Emergency medicine investigations最新文献

英文中文

Pseudoaneurysm of the Left Ventricle 左心室假性动脉瘤

Emergency medicine investigations

Pub Date : 2018-09-25 DOI: 10.29011/2475-5605.000084

V. Firich, P. Angleitner, G. Laufer, D. Wiedemann

Pseudoaneurysm of the left ventricle most often occurs after transmural myocardial infarction but may also follow cardiac operations, trauma, inflammation, or infection. In contrast to patients with true ventricular aneurysm, those with false aneurysm most commonly die of hemorrhage. Review of the reported surgical experience and of our 14 cases confirms that standard chest radiographs with an abnormal cardiac silhouette and rapidly expanding size may alert the physician to this sometimes overlooked diagnosis. Noninvasive tests such as color-flow Doppler echocardiography, 2-dimensional echocardiography, cineangiographic computed tomography, and transesophageal echocardiography allow relatively easy recognition of these apparently rare lesions with increasing frequency. Cardiac catheterization, however, is usually still necessary for a clear picture of the location and anatomy of the aneurysm and the state of the coronary arteries. Finally, a new classification is proposed, consisting of true aneurysm, false aneurysm, pseudo-false aneurysm, and mixed aneurysm. (Texas Heart Institute Journal 1994; 21:296-301)

左心室假性动脉瘤最常发生在经壁心肌梗死后，但也可能发生在心脏手术、创伤、炎症或感染后。与真室性动脉瘤患者相比，假室性动脉瘤患者最常死于出血。回顾报告的手术经验和我们的14例病例证实，标准胸片显示异常的心脏轮廓和迅速扩大的大小可能会提醒医生注意这个有时被忽视的诊断。彩色血流多普勒超声心动图、二维超声心动图、血管造影计算机断层扫描和经食管超声心动图等无创检查相对容易识别这些明显罕见且频率越来越高的病变。然而，为了清楚动脉瘤的位置和解剖结构以及冠状动脉的状态，通常仍然需要心导管检查。最后，提出了一种新的分类方法，包括真动脉瘤、假动脉瘤、伪假动脉瘤和混合性动脉瘤。(Texas Heart Institute Journal 1994;21:296 - 301)

引用次数: 0

Short Term Outcomes of Laparoscopic Sleeve Gastrectomy for Obesity in Pakistan 巴基斯坦腹腔镜袖式胃切除术治疗肥胖症的近期疗效

Emergency medicine investigations

Pub Date : 2018-09-24 DOI: 10.29011/2475-5605.000082

R. Gill, F. Mannan, M. Aslam, M. Jilani, Muhammad Muneeb Khan, A. Khan, Y. Hadi, A. Alvi, A. Shariff

Introduction: Obesity has been established as a major risk factor for a number of non-communicable diseases and over the year’s multiple strategies have been directed at addressing this issue including minimally invasive procedures like laparoscopic sleeve Gastrectomy, specifically with an end goal of weight reduction for the morbidly obese. This procedure has become the preferred choice for both patients and physicians over the past few years. Laparoscopic sleeve Gastrectomy was introduced at our center recently; we have carried out a retrospective review of charts to evaluate this procedure short-term outcome at our center in our local population. Methods: A retrospective Cohort study, based on a record review for the treatment outcome of laparoscopic sleeve gastrectomy, was carried out at the department of surgery, Aga khan University Hospital, Karachi over a three-year period since its inception and analyzed in June 2015 using SPSS version 20. Results: A total of 17 patients fulfilled the inclusion criteria, out of which 12 were females (70.6%). The mean age of study participants was 41.53 years. Only one patient had undergone liposuction previously for weight loss. The most common comorbidities observed were diabetes mellitus (23.6%), hypertension (23.6%) and polycystic ovarian syndrome (17.7%). A statistically significant mean reduction in excess body weight of 28.9±14.90 Kg, CI 21.27-36.59 was observed along with reduction in BMI at 1 year with a mean difference of 11.1±5.38 Kg/m2, CI 21.27-36.60. Results were further analyzed for reduction in percentage excess body weight which showed a mean reduction of 43.6% for the study participants. Co-morbidity improvement was seen as reduction in systolic blood pressures in 9 patients (52%) though these were not found to be significant. Conclusion: Laparoscopic Sleeve Gastrectomy shows great potential for the Indian sub-continent population, especially for patients requiring rapid weight loss for better health outcomes, although long term follow up and out comes will determine the effectiveness of the procedure over extended periods and its role as a first line intervention for obesity.

导论:肥胖已被确定为许多非传染性疾病的主要危险因素，多年来，多种策略已被用于解决这一问题，包括微创手术，如腹腔镜袖胃切除术，特别是以减轻病态肥胖的最终目标。在过去的几年里，这种手术已经成为病人和医生的首选。我中心最近引进了腹腔镜袖式胃切除术;我们对图表进行了回顾性审查，以评估本中心在当地人群中该手术的短期效果。方法:回顾性队列研究，在回顾卡拉奇阿迦汗大学医院外科自成立3年以来腹腔镜袖胃切除术治疗结果的基础上进行，并于2015年6月使用SPSS version 20进行分析。结果:17例患者符合纳入标准，其中女性12例(70.6%)。研究参与者的平均年龄为41.53岁。此前只有一名患者接受过吸脂手术。最常见的合并症为糖尿病(23.6%)、高血压(23.6%)和多囊卵巢综合征(17.7%)。1年后，体重减轻(28.9±14.90 Kg, CI 21.27 ~ 36.59)， BMI降低(11.1±5.38 Kg/m2, CI 21.27 ~ 36.60)，具有统计学意义。结果进一步分析了超重百分比的减少，结果显示研究参与者平均减少了43.6%。9例患者(52%)的收缩压降低，但没有发现显著性改善。结论:腹腔镜袖胃切除术在印度次大陆人群中显示出巨大的潜力，特别是对于需要快速减肥以获得更好健康结果的患者，尽管长期随访和结果将决定该手术在较长时间内的有效性及其作为肥胖一线干预措施的作用。

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引用次数: 1

Healthcare Utilization Following Pediatric Out-of-Hospital Cardiac Arrest 儿科院外心脏骤停后的医疗利用

Emergency medicine investigations

Pub Date : 2018-09-03 DOI: 10.29011/2475-5605.000080

E. Michiels, L. Quan, Randall Leja, T. Rea

Background: Understanding longterm health care utilization after survival of a pediatric OHCA (out-of-hospital cardiac arrest) may allow more fully integrated and cost-conscious health care. Objective: To evaluate frequency and type of re-hospitalizations, procedures and hospital charges for pediatric OHCA survivors. Methods: Retrospective cohort study from 1/1/1976 to 12/31/2007 of persons < 19 years who survived OHCA in King County, WA. Results: Patients were female (49.4%) and ≤ 5 years (43.2%). 53% were readmitted in 189 readmission events, most commonly respiratory (30%) and cardiac (21%) related. Those with unfavorable Pediatric Cerebral Performance Category (PCPC) scores at initial discharge were at higher risk for ≥ 3 hospital readmissions compared to those with favorable PCPC scores (RR 5.94 (95% CI 1.50, 23.61)). Unwitnessed compared to witnessed events were associated with an increased risk of ≥ 3 hospital readmissions (RR 2.59 [95% CI 1.26, 5.31]). Upon readmission, half of patients required procedures of which acute, unplanned procedures including intubation, central and arterial line placement were most common. Adjusted to 2017 consumer price index, average charges/hospitalization were $67,005. Over long-term follow-up, the median adjusted total hospital charges/survivor were $123,190 ($11,091-$822,677). Conclusions: This demonstrates that many children who survive OHCA will develop new chronic health conditions requiring hospital readmission and additional procedures. This data should help parents, primary care providers and subspecialists anticipate and address subsequent needs prior to discharge after the arrest. Early coordinated interventions and establishment of effective outpatient services may reduce hospital readmissions and cost.

背景：了解儿科OHCA（院外心脏骤停）存活后的长期医疗保健利用情况，可能会使医疗保健更全面、更注重成本。目的：评估儿童OHCA幸存者再次住院的频率和类型、程序和住院费用。方法：从1976年1月1日至2007年12月31日，对华盛顿州金县19岁以下OHCA幸存者进行回顾性队列研究。结果：患者为女性（49.4%），≤5岁（43.2%）。在189例再入院事件中，53%的患者再次入院，最常见的是与呼吸系统（30%）和心脏系统（21%）有关。与PCPC评分良好的患者相比，初次出院时儿童大脑功能类别（PCPC）评分不佳的患者再次入院≥3次的风险更高（RR 5.94（95%CI 1.50，23.61））。与目睹的事件相比，无症状的患者再次住院风险增加（RR 2.59[95%CI 1.26，5.31]）。再次入院后，一半的患者需要进行手术，其中最常见的是急性、计划外手术，包括插管、中心线和动脉线放置。根据2017年消费者价格指数调整后，平均费用/住院费为67005美元。在长期随访中，调整后的住院费用中位数为123190美元（11091美元至822677美元）。结论：这表明，许多OHCA存活下来的儿童将出现新的慢性健康状况，需要再次入院和额外的手术。这些数据应该有助于父母、初级保健提供者和专科医生在被捕后出院前预测和解决后续需求。早期协调的干预措施和建立有效的门诊服务可能会减少住院次数和费用。

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引用次数: 0

Psychosocial Support: A Tool for Empowering Communities in Puerto Rico after a Catastrophic Event 心理社会支持：灾难性事件后赋予波多黎各社区权力的工具

Emergency medicine investigations

Pub Date : 2018-08-21 DOI: 10.29011/2475-5605.000079

Joseph O. Prewitt Diaz

Puerto Rico was affected by Hurricane Maria in September 2017, and today, hundreds of thousands of people are experiencing fear, panic attacks, anxiety, and night terrors as a result of that hurricane. A community-based psychosocial support structure to be integrated into the National Disaster Response Plan of Puerto Rico is proposed herein.

波多黎各在2017年9月受到飓风“玛丽亚”的影响，如今，数十万人正因这场飓风而经历恐惧、恐慌、焦虑和夜惊。本文提议建立一个以社区为基础的社会心理支持结构，将其纳入波多黎各国家灾害应对计划。

引用次数: 0

Unusual Presentation of an Everest Trekker 珠穆朗玛峰徒步旅行者的不同寻常的展示

Emergency medicine investigations

Pub Date : 2018-08-06 DOI: 10.29011/2475-5605.000058

B. Amatya, P. Lakhey, P. Pandey

Gastro-intestinal symptoms including nausea, vomiting, and abdominal pain are common in high altitude areas of Nepal due to Acute Mountain Sickness (AMS) or due to a gastro-intestinal illness. Occasionally complications of common conditions manifest at high altitude and delay in diagnosis could be catastrophic for the patient presenting with these symptoms. We present a rare case of duodenal ulcer perforation at high altitude. Timely evacuation from high altitude, proper diagnosis and prompt treatment are essential for taking care of such patients.

在尼泊尔的高海拔地区，由于急性山病（AMS）或胃肠道疾病，包括恶心、呕吐和腹痛在内的胃肠道症状很常见。偶尔在高海拔地区会出现常见疾病的并发症，诊断延误对出现这些症状的患者来说可能是灾难性的。我们报告一例罕见的高海拔十二指肠溃疡穿孔病例。及时从高海拔地区撤离、正确诊断和及时治疗对于照顾这些患者至关重要。

引用次数: 0

An Overview of Pyogenic Liver Abscess 化脓性肝脓肿综述

Emergency medicine investigations

Pub Date : 2018-07-16 DOI: 10.29011/2475-5605.000062

B. Batabyal

引用次数: 0

An Unusual Case of Emphysematous Cystitis in Non Diabetes Metastatic Lung Cancer Patient Undergoing Chemotherapy 非糖尿病转移性肺癌化疗患者发生肺气肿性膀胱炎1例

Emergency medicine investigations

Pub Date : 2018-06-25 DOI: 10.29011/2475-5605.000078

Marwane Andaloussi Benatiya, G. Rais

Emphysematous cystitis is a rare and severe infection of the bladder wall and/or lumen that causes gas accumulation in the tissues. The gas is mainly produced by gram-negative bacteria such as Echirichia coli or fungal pathogens. Emphysematous cystitis most often occurs in older women with poorly controlled diabetes. Its has fulminating course, and can be fatal if not recognized and treated promptly. We report a case of a 45-year-old male, under chemotherapy for metastatic lung cancer, presented with fever, dysuria, and pneumaturia. Emphysematous cystitis diagnosed by a computed tomography scan.The treatment was based on antibiotics associated with bladder drainage. The purpose of presenting this case report is not only to report an uncommon case of emphysematous cystitis but also to raise awareness among clinicians that this rare entity can occurs in non diabetes patients, during chemotherapy

肺气肿性膀胱炎是一种罕见且严重的膀胱壁和/或管腔感染，会导致组织中的气体积聚。这种气体主要由革兰氏阴性细菌产生，如大肠杆菌或真菌病原体。肺气肿性膀胱炎最常见于糖尿病控制不佳的老年女性。它有暴发型，如果不及时识别和治疗，可能会致命。我们报告一例45岁男性，因转移性肺癌癌症接受化疗，伴有发热、排尿困难和呼吸困难。电脑断层扫描诊断为肺气肿性膀胱炎。治疗是基于与膀胱引流相关的抗生素。本病例报告的目的不仅是报告一例罕见的肺气肿性膀胱炎病例，还旨在提高临床医生的意识，即这种罕见的疾病可能发生在化疗期间的非糖尿病患者身上

引用次数: 1

Spinal Cord Injury Patient Treated with Cell-based Therapy and CellSonic VIPP 细胞疗法与细胞声学VIPP治疗脊髓损伤患者

Emergency medicine investigations

Pub Date : 2018-06-20 DOI: 10.15761/gmo.1000133

A. Hague

引用次数: 0

Sodium Nitroprusside Enhanced CPR and intra-CPR Hypothermia 硝普钠增强心肺复苏和心肺复苏术中低温

Emergency medicine investigations

Pub Date : 2018-05-29 DOI: 10.29011/2475-5605.000072

A. Tsangaris, T. Matsuura, J. Bartos, Matthew D. Olson, S. McKnite, J. Rees, K. Shekar, D. Yannopoulos

Objective : Therapeutic Hypothermia (TH) is thought to improve neurologically intact survival when applied after Return of Spontaneous Circulation (ROSC) is achieved in patients who suffer a cardiac arrest. Intra-CPR cooling may accelerate the time to reach TH and thus enhance its neurological benefit. Sodium Nitroprusside Enhanced Cardiopulmonary Resuscitation (SNPeCPR) has been shown to accelerate intra-CPR cooling compared to standard CPR. The aim of this study is to assess which method of therapeutic hypothermia is the most efficient in decreasing brain temperature during SNPeCPR. Methods: This study included 24 intubated and anesthetized swine. After induction of Ventricular Fibrillation (VF), animals were randomized to one of the following groups: 500cc cold saline infusion (group A), 500cc cold saline infusion plus surface cooling with ice packs (group B), surface cooling only (group C) or control/no cooling method applied (group D). After 10 minutes of VF, CPR was initiated. One minute after the initiation of CPR, the randomized intervention was initiated and abdominal binding was applied. SNP (2 mg) was administered at minutes 1, 4 and 8. Animals were defibrillated at minute10. Results: Within 4 minutes of CPR, animals that received intravenous cold saline (Group A and Group B) had decreased their brain temperature by 0.5 °C lower compared to the groups that had not (Group C and Group D). Group B presented a superior heat exchange rate from blood to skin compared to group A. Conclusion : It was observed that cold saline infusion during SNPeCPR accelerates cooling of the brain. Ice packs work synergistically by optimizing heat transfer from the blood to the skin. Further studies will assess the potential neurologic benefit of the combination of SNPeCPR with intra-CPR infusion of cold saline.

目的：治疗性低温（TH）被认为可以在心脏骤停患者恢复自然循环（ROSC）后提高神经系统的完整生存率。心肺复苏术内冷却可以加快到达TH的时间，从而增强其神经益处。与标准心肺复苏相比，硝普钠增强心肺复苏（SNPeCPR）已被证明可以加速心肺复苏术中的冷却。本研究的目的是评估在SNPeCPR期间，哪种治疗性低温方法对降低大脑温度最有效。方法：本研究包括24只插管和麻醉的猪。心室颤动（VF）诱导后，将动物随机分为以下组之一：500cc冷盐水输注（A组）、500cc冷生理盐水输注加冰块表面冷却（B组）、仅表面冷却（C组）或应用对照/不应用冷却方法（D组）。心室颤动10分钟后，开始心肺复苏。心肺复苏术开始一分钟后，开始随机干预并应用腹部捆绑。SNP（2mg）在第1、4和8分钟给药。动物在第10分钟进行除颤。结果：在心肺复苏术后4分钟内，接受静脉注射冷盐水的动物（A组和B组）的脑温度比未接受静脉注射的动物（C组和D组）降低了0.5°C。与a组相比，B组从血液到皮肤的热交换率更高。结论：观察到在SNPeCPR过程中输注冷盐水加速了大脑的冷却。冰袋通过优化从血液到皮肤的热传递而协同工作。进一步的研究将评估SNPeCPR与冷盐水心肺复苏术联合应用的潜在神经益处。

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引用次数: 0

Health Disparities in Patients with Congestive Heart Failure Exacerbations in Los Angeles County. 洛杉矶县充血性心力衰竭加重患者的健康差异

Emergency medicine investigations

Pub Date : 2018-01-01 Epub Date: 2018-06-20 DOI: 10.29011/2475-5605.000076

Vinh Q Lam, Shahrzad Bazargan-Hejazi, Deyu Pan, Stacey A Teruya

Background: 1.1.Congestive Heart Failure (CHF) is a leading cause of death in the USA, with over 500,000 new cases diagnosed each year. While rates of CHF exacerbation across all races and ethnicities decreased from 2005 to 2009, the number of Black patients with CHF exacerbation who present in Los Angeles (L. A.) County Emergency Departments (ED) remained the highest. We examine disparities in CHF exacerbation rates in L. A. County, and in Los Angeles Service Planning Area (SPA) 6, and compare CHF-related outcomes, and the disposition of these patients post-ED visit.

Methods: 1.2.This is a retrospective analysis using the Office of Statewide Health Planning and Development (OSHPD) Emergency Department, and Ambulatory Surgery Center database from 2005 to 2009. We used the following variables: congestive heart failure, ICD-9 code 428.0, age, gender, race/ethnicity, insurance status, and disposition. Univariate and descriptive statistics identified distributions of the study variables. There were a total of 13,766 in the study population.

Results: 1.3.SPA 6 had higher hospitalization rates across all races and ethnicities, compared to L.A. County as a whole. Blacks constitute 9.1% of the County population, but represented 32% of patients diagnosed with CHF in the ED. Only about 10% of L. A. County's population resides in SPA 6, yet over 22% of the entire County's CHF patients reside there.

Conclusions: 1.4.CHF continues to disproportionately affect Black individuals in L.A. County, and younger adults in SPA 6. Our results indicate that residing in this service planning area, in addition to race, can predict greater likelihood of presenting with CHF exacerbation in the ED, and greater likelihood of hospitalization. Future research on the association of CHF exacerbation with different sociodemographic measures among minority, underserved and disadvantaged patients is needed. These can identify and help mitigate inequities and weaknesses in our health care system, which are manifest through stark health disparities among different racial, ethnic and socioeconomic groups.

背景:1.1。在美国，充血性心力衰竭(CHF)是导致死亡的主要原因，每年有超过50万的新病例被诊断出来。从2005年到2009年，虽然所有种族和民族的CHF加重率都有所下降，但在洛杉矶(L. A.)出现的黑人CHF加重患者的数量。县急诊科(ED)仍然是最高的。我们研究了洛杉矶县和洛杉矶服务规划区(SPA) CHF恶化率的差异，并比较了CHF相关的结果，以及这些患者在急诊科就诊后的处理。方法:1.2。这是一项回顾性分析，使用了2005年至2009年全州卫生计划与发展办公室(OSHPD)急诊科和门诊手术中心的数据库。我们使用了以下变量:充血性心力衰竭，ICD-9代码428.0，年龄，性别，种族/民族，保险状况和性格。单变量和描述性统计确定了研究变量的分布。研究人群中共有13766人。结果:1.3。与整个洛杉矶县相比，所有种族和族裔的SPA 6的住院率都更高。黑人占该县人口的9.1%，但在急诊科诊断为CHF的患者中占32%。洛杉矶县人口中只有10%居住在SPA 6，但全县超过22%的CHF患者居住在那里。结论:1.4。CHF继续不成比例地影响洛杉矶县的黑人和SPA 6区的年轻人。我们的研究结果表明，除了种族之外，居住在该服务规划区域的患者在急诊科出现CHF加重的可能性更大，住院的可能性也更大。未来需要在少数民族、服务不足和弱势患者中研究不同社会人口统计学指标与CHF恶化的关系。这些可以识别并帮助减轻我们医疗保健系统中的不平等和弱点，这些不平等和弱点体现在不同种族、民族和社会经济群体之间的严重健康差距上。

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