Clinical and Experimental Emergency Medicine最新文献

{"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}

{"title":"Mortality case due to minimal bentazone intoxication.","authors":"Yumin Jeon, Sejoong Ahn, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sukyo Lee","doi":"10.15441/ceem.24.217","DOIUrl":"https://doi.org/10.15441/ceem.24.217","url":null,"abstract":"<p><p>Bentazone is a widely used herbicide and is considered a moderate hazard. Fatalities are rarely reported, with reports of deaths occurring in doses of 200 ml or more. In some literature, it is accompanied by generalized rigidity. Malignant hyperthermia (MH) is a pharmacogenetic diseases that presents a hypermetabolic response to anesthetic gases or depolarizing muscle relaxant due to calcium channel dysfunction. The classic symptom of MH include hyperthermia and muscle rigidity. In this article, we report a case of a 65-year-old man who died 4 hours after presenting to the emergency department after taking approximately 75 ml of Basagran M60 (bentazone 33.6%, 25.2 g). This is the smallest dose (364 mg/kg) reported in a fatal case to date. Electrocardiogram changes, including QRS widening and QT prolongation, were present, and hypocalcemia was confirmed. We propose the possibility that bentazone intoxication causes patient deterioration by a mechanism similar to malignant hyperthermia.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound by emergency physicians for direct ureteral stone detection: a case series and review of the literature.","authors":"Nadav Granat, Evan Avraham Alpert","doi":"10.15441/ceem.23.096","DOIUrl":"10.15441/ceem.23.096","url":null,"abstract":"<p><p>Symptomatic urolithiasis is a common cause of emergency department visits, with noncontrast computed tomography considered the imaging gold standard. According to the current guidelines, point-of-care ultrasound (POCUS) is limited to evaluating hydronephrosis as a secondary sign of acute ureteral stones. However, the use of POCUS to detect ureteral stones may lead to decreased radiation to the patient and a more rapid diagnosis. This case series describes 10 patients with suspected symptomatic urolithiasis who were diagnosed accurately by emergency physicians using POCUS to detect obstructive ureteral stones. In three of the cases, POCUS significantly changed the patient's management. This article also describes the proper techniques for the emergency physician to learn to master POCUS for ureteral stone detection.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"218-223"},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575286","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":"Prognostic utility of paraspinal muscle index in elderly patients with community-acquired pneumonia.","authors":"Ga Ram Lee, Seok Hoon Ko, Hang Sung Choi, Hoon Pyo Hong, Jong Seok Lee, Ki Young Jeong","doi":"10.15441/ceem.23.142","DOIUrl":"10.15441/ceem.23.142","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the associations between paraspinal muscle measurements on chest computed tomography and clinical outcomes of elderly patients with community-acquired pneumonia (CAP).</p><p><strong>Methods: </strong>This single-center, retrospective, observational study analyzed elderly patients (≥65 years) with CAP hospitalized through an emergency department between March 2020 and December 2022. We collected their baseline characteristics and laboratory data at the time of admission. The paraspinal muscle index and attenuation were calculated at the level of the 12th thoracic vertebra using chest computed tomography taken within 48 hours before or after admission. Univariable and multivariable logistic regression analyses were conducted to evaluate the association between paraspinal muscle measurements and 28-day mortality. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to evaluate the prognostic predictive power.</p><p><strong>Results: </strong>Of the 338 enrolled patients, 60 (17.8%) died within 28 days after admission. A high paraspinal muscle index was associated with low 28-day mortality in elderly patients with CAP (adjusted odds ratio, 0.994; 95% confidence interval, 0.992-0.997). The area under the ROC curve for the muscle index was 0.75, which outperformed the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65 years) metric, both of which showed an AUC of 0.64 in predicting mortality.</p><p><strong>Conclusion: </strong>A high paraspinal muscle index was associated with low 28-day mortality in patients aged 65 years or older with CAP.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"171-180"},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575292","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":"Bezold abscess in a 4-year-old: an exceptionally rare complication of otitis media.","authors":"Zachary Tillett, Robert Anderson","doi":"10.15441/ceem.23.034","DOIUrl":"10.15441/ceem.23.034","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"229-230"},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899496","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}