Acute Medicine & Surgery最新文献_第6页

Performance of Universal TOR rule for out-of-hospital cardiac arrest in the Pan-Asian Resuscitation Outcomes Study 在泛亚复苏结果研究中，通用TOR规则在院外心脏骤停中的表现

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-05-22 DOI: 10.1002/ams2.70063

Atsunori Onoe, Kentaro Kajino, Ng Wei Ming, Hideharu Tanaka, Takashi Tagami, Hyun Ho Ryu, Chih-Hao Lin, Marcus Eng Hock Ong, Yasuyuki Kuwagata

Aim

Out-of-hospital cardiac arrest (OHCA) is a public health problem. The Universal Termination of Resuscitation (TOR) rule attempts to reduce the rate of futile transports. The aim of this study was to examine and compare the performance of the TOR rule for OHCA cases in Japan, Korea, Singapore, and Taiwan, where the TOR rule has not been implemented.

Methods

This retrospective cohort study examined data from January 1, 2009, to June 30, 2018, reported to the Pan-Asian Resuscitation Outcomes Study. We included patients with nontraumatic OHCA in the four countries and compared the performance of the Universal TOR rule in these countries.

Results

The number of eligible cases was 173,629. The performance of the Universal TOR rule for cases of neurologically poor survival showed a positive predictive value of more than 0.99 in all four countries. However, specificity differed among them: Japan 0.938, 95% confidence interval (CI): 0.931–0.945; Korea 0.922, 95% CI: 0.901–0.939; Singapore 0.985, 95% CI: 0.964–0.993; and Taiwan 0.773, 95% CI: 0.736–0.807.

Conclusion

The positive predictive value of neurologically poor survival in cases meeting the Universal TOR rule among the four countries was greater than 99%. However, the specificity of these cases that met the Universal TOR rule differed among the four countries. Therefore, further refinement of the Universal TOR rule may be needed for local implementation. The quality of resuscitation in an out-of-hospital setting may also impact survival and neurological outcomes and needs to be considered in any implementation of TOR.

目的院外心脏骤停（OHCA）是一个公共卫生问题。普遍终止复苏（TOR）规则试图减少无效传输的比率。本研究的目的是检查和比较尚未实施TOR规则的日本、韩国、新加坡和台湾地区对OHCA案件的TOR规则的表现。方法本回顾性队列研究分析了2009年1月1日至2018年6月30日的数据，这些数据已发表在泛亚复苏结果研究中。我们纳入了四个国家的非创伤性OHCA患者，并比较了这些国家普遍TOR规则的表现。结果合格病例数为173,629例。在所有四个国家中，通用TOR规则对神经系统生存不良病例的表现均显示出超过0.99的阳性预测值。但各国特异性不同：日本0.938,95%可信区间（CI）： 0.931-0.945；韩国0.922,95% CI: 0.901-0.939；新加坡0.985,95% CI: 0.964-0.993；台湾0.773,95% CI: 0.736-0.807。结论四个国家符合通用TOR规则的患者神经系统不良生存阳性预测值大于99%。然而，这些符合通用TOR规则的案例的特殊性在四个国家之间有所不同。因此，为了在本地实现，可能需要进一步改进通用TOR规则。院外复苏的质量也可能影响生存和神经预后，在任何实施TOR时都需要考虑这一点。

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引用次数: 0

Rapidly progressive dementia due to superior sagittal sinus dural arteriovenous fistula: A case report 上矢状窦硬脑膜动静脉瘘致快速进行性痴呆1例

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-05-21 DOI: 10.1002/ams2.70059

Hiroki Karita, Koji Hirata, Kyoji Tsuda, Keishi Fujita, Alexander Zaboronok, Yuji Matsumaru, Eiichi Ishikawa

Background

Dural arteriovenous fistula (dAVF) presenting primarily with memory disturbance is relatively rare and may be diagnosed late. However, symptoms often improve with appropriate treatment, as in our case.

Case Presentation

A 74-year-old man presented with cognitive decline and, within 2 months, developed gait disturbance, dysarthria, and ataxia, leading to hospitalization for suspected dAVF on magnetic resonance imaging. Angiography revealed a superior sagittal sinus dAVF. The patient underwent surgical disconnection of the dAVF from the superior sagittal sinus, and his cognitive function, paresis, and dysarthria improved, allowing for discharge with a modified Rankin Scale score of 2.

Conclusion

In cases with memory disturbance, dAVF should be considered a differential diagnosis, verified, and treated accordingly.

背景：以记忆障碍为主要表现的硬脑膜动静脉瘘（dAVF）较为罕见，诊断较晚。然而，经过适当的治疗，症状通常会得到改善，就像我们的情况一样。一名74岁男性患者表现为认知能力下降，在2个月内出现步态障碍、构音障碍和共济失调，导致磁共振成像疑似dAVF住院。血管造影显示上矢状窦dAVF。患者接受了从上矢状窦断开dAVF的手术，其认知功能、神经麻痹和构音障碍得到改善，并以改良的Rankin量表评分2分出院。结论对伴有记忆障碍的患者，应将dAVF作为鉴别诊断，加以确认和治疗。

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引用次数: 0

A case report: Efficacy of thoracic MRA for ischemic stroke due to acute aortic dissection 1例报告：胸部MRA对急性主动脉夹层缺血性脑卒中的疗效

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-05-19 DOI: 10.1002/ams2.70066

Jun Nagayama, Kenji Fujizuka, Shioya Hayato, Ryosuke Tsuchiya, Mitsunobu Nakamura

Background

Ischemic stroke requires prompt diagnosis and treatment but rarely results from acute aortic dissection. The administration of tissue-type plasminogen activator (t-PA) to such patients can lead to serious complications and potentially fatal outcomes. Here, we report a case in which thoracic magnetic resonance angiography (MRA) was useful for identifying cerebral infarction complicated by acute aortic dissection.

Case Presentation

A 60-year-old man presented with a sudden onset of left-sided hemiplegia, right-sided hemiparesis, and dysarthria. Noncontrast CT ruled out intracranial hemorrhage; however, aortic dissection was not detected. MRI showed reduced blood flow in the right middle cerebral artery, and t-PA administration was suspected to have caused ischemic stroke. However, thoracic MRA revealed dissection from the ascending aorta to the arch, which was diagnosed using contrast-enhanced CT.

Conclusion

Thoracic MRA is useful for diagnosing acute aortic dissection in patients with a stroke.

背景缺血性脑卒中需要及时诊断和治疗，但很少由急性主动脉夹层引起。组织型纤溶酶原激活剂（t-PA）可导致严重的并发症和潜在的致命后果。在此，我们报告一例胸部磁共振血管造影（MRA）对识别脑梗死合并急性主动脉夹层是有用的。60岁男性，突然出现左侧偏瘫、右侧偏瘫和构音障碍。CT造影排除颅内出血；但未发现主动脉夹层。MRI显示右侧大脑中动脉血流减少，怀疑t-PA给药引起缺血性脑卒中。然而，胸部MRA显示从升主动脉到弓的夹层，使用增强CT诊断。结论胸部MRA对脑卒中患者急性主动脉夹层的诊断有一定价值。

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引用次数: 0

Letter to ‘Automated CT image prescription of the gallbladder using deep learning: Development, evaluation, and health promotion’ 致“使用深度学习的胆囊自动CT图像处方：开发、评估和健康促进”的信

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-05-14 DOI: 10.1002/ams2.70065

Hinpetch Daungsupawong, Viroj Wiwanitkit

We would like to comment on “Automated CT image prescription of the gallbladder using deep learning: Development, evaluation, and health promotion.¹” This study created an automatic detection system for acute cholecystitis (AC) that can recognize gallbladders from CT scans of patients and controls. It detected gallbladders using the VGG-16 architecture and processed them using techniques such as the Flood fill algorithm and centroid calculation, as well as U-Net for picture segmentation and feature extraction. The combination of results from many models aided in the development of an automatic and accurate AC detection system.

However, using the accuracy value to evaluate the system's performance may not be sufficient to reflect the ability to distinguish between cases with different conditions, especially when there is an imbalance of data, such as the difference between AC patients and non-patient controls, or when the data is not evenly distributed, which may cause the accuracy value to not reflect the model's effectiveness in handling more difficult cases. Other indices, such as sensitivity, specificity, and AUC (Area Under Curve) values, can help increase the accuracy of model performance evaluation. The example of this kind of study is the previous publication by Ma et al.²

Furthermore, it should be considered to develop techniques that improve processing in cases with low-quality or noisy images, which may cause the model to misclassify or skip over complex cases. This includes the use of diverse data from various sources, such as adding images from patients with complications or changes in gallbladder characteristics.

Approaches that can learn from various data and adapt to the diversity of CT scans, as well as deep learning approaches, should be applied in future development. Further investigation into the model's capacity to process under multiple scenarios, such as changing operational conditions or patient diversity, will improve the system's robustness and accuracy in practice. This study describes the development of an AI-based AC detection system that can work quickly and accurately; however, further developments in low-quality image processing and the use of more diverse statistical techniques are required to enable this technology to detect the disease more accurately and efficiently in clinical practice.

The authors declare no conflicts of interest.

Approval of the research protocol: Not applicable, there is no involvement of humans or animals.

Informed consent: Not applicable, there is no human subject.

Registry and the registration no. of the study/trial: NA.

Animal studies: NA.

我们想对“使用深度学习的胆囊自动CT图像处方：发展，评估和健康促进”发表评论。“这项研究创建了一个急性胆囊炎（AC）的自动检测系统，可以从患者和对照组的CT扫描中识别胆囊。采用VGG-16架构对胆囊进行检测，利用Flood填充算法、质心计算等技术对胆囊进行处理，并利用U-Net进行图像分割和特征提取。结合许多模型的结果有助于开发一个自动和准确的交流检测系统。然而，使用准确度值来评价系统的性能可能不足以反映系统区分不同情况病例的能力，特别是当数据不平衡时，例如AC患者与非患者对照的差异，或者当数据分布不均匀时，可能导致准确度值不能反映模型处理更困难病例的有效性。其他指标，如敏感性、特异性、曲线下面积（AUC）值，可以帮助提高模型性能评价的准确性。这类研究的例子是Ma等人之前发表的文章。2此外，应该考虑开发技术来改进低质量或噪声图像的处理，这可能会导致模型错误分类或跳过复杂的情况。这包括使用来自不同来源的不同数据，例如添加来自并发症或胆囊特征改变患者的图像。在未来的发展中，应该应用能够从各种数据中学习并适应CT扫描多样性的方法，以及深度学习方法。进一步研究该模型在多种情况下的处理能力，如不断变化的操作条件或患者多样性，将提高系统在实践中的鲁棒性和准确性。本研究描述了一种基于人工智能的交流检测系统的开发，该系统可以快速准确地工作；然而，需要进一步发展低质量图像处理和使用更多样化的统计技术，使该技术能够在临床实践中更准确、更有效地检测疾病。作者声明无利益冲突。研究方案的批准：不适用，没有涉及人类或动物。知情同意：不适用，没有人体受试者。注册表及注册编号研究/试验：NA。动物实验：无。

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引用次数: 0

Incidence and risk stratification of caller noncompliance with dispatcher instructions for cardiopulmonary resuscitation 呼叫者不遵守调度员心肺复苏指示的发生率和风险分层

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-05-14 DOI: 10.1002/ams2.70057

Keita Shibahashi, Norikazu Nonoguchi, Ken Inoue, Taichi Kato, Kazuhiro Sugiyama

Aim

This study aimed to describe the incidence of, identify risk factors for, and develop a simple risk-scoring model for cases where callers fail to follow dispatcher instructions regarding cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest.

Methods

Using the Tokyo Fire Department's database, cases of out-of-hospital cardiac arrest in adults where callers received dispatcher instructions regarding CPR between 1 January 2018 and 31 December 2022 were identified. Factors associated with noncompliance with CPR instructions were determined using multivariable logistic regression analysis. A simple scoring model was developed to stratify the caller noncompliance probability.

Results

Overall, 19,525 cases were included. Bystander CPR was not provided in 11,443 (58.6%) of these cases; the 1-month favorable neurological outcome rate was significantly lower in this group (1.1% vs. 2.2%, p < 0.001). Regression analysis revealed that patient age, male patient sex, emergency call at night, cardiac arrest in the bathroom, and a familial relationship between the caller and the patient were significantly associated with noncompliance. The scoring model assigned 1 point for each of the following criteria: patient aged ≥65 years, familial relationship between the caller and the patient, and cardiac arrest in the bathroom. It also stratified caller noncompliance probability, with scores of 0, 1, 2, and 3 corresponding to probabilities of 48.0%, 50.8%, 61.3%, and 70.5%, respectively.

Conclusion

We found that callers frequently did not follow dispatcher CPR instructions and identified risk factors for caller noncompliance. Furthermore, the simple scoring model developed effectively stratified the probability of caller noncompliance associated with dispatcher instructions.

本研究旨在描述院外心脏骤停的发生率，识别危险因素，并开发一个简单的风险评分模型，用于呼叫者未能遵循调度员关于心肺复苏（CPR）的指示。方法利用东京消防局的数据库，确定2018年1月1日至2022年12月31日期间呼救者收到调度员有关心肺复苏指示的成人院外心脏骤停病例。使用多变量logistic回归分析确定与不遵守CPR指示相关的因素。建立了一个简单的评分模型，对呼叫者不服从概率进行分层。结果共纳入19525例。11443例（58.6%）患者未接受旁观者心肺复苏术；该组1个月良好神经转归率显著低于对照组（1.1% vs. 2.2%, p < 0.001）。回归分析显示，患者年龄、男性患者性别、夜间紧急呼叫、浴室内心脏骤停以及呼叫者与患者之间的家庭关系与不遵医嘱显著相关。评分模型对以下标准分别给予1分：患者年龄≥65岁，呼叫者与患者之间的家庭关系，以及在浴室中心脏骤停。它还对呼叫者不服从概率进行了分层，得分0、1、2和3分别对应48.0%、50.8%、61.3%和70.5%的概率。结论：我们发现呼叫者经常不遵守调度员的CPR指令，并确定了呼叫者不遵守指令的危险因素。此外，开发的简单评分模型有效地分层了与调度指令相关的调用者不遵守的概率。

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引用次数: 0

Outcomes of blunt trauma patients in police versus ground ambulance transport across US trauma centers 美国创伤中心警察与地面救护车运送钝性创伤患者的结果

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-05-08 DOI: 10.1002/ams2.70061

Romy Rahhal, Paul Sakr, Rana Bachir, Mazen El Sayed

Aim

Blunt injuries constitute a major cause of death in the United States. Regionalization in trauma systems improves patients' survival and outcomes. Limited data exist on the impact of mode of transport in regionalized trauma systems. This study examines the association between trauma designation levels and survival to hospital discharge of patients with blunt trauma transported by police or ground ambulance.

Methods

This retrospective-matched cohort study used the 2017 National Trauma Data Bank dataset. Adult blunt trauma patients transported by police were identified and matched (one-to-four) to those transported by ground ambulance. Demographic characteristics, injury, and clinical data were described and compared according to trauma designation levels. The survival rate was determined by the transport mode and/or the trauma designation levels.

Results

A total of 5316 blunt trauma patients were included. Mean age was 41.8 (±16.5) years, and most were males (81.8%). Most patients were transported to Level I centers and were more likely to be admitted (91.1%) compared to those transported to level II and level III trauma centers (87.5%). They also had a lower survival rate compared with the latter group ((98.7%) vs. (99.7%), p = 0.001). Survival rates were similar when comparing patients by mode of transport (p = 0.785). This remained unchanged after stratifying by the trauma designation levels (p > 0.05).

Conclusions

Adult patients with blunt trauma transported by police or ground ambulance had similar survival across different trauma level centers. Increased police involvement in the transport of blunt trauma patients is recommended.

目的：在美国，钝器伤害是造成死亡的主要原因。创伤系统的区域化改善了患者的生存和预后。关于运输方式对区域化创伤系统影响的数据有限。本研究探讨了由警察或地面救护车运送的钝性创伤患者的创伤指定水平与存活至出院之间的关系。方法本回顾性匹配队列研究使用2017年国家创伤数据库数据集。由警察运送的成年钝性创伤患者被识别并与由地面救护车运送的患者进行匹配（1 - 4）。根据创伤指定水平描述和比较人口统计学特征、损伤和临床数据。生存率取决于运送方式和/或创伤等级。结果共纳入5316例钝性创伤患者。平均年龄41.8（±16.5）岁，以男性居多（81.8%）。大多数患者被送往一级创伤中心，与送往二级和三级创伤中心的患者（87.5%）相比，住院的可能性更高（91.1%）。与后者相比，前者的生存率也较低（98.7% vs. 99.7%, p = 0.001）。不同运输方式的患者生存率相似（p = 0.785）。在按创伤指定水平分层后，这一结果保持不变（p > 0.05）。结论由警察或地面救护车运送的成年钝性创伤患者在不同创伤级别中心的生存率相似。建议增加警察参与运送钝性创伤患者。

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引用次数: 0

Beyond respiratory distress: The impact of H1N1 influenza on circulatory failure 呼吸窘迫之外：H1N1流感对循环衰竭的影响

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-05-02 DOI: 10.1002/ams2.70062

Kei Kimoto, Yudai Iwasaki, Yoshihiro Hagiwara, Takayuki Ogura

<p>We are writing to discuss the occasionally severe clinical course of patients infected with the H1N1 influenza virus, which can cause respiratory failure and severe acute respiratory distress syndrome (ARDS), requiring venovenous extracorporeal membrane oxygenation (ECMO).<span><sup>1</sup></span> However, it can also result in severe cardiovascular complications like fulminant myocarditis and secondary circulatory failure. We encountered two cases requiring venoarterial ECMO due to secondary cardiovascular complications. Informed consent was obtained from the patients' families.</p><p>A 74-year-old woman with diabetes and valvular heart disease presented in early December 2024 with fever, followed by chest pain. She was diagnosed with influenza A (H1N1) pdm09 and type 2 myocardial infarction due to an ischemic supply–demand mismatch triggered by influenza infection. On admission, her Glasgow Coma Scale (GCS) score was E3V4M6, temperature 37.9°C, heart rate 117 beats/min, blood pressure 121/72 mmHg, respiratory rate 24 breaths/min, and oxygen saturation (SpO<sub>2</sub>) 93% on 6 L of oxygen. She reported moderate chest pain, with no other significant abnormalities. Electrocardiography showed extensive ischemic patterns, and echocardiography revealed mild wall motion abnormalities in the anterior septum and apex. Antiviral therapy was initiated, and percutaneous coronary intervention (PCI) was planned. On Day 2, she developed ventricular fibrillation and underwent emergency extracorporeal cardiopulmonary resuscitation. PCI for triple vessel disease improved circulation, but worsening respiratory status necessitated venovenous ECMO. However, her respiratory condition did not improve due to secondary bacterial pneumonia, making ECMO weaning difficult. Despite prolonged ECMO support, she passed away on Day 53.</p><p>A 49-year-old woman with no significant medical history experienced fever and dyspnea 3 days before admission. Symptoms worsened on the admission day, leading to severe mobility difficulties and an emergency call. On admission, GCS score was E1V1M4, temperature 39.0°C, heart rate 180 beats/min (atrial fibrillation), blood pressure 100/70 mmHg, respiratory rate 32 breaths/min, and SpO<sub>2</sub> 90% on 10 L of oxygen. Tests showed severe metabolic acidosis (pH, 7.19; base excess, −1.7 mmol/L), elevated thyroid stimulating hormone levels (<0.01 μIU/mL), free triiodothyronine (16.2 pg/mL), and free thyroxine (5.28 ng/dL). Echocardiography showed diffuse severe wall motion abnormalities with a left ventricular ejection fraction of 10%. The patient was diagnosed with acute heart failure (AHF) due to thyroid storm triggered by influenza A (H1N1) pdm09 infection, and venoarterial ECMO was initiated for circulatory failure. Treatments included antivirals, methimazole, and potassium iodide. On Day 2, diuresis improved and cardiac function gradually recovered. The patient was successfully weaned from VA-ECMO on Day 7 and subsequently discha

我们写信是为了讨论感染H1N1流感病毒的患者偶尔出现的严重临床病程，这种病毒可导致呼吸衰竭和严重急性呼吸窘迫综合征（ARDS），需要静脉-静脉体外膜氧合（ECMO）然而，它也可能导致严重的心血管并发症，如暴发性心肌炎和继发性循环衰竭。我们遇到了2例由于继发性心血管并发症而需要静脉动脉ECMO的病例。获得患者家属的知情同意。一名74岁女性糖尿病和瓣膜性心脏病患者于2024年12月初出现发热，随后出现胸痛。由于流感感染引发的缺血供需不匹配，她被诊断为甲型H1N1流感pdm09和2型心肌梗死。入院时，患者格拉斯哥昏迷评分（GCS）为E3V4M6，体温37.9℃，心率117次/分，血压121/72 mmHg，呼吸频率24次/分，氧饱和度（SpO2）为93%，供氧6 L。她报告有中度胸痛，无其他明显异常。心电图显示广泛的缺血模式，超声心动图显示前间隔和心尖轻度壁运动异常。开始抗病毒治疗，并计划经皮冠状动脉介入治疗（PCI）。第2天，她出现心室颤动，接受了紧急体外心肺复苏。三支血管疾病的PCI改善了循环，但呼吸状况恶化需要静脉-静脉ECMO。然而，由于继发性细菌性肺炎，她的呼吸状况没有改善，使得ECMO脱机困难。尽管长期体外膜肺支持，她还是在第53天去世。49岁女性，无明显病史，入院前3天出现发热和呼吸困难。入院当天症状恶化，导致严重的行动困难和紧急呼叫。入院时，GCS评分为E1V1M4，体温39.0℃，心率180次/分（房颤），血压100/70 mmHg，呼吸频率32次/分，10 L氧下SpO2 90%。试验显示严重代谢性酸中毒(pH, 7.19；碱过量，−1.7 mmol/L)，促甲状腺激素水平升高（<0.01 μIU/mL），游离三碘甲状腺原氨酸（16.2 pg/mL）和游离甲状腺素（5.28 ng/dL）。超声心动图显示弥漫性严重壁运动异常，左心室射血分数为10%。患者被诊断为甲型H1N1流感pdm09感染引发的甲状腺风暴导致急性心力衰竭（AHF），并因循环衰竭启动静脉动脉ECMO。治疗包括抗病毒药物、甲巯咪唑和碘化钾。第2天利尿改善，心功能逐渐恢复。患者于第7天成功脱离VA-ECMO，随后出院，病情稳定。甲型H1N1流感感染可引发急性心血管事件，包括急性冠状动脉综合征（ACS）和AHF，特别是在已有疾病的个体中。2,3 H1N1感染引起的炎症和缺氧可加重内皮功能障碍，促进血栓形成。此外，由H1N1感染引起的生理应激会加剧潜在的疾病，正如我们的甲状腺风暴病例所证明的那样这种严重的高代谢状态使心血管系统紧张，并可能导致AHF。在H1N1大流行期间，认识到双器官衰竭的风险至关重要，例如呼吸衰竭，包括ARDS，以及暴发性心肌炎或继发性ACS引起的循环衰竭。鉴于这些并发症的严重性和复杂性，迫切需要在全国范围内进行调查，以澄清和解决H1N1对呼吸系统和心血管系统的全面影响。作者声明无利益冲突。研究方案的批准：无。知情同意：经患者家属知情同意报告病例。注册表及注册编号研究/试验：无。动物研究：无。

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引用次数: 0

Hemostatic technique using cyanoacrylate for fingertip cut injury: A review of 21 cases 氰基丙烯酸酯止血治疗指尖割伤21例临床分析

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-04-29 DOI: 10.1002/ams2.70056

Shingo Sasamatsu, Takeshi Ueda

Aim

In the emergency department, fingertip cut injuries often involve skin loss and bleeding. Traditional hemostatic methods, such as applying simple pressure or using pressure combined with alginate fibers, are sometimes insufficient and require sutures or cauterization. To address these challenges, we explored the use of cyanoacrylate for hemostasis in fingertip cut injuries.

Methods

We retrospectively collected data from patients aged ≥ 20 years who presented to our emergency department for fingertip cut injuries between April 2023 and March 2024. Injuries were characterized by skin loss without contamination, bone exposure, or fractures. We suggest the cyanoacrylate sealing method (CASM) in most cases. CASM involved wound cleansing, a proximal tourniquet with a rubber band, a thin cyanoacrylate coating on the wound, and observation for rebleeding.

Results

A total of 21 patients (mean age: 46.4 years) underwent CASM, achieving successful hemostasis in all cases. Compression hemostasis was attempted in 12 patients before CASM; however, no hemostasis was achieved. Five patients reported a tolerable stinging sensation at the wound site. The cyanoacrylate coating detached naturally within 4 to10 days, and complete epithelialization was achieved within 14 days. No significant complications, such as infection or delayed wound healing, were observed.

Conclusion

CASM is a simple and minimally invasive method to achieve hemostasis in fingertip cut injuries. It significantly reduces the procedure time compared with traditional methods such as suturing or cauterization.

目的在急诊科，指尖割伤通常包括皮肤脱落和出血。传统的止血方法，如施加简单的压力或使用压力结合海藻酸盐纤维，有时是不够的，需要缝合或烧灼。为了解决这些挑战，我们探索了氰基丙烯酸酯在指尖割伤止血中的应用。方法回顾性收集2023年4月至2024年3月期间因指尖割伤就诊于急诊科的年龄≥20岁患者的资料。损伤的特征是皮肤脱落，无污染，骨暴露或骨折。我们建议在大多数情况下采用氰基丙烯酸酯密封方法（CASM）。CASM包括伤口清洗，近端止血带和橡皮筋，伤口上薄薄的氰基丙烯酸酯涂层，并观察再出血。结果21例患者行CASM手术，均止血成功，平均年龄46.4岁。12例患者在CASM前尝试压迫止血；然而，没有止血。5例患者报告伤口部位有可耐受的刺痛感。氰基丙烯酸酯涂层在4 ~ 10天内自然脱落，14天内完全上皮化。无明显并发症，如感染或伤口愈合延迟。结论CASM是一种简便、微创的指尖割伤止血方法。与传统的缝合或烧灼等方法相比，它大大缩短了手术时间。

{"title":"Hemostatic technique using cyanoacrylate for fingertip cut injury: A review of 21 cases","authors":"Shingo Sasamatsu, Takeshi Ueda","doi":"10.1002/ams2.70056","DOIUrl":"https://doi.org/10.1002/ams2.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>In the emergency department, fingertip cut injuries often involve skin loss and bleeding. Traditional hemostatic methods, such as applying simple pressure or using pressure combined with alginate fibers, are sometimes insufficient and require sutures or cauterization. To address these challenges, we explored the use of cyanoacrylate for hemostasis in fingertip cut injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively collected data from patients aged ≥ 20 years who presented to our emergency department for fingertip cut injuries between April 2023 and March 2024. Injuries were characterized by skin loss without contamination, bone exposure, or fractures. We suggest the cyanoacrylate sealing method (CASM) in most cases. CASM involved wound cleansing, a proximal tourniquet with a rubber band, a thin cyanoacrylate coating on the wound, and observation for rebleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 21 patients (mean age: 46.4 years) underwent CASM, achieving successful hemostasis in all cases. Compression hemostasis was attempted in 12 patients before CASM; however, no hemostasis was achieved. Five patients reported a tolerable stinging sensation at the wound site. The cyanoacrylate coating detached naturally within 4 to10 days, and complete epithelialization was achieved within 14 days. No significant complications, such as infection or delayed wound healing, were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CASM is a simple and minimally invasive method to achieve hemostasis in fingertip cut injuries. It significantly reduces the procedure time compared with traditional methods such as suturing or cauterization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Response to “Letter to Early do-not-attempt resuscitation orders and neurological outcomes in older out-of-hospital cardiac arrest patient” 对《致老年院外心脏骤停患者早期不尝试复苏指令与神经系统预后的信函》的回应

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-04-25 DOI: 10.1002/ams2.70055

Megumi Kohri, Shinnosuke Kitano, Takashi Tagami

<p>We thank Dr. Tangkamolsuk and colleagues for their insightful comments and interest in our recent article, “Early do-not-attempt resuscitation orders and neurological outcomes in older out-of-hospital cardiac arrest patient: A multicenter observational study.”<span><sup>1, 2</sup></span> We appreciate the opportunity to clarify several important points raised.</p><p>First, Tangkamolsuk et al.<span><sup>1</sup></span> highlighted the absence of a comprehensive assessment of patient symptoms or pain management associated with Do Not Attempt Resuscitation (DNAR) decision-making. We acknowledge this limitation. However, it is crucial to emphasize that our study exclusively included patients who had achieved the return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA), meaning our entire cohort presented with comatose post-cardiac arrest syndrome. Nearly all these patients were unconscious, mechanically ventilated, and incapable of personally communicating their preferences regarding DNAR orders. In the field of emergency and critical care, it has been reported that DNAR orders are often decided not by the patients themselves but by their families or medical professionals.<span><sup>3</sup></span> Furthermore, patients who already had explicit DNAR orders prior to hospital admission were excluded from the analyses.</p><p>In this clinical context, pain and symptom management is routinely and rigorously provided using sedation and analgesia protocols as part of standardized intensive care practices. Given these standard protocols and patient conditions, we believe variability in pain management or subjective symptom assessment is unlikely to have significantly influenced DNAR decision-making in our cohort. Nevertheless, as the authors appropriately suggest, prospective studies specifically exploring these dimensions in DNAR decisions would be valuable.</p><p>Second, we appreciate the authors' comment regarding the potential effects of institutional policies and clinicians' personal judgments or biases. To minimize such confounding, our analysis employed propensity score analysis with inverse probability of treatment weighting (IPTW) and generalized estimation equation modeling to account for clustering by institution. Despite these statistical adjustments, we agree that institutional and personal variations cannot be fully excluded as influencing factors.</p><p>Finally, the authors raised an important point regarding religious and socioeconomic influences. Previous research has indicated a limited correlation between these factors and DNAR decisions, especially within the Japanese healthcare and sociocultural environment.<span><sup>4, 5</sup></span> Japan's national health insurance provides comprehensive coverage, significantly reducing financial barriers to healthcare. Moreover, the cultural context in Japan, where individuals commonly practice multiple religions without adherence to a single doctrine, makes it less

我们感谢Tangkamolsuk博士和他的同事对我们最近的文章“早期不尝试复苏指令和老年院外心脏骤停患者的神经预后：一项多中心观察性研究”的深刻评论和兴趣。“1、2我们感谢有机会澄清提出的几个要点。首先，Tangkamolsuk等人1强调了缺乏与“不尝试复苏”（DNAR）决策相关的患者症状或疼痛管理的全面评估。我们承认这一限制。然而，必须强调的是，我们的研究仅包括院外心脏骤停（OHCA）后实现自发循环恢复（ROSC）的患者，这意味着我们的整个队列都表现为昏迷后心脏骤停综合征。几乎所有这些患者都是无意识的，机械通气，无法亲自交流他们对DNAR顺序的偏好。在急诊和重症监护领域，据报道，DNAR指令往往不是由患者自己决定，而是由其家属或医疗专业人员决定此外，在入院前已经有明确DNAR命令的患者被排除在分析之外。在这种临床背景下，作为标准化重症监护实践的一部分，常规和严格地使用镇静和镇痛方案进行疼痛和症状管理。考虑到这些标准方案和患者情况，我们认为疼痛管理或主观症状评估的可变性不太可能显著影响我们队列中DNAR的决策。然而，正如作者适当建议的那样，在DNAR决策中专门探索这些维度的前瞻性研究将是有价值的。其次，我们赞赏作者关于制度政策和临床医生个人判断或偏见的潜在影响的评论。为了最大限度地减少这种混淆，我们的分析采用了倾向得分分析和处理加权逆概率（IPTW）和广义估计方程模型来解释机构的聚类。尽管有这些统计调整，但我们同意不能完全排除体制和个人差异是影响因素。最后，作者提出了一个关于宗教和社会经济影响的重要观点。先前的研究表明，这些因素与DNAR决策之间的相关性有限，特别是在日本的医疗保健和社会文化环境中。4,5日本的国民健康保险提供全面覆盖，大大减少了医疗保健的财务障碍。此外，在日本的文化背景下，个人通常信奉多种宗教，而不遵守单一教义，这使得宗教信仰不太可能显著影响DNAR的决定。然而，我们一致认为未来的研究应该在不同的环境中考虑这些因素。我们衷心感谢作者对这些相关观点的强调。我们希望我们的研究结果能促进对急性护理环境中DNAR订单的进一步研究和讨论。作者声明无利益冲突。研究方案的批准：无。知情同意：无。注册表及注册编号研究/试验：无。动物研究：无。

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引用次数: 0

Multiple trauma and shock vital signs as potential for improved outcome in patients with severe head trauma 多重创伤和休克生命体征可能改善严重头部创伤患者的预后

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2025-04-25 DOI: 10.1002/ams2.70058

Yuya Imanishi, Makoto Ohtake, Taisuke Akimoto, Takafumi Kawasaki, Masaki Yasuda, Kaoru Shizawa, Jun Suenaga, Takashi Kawasaki, Katsumi Sakata, Ichiro Takeuchi, Tetsuya Yamamoto

Aim

To evaluate the prognostic factors in severe head trauma patients (Glasgow Coma Score (GCS) ≤ 8) with all trauma, including those with trunk injury as well as single severe head trauma (abbreviated injury scale (AIS) ≥ 3).

Methods

We included 152 consecutive patients with head trauma (AIS ≥ 3) and consciousness disorders (GCS ≤ 8) who were transported to our institute from January 2017 to October 2022. Data on the patients' background, vital signs at presentation, multiple trauma (AIS ≥ 3 in two or more locations), surgical intervention, and hematological findings were examined; a retrospective analysis was conducted with the modified Rankin Scale score after 3 months assigned as the primary outcome.

Results

The patients' mean age was 57.6 ± 23.4 years (0–89), 49 patients (32.2%) had multiple trauma, and 25 patients (16.4%) had accompanying shock vital signs. In the multivariate analysis of prognosis, age (p = 0.0007) and D-dimer levels (p = 0.0007) were independent poor prognostic factors. On the contrary, patients with multiple trauma (p = 0.027) and shock vital signs at presentation (p = 0.037) had a significantly better prognosis. In the non-shock group, 97.6% (41/42) of patients aged ≥50 years and with D-dimer level of 40 μg/mL or higher had a poor prognosis after 3 months.

Conclusion

Advanced age and high D-dimer levels are important independent associated factors in patients with severe consciousness disorder associated with head trauma; meanwhile, the prognosis is more favorable in patients whose consciousness disorders are associated with multiple trauma or circulatory failure, indicating that rapid improvement of circulatory failure may lead to better outcomes.

目的探讨重型颅脑外伤患者（格拉斯哥昏迷评分（GCS)≤8分）的预后影响因素，包括合并躯干损伤及单发重型颅脑外伤(AIS)≥3分）。方法纳入2017年1月至2022年10月收治的152例头部外伤（AIS≥3）和意识障碍（GCS≤8）患者。检查了患者的背景、就诊时的生命体征、多发创伤（2处或2处以上AIS≥3）、手术干预和血液学结果等数据；以3个月后的修正Rankin量表评分为主要终点进行回顾性分析。结果患者平均年龄57.6±23.4岁（0 ~ 89岁），多发伤49例（32.2%），伴有休克生命体征25例（16.4%）。在多因素预后分析中，年龄（p = 0.0007）和d -二聚体水平（p = 0.0007）是独立的预后不良因素。相反，多发创伤（p = 0.027）和首发时休克生命体征（p = 0.037）的患者预后明显较好。非休克组中，97.6%（41/42）年龄≥50岁、d -二聚体水平≥40 μg/mL的患者3个月后预后不良。结论高龄和高d -二聚体水平是颅脑外伤合并严重意识障碍的重要独立相关因素；同时，意识障碍合并多重创伤或循环衰竭的患者预后更佳，提示循环衰竭的快速改善可能会带来更好的预后。

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引用次数: 0