International Journal of Critical Care and Emergency Medicine最新文献

{"title":"Management of Multiple Rib Fractures-Results from a Major Trauma Centre with Review of the Existing Literature","authors":"C. D, Okoh P, D. H","doi":"10.23937/2474-3674/1510113","DOIUrl":"https://doi.org/10.23937/2474-3674/1510113","url":null,"abstract":"Management of multiple rib fractures-results from a Major Trauma Centre with the review of the existing literature Chowdhury D.1*, Okoh P.2, Dambappa H.3 DOI: https://doi.org/10.17511/ijmrr.2020.i06.01 1* D. Chowdhury, Specialty Registrar, Emergency Medicine, Royal Preston Hospital, England, United Kingdom. 2 P. Okoh, Specialty Registrars, Emergency Medicine, Royal Preston Hospital, England, United Kingdom. 3 H. Dambappa, Specialty Registrars, Emergency Medicine, Royal Preston Hospital, England, United Kingdom.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73645364","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":"Extracorporeal Membrane Oxygenation (ECMO) Transpires to be a Promising Surrogate Therapy for Severe Refractory near Fatal Asthma: A Case Report","authors":"Bshabshe Ali Al, Palanivel Omprakash, Bahis Mohammed Amer, Alwadai Nasser Mohammed, Mushabebassiri Ali","doi":"10.23937/2474-3674/1510112","DOIUrl":"https://doi.org/10.23937/2474-3674/1510112","url":null,"abstract":"The standard first-line therapy for severe asthma exacerbation is bronchodilators and corticosteroids. Any patients not responding to this standard therapy often needs invasive ventilation, which can promote numerous related complications and mortality. Recent studies conclude that ECMO can be adopted as an alternative approach as it significantly enhances the survival rate in severe respiratory failure compared to standard invasive ventilation. In contrast, ECMO effectiveness in near-fatal asthma is not well studied, possibly due to unpredictable asthma death before reaching the hospital and lack of current evidence-based studies that support the usage and benefits of ECMO. Herein, we present 39-year-old male as a case of near-fatal asthma with severe persistent hypercapnic respiratory failure refractory to conventional ventilation. Our early application of VV-ECMO for continuous 58 hours improved the patient hemodynamics and respiratory mechanics along with a rapid reduction of carbon dioxide tension. Thus it reduces the further complications and the length of the intensive care unit. Our case demonstrates the significance of the early hours of ECMO as promising surrogate therapy when conventional treatment fails. Long-term research urged to validate VV ECMO effectiveness in this group of patients.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73073684","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":"Simulation Education to Advance Emergency Medicine and Pediatric Critical Care in Nepal","authors":"Shrestha Roshana, A. Lisa, A. Shaza, Kholwadwala Fenil, D. Nicholas, Nguyen Kevin, Brickman Kris, Shrestha Anmol","doi":"10.23937/2474-3674/1510105","DOIUrl":"https://doi.org/10.23937/2474-3674/1510105","url":null,"abstract":"Background: Internationally emergency medicine is a relatively young specialty that is increasingly recognized for its potential for growth. In low middle-income (LMICs) like resources are quite limited and the development of new specialties such as emergency medicine can be slow to evolve. Specific areas of emergency care, including pediatric critical care have significant challenges due to clinical and educational limitations in countries like Nepal. Countries with robust healthcare systems like the United States can play a significant role in bridging this education and clinical divide in LMICs. In 2018 and 2019 the University of Toledo Medical Center in collaboration with Dhulikhel Hospital-Kathmandu University Hospital School of Medicine developed adult and pediatric critical emergency care workshops and educational sessions in an effort to improve the development of emergency medicine in Nepal. These sessions included hands-on workshops, educational lectures, and simulation participation environments in critical care procedures and decision making for both adult and pediatric emergencies. In these two workshops a total of 71 participants, including Nepalese emergency care providers ranging from pre-hospital personnel to faculty, engaged in these sessions. Results: Pre and post-workshop surveys were provided and this subjective data showed significant improvement in confidence levels along with procedural skills technique and knowledge as a result of the educational sessions provided. Conclusion: Multidisciplinary education and workshops to LMIC are necessary for development of emergency medicine and pediatric critical care. Simulation education and workshop training are highly valuable “hands on” methods to educate these healthcare providers. Highly developed healthcare systems in emergency and critical care must assist in the world wide development acute care management in these poorly resourced countries","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75397127","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":"Transport of Critically Ill COVID-19 Patients","authors":"Yousuf Beena, Sujatha Kandela Swancy, AlFoudari Huda","doi":"10.23937/2474-3674/1510103","DOIUrl":"https://doi.org/10.23937/2474-3674/1510103","url":null,"abstract":"","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90404284","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":"Acute Pneumonia: The Beginning of a Revision of Views or Just a Statement of Known Facts?","authors":"K. Igor","doi":"10.23937/2474-3674/1510100","DOIUrl":"https://doi.org/10.23937/2474-3674/1510100","url":null,"abstract":"Klepikov. Int J Crit Care Emerg Med 2020, 6:100 • Page 1 of 2 • Citation: Klepikov I (2020) Acute Pneumonia: The Beginning of a Revision of Views or Just a Statement of Known Facts?. Int J Crit Care Emerg Med 6:100. doi.org/10.23937/2474-3674/1510100 Accepted: March 12, 2020: Published: March 14, 2020 Copyright: © 2020 Klepikov I. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Acute Pneumonia: The Beginning of a Revision of Views or Just a Statement of Known Facts?","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"116 10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84247365","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":"Covid-19 Pandemic and Health Professionals: Practical Approaches","authors":"Monte Rebecca Renata Lapenda do, Tavares Francisco de Assis Fernandes, Cardoso Bruno Barreira, Goés Alyne Barreto Mesquita de, Silva Thais Cristina Loyola da, Silva Brenda de Oliveira, Araujo Yara Saiane Marim, Rêgo Amália Cinhtia Meneses, Araújo-Filho* Irami","doi":"10.23937/2474-3674/1510108","DOIUrl":"https://doi.org/10.23937/2474-3674/1510108","url":null,"abstract":"Monte et al. Int J Crit Care Emerg Med 2020, 6:108 Citation: Monte RRL, Tavares FAF, Cardoso BB, Goes ABM, Silva TCL, et al. (2020) Covid-19 Pandemic and Health Professionals: Practical Approaches. Int J Crit Care Emerg Med 6:108. doi.org/10.23937/24743674/1510108 Accepted: May 07, 2020: Accepted: May 26, 2020: Published: May 28, 2020 Copyright: © 2020 Monte RRL, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81880572","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":"Isoproterenol and Lidocaine for Recurrent Torsades de Pointes in a 32-year-old Pregnant Woman","authors":"Reachi Breyanna, Negrelli Jenna, H. Abby, B. Sarah, Osborn Jeffrey","doi":"10.23937/2474-3674/1510092","DOIUrl":"https://doi.org/10.23937/2474-3674/1510092","url":null,"abstract":"Guidelines recommend magnesium and defibrillation for Torsades de Pointes (TdP) treatment in pregnancy, both of which were unsuccessful at terminating our patient’s recurrent ventricular arrhythmias. Both lidocaine and isoproterenol carry potential risks to mother and fetus, but the risk of congenital abnormalities is significantly lower compared to other antiarrhythmics such as amiodarone. A 15-week pregnant 32-year-old female was admitted to an outside hospital for alcohol withdrawal and developed multiple episodes of ventricular tachycardia (VT) and TdP resulting in her prompt transfer to our hospital for escalation of care. On arrival she was awake, alert, and hemodynamically stable but quickly began experiencing recurrent episodes of TdP that developed into pulseless VT despite defibrillation, magnesium and calcium administration, and chest compressions. We initiated lidocaine and isoproterenol infusions, after which the patient stabilized. Isoproterenol and lidocaine were successfully discontinued after 2 days of treatment and the patient was discharged after 4 days of hospitalization with fetal heart sounds intact. While there are guideline recommendations for the management of TdP and ventricular arrhythmias, primary literature is lacking. This unique case demonstrates efficacy of isoproterenol pacing combined with the antiarrhythmic lidocaine for terminating a refractory and life-threatening ventricular arrhythmia.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"115 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73414176","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":"Comparison of Normal Skin and Thermal and Chemical Burn Wounds using Vibrational Optical Coherence Tomography","authors":"H SilverFrederick, K. Nikita, Shah Ruchit","doi":"10.23937/2474-3674/1510091","DOIUrl":"https://doi.org/10.23937/2474-3674/1510091","url":null,"abstract":"The search for methods to evaluate the extent and severity of skin lesions, such as burns and other skin disorders, has been a subject of extentive research. While suction testing, elastography and other tests can be done noninvasively on intact skin, these tests cannot be done on burns and open wounds due to the possible injury that may occur. In addition, they fail to yield comparable results obtained using destructive tests such as uniaxial tensile testing. We have developed a technique to combine optical coherence tomography (OCT) with vibrational analysis (VOCT) to non-invasively and non-destructively evaluate the properties of skin and wounds. The result of this analysis is a “virtual biopsy” of skin and burn tissue that can be correlated with the extent of healing. In this study we perform a comparative analysis of thermal and chemical burns and normal skin by scanning OCT images and measuring the elastic moduli of normal skin and thermal and chemical burn scars. It is concluded that the scans of OCT images and measurements of resonant frequency and moduli of burn scars show differences when compared to measurements made on normal skin. In both thermal and chemically induced scar tissue the absence of the rete pegs results in a change in slope of the average pixel intensity versus depth profiles suggesting that the loss of the rete pegs in burn wounds and perhaps skin lesions can be diagnosed non invasively using the “virtual biopsy”. Using the “virtual biopsy” it is possible to follow changes in the morphology and physical properties of the epidermis and dermis to evaluate the extent of healing and the effects of therapeutic treatments used to treat skin lesions and wounds.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78790022","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":"The Bone Phone: Improving Time to Pain Medication Administration in Long Bone Patients","authors":"W. Brian, R. Santhi, K. Kara, Kanis Jessica","doi":"10.23937/2474-3674/1510090","DOIUrl":"https://doi.org/10.23937/2474-3674/1510090","url":null,"abstract":"Background: Orthopedic complaints are one of the most frequent reasons for presentations to the pediatric emergency department (PED). National metrics have defined that each child should have a pain assessment and/or pain medication administered within one hour of arrival to an emergency department. Patient surges, transfers from referring hospitals, and acuity can affect the ability of a PED to meet this metric. Objective: To implement a quality improvement process to ensure children presenting to a PED receive a pain assessment and pain medications within one hour of arrival. Methods: We queried our electronic medical record (EMR) for all patients presenting to our level 1 trauma center PED pain for the 90 days prior to implementation and then for the 90 days post implementation of the quality improvement process. The bundle included nursing, support staff, and physician education to quickly identify children with long bone pain then calling the designated physician carrying the “bone phone.” The physician carrying the bone phone then had 15 minutes to complete an assessment, order pain medication and radiographs and document these interventions in the EMR. Results: During the study period, 553 total fractures were identified with 337 long bone fractures that met inclusion criteria (61%). Of these fractures, 105 required casting and 82 fractures required reduction in the PED, 127 necessitated OR repair, and 23 had a different outcome. Our pre-intervention average time to pain medication was 63 minutes and our time to medication ordered was 45 minutes. Our post-intervention average time to pain medication was 55 minutes and our time to medication ordered was 38 minutes. Conclusions: Our intervention bundle was successful in reducing our time to assessment and time to pain medication administration. Future studies will look at using template orders and chief complaint driven nursing order sets to further reduce the time to pain medication administration for long bone pain patients. Future studies will also benefit from exploring if opiophobia contributes to delayed pain medication administration in the pediatric emergency department.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83720177","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":"The 'SAFE PT' Handover: Impact on Safe Patient Handover between Shifts in the Emergency Department","authors":"M. Ahmed, Busafi Mohamed Al, Salmi Issa Al","doi":"10.23937/2474-3674/1510088","DOIUrl":"https://doi.org/10.23937/2474-3674/1510088","url":null,"abstract":"Objectives: This paper studies the Impact of SAFE PT tool in the handover process between shifts in the Royal Hospital adult emergency department (ED) and its impact on clinical improvement, patient satisfaction and decrease in length of stay (LOS) of patients. The study provides an insight into the end user adaptability and their opinions. Methods: A prospective observational method; prior and post implementation survey comprising a questionnaire used to study the effects of the implementation of the SAFE PT handover. Results: 50 participants each were approached prior and post implementation of SAFE PT to fill descriptive questionnaires. The new SAFE PT tool was found to be clear and user friendly. It enhanced the handover process to a smooth one and was found to be systematic and highlighted the high acuity patients as well as red flags of each patient handed over. The bedside handover coupled with the prefilled written SAFE PT made it a safe process with increased patient satisfaction emphasized by the significant reduction in percentage of patient LOS in the ED. Conclusions: The SAFE PT handover proved to be a successful method of clinical handover between shifts in the ED with an impact on patient safety and care; leading to an increased patient satisfaction. It also contributed hugely to the reduction in the percentage of LOS of patients in the ED within 4 hours period. The result of the implementation of the new tool makes the ED proud to have a safe patient (SAFE PT) culture which is user friendly and one which has an emphasis on smooth patient flow. A ‘SAFE PT’ is indeed a ‘HAPPY PT’. its efficient execution. This is possible with a well-developed tool which assists in transforming relevant information of patients to be handed over between shifts in the ED [1]. The SAFE PT handover developed and discussed in our earlier study [2] depicts a standard structured format which is the key to an efficient handover system. The implementation of the SAFE PT handover and its impact on the ED is evaluated in this study. The clinical handover between shifts in ED is a complex matrix of multiple variables based in a difficult and unpredictable environment [3]. It’s of importance that time, place and format be invested towards a structured module for safe and smooth transition of patients between shifts. The aim of a high-quality handover is to have continuity of care in an efficient and smooth way so as not to hinder or delay the care of patients but quicken the process and eliminating errors [4]. The SAFE PT tool is a well-developed tool that identifies the patient and relevant details of management of the patient during the stay in the department. It was developed based on international guidelines [5,6]. It highlights red flags with regards to the patient that are to be addressed, thereby reducing errors. It provides the user with recommendations for further management of patient including pending investigations, imaging, consultations and disposi","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79459175","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}