International Journal of Critical Care and Emergency Medicine最新文献

{"title":"Enhancement of NK Cell-Mediated Lysis of Osteosarcoma Cells by Up-Regulating the NKG2D Ligands using Spironolactone and AVE","authors":"M. Ahmed, Busafi Mohamed Al, Salmi Issa Al","doi":"10.23937/2474-3674/1510089","DOIUrl":"https://doi.org/10.23937/2474-3674/1510089","url":null,"abstract":"","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91166023","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":"Psychosocial Considerations for Pediatric Care in Emergency Departments","authors":"L. Julie","doi":"10.23937/2474-3674/1510086","DOIUrl":"https://doi.org/10.23937/2474-3674/1510086","url":null,"abstract":"","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"51 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91484218","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 Cardiopulmonary Resuscitation in a 36-Year-Old Man with Viral Myocarditis Who Survived Prolonged Cardiac Arrest and Bedside Decompressive Laparotomy Neurologically Intact","authors":"K PowellElizabeth, A LemminkGretchen, T TresterJoshua, IV Louis B Louis","doi":"10.23937/2474-3674/1510087","DOIUrl":"https://doi.org/10.23937/2474-3674/1510087","url":null,"abstract":"Powell et al. Int J Crit Care Emerg Med 2019, 5:087 Citation: Powell EK, Lemmink GA, Trester JT, Louis LB (2019) Extracorporeal Cardiopulmonary Resuscitation in a 36-Year-Old Man with Viral Myocarditis Who Survived Prolonged Cardiac Arrest and Bedside Decompressive Laparotomy Neurologically Intact. Int J Crit Care Emerg Med 5:087. doi. org/10.23937/2474-3674/1510087 Accepted: August 24, 2019: Published: August 26, 2019 Copyright: © 2019 Powell EK, 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":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89320342","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":"Hyponatremia in Children with Systemic Inflammatory Response Syndrome Presenting to the Emergency Department","authors":"El-Assal Osama, Marzec Sarah A, Forbes Michael L, B. Michael, R. Ryan, Solomon Jeffrey D, Brown Miraides F","doi":"10.23937/2474-3674/1510085","DOIUrl":"https://doi.org/10.23937/2474-3674/1510085","url":null,"abstract":"Background: Hyponatremia is observed in children with meningitis, encephalitis, pneumonia, urinary tract infections, and Kawasaki disease. The presence of hyponatremia is associated with increased morbidity and mortality in adults. The clinical significance of hyponatremia in febrile pediatric patients is unknown. The objective of this study was to evaluate the prevalence and prognostic value of hyponatremia in children presenting to the emergency department (ED) with systemic inflammatory response syndrome (SIRS). Methods: This retrospective study included children 1-19 years-old presenting to the ED between January December 2014 with fever and SIRS. Exclusion criteria included comorbidities affecting sodium levels such as diuretic use, renal insufficiency, hyperglycemia, or immune deficiencies. Hyponatremia was defined as serum sodium of < 132 mEq/L; the primary outcome was hospital admission. Continuous non-normal variables were described as median and interquartile range. Categorical variables were compared using Chi-squared or Fisher’s Exact Tests. Spearman correlation was evaluated between nonparametric variables. Level of significance was set at 0.05. Results: Out of 4,791 patients, 663 met inclusion criteria by having electrolytes collected and by triggering SIRS Best Practice Alerts. Hyponatremia occurred in 19%. Patients with hyponatremia were older (P = 0.04) and had higher maximum body temperature (P < 0.001), white blood cell counts (P = 0.04), and C-reactive protein levels (P = 0.004). Patients with hyponatremia also had higher rates of admission (P = 0.003, OR = 1.9, 95% CI [1.3-2.9]) and bacteremia (P = 0.009). Conclusions: Hyponatremia is often found among pediatric patients presenting to the ED with febrile SIRS and is associated with increased morbidity.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87311262","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 the Sequential Organ Failure Assessment (SOFA) and Quick SOFA Scores in Predicting in-Hospital Mortality among Adult Critical Care Patients with Suspected Infection","authors":"Said Mohammed A, Siika Wangari-Waweru, Mung'ayi Vitalis, Shah Reena","doi":"10.23937/2474-3674/1510084","DOIUrl":"https://doi.org/10.23937/2474-3674/1510084","url":null,"abstract":"Introduction: Sepsis is global health priority and the leading cause of death in critical care. The SEPSIS 3 criteria introduced in 2016 is the latest tool in diagnosing sepsis. It uses SOFA and qSOFA scores in place of the SIRS criteria for better ability to predict mortality in patients with suspected infections. The performance of these scores in critical care units outside high-income countries remains largely unknown. Methods: We compared the performance of SOFA and qSOFA in predicting the in-hospital mortality of an adult critical care unit in Kenya. We conducted a retrospective review of all patients admitted to the critical care units with suspected infection between 1 January 2017 and 31 December 2017. A standardized electronic data collection tool was be used to collect demographic, clinical and outcome data on the participants. Area under the receiver operating characteristic curves (AUROC) with 95% confidence inter - vals was used to compare SOFA and qSOFA. Results: We enrolled 450 patients with a mean age of 56 years [SD ± 19.10] and 57.60% were male. Majority of the patients, 352 (78.20%), presented through the emergency department. Pneumonia was the commonest source of infection 293 (65.10%). There were 92 deaths (mortality rate of 20.44%). The majority of patients, 371 (82.44%) manifested a SOFA score of ≥ 2 and 190 (42.22%) had a qSOFA score of ≥ 2. SOFA score was superior in predicting in hospital mortality compared to qSOFA with an AUROC = 0.799 [0.752-0.846] vs. 0.694 [0.691-0.748, P < 0.001]. Conclusion: A SOFA score of two or more is better than qSOFA score in predicting in-hospital mortality among adult critical care patients with suspected infection. This finding suggests that SOFA is an appropriate tool in the initial diagnosis sepsis in critical care setting in a developing country.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72914651","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":"Characterization of Pediatric Procedural Competency in Emergency Physicians","authors":"D. Slubowski, B. Wagers, J. Kanis","doi":"10.23937/2474-3674/1510083","DOIUrl":"https://doi.org/10.23937/2474-3674/1510083","url":null,"abstract":"","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"44 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72580757","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: A Qualitative Study for Developing an Improvised Tool Facilitating Safe Patient Handover","authors":"Ahmed Mikky, Mohamed Al Busafi, I. Salmi","doi":"10.23937/2474-3674/1510082","DOIUrl":"https://doi.org/10.23937/2474-3674/1510082","url":null,"abstract":"Objectives: The aim of this study is to identify and establish an effective and a standardized tool that is easily reproducible for the safe handover of patients at end of shift at the emergency department (ED) for continuity of care, smooth transition and minimising errors. This tool is designed to assist emergency physician and nurses in building a safe patient culture one that is reliable and upholds the standards of quality and improvement guided by international goals. Methods: To develop this tool; the end users were consulted for understanding the requirements through group discussion, interviews and surveys involving emergency physicians and nurses of different grades. This was further augmented by reviewing literature on international accepted tools. Based on the above information gathered; a tool was developed which was simple, practical and included all necessary details of the patient in an easy and structured format. Results: Group discussions, interviews and survey conducted showed that current handover practice needed improvement and there was inadequate information being passed on between shifts. This was of concern to most participants and they felt that absence of a reliable tool led to unsafe handovers. The need of the hour was a reliable tool which would standardize and smoothen the handover of patients between shifts in a safe manner. Participants cited examples of leak of information in the current practice which would have changed their approach to patient and having a direct impact on the quality of care delivered. There was also varied responses regarding what was a safe handover practice and prior training received on handover process and the contents of a good handover were found lacking. In order to standardize the handover process based on internationally acclaimed approach and specific to needs as received by end users of the ED, the SAFE PT tool was developed incorporating the relevant details of patient care to facilitate the smooth and safe continuity of care between shifts. Conclusions: Clinical handover is a high-risk area for patient safety and quality in health care and therefore of high priority for the ED. The SAFE PT tool was derived to emphasize on a culture of patient safety and also for easy recollection of the desired information to be included for a quicker and safer continuity of care between shifts in the ED leading to improved patient satisfaction. ISSN: 2474-3674 DOI: 10.23937/2474-3674/1510082 Mikky et al. Int J Crit Care Emerg Med 2019, 5:082 • Page 2 of 10 • • Patient centred care • Patient care planning • Patient care team • Quality of health care • Inter-professional relations • Safety • Handover • Shift change • Clinical information transfer • Handover practice • Shift handover • Tools and handover • Bedside handover • Shift briefings • Shift report • End of shift reports • Shift change reports • Handover practices • Patient handover • Team handoffs Inclusion criteria All literature included ","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88697124","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":"Extreme Hypernatraemia and Sepsis in a Patient with Huntington's Dementia: A Conundrum in Fluid Management","authors":"V. Harish, R. Sanjeev, Basu Atanu, N. Hari","doi":"10.23937/2474-3674/1510064","DOIUrl":"https://doi.org/10.23937/2474-3674/1510064","url":null,"abstract":"Venkatesh et al. Int J Crit Care Emerg Med 2019, 5:064 Citation: Venkatesh H, Ramachandran S, Basu A, Nair H (2019) Extreme Hypernatraemia and Sepsis in a Patient with Huntington’s Dementia: A Conundrum in Fluid Management. Int J Crit Care Emerg Med 5:064. doi.org/10.23937/2474-3674/1510064 Accepted: January 03, 2019: Published: January 05, 2019 Copyright: © 2019 Venkatesh H, 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":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79042185","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":"An Exploratory Study of Overnight Education in the Medical Intensive Care Unit","authors":"R PetriCamille, L RanchoffBrittany, P CohenAmy, M SullivanAmy, M SchwartzsteinRichard, M HayesMargaret","doi":"10.23937/2474-3674/1510063","DOIUrl":"https://doi.org/10.23937/2474-3674/1510063","url":null,"abstract":"Background: Many hospitals in the United States employ overnight intensivist coverage for their medical intensive care units, but little is known about the effect of this staffing model on trainee education, and the learning that occurs overnight. This study examined the educational interactions occurring between residents and overnight intensivists in the context of the overnight multidisciplinary learning environment. Methods: We conducted an anonymous, cross-sectional survey of internal medicine residents and overnight intensivists at a single, tertiary academic teaching hospital regarding teaching impact, teaching frequency, educational needs and learning preferences when working overnight. Results: Of those surveyed, 61% (33/54) of residents and 56% (15/27) of intensivists responded. Residents identified overnight intensivists as having the highest teaching impact overnight, followed by co-residents, respiratory therapists, then nurses. Residents reported learning most about ventilator management (87%), procedures (70%), and vasopressors (67%) overnight. Overnight intensivists reported teaching most about ventilator management (100%), procedures (83%), and running a “code blue” (67%). Residents favored teaching that is procedural (78%), topic-specific (75%), and delivered in a one-on-one setting (63%). Conclusion: Residents identify the overnight intensivist as an impactful teacher. Other providers working in the intensive care unit overnight also contribute to resident education. Further study is needed on the educational roles of other multidisciplinary team members. There is opportunity to tailor overnight education both in content and style to suit learners’ needs.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90670478","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":"Altruism: Brief Review of Current Opinions and Implications on Community Emergency Medicine","authors":"Ej Oshionwu, E. Nwose","doi":"10.23937/2474-3674/1510066","DOIUrl":"https://doi.org/10.23937/2474-3674/1510066","url":null,"abstract":"There are several theories on altruism including the concept of pseudo-altruism. The latter constitute divergent opinion around egoism and socioeconomic status (SES). Review has identified that the conflict between altruistic and pseudo-altruistic theoretical approaches can be resolved by combining elements from both concepts. The objective of this commentary is to advance (1) That there is ‘benefit to the helping altruistic individual in all altruism theories; and (2) A unifying viewpoint in terms of benefit that while every altruistic act is an adaptive humanitarian behaviour that benefits another person who is primarily the beneficiary, the benefactor always has a benefit that is secondary. Thus, every genuine act of altruism can be easily erroneously deconstructed and reconstructed as pseudo-altruism, which disparages the benefactor and undermines the primary benefit. SES is associated with altruism, and the concept of socioeconomic inequalities in healthcare delivery is alluded to be a reflection of degeneration of altruistic behaviour in society. The famous Good Samaritan story is empirically reviewed to translate altruistic response of individuals of higher SES compared to those of lower counterpart in community health. The implications for health of individuals at the family level, and community-level emergency is briefly espoused. The correlation to current medical practice regarding treating patients with or without health insurance is drawn. A classical workplace experience is also presented to illustrate the current state of intimidation that influences altruism in contemporary healthcare practice.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85182440","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}