Clinical and Experimental Emergency Medicine最新文献

{"title":"Canadian competency-based emergency medicine specialist training: the effect of entropy from design to implementation.","authors":"Jonathan Sherbino","doi":"10.15441/ceem.26.007","DOIUrl":"10.15441/ceem.26.007","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"115-118"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608148","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}

{"title":"Reliance on suction-based airway clearance devices hinders recommended first aid for choking.","authors":"Alexei Birkun","doi":"10.15441/ceem.25.330","DOIUrl":"10.15441/ceem.25.330","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"247-249"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608294","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}

{"title":"Lower post-rewarming control temperature at 72 hours following targeted temperature management is associated with 1-year mortality after out-of-hospital cardiac arrest.","authors":"Heesu Park, Jongwhan Shin, Dong Keon Lee, Jungeun Lee, Mijung Yun, Heeye Lim, Jernghun Kim, Gil Joon Suh","doi":"10.15441/ceem.25.158","DOIUrl":"10.15441/ceem.25.158","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the relationship between post-rewarming control temperature and neurological outcomes using data from a multicenter post-cardiac arrest syndrome (PCAS) registry in Korea.</p><p><strong>Methods: </strong>We retrospectively analyzed data from the PCAS registry, which prospectively enrolled out-of-hospital cardiac arrest patients with sustained return of spontaneous circulation in the emergency departments of three urban hospitals between December 2013 and April 2021. Patients who received targeted temperature management (TTM) were included. Body temperature was measured at 4-hour intervals during the first 72 hours after the initiation of TTM. The post-rewarming control temperature was defined as the body temperature measured at 72 hours after TTM initiation. The primary outcome was a favorable neurological outcome, defined as a Cerebral Performance Category score of 1-2 at 1 year, and the secondary outcome was 1-year mortality.</p><p><strong>Results: </strong>Of the 1,591 patients in the registry, 289 were included in the analysis. A favorable neurological outcome occurred in 75 patients (25.9%). Patients with favorable neurological outcomes exhibited higher body temperatures at 4 hours and during the 48-72-hour period of TTM than those with unfavorable outcomes. Body temperature at 72 hours of TTM was independently associated with 1-year mortality (adjusted odds ratio [aOR], 0.56; 95% confidence interval [CI], 0.37-0.82; P=0.004), but not with favorable neurological outcomes at 1 year (aOR, 1.24; 95% CI, 0.75-2.09; P=0.399).</p><p><strong>Conclusion: </strong>A lower body temperature at 72 hours after TTM was independently associated with 1-year mortality.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"13 2","pages":"167-177"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410659","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}

{"title":"Predictors of intracranial lesions in patients with traumatic facial fractures: findings derived from the National Trauma Registry of Iran.","authors":"Zahra Ramezani, Payman Salamati, Vali Baigi, Vafa Rahimi-Movaghar, Mohammadreza Zafarghandi, Esmaeil Fakharian, Seyed Houssein Saeed-Banadaky, Yousef Mohammadpour, Seyed Mohammad Piri, Sara Mirzamohamadi, Khatereh Naghdi, Marjan Laal","doi":"10.15441/ceem.25.030","DOIUrl":"10.15441/ceem.25.030","url":null,"abstract":"<p><strong>Objective: </strong>To use data from the National Trauma Registry of Iran (NTRI) to explore whether the type of traumatic facial fractures predicts intracranial lesions.</p><p><strong>Methods: </strong>This retrospective registry-based study analyzed 6 years of data from four NTRI trauma centers, focusing on patients with facial fractures. Patients with at least one facial fracture were included, and data on demographics, injury mechanisms, fracture patterns, and intracranial lesions were analyzed. A multiple logistic regression model demonstrated the associations between clinical variables and intracranial lesions.</p><p><strong>Results: </strong>Among 32,525 patients, 1,166 (3.6%) had facial fractures. Motorcycle riders had a higher probability of malar-maxillary fractures than mandibular fractures (P<0.001). Non-road traffic accident injuries were significantly associated with mandibular fractures compared to malar-maxillary fractures (P<0.001). Intracranial lesions were identified in 14.8% of patients, with subarachnoid hemorrhage (38.4%), subdural hemorrhage (19.8%), and epidural hemorrhage (18.6%) being the most common. Most intracranial lesions developed in patients with malar-maxillary fractures (n=82, 47.7%). Among the types of facial fractures, malar-maxillary fractures had the highest association with intracranial lesions (odds ratio [OR], 15.33; 95% confidence interval [CI], 6.57-35.79; P<0.001), and that finding remained significant after adjustment (adjusted OR, 7.20; 95% CI, 2.97-17.42; P<0.001).</p><p><strong>Conclusion: </strong>Among patients with traumatic facial fractures, several fracture patterns were associated with intracranial lesions, with malar-maxillary fractures showing the strongest association. Careful evaluation for intracranial lesions is warranted in patients with high-risk facial fracture patterns.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"198-206"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653812","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}

{"title":"Renal dysfunction as a marker of adverse outcomes in early sepsis in the emergency department.","authors":"Tamar J van der Aart, Jan C Ter Maaten, Raymond J van Wijk, Stephan J L Bakker, Hjalmar R Bouma, Marco van Londen","doi":"10.15441/ceem.25.136","DOIUrl":"10.15441/ceem.25.136","url":null,"abstract":"<p><strong>Objective: </strong>Sepsis is a leading cause of acute kidney injury (sepsis-associated acute kidney injury, SA-AKI) and is associated with multiorgan failure, cardiovascular events, and increased mortality. While research has generally focused on critically ill patients in intensive care units (ICUs), most sepsis cases are managed outside the ICU. This study investigated renal dysfunction as an early risk marker in patients presenting to the emergency department (ED) with severe infection and at risk for early sepsis.</p><p><strong>Methods: </strong>This post hoc analysis of patients presenting to the ED used data from the Acutelines cohort (2020-2023). Kaplan-Meier curves and univariable and multivariable Cox regression analyses were performed to assess the association between AKI and all-cause mortality, as well as in-hospital mortality and cardiovascular death, adjusting for potential confounders.</p><p><strong>Results: </strong>In total, 2,045 patients presented with sepsis at the ED, of whom 246 (12%) had AKI. The overall mortality rate was 25% over a median follow-up of 346 days. AKI was associated with higher all-cause mortality (38% vs. 26%; P<0.001). After adjustment for sex, age, comorbidities, and sepsis severity, AKI remained independently associated with all-cause mortality (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.14-1.82; P=0.003), in-hospital mortality (HR, 1.65; 95% CI, 1.16-2.34; P=0.006), and cardiovascular death (HR, 2.50; 95% CI, 1.39-4.48; P=0.001). Similar outcomes were observed in a subanalysis excluding ICU patients.</p><p><strong>Conclusion: </strong>SA-AKI at ED presentation is independently associated with increased all-cause, in-hospital, and cardiovascular mortality. These findings underscore the need for earlier recognition across care settings and the implementation of structured follow-up to improve patient outcomes.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"13 2","pages":"178-187"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410749","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}

{"title":"Emergency department crowding in the modern era: a systematic review (2018-2025).","authors":"Jonathan J Oskvarek, Andrew Leubitz, Nishad Rahman, Bryan Sure, Jesse M Pines","doi":"10.15441/ceem.25.172","DOIUrl":"10.15441/ceem.25.172","url":null,"abstract":"<p><strong>Objective: </strong>This study systematically reviews the causes, effects, and potential solutions to emergency department (ED) crowding, with emphasis on challenges amplified by the COVID-19 pandemic.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we searched MEDLINE, CINAHL, and the Web of Science for peer reviewed studies published from January 1, 2018, to January 31, 2025, that investigated ED crowding. Studies were included if they evaluated crowding causes, consequences, or interventions, using metrics such as ED length of stay, boarding, or left without being seen. Four reviewers independently screened titles, abstracts, and full texts. Study quality was assessed using the SIGN critical appraisal tools. This review was registered in PROSPERO (No. CRD420251117676).</p><p><strong>Results: </strong>Of 23,408 studies identified, 226 met inclusion criteria. Most studies were retrospective (83%) and of low (62%) or acceptable (35%) quality. Crowding was primarily driven by input (high patient volumes, limited primary care access), throughput (staffing shortages, laboratory and imaging delays), and output (boarding, late discharges) factors. Adverse effects included increased mortality, treatment delays, prolonged inpatient stays, higher rates of patients leaving without being seen, and reduced patient satisfaction. Effective strategies included provider-in-triage, nurse-initiated orders, and split-flow models. Output-focused interventions, such as active bed management and early discharge protocols, required system-wide coordination. The COVID-19 pandemic shifted patient volumes and led to innovative solutions such as drivethrough clinics and repurposed spaces to alleviate surges.</p><p><strong>Conclusion: </strong>ED crowding is a persistent global issue with significant clinical and operational consequences. While promising interventions exist, high-quality evidence remains limited, underscoring the need for system-level and multifaceted solutions.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"119-139"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13347001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003277","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}

{"title":"Vertical patellar dislocation.","authors":"Joo Shiang Ang, Xin Yu See, Han Jie Teo","doi":"10.15441/ceem.25.161","DOIUrl":"10.15441/ceem.25.161","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"244-246"},"PeriodicalIF":3.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608220","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}

{"title":"2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 5. Cardiac arrest in special circumstances.","authors":"Tae-Youn Kim, Gyo Jin Ahn, Kyoung-Chul Cha, Dong-Hyeok Kim, Youdong Sohn, Young Song, Gyuhong Shim, Do Kyun Kim, Yunhee Oh, Jin Wi, Chun Song Youn, Myung-Lyeol Lee, Mi Jin Lee, Byung Kook Lee, Byung Heon Lee, Jisook Lee, Chang Hee Lee, Hannah Lee, Youngbin Jang, Yong Soo Jang, Young Hwa Jung, Woo Jin Jung, Sung Phil Chung, Gyu Chong Cho, Ju Sun Heo, Sung Oh Hwang","doi":"10.15441/ceem.26.074","DOIUrl":"10.15441/ceem.26.074","url":null,"abstract":"<p><p>The 2025 update of the Korean guidelines for cardiac arrest under special circumstances incorporates new evidence and expert consensus to clarify when clinicians should modify standard resuscitation algorithms. For cardiac arrest caused by acute hyperkalemia, the guidelines suggest administering intravenous insulin with glucose; however, current evidence remains insufficient to recommend for or against routine use of sodium bicarbonate or calcium. In suspected pulmonary embolism-related cardiac arrest, thrombolytic therapy may be considered. In confirmed cases, thrombolysis, surgical embolectomy, or percutaneous mechanical thrombectomy may be appropriate, despite very low certainty of evidence. For opioid-related cardiac arrest, current evidence does not support the routine administration of naloxone in addition to standard advanced life support; however, naloxone may be administered when it is unclear whether the patient is in true cardiac arrest. The guidelines also emphasize managing cardiac arrest in the prone position. If the patient is intubated and immediate repositioning is unsafe or impractical, prone cardiopulmonary resuscitation and defibrillation may be attempted using invasive arterial pressure or end-tidal carbon dioxide monitoring to guide the timing of repositioning. Immediate supination is strongly recommended for non-intubated patients. Additional updates address drowning, severe hypothermia, pregnancy, anaphylaxis, and cardiac arrest during interventional procedures, underscoring the importance of early correction of reversible causes, appropriate airway strategies, and timely consideration of extracorporeal life support in selected cases. Overall, the 2025 recommendations highlight cautious, etiology-directed interventions and explicitly grade recommendation strength and certainty to support context-sensitive clinical decision-making in high-risk and resource-variable settings.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"13 Suppl 1","pages":"S61-S74"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257570","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}

{"title":"2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 10. Education and system implementation for enhanced chain of survival.","authors":"Yunhee Oh, Youdong Sohn, Mi Jin Lee, Sang-Hoon Na, Jundong Moon, Heeje Yun, Hoon Jung, Chang Hee Lee, Sung Phil Chung, Do Kyun Kim, Tae-Youn Kim, Gyuhong Shim, Young Hwa Jung, Chun Song Youn, Jisook Lee, Youngbin Jang, Yong Soo Jang, Gyu Chong Cho, Kyoung-Chul Cha, Ju Sun Heo, Sung Oh Hwang","doi":"10.15441/ceem.26.097","DOIUrl":"10.15441/ceem.26.097","url":null,"abstract":"<p><p>The 2025 Korean education and system implementation guidelines were updated using a structured evidence evaluation process and recent systematic reviews. The guidelines present a comprehensive update that aims to bridge the gap between educational theory and clinical performance and emphasize the transition toward high-fidelity, field-based training environments through the implementation of in situ simulation and rapid cycle deliberate practice to foster automaticity in high-quality cardiopulmonary resuscitation (CPR) and team coordination. The integration of real-time feedback devices during training and the adoption of structured \"hot\" and \"cold\" debriefing to maximize learning outcomes are critical shifts in this update. Furthermore, these guidelines enhance teamwork competency by recommending the integration of a dedicated CPR coach within the hospital code team. Despite acknowledging the potential of digital health, a cautious approach toward gamified and blended learning is maintained. The guidelines prioritize face-to-face instruction to ensure psychomotor proficiency. From a policy perspective, the 2025 update removes the prehospital termination of resuscitation criteria in alignment with domestic legal constraints and social consensus. In addition to context-based training strategies within hospitals, we discussed the mandatory age for CPR training. We also added recommendations to address the \"decoupling\" between high automated external defibrillator awareness and low bystander utilization rates in the prehospital setting. In conclusion, the 2025 Korean guidelines emphasize repetitive, evidence-based educational methods and systematic policy refinements to enhance resuscitation quality and survival outcomes across clinical and community settings.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"13 Suppl 1","pages":"S169-S184"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257548","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}

{"title":"2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 11. First aid.","authors":"Seon Hee Woo, Chang Hee Lee, Mi Yeon Kim, Yongin Kim, Chang Je Park, Myung-Lyeol Lee, Taehun Lee, Kyeongmin Jang, Jun-Ho Jung, Hyun-Kyung Ji, Sung Phil Chung, Do Kyun Kim, Tae-Youn Kim, Youdong Sohn, Gyuhong Shim, Young Hwa Jung, Yunhee Oh, Chun Song Youn, Mi Jin Lee, Jisook Lee, Youngbin Jang, Yong Soo Jang, Gyu Chong Cho, Kyoung-Chul Cha, Ju Sun Heo, Sung Oh Hwang","doi":"10.15441/ceem.26.076","DOIUrl":"10.15441/ceem.26.076","url":null,"abstract":"<p><p>The 2025 Korean Guidelines for Cardiopulmonary Resuscitation include a first aid section developed through a systematic review and evidence appraisal. The revision aimed to strengthen prehospital first aid response capacity while reflecting the Korean healthcare system, field feasibility, and relevant legal and institutional contexts. The guidelines provide evidence-based recommendations for seven priority emergencies: adult chest pain suggestive of myocardial infarction, suspected acute ischemic stroke, asthma-related dyspnea, anaphylaxis, seizures, shock, and syncope. Core principles emphasize early recognition, prompt activation of emergency medical services, minimizing delays to definitive care, and safe condition-specific interventions. Key recommendations include assisting with patient-prescribed medications when appropriate (e.g., nitroglycerin, inhaled bronchodilators, and epinephrine autoinjectors), using structured stroke screening tools, preventing aspiration through proper positioning and withholding oral intake in patients at risk of dysphagia, administering oxygen only for hypoxemia, and initiating cardiopulmonary resuscitation in patients who are unconscious and not breathing normally. Seizure management focuses on safety and emergency medical services activation criteria, while care for shock and syncope emphasizes patient positioning and post-event assessment. These recommendations provide practical, evidence-based guidance for improving patient safety and outcomes in prehospital settings.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"13 Suppl 1","pages":"S185-S194"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257515","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}