Open Access Emergency Medicine最新文献

Kikuchi-Fujimoto disease (KFD), is rare, self-limiting disorder with necrotizing lymphadenitis as its hallmark, can be difficult to diagnose because it may have multiple nonspecific features. The study presented here describes the rare type of KFD that occurred in a young male patient suffering from quadriplegia and who was wrongly diagnosed as having tuberculous lymphadenitis, which is a common cause of lymphadenopathy in tuberculosis-endemic area. A 19-year-old man had presented with two week history of fever, quadriplegia, and cervical lymphadenopathy. On physical examination revealed cervical lymphadenopathy. A laceration procedure was performed to address the lymphadenopathy. The patient was treated with anti-tubercular medication for 11 days. Currently, his urinary and bowel functions are stable, and he is fully conscious, alert, and oriented to time, place, and person. Histopathology showed classical changes in histiocytic necrotizing lymphadenitis in the lymph nodes with no evidence of either tuberculosis or neoplasm. This KFD case is particularly glaring in terms of the obstacles it presented in making a diagnosis due to its endemicity of tuberculosis. The case actually had a complicated clinical picture with KFD's initial presentation of quadriplegia. Hence, the list of differential diagnosis should include KFD as one of the uncommon causes. Timely recognition and appropriate management of KFD can prevent unnecessary treatments and improve patient outcomes.

Background: Aerodigestive foreign bodies are common issue especially in children, who often place objects in their mouths, leading to inhalation or ingestion. Despite global data on this issue, no comprehensive study has been conducted in Rwanda. This study aimed to assess the prevalence, demographic factors, clinical presentations, diagnostic and management techniques of aerodigestive foreign bodies at Rwanda Military Hospital (RMH).

Methods: This retrospective study reviewed patient records from ENT department of RMH over the period of six years, from January 2017 to December 2022. Data on aerodigestive foreign bodies were extracted from operating room archives and OpenClinic hospital online system, then compiled in Excel spreadsheet, and descriptively analyzed using and SPSS 23.

Results: Among 39,240 patients who consulted the ENT department over the six years, 290 (0.74%) cases of aerodigestive foreign bodies were identified, with male-to-female ratio of 1.34:1. The highest incidence was in children aged 1-3 years (49.66%). Inorganic foreign bodies, especially coins (35.17%), were more common than organic ones. Clinical presentations varied, with 46.21% of cases being asymptomatic, and others showing drooling (17.93%) and dysphagia (9.66%). Chest X-rays were the most frequently used diagnostic tool (49.66%). Esophagoscopy was the primary management method for esophageal cases (45.52%), with bronchoscopy (13.10%) and forceps (34.14%) used for bronchial and nasal cases, respectively.

Conclusion: Aerodigestive foreign bodies, particularly coins, are prevalent in Rwanda, especially among young children and males. This highlights the need for targeted preventive strategies and educational programs to reduce incidence and improve management.

Spontaneous spinal epidural hematoma (SSEH) is a rare pathology with potentially severe consequences for the patient. Given its uncommon incidence and frequent atypical presentation, SSEH can easily be misdiagnosed. The association between anticoagulation or antiplatelet therapy and SSEH has been described in multiple case reports and literature reviews. We present a case of a 61-year-old man on anticoagulation and antiplatelet therapy (Rivaroxaban and Clopidogrel respectively), diagnosed with spinal SSEH with good recovery after laminectomy and hematoma evacuation. However, treatment guidelines for SSEH are difficult to find and there is no clear strategy about management of anticoagulation and antiplatelet therapy. The aim of this report is to highlight the importance of rapid diagnosis and surgical therapy in selected cases and to give an insight on the anticoagulation and antiplatelet management in these patients and their prognosis.

Animal bites represent a significant global public health concern, with hyena attacks being rare but highly destructive. This report details the case of a 22-year-old male who was attacked by a hyena while herding camels in rural Qardho, Somalia. The attack resulted in traumatic amputation of both testicles and the penis, finger loss, extensive muscle damage, and a jawbone fracture. The patient initially received local care and was subsequently transferred to Mogadishu for advanced treatment. Key interventions included wound closure, tracheotomy, broad-spectrum antibiotics, and tetanus prophylaxis. This case highlights the complexities of managing severe trauma in resource-limited settings and underscores the necessity of timely, multidisciplinary care. Long-term rehabilitation, along with psychological support, are essential components of the patient's recovery. Furthermore, the case emphasizes the importance of trauma prevention strategies and ensuring access to specialized medical care in remote regions.

Purpose: Appropriate use and timing of agents for chemical management of patient agitation is critical for the safety of patients and providers. Ketamine may have a preferable safety profile in acutely agitated patients, especially those with an unknown medication history given that it does not carry the same cardiovascular and respiratory risks as other sedative agents currently used in practice. This study aimed to evaluate subsequent chemical sedation requirements and the incidence of adverse events following the use of ketamine for agitation as compared to combination antipsychotic/sedative use in the ED.

Methods: This was a retrospective, single-center, observational cohort study of 102 adult patients who received chemical sedation for agitation/aggression/combative behavior from January 2018 to December 2023 at the Mount Sinai Medical Center Emergency Department. Patients who received at least one dose of ketamine (n = 51) were compared to patients who received at least one dose of the B52 combination (diphenhydramine (Benadryl) 25 mg, haloperidol (Haldol) 5 mg, and lorazepam (Ativan) 2 mg) (n = 51) for management of aggression. The primary endpoint was restricted mean survival time (RMST) to next sedative given. Secondary endpoints included the number of additional sedatives needed, adverse events, and length of stay.

Results: The use of ketamine was associated with patients requiring additional sedation both more often and sooner than patients who received the B52 combination (RMST to next sedative: 2.1 hours ketamine vs 4 hours B52; p = 0.032, median additional doses: 3 doses ketamine group vs 0 doses B52 group; p < 0.00).

Conclusion: In agitated patients within the ED, the administration of ketamine demonstrated inadequate duration of sedation and increased need for supplemental sedative use compared to B52.

Purpose: This study aims to evaluate the preparedness of Saudi radiological sciences students for emergencies by assessing their awareness of cardiac arrest evaluation criteria, knowledge of Cardiopulmonary Resuscitation (CPR) and defibrillators, and attitudes towards performing CPR.

Methods: A cross-sectional descriptive study was conducted among students from the radiological sciences program at three Saudi universities. Using a well-established questionnaire, the study employed non-probability convenient sampling. Descriptive statistics were generated, and chi-square test examined associations between categorical variables and Basic Life Support (BLS) training status.

Results: Out of 367 students contacted, 261 participated (71.1% response rate). BLS training markedly enhances knowledge of the correct chest compression rate, with 50.9% of trained students demonstrating accurate understanding compared to 27.5% of untrained students (P < 0.0001). A significant correlation was found between BLS training and the ability to perform cardiac massage during cardiac arrest and respiratory standstill, with 44.1% of students demonstrating this knowledge (P < 0.0001). Notably, 80.8% of students without BLS training lacked knowledge of cardiac massage, compared to only 30.4% of those with training. Additionally, 30.6% of students were familiar with defibrillators, and 44.1% knew AED locations (P = 0.0007). Hesitation to perform CPR was mainly due to fear of mistakes (53.6%) and harm concerns (31.1%).

Conclusion: Our findings reveal significant gaps in knowledge, confidence, and preparedness for cardiac emergencies among Saudi radiological sciences students, with only 41.4% having completed BLS training. These results highlight the urgent need for comprehensive BLS education to.

Background: Accurate decision-making in triage largely determines the amount of time required for a patient to be evaluated and treated while in the emergency department. Nursing staff worldwide have similar learning characteristics with similar working hours and common goals, despite the fact that different triage scales are used globally. The aim of this mini review is to present the different educational methods and identify the most effective for triage training of triage nurses.

Materials and methods: We screened studies concerning triage education for nurses in Emergency Department, in databases including PubMed, CENTRAL and CINAHL. From November 12, 2023 to February 15, 2024, databases were searched for relevant literature. "Triage education" OR "triage training" AND "emergency nurses" OR "triage nurses" were the MeSH terms.

Results: There are various educational methods, including traditional, web-based, audiovisual, simulation-based, blended learning, and other specialized approaches. Almost all of the studies that are currently available demonstrate how effectively an educational intervention might improve nurses' comprehension of triage. Except for one, every study concluded that the educational intervention significantly improved nurses' triage knowledge. Comparing the included studies is challenging due to their heterogeneity, and applying the results in practice requires caution.

Conclusion: The majority of studies reported that educational interventions effectively increased nurses' triage knowledge. Blended learning in conjunction with refresher courses enhanced triage-related knowledge and decision-making; however, additional research is required to ascertain whether this approach is superior to the others and whether these improvements will last.

In this case, we describe a case of cutaneous leishmaniasis, a protozoan disease not typically found in the United States, that presented to our emergency department (ED). The diagnosis was confirmed by the Center for Disease Control and Prevention (CDC) through a polymerase chain reaction (PCR) sample from the presenting skin lesion. The patient was a 43-year-old woman with history of a bite by an unknown organism while traveling by foot through Panama. She presented with a large, ulcerated lesion on her lower left shin. She was admitted on suspicion of leishmaniasis, and physicians of several specialties initiated a broad laboratory workup, collected wound cultures, prescribed antibiotics, and surgically repaired the lesion. The rapid recognition of leishmaniasis allowed for the patient to begin treatment before the definitive diagnosis returned, emphasizing the importance of knowledge of worldwide diseases and their presenting features for the ED physician.