Archives of Academic Emergency Medicine最新文献

Introduction: Traumatic out-of-hospital cardiac arrest (TOHCA) presents significant public health challenges. The high accident rates and variability in prehospital management in Thailand further complicate TOHCA treatment. This study aimed to analyze prehospital prognostic factors of survival in TOHCA cases.

Methods: This study is a retrospective cohort study utilizing data from the Information Technology of Emergency Medicine System (ITEMS) from January 2012 to December 2022. It included TOHCA patients who received prehospital care and were transported to the emergency department (ED). We used an exploratory approach, incorporating all prognostic variables into a multivariable logistic regression model. Results are presented as odds ratios (OR) with 95% confidence intervals (CIs) and p-values.

Results: Over an 11-year period, 35,724 patients with the mean age of 39.69±20.53 (range: 1-99) years were included in the final analysis (78.69% male). Of these, 6,590 (18.45%) survived to hospital admission, while 29,134 (81.55%) died in the ED. Prehospital management factors significantly increasing the likelihood of survival to hospital admission included stopping bleeding (OR=1.38, 95% CI=1.24-1.54, P<0.001), endotracheal intubation (ETT) (OR=2.09, 95% CI=1.74-2.50, P<0.001), intravenous fluid administration (OR=1.66, 95% CI=1.35-2.05, P<0.001), defibrillation (OR = 2.35, 95% CI=1.96-2.81, P<0.001), age (aOR = 0.99, 95% CI = 0.98-0.99, P < 0.001), closed fracture (aOR = 0.59, 95% CI = 0.53-0.66, P < 0.001), open fracture (aOR = 0.54, 95% CI = 0.48-0.61, P < 0.001), dislocation (aOR = 0.60, 95% CI = 0.45-0.81, P = 0.001), and on scene time <10 min (aOR = 0.63, 95% CI = 0.54-0.75, P < 0.001).

Conclusions: To improve survival to hospital admission in TOHCA, several factors should be prioritized. These include administering intravenous fluid boluses, controlling external bleeding, delivering defibrillation when indicated, and performing ETT.

Decisions on life-sustaining treatment depend on evaluating fundamental ethical principles regarding taking human life. This study aimed to compare the Islamic standpoint with secular views on ethical decision-making in end-of-life care. We conducted a scoping review to analyze and compare articles published in 2000-2022, regarding ethical criteria for withdrawing life-prolonging treatments in dying patients, and the final decision-maker in such cases. The main difference between the two viewpoints, however, lies in the perspective that in Islam to save human life is of utmost importance, and therefore the criteria for treatment benefits, indications, and goals should all be evaluated in the light of this profound Islamic concept. The most significant similarity discovered between the two standpoints was that a terminal patient's wish not to prolong the process of dying should be respected, and the physician's opinion in determining the benefit or futility of treatment is of utmost importance. Comparison of Islamic and Secular perspectives about ethical decision-making in end-of-life care regarding life sustaining treatment indicates that benefits of treatments for patients, and healthcare goals are among the major factors in decision-making according to both viewpoints, and patients, their families, physicians, and the medical team are all involved in making the final decision.

Monkeypox (Mpox), an uncommon zoonotic Orthopoxvirus, is commonly manifested by blisters on the skin and has a mortality rate of approximately 0-10%. Approximately two decades after the cessation of global smallpox vaccination, the number of confirmed cases of Mpox has been growing, making it the most common Orthopoxvirus infection. Therefore, in this narrative review, we aimed to shed light on recent advancements in the pathophysiology, transmission routes, epidemiology, manifestations, diagnosis, prevention, and treatment of Mpox, as well as the application of artificial intelligence (AI) methods for predicting this disease. The clinical manifestations of Mpox, including the onset of symptoms and dermatologic characteristics, are similar to those of the infamous smallpox, but Mpox is clinically milder. Notably, a key difference between smallpox and Mpox is the high prevalence of lymphadenopathy. Human-to-human, animal-to-human, and animal-to-animal transmission are the three main pathways of Mpox spread that must be considered for effective prevention, particularly during outbreaks. PCR testing, as the preferred method for diagnosing Mpox infection, can enhance early detection of new cases and thereby improve infection control measures. JYNNEOS and ACAM2000 are among the vaccines most commonly recommended for the prevention of Mpox. Brincidofovir, Cidofovir, and Tecovirimat are the primary treatments for Mpox cases. Similar to other viral infections, the best approach to managing Mpox is prevention. This can, in part, be achieved through measures such as reducing contact with individuals displaying symptoms, maintaining personal safety, and adhering to practices commonly used to prevent sexually transmitted infections.

After the implementation of vaccination against Haemophilus Influenza Type B (Hib), adult patients comprise the majority of patients with acute epiglottitis. Its presentation with stridor mandates swift recognition and intervention to prevent airway compromise and mortality. Here, we present a case of a 44-year-old male with diabetes mellitus who presented with acute onset of shortness of breath and stridor following days of throat soreness and fever. Initial treatment for suspected anaphylaxis provided partial relief, and emergency department evaluation revealed characteristic signs of acute epiglottitis on lateral soft tissue neck x-ray and nasopharyngoscopy. Treatment was initiated with intravenous ampicillin/sulbactam and dexamethasone, and the patient was discharged home on day 4. This case underscores the critical importance of maintaining a high index of suspicion for acute epiglottitis in adults presenting with stridor and respiratory distress. Prompt recognition, airway management, and appropriate antibiotic therapy are paramount in mitigating the potentially devastating outcomes associated with this condition. As demographics shift and vaccination impacts epidemiology, heightened vigilance in emergency settings is essential to improve outcomes in adult patients with acute epiglottitis.

Introduction: Torsade de pointes (TdP) is a deadly complication from drug-induced QT prolongation. Each of the 12 lead of an electrocardiogram (ECG) has a different length of QT interval, and thus might have a different performance in TdP prediction. This study aimed to determine the best ECG lead or set of leads in this regard.

Methods: This is a comparative prognostic accuracy study using a two-gate data gathering design. The population in this study was from two sources, a case group (Patients who had drug-induced TdP, which were identified through a systematic Medline search) and a control group (those who overdosed on QT-prolonging drugs, which included patients who were under the consultation of Medical Toxicology Services). The areas under the receiver operating characteristic curve (AUROC) of heart rate-corrected QT (QTc) in each single ECG lead and of a mean/median QTc from a set of ECG leads (17 index test) in predicting the risk of TdP were calculated and compared with each other, trying to find the best lead for this propose. QTc Interval measurements were done by four investigators (Interrater reliabilities 0.95).

Results: Finally, we included 136 and 148 ECGs from TdP cases and controls, respectively. V3 lead had the highest frequency of longest QTc interval, among the leads. The lead having the longest QTc yielded the greatest AUROC in predicting TdP regardless of QT correction formulas (QTcFRA=0.9915, QTcRTH=0.9893, QTcBZT=0.9904). The mean QTc of 3 leads (lead II, plus any two of leads V2-V4), and a median QTc of 6 leads (I, II, aVF, V2, V4, V6) provided similar overall performance for TdP prediction (regardless of the type of QTc formula).

Conclusion: The longest QTc provided the greatest AUROC in predicting drug-induced TdP, however, the longest QTc is not located in a fixed individual lead in any patient. A less time-consuming method with comparable performance to that of the longest QTc was to use a mean QTc from 3 leads (lead II, plus any two of leads V2-V4). The potential clinical impact of this finding needs to be verified in a prospective cohort study.

Foreign body airway obstruction (FBAO) frequently occurs unwitnessed. In the absence of external assistance and the ability to rapidly reach help, immediate self-management of FBAO could be the only way to avoid impending death from asphyxia. In this letter, relevant evidence of real-life self-management of severe FBAO from public comments posted on social media were gathered and reported. The results indicate that in cases of severe FBAO, laypeople apply self-management maneuvers notwithstanding that self-help is omitted from the current resuscitation guidelines.

Introduction: Adequate knowledge and positive attitude among nurses are essential for successful pain management as a fundamental aspect of patients' rights. This study aimed to assess the knowledge, attitude and perceived barriers of nurses regarding acute pain management in emergency department.

Methods: In this cross-sectional study, participating nurses were selected using a consecutive sampling technique within a medical university. Data were collected using 4 questionnaires, which consisted of demographic information checklist, Pain Management Principles Assessment Tool (PMPAT), Nurses' Attitude Survey (NAS), and Nurses' practice checklist. The correlation between knowledge, attitude, and barriers with each other and with baseline characteristics of participates were studied.

Results: 400 nurses with the mean age of 38.26±10.39 years were studied (63% male). The average knowledge score of studied nurses was 7.38 ± 2.16 (range: 1 -14). All 400 (100%) nurses exhibited a low level of knowledge. The mean attitude score of participants was 58.47± 22.08 (range:26-100). 214 (53.5%) cases had low attitude, 44 (11.0 %) average attitude, and 142 (35.5%) cases exhibited a high attitude score. The mean score of barriers about pain management was 36.48 ± 23.52 (range: 0 - 80). 23 (5.8%) participants answered the perceived barriers as never, 113 (28.3%) as seldom, 71 (17.8%) as sometimes, 133 (33.3%) as often, and 60 (15.0%) as routine. There was an reverse relationship between the knowledge score and perceived barriers of pain management (r=-0.164, p<0.001). No significant relationship was found between the average knowledge score and nurses' attitudes (r = 0.092; p > 0.065).

Conclusions: The findings of this study highlight the need for ongoing training and the organization of workshops for nurses due to their low levels of knowledge and attitude. These training sessions should focus on the concept of pain, assessment methods, pain relief, as well as pharmacology and the physiology of pain.

Introduction: In infectious diseases, there are essential indices used to describe the disease state. In this study, we estimated the basic reproduction number, R0, peak level, doubling time, and daily growth rate of COVID-19.

Methods: This ecological study was conducted in 5 provinces of Iran. The daily numbers of new COVID-19 cases from January 17 to February 8, 2020 were used to determine the basic reproduction number (R0), peak date, doubling time, and daily growth rates in all five provinces. A sensitivity analysis was conducted to estimate epidemiological parameters.

Result: The highest and lowest number of deaths were observed in Hamedan (657 deaths) and Chaharmahal and Bakhtiari (54 deaths) provinces, respectively. The doubling time of confirmed cases in Kermanshah and Hamedan ranged widely from 18.59 days (95% confidence interval (CI): 17.38, 20) to 76.66 days (95% CI: 56.36, 119.78). In addition, the highest daily growth rates of confirmed cases were observed in Kermanshah (0.037, 95% CI: 0.034, 0.039) and Sistan and Baluchestan (0.032, 95% CI: 0.030, 0.034) provinces.

Conclusion: In light of our findings, it is imperative to tailor containment strategies to the unique epidemiological profiles of each region in order to effectively mitigate the spread and impact of COVID-19. The wide variation in doubling times underscores the importance of flexibility in public health responses. By adapting measures to local conditions, we can better address the evolving dynamics of the pandemic and safeguard the well-being of communities.