specificity of 29%. The diagnostic likelihood ratios for ACS was 1.0 for hs-CRP>2 mg/L and IL-6 > 1.3 pg/mL, respectively. Logistic regression analysis revealed that age, male gender, and ongoing smoking were associated with ACS in patients with acute chest pain. No association was found between IL-6 or hs-CRP level and ACS. This was observed for both IL-6 and hs-CRP, whether assessed on a continuous scale or using prespecified cut-off values.

Conclusion: Among the 818 patients admitted to the ED with chest pain suggestive of ACS, neither hs-CRP nor IL-6 provided an independent added diagnostic value. Our results suggest that inflammatory markers have limited diagnostic value in detecting patients with ACS in the ED.

目的:探讨hs-CRP和IL-6在急诊科(ED)胸痛提示急性冠状动脉综合征(ACS)患者中是否提供了超出HEART评分的额外诊断价值。方法:这是一项使用RACING-MI研究数据的事后分析。使用生物库的血浆分析基线数据,包括hs-CRP和IL-6水平。本分析共纳入818例提示急性冠脉综合征的胸痛患者。其中,98人被诊断为ACS(12%)。Logistic回归用于确定胸痛患者ACS发展的独立预测因素。结果:50%的ACS患者hs-CRP水平>2mg/L。在71%的ACS病例中观察到IL-6水平>1.3pg/mL。hs-CRP诊断ACS的敏感性为50%,特异性为51%,而IL-6诊断ACS的灵敏度为71%,特异性为29%。hs-CRP>2 mg/L和IL-6>1.3 pg/mL时,ACS的诊断似然比分别为1.0。Logistic回归分析显示,年龄、男性和持续吸烟与急性胸痛患者的ACS相关。IL-6或hs-CRP水平与ACS无相关性。IL-6和hs-CRP都观察到了这一点,无论是在连续量表上还是使用预先指定的临界值进行评估。结论:在818例提示ACS的胸痛患者中,hs-CRP和IL-6都没有提供独立的附加诊断价值。我们的研究结果表明,炎症标志物在ED中检测ACS患者的诊断价值有限。
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引用次数: 0
Lasting Effects of COVID-19 Pandemic on Prehospital Emergency Medical Service Missions. 新冠肺炎大流行对院前紧急医疗服务任务的持久影响。
IF 1.5 Q3 EMERGENCY MEDICINE Pub Date : 2023-09-18 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S425272
Isabella Metelmann, Matthes Nagel, Bastian Schneider, Bernd Krämer, Sebastian Kraemer

Purpose: The COVID-19 pandemic confronted prehospital emergency medical services (PHEMS) with immense challenges. This study aimed to investigate the development of PHEMS mission numbers and times in the COVID-affected region of Southwest Saxony (SWS).

Patients and methods: This was a retrospective analysis of PHEMS in SWS during lockdown periods and equal time spans in the previous and following years. Differences were tested for statistical significance using the chi-squared test and one-way analysis of variance (ANOVA).

Results: The total number of missions showed a substantial drop during the first (-16.6%) and the second (-4.5%) lockdown period compared with the previous year. Next-year periods showed a recovery that was nearly equivalent to the starting point. The first lockdown period was not associated with longer overall mission times. The minutes spent at the scene differed significantly between the first lockdown period (31.1 ± 3.52 min), previous year (28.4 ± 4.84 min), and follow-up period (31.8 ± 0.98 min). During the second lockdown, the overall mission times (71.6 ± 2.91 min), response times in minutes (8.9 ± 0.49 min), and minutes spent at the scene (31.4 ± 2.99 min) were significantly longer. The minutes spent at the scene (32.3 ± 18.68 min) and the overall mission time (69.6 ± 1.92 min) remained significantly longer during the control period.

Conclusion: Our data confirm the impact of the SARS-CoV-2 pandemic on German PHEMS. It can be concluded that nationwide lockdown measures led to lasting effects regarding a reduction in the total mission number, transport-on-site released-ratio, and emergency time intervals in the following year, without lockdown restrictions. The lasting effects on the transport-on-site released-ratio and emergency time intervals call for a re-evaluation of the delivery of emergency services during pandemics. These findings can inform future policy decisions and resource allocations to ensure optimal emergency medical services.

目的:新冠肺炎大流行给院前急救医疗服务(PHEMS)带来了巨大挑战。本研究旨在调查西南萨克森州受新冠肺炎影响地区(SWS)PHEMS任务数量和时间的发展。患者和方法:这是对前几年和后几年封锁期和同等时间跨度内SWS PHEMS的回顾性分析。使用卡方检验和单因素方差分析(ANOVA)对差异进行统计显著性检验。结果:与前一年相比,第一次(-16.6%)和第二次(-4.5%)封锁期间的任务总数大幅下降。在接下来的一年里,经济出现了几乎与起点相当的复苏。第一次封锁期与更长的总体任务时间无关。在第一次封锁期间(31.1±3.52分钟)、前一年(28.4±4.84分钟)和随访期间(31.8±0.98分钟),在现场花费的分钟数存在显著差异。在第二次封锁期间,总体任务时间(71.6±2.91分钟)、响应时间(8.9±0.49分钟)和在现场花费的时间(31.4±2.99分钟)明显更长。在控制期间,在现场花费的分钟数(32.3±18.68分钟)和总任务时间(69.6±1.92分钟)明显更长。结论:我们的数据证实了严重急性呼吸系统综合征冠状病毒2型疫情对德国PHEMS的影响。可以得出的结论是,在没有封锁限制的情况下,全国范围内的封锁措施导致了任务总数、现场运输释放率和下一年紧急时间间隔的减少,产生了持久的影响。对运输现场释放率和应急时间间隔的持久影响要求重新评估疫情期间应急服务的提供情况。这些发现可以为未来的政策决策和资源分配提供信息,以确保最佳的紧急医疗服务。
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引用次数: 0
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Open Access Emergency Medicine
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