American Journal of Emergency Medicine最新文献_第4页

Comment on "The accuracy of Gemini, GPT-4, and GPT-4o in ECG analysis: A comparison with cardiologists and emergency medicine specialists". 就 "Gemini、GPT-4 和 GPT-4o 在心电图分析中的准确性：与心脏病专家和急诊医学专家的比较 "发表评论。

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-09-16 DOI: 10.1016/j.ajem.2024.09.041

Haihua Wang, Ji Lan

引用次数: 0

Effects of Low Dose High-frequency Triage Education on Knowledge, Attitude, and Practices of Healthcare Professionals. 小剂量高频率分诊教育对医护人员知识、态度和实践的影响。

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-09-16 DOI: 10.1016/j.ajem.2024.09.040

Jamal Hussain, Gideon Victor, Khair Ul Nisa Ajani, Changaiz Dil Essa

引用次数: 0

Correlates of improved outcomes in patients with COVID-19 treated in US emergency departments 在美国急诊科接受治疗的 COVID-19 患者疗效改善的相关因素

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-09-14 DOI: 10.1016/j.ajem.2024.09.035

Background

The COVID-19 pandemic was managed in part by the rapid development of vaccines, diagnostics, and therapeutics including antiviral agents and advances in emergency airway and ventilatory management. The impact of these therapeutic advances on clinically pertinent metrics of emergency care have not been well-studied.

Methods

We abstracted data from emergency department (ED) visits made to 21 US health systems during the first two years of the pandemic, from February 1, 2020 to January 31, 2022. These health systems were participants in the NIH-supported COVID EHR Cohort, in which the University of Wisconsin served as the coordinating site. Limited patient-level data files were submitted monthly. Data elements included demographic and clinical variables, as well as standard measures of ED outcomes including 72-h returns, 72-h returns leading to readmission, and in-hospital mortality. Multivariable models were fitted to identify correlates of each of the dependent variables. A test for trend was used to detect changes in outcomes over time.

Results

During the two-year period, 150,357 individuals aged 18 years or older visited the ED. The median age was 45.4 years (IQR 27), 58.1 % were female, 49 % were White, 18.3 % Hispanic/Latino, and 45 % were publicly insured or uninsured. The prevalence of 72-h ED returns, readmissions, and in-hospital mortality significantly declined across the two-year period. SARS-CoV-2 vaccination was associated with reduced ED returns and mortality. Therapeutic agents were associated with increased mortality risk but were likely confounded by unmeasured covariates.

Conclusions

Operational and clinical outcomes of ED-based treatment of individuals with COVID-19 improved in the first two years of the pandemic. This improvement is likely multifactorial and includes the development and deployment of SARS-CoV-2-specific vaccines, therapeutic agents, and improved healthcare delivery in the ED and elsewhere addressing management of airway and ventilatory status, as well as increased innate immunity in the general population.

背景COVID-19 大流行的部分原因是疫苗、诊断和治疗（包括抗病毒药物）的快速发展以及气道和呼吸道急救管理的进步。我们从大流行头两年（2020 年 2 月 1 日至 2022 年 1 月 31 日）期间 21 个美国医疗系统的急诊科（ED）就诊数据中提取了摘要。这些医疗系统都是美国国立卫生研究院（NIH）支持的 COVID EHR 群体的参与者，威斯康星大学是该群体的协调机构。每月提交有限的患者级数据文件。数据元素包括人口统计学和临床变量，以及 ED 结果的标准测量值，包括 72 小时返院率、72 小时返院导致再入院率和院内死亡率。多变量模型用于确定每个因变量的相关因素。结果在两年时间内，150357 名 18 岁或以上的人到急诊室就诊。中位年龄为 45.4 岁（IQR 为 27），58.1% 为女性，49% 为白人，18.3% 为西班牙/拉丁美洲人，45% 有公共保险或无保险。72 小时内急诊室复诊率、再入院率和院内死亡率在两年期间显著下降。接种 SARS-CoV-2 疫苗与减少急诊室复诊率和死亡率有关。治疗药物与死亡率风险增加有关，但可能与未测量的协变量有关。这种改善可能是多因素的，包括 SARS-CoV-2 特异性疫苗、治疗药物的开发和应用，急诊室和其他地方医疗服务的改善，气道和通气状态的管理，以及普通人群先天免疫力的提高。

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引用次数: 0

Test results pending at discharge among emergency department patients experiencing homelessness 无家可归的急诊科患者出院时尚未得到检测结果

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-09-14 DOI: 10.1016/j.ajem.2024.09.028

Background

Persons experiencing homelessness (PEH) are vulnerable emergency department (ED) patients due to high rates of multi-comorbidity and mortality, as well as a lack of follow up care. Communication of test results pending at discharge (TPAD) is an important area of post-ED follow up care. We examined phone access, successful contact, and change in treatment among PEH and non-PEH with TPAD from the ED.

Methods

We performed a retrospective cohort study and included all abnormal TPAD and patient telephone notes regarding TPAD over 7 months extracted from the electronic health record of a single, high-volume, urban, safety-net hospital in Denver, Colorado. Two investigators reviewed all data to determine phone access, successful contact, and recommended treatment change. Descriptive statistics were calculated for all variables and compared between PEH and non-PEH. We assessed associations between homelessness and successful contact and phone access while adjusting for age and sex using multivariable logistic regression.

Results

A total of 940 patient encounters with TPAD were included. 142 telephone notes regarding abnormal TPAD were included, of which 33 (23 %) were to PEH. Compared to PEH, housed patients were significantly more likely to have access to a phone (+31 %, 95 % CI: 14–48 %), have an active phone (+46 %, 95 % CI: 29–64 %), and be successfully contacted (+42 %, 95 % CI: 24–60 %), but were less likely to have a recommended change in treatment (−14 %, 95 % CI: −24 to −5 %). Homelessness was significantly associated with decreased successful contact (odds ratio [OR] 0.16, 95 % CI: 0.07–0.38) and decreased phone access (OR 0.11, 95 % CI: 0.04–0.33) after adjusting for age and sex. In the subgroup of patients with phone access (n = 124), homelessness was significantly associated with decreased successful contact (OR 0.26, 95 % CI: 0.10–0.70) after adjusting for age and sex.

Conclusion

PEH are less likely to have phone access and be successfully contacted regarding TPAD, resulting in untreated or improperly treated infectious disease. Thus, EDs and hospital systems should explore innovative communication solutions, such as shared responsibility models and partnerships with shelters and healthcare for the homeless clinics to improve successful contact with PEH regarding TPAD.

背景无家可归者（PEH）是急诊科（ED）的易感性患者，因为他们的多病症发病率和死亡率都很高，而且缺乏后续护理。出院时检验结果的沟通（TPAD）是急诊室后续护理的一个重要方面。方法我们进行了一项回顾性队列研究，从科罗拉多州丹佛市一家单一、大容量、城市、安全网医院的电子健康记录中提取了 7 个月内所有异常 TPAD 和有关 TPAD 的患者电话记录。两名调查人员审查了所有数据，以确定电话接入、成功联系和建议的治疗改变。我们计算了所有变量的描述性统计，并对 PEH 和非 PEH 进行了比较。我们评估了无家可归与成功联系和电话接入之间的关联，同时使用多变量逻辑回归对年龄和性别进行了调整。共纳入了 142 份有关 TPAD 异常的电话记录，其中 33 份（23%）是打给 PEH 的。与 PEH 相比，有住房的患者更有可能使用电话（+31 %，95 % CI：14-48 %）、拥有活动电话（+46 %，95 % CI：29-64 %）和成功取得联系（+42 %，95 % CI：24-60 %），但建议改变治疗方法的可能性较低（-14 %，95 % CI：-24 至 -5 %）。在对年龄和性别进行调整后，无家可归与成功联系率降低（几率比 [OR] 0.16，95 % CI：0.07-0.38）和电话使用率降低（OR 0.11，95 % CI：0.04-0.33）有明显关联。在可使用电话的亚组患者（n = 124）中，在调整年龄和性别后，无家可归与成功联系率降低（OR 0.26，95 % CI：0.10-0.70）显著相关。因此，急诊室和医院系统应探索创新的沟通解决方案，如责任分担模式以及与庇护所和无家可归者医疗诊所合作，以改善与 PEH 就 TPAD 成功取得联系的情况。

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引用次数: 0

Psychedelic mushroom-containing chocolate exposures: Case series 接触含迷幻蘑菇的巧克力：病例系列

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-09-14 DOI: 10.1016/j.ajem.2024.09.038

Introduction

The recreational use of psilocybin or psilocin-containing products, a chemical found naturally in certain mushroom species, is on the rise across the United States. Several cases of serious clinical effects related to mushroom-containing products have recently been reported to the Food and Drug Administration (FDA). The emergence of these new products and their health consequences are not yet well understood. This case series aims to characterize exposures to mushroom-containing chocolate products, including patient characteristics, clinical effects, treatment(s), and clinical outcome severity, reported to a poison center network.

Material and methods

This was a retrospective case series conducted in patients exposed to mushroom-containing chocolate products across three poison centers between January 2023 to August 2024. Patients were identified via a database search of ToxSentry®. Patients were included if they were exposed to a mushroom-containing chocolate product. Patients were excluded if they ingested an unrelated product or if there was insufficient information documented within ToxSentry®. The primary endpoint was to describe clinical outcome severity after exposure to mushroom-containing chocolate products.

Results

A query of ToxSentry® identified 164 cases; 36 cases met study criteria. The median age of patients in this case series was 17 years old. For most patients (23, 64 %), the reason for the exposure was intentional, with 20 reporting intentional abuse or misuse of the product. Common clinical effects reported included mental status changes (26, 76 %), paranoia/hallucinations (10, 28 %), dysrhythmias (7, 19 %) and gastrointestinal discomfort (6, 17 %). There was one report of seizure. Most clinical effects lasted between 3 and 24 h after ingestion (29, 81 %). Intravenous fluids (18, 50 %) and benzodiazepines (7, 19 %) were the most common treatments given. No fatalities were reported.

Discussion

While most patients in this series experienced minor clinical effects, some developed serious effects after ingestion of a mushroom-containing chocolate product. Findings from this study further characterize the limited patient demographics, clinical effects, and outcomes published thus far. Further characterization in a larger cohort of patients could expand on our initial findings and is needed to better identify factors that may influence clinical outcomes.

导言：迷幻药或含迷幻药的产品是一种天然存在于某些蘑菇物种中的化学物质，在美国的娱乐性使用呈上升趋势。最近，美国食品和药物管理局（FDA）收到了几例与含蘑菇产品有关的严重临床影响报告。人们对这些新产品的出现及其对健康的影响还不甚了解。本病例系列旨在描述暴露于含蘑菇的巧克力产品的特征，包括向毒物中心网络报告的患者特征、临床效应、治疗方法和临床结果的严重程度。患者通过ToxSentry®数据库搜索确定。暴露于含蘑菇巧克力产品的患者被纳入研究范围。如果患者摄入的是不相关的产品或 ToxSentry® 中记录的信息不足，则将其排除在外。主要终点是描述暴露于含蘑菇的巧克力产品后的临床结果严重程度。结果通过查询 ToxSentry® 确定了 164 个病例，其中 36 个病例符合研究标准。该系列病例中患者的中位年龄为 17 岁。大多数患者（23 例，占 64%）的接触原因是有意为之，其中 20 例报告称有意滥用或误用该产品。报告的常见临床症状包括精神状态改变（26 例，占 76%）、妄想/幻觉（10 例，占 28%）、心律失常（7 例，占 19%）和胃肠道不适（6 例，占 17%）。有一例癫痫发作报告。大多数临床效应在摄入后 3 到 24 小时内持续（29，81%）。静脉输液（18 例，50%）和苯二氮卓类药物（7 例，19%）是最常用的治疗方法。讨论本系列研究中的大多数患者临床症状轻微，但也有一些患者在摄入含蘑菇的巧克力产品后出现严重症状。本研究的结果进一步描述了迄今为止公布的有限的患者人口统计学特征、临床影响和结果。我们需要在更大的患者群体中进一步确定特征，以扩展我们的初步发现，并更好地确定可能影响临床结果的因素。

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引用次数: 0

Etiology and characteristics of non-aneurysmal thunderclap headache presenting to an acute setting 急性非动脉瘤性雷鸣头痛的病因和特征

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-09-12 DOI: 10.1016/j.ajem.2024.09.031

Objectives

To describe the characteristics and causes of non-aneurysmal thunderclap headache (TCH) and compare serious from benign underlying causes.

Methods

Retrospective cohort study of consecutive adult patients with TCH presenting to a tertiary care academic medical center between 2010 and 2020. Aneurysmal subarachnoid hemorrhage cases were excluded. Cases were categorized into serious or benign; serious TCH was defined as any condition in which delayed diagnosis and treatment could result in neurological disability or death. Risk factors for serious TCH were analyzed. We adhere to standardized guidelines for reporting observational studies.

Results

A total of 932 patients presented with TCH. After exclusion of 393 patients with aneurysmal-type subarachnoid hemorrhage, 539 were included in the analysis. One-half (n = 275, 51.0 %) had a serious cause. Median age was 51 years, 69.0 % were female. Most frequent diagnoses were intracranial hemorrhage (n = 102, 18.9 %), reversible cerebral vasoconstriction syndrome (n = 97, 18.0 %), and idiopathic TCH (n = 102, 38.6 %). A multivariable logistic regression model for prediction of serious TCH included age, hypertension, migraines, recurrent TCH, level of consciousness and other clinical exam findings, and achieved an AUROC of 0.732. This score had a sensitivity of 79.9 % (95 % CI 73.5–83.5 %) for the identification of serious TCH. A 0.5-point increase in the risk score was associated with a 73 % increase in the odds of serious TCH (odds ratio 1.73, 95 % CI 1.53–1.95, p < 0.001).

Conclusion

Our study describes the relative frequency of presentation and etiologies among patients with TCH This score can aide clinicians in recognising patients with potentially serious cause of TCH, for whom additional imaging and neurological consultation is necessary.

目的描述非动脉瘤性雷鸣头痛（TCH）的特征和病因，并将严重病因与良性病因进行比较。方法对 2010 年至 2020 年间在一家三级学术医疗中心就诊的 TCH 连续成年患者进行回顾性队列研究。动脉瘤性蛛网膜下腔出血病例除外。病例被分为重症和良性两类；重症TCH是指任何延误诊断和治疗可能导致神经系统残疾或死亡的病症。分析了严重 TCH 的风险因素。我们遵守观察性研究报告的标准化指南。在排除了393名动脉瘤型蛛网膜下腔出血患者后，539名患者被纳入分析。二分之一（n = 275，51.0 %）的患者病因严重。中位年龄为 51 岁，69.0% 为女性。最常见的诊断是颅内出血（102 人，占 18.9%）、可逆性脑血管收缩综合征（97 人，占 18.0%）和特发性 TCH（102 人，占 38.6%）。预测严重 TCH 的多变量逻辑回归模型包括年龄、高血压、偏头痛、复发性 TCH、意识水平和其他临床检查结果，其 AUROC 为 0.732。该评分对识别严重 TCH 的灵敏度为 79.9 %（95 % CI 73.5-83.5%）。风险评分每增加 0.5 分，严重 TCH 的发生几率就会增加 73%（几率比 1.73，95 % CI 1.53-1.95，p <0.001）。

{"title":"Etiology and characteristics of non-aneurysmal thunderclap headache presenting to an acute setting","authors":"","doi":"10.1016/j.ajem.2024.09.031","DOIUrl":"10.1016/j.ajem.2024.09.031","url":null,"abstract":"<div><h3>Objectives</h3><p>To describe the characteristics and causes of non-aneurysmal thunderclap headache (TCH) and compare serious from benign underlying causes.</p></div><div><h3>Methods</h3><p>Retrospective cohort study of consecutive adult patients with TCH presenting to a tertiary care academic medical center between 2010 and 2020. Aneurysmal subarachnoid hemorrhage cases were excluded. Cases were categorized into serious or benign; serious TCH was defined as any condition in which delayed diagnosis and treatment could result in neurological disability or death. Risk factors for serious TCH were analyzed. We adhere to standardized guidelines for reporting observational studies.</p></div><div><h3>Results</h3><p>A total of 932 patients presented with TCH. After exclusion of 393 patients with aneurysmal-type subarachnoid hemorrhage, 539 were included in the analysis. One-half (<em>n</em> = 275, 51.0 %) had a serious cause. Median age was 51 years, 69.0 % were female. Most frequent diagnoses were intracranial hemorrhage (<em>n</em> = 102, 18.9 %), reversible cerebral vasoconstriction syndrome (<em>n</em> = 97, 18.0 %), and idiopathic TCH (n = 102, 38.6 %). A multivariable logistic regression model for prediction of serious TCH included age, hypertension, migraines, recurrent TCH, level of consciousness and other clinical exam findings, and achieved an AUROC of 0.732. This score had a sensitivity of 79.9 % (95 % CI 73.5–83.5 %) for the identification of serious TCH. A 0.5-point increase in the risk score was associated with a 73 % increase in the odds of serious TCH (odds ratio 1.73, 95 % CI 1.53–1.95, <em>p</em> < 0.001).</p></div><div><h3>Conclusion</h3><p>Our study describes the relative frequency of presentation and etiologies among patients with TCH This score can aide clinicians in recognising patients with potentially serious cause of TCH, for whom additional imaging and neurological consultation is necessary.</p></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Grand theft ambulance: Media reports of stolen ambulances in the United States, 1980 to 2020 偷窃救护车：1980年至2020年美国媒体对被盗救护车的报道

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-09-12 DOI: 10.1016/j.ajem.2024.09.025

Background

Ambulance thefts are frequently reported in the media, particularly over the past decade, with increasing numbers of news stories on these events. Despite these media reports, there is a paucity of peer-reviewed literature describing details and themes of these events.

Methods

We performed a structured review of media reports published between 1980 and 2020 using publicly available databases EMS1.com and Newspaper Source Plus, with keywords “stolen” and “ambulance,” with filters for date range, “1980 to 2020,” and location, “US.” The search was limited to English language articles and duplicate reports were excluded.

Results

263 unique media reports of stolen ambulances were identified (n = 149 from EMS1.com and n = 114 from Newspaper Source Plus (NSP)). Texas (n = 19) and Pennsylvania (n = 15) had the most media-reported cases of stolen ambulances. Montana, North Dakota, Rhode Island, and Washington, District of Columbia (DC) had the fewest media-reported stolen ambulances. Most cases occurred at a hospital (n = 141), followed by theft on scene (n = 71). Males accounted for approximately two-thirds of alleged perpetrators (68 %, EMS1.com, 66 %, NSP).

Conclusions

Media reports of ambulance thefts in the US have increased in recent years, highlighting the opportunity for improved education, standard policies and procedures, and increased security countermeasures to prevent the potential injuries and economic losses associated with these events.

背景媒体经常报道救护车失窃事件，尤其是在过去十年中，有关这些事件的新闻报道越来越多。尽管有这些媒体报道，但描述这些事件的细节和主题的同行评审文献却很少。方法我们使用公开数据库 EMS1.com 和 Newspaper Source Plus，以 "被盗 "和 "救护车 "为关键词，对 1980 年至 2020 年间发表的媒体报道进行了结构化审查，筛选条件包括日期范围 "1980 年至 2020 年 "和地点 "美国"。搜索仅限于英文文章，排除重复报道。结果共发现 263 篇关于救护车被盗的独特媒体报道（EMS1.com 中有 149 篇，Newspaper Source Plus (NSP) 中有 114 篇）。得克萨斯州（n = 19）和宾夕法尼亚州（n = 15）媒体报道的救护车被盗案件最多。蒙大拿州、北达科他州、罗得岛州和华盛顿哥伦比亚特区（DC）媒体报道的救护车被盗案件最少。大多数案件发生在医院（n = 141），其次是现场失窃（n = 71）。在被指控的犯罪者中，男性约占三分之二（68%，EMS1.com；66%，NSP）。近年来，美国救护车失窃的媒体报道有所增加，这突出表明有必要加强教育、制定标准政策和程序，并采取更多安全对策，以防止与这些事件相关的潜在伤害和经济损失。

{"title":"Grand theft ambulance: Media reports of stolen ambulances in the United States, 1980 to 2020","authors":"","doi":"10.1016/j.ajem.2024.09.025","DOIUrl":"10.1016/j.ajem.2024.09.025","url":null,"abstract":"<div><h3>Background</h3><p>Ambulance thefts are frequently reported in the media, particularly over the past decade, with increasing numbers of news stories on these events. Despite these media reports, there is a paucity of peer-reviewed literature describing details and themes of these events.</p></div><div><h3>Methods</h3><p>We performed a structured review of media reports published between 1980 and 2020 using publicly available databases <span><span>EMS1.com</span><svg><path></path></svg></span> and Newspaper Source Plus, with keywords “stolen” and “ambulance,” with filters for date range, “1980 to 2020,” and location, “US.” The search was limited to English language articles and duplicate reports were excluded.</p></div><div><h3>Results</h3><p>263 unique media reports of stolen ambulances were identified (<em>n</em> = 149 from <span><span>EMS1.com</span><svg><path></path></svg></span> and <em>n</em> = 114 from Newspaper Source Plus (NSP)). Texas (<em>n</em> = 19) and Pennsylvania (<em>n</em> = 15) had the most media-reported cases of stolen ambulances. Montana, North Dakota, Rhode Island, and Washington, District of Columbia (DC) had the fewest media-reported stolen ambulances. Most cases occurred at a hospital (<em>n</em> = 141), followed by theft on scene (<em>n</em> = 71). Males accounted for approximately two-thirds of alleged perpetrators (68 %, <span><span>EMS1.com</span><svg><path></path></svg></span>, 66 %, NSP).</p></div><div><h3>Conclusions</h3><p>Media reports of ambulance thefts in the US have increased in recent years, highlighting the opportunity for improved education, standard policies and procedures, and increased security countermeasures to prevent the potential injuries and economic losses associated with these events.</p></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Studies of hypothermic cardiac arrest outcomes without core temperature measurements are deeply flawed. 在没有测量核心体温的情况下，对低体温心脏骤停结果的研究存在严重缺陷。

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-09-12 DOI: 10.1016/j.ajem.2024.09.011

Raimund Lechner, Hermann Brugger, Evelien Cools, Tomasz Darocha, Peter Paal, Mathieu Pasquier, Giacomo Strapazzon, Bernd Wallner, Beat Walpoth, Ken Zafren, Les Gordon

引用次数: 0

High risk and low incidence diseases: Lisfranc injury 高风险和低发病率疾病：膝关节损伤

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-09-11 DOI: 10.1016/j.ajem.2024.09.019

Introduction

Lisfranc injuries are uncommon but frequently misdiagnosed and carry a high rate of morbidity.

Objective

This review highlights the pearls and pitfalls of Lisfranc injuries, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

Discussion

Lisfranc injuries are caused by high- or low-energy trauma to the tarsometatarsal (TMT) joint complex. The severity of injury exists on a spectrum, ranging from minor subluxations to fractures and dislocations involving the TMT joint complex. They can be complicated by compartment syndrome, neurovascular compromise, and open fractures. Prompt diagnosis is critical in preventing chronic pain and mobility challenges, as even small subluxations can result in significant morbidity. Lisfranc injuries should be considered in all patients with a foot injury. Patients with Lisfranc injuries most commonly present with midfoot pain, swelling, or ecchymosis. Despite the importance of a timely diagnosis, Lisfranc injuries are commonly missed on plain radiographs due to their often subtle findings. When x-rays are negative but there is significant clinical suspicion, emergency clinicians should obtain advanced imaging such as computed tomography to aid in diagnosis. All Lisfranc injuries should be discussed with orthopedic surgery to determine definitive management. Patients who can be discharged should be made non-weightbearing and placed in a short-leg splint.

Conclusion

The consideration of Lisfranc injuries can help emergency clinicians make a timely diagnosis to prevent future complications.

讨论Lisfranc损伤是由跖跗关节（TMT）复合体的高能量或低能量创伤引起的。损伤的严重程度不一，从轻微的半脱位到涉及 TMT 关节复合体的骨折和脱位不等。室间隔综合症、神经血管损伤和开放性骨折都可能使病情复杂化。及时诊断对于预防慢性疼痛和行动不便至关重要，因为即使是轻微的半脱位也会导致严重的发病率。所有足部受伤的患者都应考虑到Lisfranc损伤。Lisfranc 损伤患者最常见的症状是足中部疼痛、肿胀或瘀斑。尽管及时诊断非常重要，但由于 Lisfranc 损伤往往很不明显，因此在普通 X 光片上很容易被漏诊。当X光片呈阴性但临床上有重大怀疑时，急诊临床医生应采用计算机断层扫描等先进的成像技术来帮助诊断。所有 Lisfranc 损伤均应与骨科讨论，以确定最终的处理方法。可以出院的患者应在不负重的情况下使用短腿夹板。

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引用次数: 0

Association between multiple intubation attempts and complications during emergency department airway management: A national emergency airway registry study 急诊科气道管理中多次插管尝试与并发症之间的关系：全国急诊气道登记研究

IF 2.7 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2024-09-11 DOI: 10.1016/j.ajem.2024.09.014

Objective

Peri-intubation complications are important sequelae of airway management in the emergency department (ED). Our objective was to quantify the increased risk of complications with multiple attempts at emergency airway intubation in the ED.

Methods

This is a secondary analysis of a prospectively collected multicenter registry (National Emergency Airway Registry) consisting of attempted ED intubations among subjects aged >14 years. The primary exposure variable was the number of intubation attempts. The primary outcome measure was the occurrence of peri-intubation major complications within 15 min of intubation including hypotension, hypoxemia, vomiting, dysrhythmias, cardiac arrest, esophageal intubation, and failed airway with cricothyrotomy. We constructed multivariable logistic regression models to determine the associations between complications and the number of intubation attempts while controlling for measured pre-exposure variables.

Results

There were 19,071 intubations in the NEAR database, of which 15,079 met inclusion for this analysis. Of these, 13,459 were successfully intubated on the first attempt, 1,268 on the second attempt, 269 on the third attempt, 61 on the fourth attempt, and 22 on the fifth or more attempt. A complication occurred in 2,137 encounters (14 %). Major complications accompanied 1,968 encounters (13 %) whereas minor complications affected 315 encounters (2 %). The most common major complication was hypoxia. In our multivariable logistic regression model, odds ratios with 95 % confidence intervals for the occurrence of major complications for multiple attempts compared to first-pass success were 4.4 (3.6–5.3), 7.4 (5.0–10.7), 13.9 (5.6–34.3), and 9.3 (2.1–41.7) for attempts 2–5+ (reference attempt 1), respectively.

Conclusions

We found an independent association between the number of intubation attempts among ED patients undergoing emergency airway intubation and the risk of complications.

目标插管并发症是急诊科（ED）气道管理的重要后遗症。我们的目的是量化在急诊室多次尝试急诊气道插管所增加的并发症风险。方法这是对前瞻性收集的多中心登记（国家急诊气道登记）进行的二次分析，该登记包括年龄为 14 岁的受试者在急诊室尝试插管的情况。主要暴露变量是尝试插管的次数。主要结果指标是插管后 15 分钟内发生的插管周围主要并发症，包括低血压、低氧血症、呕吐、心律失常、心脏骤停、食管插管和环甲膜切开术气道失败。我们建立了多变量逻辑回归模型，以确定并发症与插管尝试次数之间的关系，同时控制测量的暴露前变量。结果NEAR数据库中有19,071次插管，其中15,079次符合纳入分析的条件。其中，13459 人在第一次尝试时成功插管，1268 人在第二次尝试时成功插管，269 人在第三次尝试时成功插管，61 人在第四次尝试时成功插管，22 人在第五次或更多次尝试时成功插管。有 2,137 例（14%）发生了并发症。主要并发症有 1968 例（13%），而轻微并发症有 315 例（2%）。最常见的主要并发症是缺氧。在我们的多变量逻辑回归模型中，多次尝试与首次成功相比，发生主要并发症的几率比为 4.4（3.6-5.3）、7.4（5.0-10.7）、13.9（5.6-34.3）和 9.3（2.1-41.3）。结论我们发现在接受急诊气道插管的急诊患者中，插管尝试次数与并发症风险之间存在独立关联。

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引用次数: 0