Clinical and Experimental Emergency Medicine最新文献

{"title":"Inappropriate use of intravenous epinephrine leading to atrial fibrillation during prehospital anaphylaxis treatment: a case report.","authors":"Haewon Jung, Hyun Wook Ryoo, Jungbae Park, Seung Hyuk Choi, Jae Hyuk Lee, Sujeong Kim","doi":"10.15441/ceem.23.129","DOIUrl":"10.15441/ceem.23.129","url":null,"abstract":"<p><p>In a prehospital setting, the narrow therapeutic window of epinephrine necessitates its cautious administration to avoid anaphylaxis. In this case, a 46-year-old man presented severe anaphylactic symptoms. Following the standard protocol, the emergency medical technician (EMT) administered intramuscular epinephrine; however, symptoms persisted. Under the oversight of the emergency medical services (EMS) medical director, an additional intravenous bolus of epinephrine was administered, unfortunately leading to atrial fibrillation. This case underscores the potential risks of intravenous epinephrine, which is not typically recommended for anaphylaxis without continuous monitoring. Since 2019, Korea has initiated a pilot program to expand the EMT scope of practice, which gives them the authority to administer epinephrine for anaphylaxis. The ultimate decision regarding epinephrine use for anaphylaxis, emphasizing patient safety, rests with the EMS medical director. Proper training for EMTs, coupled with the EMS medical director's comprehensive knowledge and meticulous protocol adherence, can ensure patient safety and optimal outcomes.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"304-308"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575125","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":"The accuracy of the Hounsfield unit in pulmonary embolism diagnostics.","authors":"Mümin Murat Yazici, Sümeyye Sekmen, Ali Çelik, Özcan Yavaşi, Nur Hürsoy","doi":"10.15441/ceem.23.113","DOIUrl":"10.15441/ceem.23.113","url":null,"abstract":"<p><strong>Objective: </strong>Pulmonary embolism (PE) is a vascular disease that is most frequently diagnosed using the radiological imaging technique computed tomography pulmonary angiography (CTPA). In this study, we aimed to demonstrate the diagnostic accuracy of the Hounsfield unit (HU) for PE based on the hypothesis that acute thrombosis causes an increase in HU value on CT.</p><p><strong>Methods: </strong>This research was a single-center, retrospective study. Patients presenting to the emergency department diagnosed with PE on CTPA were enrolled as the study group. Patients admitted to the same emergency department who were not diagnosed with PE and had noncontrast CT scans were included as the control group. A receiver operating curve was produced to determine the diagnostic accuracy of HU values in predicting PE.</p><p><strong>Results: </strong>The study population (n=74) consisted of a study group (n=46) and a control group (n=28). The sensitivity and specificity of the HU value for predicting PE on thoracic CT were as follows: for the right main pulmonary artery, 61.5% and 96.4% at a value of 54.8 (area under the curve [AUC], 0.690); for the left main pulmonary artery, 65.0% and 96.4% at a value of 55.9 (AUC, 0.736); for the right interlobar artery, 44.4% and 96.4% at a value of 62.7 (AUC, 0.615); and for the left interlobar artery, 60.0% and 92.9% at a value of 56.7 (AUC, 0.736).</p><p><strong>Conclusion: </strong>HU may exhibit high diagnostic specificity on CT for thrombi up to the interlobar level. An HU value exceeding 54.8 up to the interlobar level may raise suspicion of the presence of PE.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"295-303"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575296","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":"Therapeutic hypothermia is not dead, but hibernating!","authors":"Robert J Freedman, Robert B Schock, W Frank Peacock","doi":"10.15441/ceem.24.291","DOIUrl":"10.15441/ceem.24.291","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"11 3","pages":"238-242"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399590","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":"Barriers to utilization of intraosseous vascular access in pediatric emergencies.","authors":"Hussein Omari Sombi","doi":"10.15441/ceem.24.247","DOIUrl":"10.15441/ceem.24.247","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"309-313"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723140","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":"Comparison of modified quick Sequential Organ Failure Assessment models as triage tools for febrile patients.","authors":"Dong-Young Lee, Seung Ryu, So-Young Jeon, Jung-Soo Park, Yeon-Ho You, Won-Joon Jeong, Yong-Chul Cho, Hong-Joon Ahn, Chang-Shin Kang, Se-Kwang Oh","doi":"10.15441/ceem.23.125","DOIUrl":"10.15441/ceem.23.125","url":null,"abstract":"<p><strong>Objective: </strong>Effective triage of febrile patients in the emergency department is crucial during times of overcrowding to prioritize care and allocate resources, especially during pandemics. However, available triage tools often require laboratory data and lack accuracy. We aimed to develop a simple and accurate triage tool for febrile patients by modifying the quick Sequential Organ Failure Assessment (qSOFA) score.</p><p><strong>Methods: </strong>We retrospectively analyzed data from 7,303 febrile patients and created modified versions of qSOFA using factors identified through multivariable analysis. The performance of these modified qSOFAs in predicting in-hospital mortality and intensive care unit (ICU) admission was compared using the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>Through multivariable analysis, the identified factors were age (\"A\" factor), male sex (\"M\" factor), oxygen saturation measured by pulse oximetry (SpO2; \"S\" factor), and lactate level (\"L\" factor). The AUROCs of ASqSOFA (in-hospital mortality: 0.812 [95% confidence interval, 0.789-0.835]; ICU admission: 0.794 [95% confidence interval, 0.771-0.817]) were simple and not inferior to those of other more complex models (e.g., ASMqSOFA, ASLqSOFA, and ASMLqSOFA). ASqSOFA also displayed significantly higher AUROC than other triage scales, such as the Modified Early Warning Score and Korean Triage and Acuity Scale. The optimal cutoff score of ASqSOFA for the outcome was 2, and the score for redistribution to a lower level emergency department was 0.</p><p><strong>Conclusion: </strong>We demonstrated that ASqSOFA can be employed as a simple and efficient triage tool for emergency febrile patients to aid in resource distribution during overcrowding. It also may be applicable in prehospital settings for febrile patient triage.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"286-294"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575152","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":"Urological emergencies: unmasking massive bladder hematomas.","authors":"Ajay Pawar, Varsha Shinde","doi":"10.15441/ceem.23.134","DOIUrl":"10.15441/ceem.23.134","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"314-315"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575325","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":"Current trends in emergency airway management: a clinical review.","authors":"Sangun Nah, Yonghee Lee, Sol Ji Choi, Jeongwoo Lee, Soyun Hwang, Seongmi Lim, Inhye Lee, Young Soon Cho, Hyun Soo Chung","doi":"10.15441/ceem.23.173","DOIUrl":"10.15441/ceem.23.173","url":null,"abstract":"<p><p>Airway management is a fundamental and complex process that involves a sequence of integrated tasks. Situations requiring emergency airway management may occur in the emergency department, intensive care units, and various other clinical spaces. A variety of challenges can arise during emergency airway preparation, intubation, and postintubation, which may result in significant complications for patients. Therefore, many countries are establishing step-by-step systemization and detailed guidelines and/or updating their content based on the latest research. This clinical review introduces the current trends in emergency airway management, such as emergency airway management algorithms, comparison of video and direct laryngoscopy, rapid sequence intubation, pediatric airway management, prehospital airway management, surgical airway management, and airway management education.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"243-258"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140130871","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":"Update on the pathophysiology and management of acute trauma hemorrhage and trauma-induced coagulopathy based upon viscoelastic testing.","authors":"Marc Maegele","doi":"10.15441/ceem.24.202","DOIUrl":"10.15441/ceem.24.202","url":null,"abstract":"<p><p>Uncontrolled hemorrhage and trauma-induced coagulopathy (TIC) are the two predominant causes of preventable death after trauma. Early control of bleeding sources and rapid detection, characterization and management of TIC have been associated with improved outcomes. However, recent surveys confirm vast heterogeneity in the clinical diagnosis and management of hemorrhage and TIC from acute trauma, even in advanced trauma centers. In addition, conventional coagulation assays, although still used frequently during the early assessment of bleeding trauma patients, have their limitations. This narrative review highlights the clinical value of rapid point-of-care viscoelastic testing for the early diagnosis and individualized goal-directed therapy in bleeding trauma patients with TIC.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"259-267"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140130872","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":"Evaluation of the quality of emergency department management for patients with chronic obstructive pulmonary disease.","authors":"Pascale J King, Lana Ramic, Janet Wilson, Shawn Aaron, Ian G Stiell","doi":"10.15441/ceem.24.197","DOIUrl":"10.15441/ceem.24.197","url":null,"abstract":"<p><strong>Objective: </strong>Chronic obstructive pulmonary disease (COPD) is associated with exacerbations and high risk of serious outcomes. Our goal was to determine the appropriateness of the emergency department (ED) management of COPD exacerbations.</p><p><strong>Methods: </strong>This observational cohort study incorporated a health records review and included COPD exacerbation cases seen at two large academic EDs. We included all patients with the primary diagnosis of COPD exacerbation. From the electronic medical record, demographic and clinical data were abstracted, and the Ottawa COPD Risk Score (OCRS) was calculated for each. Short-term serious outcomes included intensive care unit admission, intubation, myocardial infarction, noninvasive positive pressure ventilation (NIV), and death at 30 days. Cases were judged for appropriateness of treatment according to explicit indications and standards developed a priori.</p><p><strong>Results: </strong>We enrolled 500 cases with mean age of 71.9 years, 51.2% female patients, 50.2% admitted, and 4.4% death. The calculated OCRS score was >2 for 70.8% of patients. The treatments provided were inhaled β-agonists (82.6%), inhaled anticholinergics (76.6%), corticosteroids (75.2%), antibiotics (71.0%), oxygen (63.8%), NIV (8.8%), and intubation (0.6%). Overall, 50.0% of cases were judged to have had inadequate management due to missing treatments. Specifically, the proportion of missing treatments were inhaled β-agonist (17.0%), inhaled anticholinergic (22.6%), corticosteroids (24.4%), antibiotics (12.8%), and NIV (2.0%).</p><p><strong>Conclusion: </strong>Adequate treatment of COPD exacerbation was lacking in 50.0% of patients in these two large academic EDs. Concerning were the number of patients not receiving corticosteroids or antibiotics. Implementation of explicit treatment standards should lead to improved patient care of this common and serious condition.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"268-275"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080701","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":"Optimizing dispatcher-bystander dyadic collaboration in emergency medical communication to improve cardiac arrest response.","authors":"Guglielmo Imbriaco, Nicola Ramacciati","doi":"10.15441/ceem.24.296","DOIUrl":"10.15441/ceem.24.296","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"233-237"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139480","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}