International Journal of Emergency Medicine最新文献

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A penetrating aortic ulcer rapidly evolving into aortic dissection in a patient presenting with respiratory tract infection to the emergency department: an acute aortic syndrome case report. 急诊科一名呼吸道感染患者的穿透性主动脉溃疡迅速演变为主动脉夹层:急性主动脉综合征病例报告。
IF 2
International Journal of Emergency Medicine Pub Date : 2024-10-02 DOI: 10.1186/s12245-024-00724-z
Victoria Al Karaki, Aed Saab
{"title":"A penetrating aortic ulcer rapidly evolving into aortic dissection in a patient presenting with respiratory tract infection to the emergency department: an acute aortic syndrome case report.","authors":"Victoria Al Karaki, Aed Saab","doi":"10.1186/s12245-024-00724-z","DOIUrl":"10.1186/s12245-024-00724-z","url":null,"abstract":"<p><strong>Background: </strong>Penetrating aortic ulcers (PAU) are life-threatening conditions which derive from severely advanced atherosclerotic lesions of the aorta. The clinical course is unpredictable; thus clinical vigilance should be maintained. It is very challenging to separate PAU from co-existing AAS as predisposing factors and findings overlap.</p><p><strong>Case presentation: </strong>Case of 58-year-old gentleman, who presented for atypical chest pain in the setting of respiratory tract infection. Computed Tomographic angiography (CTA) of the chest showed a large PAU and intramural hematoma which rapidly progressed into an acute aortic dissection in the emergency department. Close follow up with cardiac point of care ultrasound one hour later detected an intimal flap which was not initially present on CTA. Patient underwent surgical aortic graft replacement and had an uneventful in-hospital stay.</p><p><strong>Discussion: </strong>This case underlines the importance of broadening differential diagnoses in atypical presentations in patients with risk factors. Prompt intervention and careful management are imperative to optimize patient outcomes and prevent complications of aortic lesions. Cardiac point of care ultrasound can help in detecting progression of dynamic atherosclerotic diseases such as acute aortic syndrome.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"132"},"PeriodicalIF":2.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11445960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365170","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}
引用次数: 0
The Addis Ababa toxicology curriculum project: educational needs assessment for the toxicology modules of an emergency medicine training program. 亚的斯亚贝巴毒理学课程项目:急诊医学培训课程毒理学模块的教育需求评估。
IF 2
International Journal of Emergency Medicine Pub Date : 2024-10-02 DOI: 10.1186/s12245-024-00696-0
Anna Nowacki, Sofia Kebede, Margaret Thompson, Alexandra McKnight, Aklilu Azazh, Lisa M Puchalski Ritchie
{"title":"The Addis Ababa toxicology curriculum project: educational needs assessment for the toxicology modules of an emergency medicine training program.","authors":"Anna Nowacki, Sofia Kebede, Margaret Thompson, Alexandra McKnight, Aklilu Azazh, Lisa M Puchalski Ritchie","doi":"10.1186/s12245-024-00696-0","DOIUrl":"10.1186/s12245-024-00696-0","url":null,"abstract":"<p><strong>Background: </strong>The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) is a bi-institutional partnership between the University of Toronto (UofT) and Addis Ababa University (AAU) focused on addressing the need for emergency medicine (EM) postgraduate training and care in Ethiopia. Toxicology is a key competency in EM. EM physicians are often the first and sole clinicians to identify and treat patients presenting with a wide range of intoxications. The goal of this project was to conduct an educational needs assessment to inform the development of a context-specific toxicology curriculum for the AAU EM training program.</p><p><strong>Methods: </strong>Our needs assessment employed a survey (available electronically and in paper format) and face-to-face interviews conducted with Ethiopian EM faculty (all graduates of the AAU EM residency training program) and current AAU EM residents. The survey was distributed in October 2018 and the interviews were conducted in November 2018.</p><p><strong>Results: </strong>Of the 63 surveys distributed, we received 17 complete responses and completed 11 interviews with AAU EM faculty and residents. The survey conducted on toxicology training highlighted overall satisfaction with current training, with thematic analysis revealing key areas for growth. System-related themes focused on resource availability, healthcare access, and public health education. Provider-related themes emphasized the need for context-specific training, including common local toxins, and for advanced toxicology training such as poison center rotations. Patient-related themes centered on specific toxicological presentations in Ethiopia, highlighting the importance of public health advocacy, education on safe handling, and governmental regulation of toxic substances. Both survey and interview data highlighted challenges stemming from inconsistent availability of resources and underscored the need for tailored education to manage poisoned patients with locally available resources.</p><p><strong>Conclusions: </strong>Our findings indicate the need to focus on the most prevalent local toxicological presentations and practical management challenges in local contexts, including resource limitations and delayed presentations. Moreover, it emphasizes the importance of public health initiatives such as regulation of the sale and promotion of safe handling of toxic substances to mitigate toxicological risks. These findings are likely relevant to other resource-constrained settings outside of Ethiopia.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"131"},"PeriodicalIF":2.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365172","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}
引用次数: 0
Demographics and scope of Australian emergency department physiotherapists. 澳大利亚急诊科理疗师的人口统计和工作范围。
IF 2
International Journal of Emergency Medicine Pub Date : 2024-10-02 DOI: 10.1186/s12245-024-00719-w
Tina Vickery, Lindsey Brett, Taryn Jones
{"title":"Demographics and scope of Australian emergency department physiotherapists.","authors":"Tina Vickery, Lindsey Brett, Taryn Jones","doi":"10.1186/s12245-024-00719-w","DOIUrl":"10.1186/s12245-024-00719-w","url":null,"abstract":"<p><strong>Questions: </strong>To provide workforce data on the status of Australian Emergency Department (ED) physiotherapy practice, including physiotherapist demographic data, staffing levels and funding sources. Evaluate the scope of practice currently undertaken by ED physiotherapists and alignment of ED physiotherapy service provision with demand levels.</p><p><strong>Design: </strong>Cross sectional survey.</p><p><strong>Participants: </strong>Australian physiotherapists working within an Australian ED.</p><p><strong>Outcome measures: </strong>Workforce data, scope of practice and alignment of physiotherapy service provision to ED presentations and demand.</p><p><strong>Results: </strong>94 Australian ED physiotherapists completed the survey, 76.9% were working as primary contact clinicians. They had a diverse scope of practice, 100% perform mobility assessments, 89.9% provide care for paediatric patients and 10.1% were involved in administration of medications. 86.2% of participants (75/87) reported working within a service model that provided seven-day per week physiotherapy coverage to ED.</p><p><strong>Conclusion: </strong>The sample of ED physiotherapists were found to be experienced and highly trained clinicians with a diverse scope of practice, who are well placed to meet the unpredictable and highly variable patient caseload of Australian EDs.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"133"},"PeriodicalIF":2.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365171","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}
引用次数: 0
Anaphylactic reaction to tranexamic acid infusion in a six-year-old child: a case report. 一名六岁儿童输注氨甲环酸后出现过敏反应:病例报告。
IF 2
International Journal of Emergency Medicine Pub Date : 2024-09-30 DOI: 10.1186/s12245-024-00718-x
Nazanin Zibanejad, Nikta Nouri, Sharareh Babaie
{"title":"Anaphylactic reaction to tranexamic acid infusion in a six-year-old child: a case report.","authors":"Nazanin Zibanejad, Nikta Nouri, Sharareh Babaie","doi":"10.1186/s12245-024-00718-x","DOIUrl":"10.1186/s12245-024-00718-x","url":null,"abstract":"<p><strong>Background: </strong>Tranexamic acid (TXA) is commonly considered a safe drug to mitigate bleeding during and after various surgical settings among adults and children. In recent decades, anaphylaxis induced by TXA has been increasingly reported in adults. However, among pediatrics, there are fewer reported cases.</p><p><strong>Case presentation: </strong>We report a case of a 6-year-old female who experienced anaphylaxis after receiving intravenous TXA following unilateral cleft lip and palate repair surgery. She exhibited clinical symptoms involving the cardiovascular system, respiratory system, and skin. Following the administration of epinephrine, corticosteroid, and anti-histamine, the patient's symptoms were relieved. A few months after discharge, an intradermal test, yielded a positive result, confirming TXA as the culprit drug.</p><p><strong>Conclusion: </strong>Our report emphasizes the importance of considering anaphylaxis as a potential adverse reaction to TXA in pediatric patients, showing the criticality of rapid diagnosis and appropriate management for a successful outcome.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"129"},"PeriodicalIF":2.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11441140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346180","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}
引用次数: 0
Frontoparietal intraparenchymal hemorrhage secondary to anticoagulation. 继发于抗凝治疗的额顶叶脑实质内出血。
IF 2
International Journal of Emergency Medicine Pub Date : 2024-09-30 DOI: 10.1186/s12245-024-00723-0
Savitra Ward, Benjamin Colaco Jamal, Latha Ganti
{"title":"Frontoparietal intraparenchymal hemorrhage secondary to anticoagulation.","authors":"Savitra Ward, Benjamin Colaco Jamal, Latha Ganti","doi":"10.1186/s12245-024-00723-0","DOIUrl":"10.1186/s12245-024-00723-0","url":null,"abstract":"<p><p>The authors present the case of a patient experiencing frontoparietal intraparenchymal hemorrhage. With a history of a mechanical heart valve due to rheumatic disease, the patient was on warfarin and experienced a warfarin-associated bleed. The new 2002 guidelines for the management of intracerebral hemorrhage are discussed in the context of this case.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"130"},"PeriodicalIF":2.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346183","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}
引用次数: 0
Red blood cell transfusion in a tertiary Haitian hospital's emergency department: patient characteristics and availability challenges. 海地一家三甲医院急诊科的红细胞输注:患者特点和供应挑战。
IF 2
International Journal of Emergency Medicine Pub Date : 2024-09-27 DOI: 10.1186/s12245-024-00672-8
Flawendjee Djaweelentz Jacques, Samentha Cyndie Julmisse, Ange Cindy Laurore, Ralph Mackenson Lefruit, Maurice Junior Chery, Kobel Dubique
{"title":"Red blood cell transfusion in a tertiary Haitian hospital's emergency department: patient characteristics and availability challenges.","authors":"Flawendjee Djaweelentz Jacques, Samentha Cyndie Julmisse, Ange Cindy Laurore, Ralph Mackenson Lefruit, Maurice Junior Chery, Kobel Dubique","doi":"10.1186/s12245-024-00672-8","DOIUrl":"https://doi.org/10.1186/s12245-024-00672-8","url":null,"abstract":"<p><strong>Background: </strong>Red blood cell (RBC) transfusions are essential for many patients admitted to emergency departments (ED). However, accessibility to red cell transfusions is often limited, especially in low-income countries such as Haiti. This article aims to determine the proportion of patients requiring emergency transfusion, transfused patients' characteristics, as well as the response rate and timeliness of blood product delivery for requests made.</p><p><strong>Methods: </strong>A retrospective study was conducted among all patients with RBC transfusion indications from January to June 2022 at the ED of Mirebalais Teaching Hospital. The parameters studied included transfusion indications, pre-transfusion hemoglobin levels, and delay from prescription to transfusion.</p><p><strong>Results: </strong>During the study period, 3993 patients received treatment in the ED. The proportion of patients requiring RBCs was 7.69%, including 145 males and 117 females, with a median age of 43 [30-56] years. Only 21.7% of these patients received a transfusion. The average pre-transfusion hemoglobin level was 4.75 ± 1.68 g/dL. The most common transfusion's indications were infection/sepsis (36.74%), trauma (23.48%), and cancer (21.57%). The median time delay from prescription to transfusion was 2.37 [0.97-4.93] days. The study identified significant associations between RBC transfusion probability and patient factors like hemoglobin levels, patient disposition, urgency of RBC request, and length of stay.</p><p><strong>Conclusion: </strong>RBC transfusion requests are frequent in the ED of Mirebalais Teaching Hospital, with a relatively high transfusion delay. Further studies on the relevance of RBC requests and ways to reduce delay from prescription to transfusion would be beneficial to improve this situation.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"128"},"PeriodicalIF":2.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346185","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}
引用次数: 0
Characteristics and outcomes of emergency department patients across health care systems: an international multicenter cohort study. 不同医疗系统急诊科患者的特征和治疗效果:一项国际多中心队列研究。
IF 2
International Journal of Emergency Medicine Pub Date : 2024-09-27 DOI: 10.1186/s12245-024-00715-0
Bas de Groot, Nicoline T C Meijs, Michelle Moscova, Wouter Raven, Menno I Gaakeer, Wendy A M H Thijssen, Heleen Lameijer, Amith Shetty, Annmarie T Lassen
{"title":"Characteristics and outcomes of emergency department patients across health care systems: an international multicenter cohort study.","authors":"Bas de Groot, Nicoline T C Meijs, Michelle Moscova, Wouter Raven, Menno I Gaakeer, Wendy A M H Thijssen, Heleen Lameijer, Amith Shetty, Annmarie T Lassen","doi":"10.1186/s12245-024-00715-0","DOIUrl":"https://doi.org/10.1186/s12245-024-00715-0","url":null,"abstract":"<p><strong>Background: </strong>A wide variation of emergency medical system configurations across countries has limited the value of comparison of quality and performance measures in the past. Furthermore, lack of quantitative data on EDs prevents definition of the problems and possibilities for data driven improvement of quality of care. Therefore, the objective is to describe and compare Emergency Department (ED) populations and characteristics, and their outcomes in the Netherlands, Denmark and Australia, using a recently developed template for uniform reporting of standardized measuring and describing of care provided in the ED (structure, staffing and governance, population, process times and outcomes).</p><p><strong>Methods: </strong>This international multicenter cohort included all consecutive ED visits from National Quality Registries or Databases from participating sites from three countries. Patient and ED characteristics (using the template for uniform reporting) and relevant clinical outcomes were described and compared per country.</p><p><strong>Results: </strong>We included 212,515 ED visits in the Netherlands, 408,673 in Denmark and 556,652 in Australia. Patient characteristics differed markedly, with Australian ED patients being younger, less often triaged as \"immediate\", and less often triaged with the high-risk chief complaints \"feeling unwell\" compared to Danish and Dutch patients. ED characteristics mainly differed with respect to the mean annual census per ED (Netherlands 26,738 (SD 2630), Denmark 36,675 (SD 12974), Australia 50,712 (4884)), median (IQR) lengths of stay of patients discharged home (Netherlands 2.1 (1.4-3.1); Denmark 2.8 (1.7-5.0); Australia 3.3 (2.0-5.0) hrs) and proportion of hospitalizations (ranging from 30.6 to 39.8%). In-hospital mortality was 4.0% in Australia, higher compared to the Netherlands and Denmark (both 1.6%). Not all indicators of the framework were available in all registries.</p><p><strong>Conclusions: </strong>Patient and ED characteristics and outcomes varied largely across countries. Meaningful interpretation of outcome differences across countries could be improved if quality registries would more consistently register the measures of the recently developed template for uniform reporting.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"123"},"PeriodicalIF":2.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11437790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346181","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}
引用次数: 0
Development of decision tree classification algorithms in predicting mortality of COVID-19 patients. 开发决策树分类算法,预测 COVID-19 患者的死亡率。
IF 2
International Journal of Emergency Medicine Pub Date : 2024-09-27 DOI: 10.1186/s12245-024-00681-7
Zahra Mohammadi-Pirouz, Karimollah Hajian-Tilaki, Mahmoud Sadeghi Haddat-Zavareh, Abazar Amoozadeh, Shabnam Bahrami
{"title":"Development of decision tree classification algorithms in predicting mortality of COVID-19 patients.","authors":"Zahra Mohammadi-Pirouz, Karimollah Hajian-Tilaki, Mahmoud Sadeghi Haddat-Zavareh, Abazar Amoozadeh, Shabnam Bahrami","doi":"10.1186/s12245-024-00681-7","DOIUrl":"https://doi.org/10.1186/s12245-024-00681-7","url":null,"abstract":"<p><strong>Introduction: </strong>The accurate prediction of COVID-19 mortality risk, considering influencing factors, is crucial in guiding effective public policies to alleviate the strain on the healthcare system. As such, this study aimed to assess the efficacy of decision tree algorithms (CART, C5.0, and CHAID) in predicting COVID-19 mortality risk and compare their performance with that of the logistic model.</p><p><strong>Methods: </strong>This retrospective cohort study examined 5080 cases of COVID-19 in Babol, a city in northern Iran, who tested positive for the virus via PCR from March 2020 to March 2022. In order to check the validity of the findings, the data was randomly divided into an 80% training set and a 20% testing set. The prediction models, such as Logistic regression models and decision tree algorithms, were trained on the 80% training data and tested on the 20% testing data. The accuracy of these methods for the test samples was assessed using measures like ROC curve, sensitivity, specificity, and AUC.</p><p><strong>Results: </strong>The findings revealed that the mortality rate for COVID-19 patients who were admitted to hospitals was 7.7%. Through cross validation, it was determined that the CHAID algorithm outperformed other decision tree and logistic regression algorithms in specificity, and precision but not sensitivity in predicting the risk of COVID-19 mortality. The CHAID algorithm demonstrated a specificity, precision, accuracy, and F-score of 0.98, 0.70, 0.95, and 0.52 respectively. All models indicated that factors such as ICU hospitalization, intubation, age, kidney disease, BUN, CRP, WBC, NLR, O2 sat, and hemoglobin were among the factors that influenced the mortality rate of COVID-19 patients.</p><p><strong>Conclusions: </strong>The CART and C5.0 models had outperformed in sensitivity but CHAID demonstrates a better performance compared to other decision tree algorithms in specificity, precision, accuracy and shows a slight improvement over the logistic regression method in predicting the risk of COVID-19 mortality in the population under study.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"126"},"PeriodicalIF":2.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346182","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}
引用次数: 0
A 26 years old primigravida woman presented with abdominal cutaneous entrapment syndrome: a case report. 一名 26 岁初产妇的腹部皮肤夹层综合征病例报告。
IF 2
International Journal of Emergency Medicine Pub Date : 2024-09-27 DOI: 10.1186/s12245-024-00720-3
Melaku Tsediew Berhanu, Molla Asnake Kebede, Adamu Tigabu Tessfaw, Alemayehu Beharu Tekle, Anteneh Messele Birhanu, Meron Teka Deresa
{"title":"A 26 years old primigravida woman presented with abdominal cutaneous entrapment syndrome: a case report.","authors":"Melaku Tsediew Berhanu, Molla Asnake Kebede, Adamu Tigabu Tessfaw, Alemayehu Beharu Tekle, Anteneh Messele Birhanu, Meron Teka Deresa","doi":"10.1186/s12245-024-00720-3","DOIUrl":"https://doi.org/10.1186/s12245-024-00720-3","url":null,"abstract":"<p><strong>Background: </strong>Abdominal cutaneous nerve entrapment syndrome (ACNES) is characterized by severe, mostly refractory, chronic pain due to the entrapment of the cutaneous branches of the lower torso intercostal nerves at the lateral edge of the rectus abdominis muscle. ACNES is rare compared to other pregnancy-related peripheral neuropathies and is often overlooked as a differential diagnosis for abdominal pain, despite the diagnosis relying primarily on patient history and physical examination. Emergency physicians and other medical personnel's lack of exposure to such cases results in unnecessary laboratory requests, repeated visits, and increased fear and tension for the patient.</p><p><strong>Case presentation: </strong>A 26-year-old primigravida on her second trimester of pregnancy presented to our Emergency department with persistent localized right upper quadrant abdominal pain. Despite repeated visit to the nearby hospital, no diagnosis was settled and the pain persisted. At our ED after a thorough history, physical examination and diagnostic test no abnormality was found. Finally Abdominal cutaneous nerve entrapment syndrome (ACNES) was considered and a mixture of 1 ml 2% lidocaine with adrenaline and 1 ml dexamethasone (4 mg) was infiltrated into the fascial plane in a fanning fashion into the most tender area using a modified technique and the patient reported significant improvement in pain.</p><p><strong>Conclusion: </strong>Abdominal cutaneous nerve entrapment syndrome (ACNES) is a cause of abdominal pain in pregnancy that is often overlooked. The objective of this study is to describe a rare case of ACNES in a 26-year-old primigravida woman who presented to a low-resource emergency department to assist patient management.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"124"},"PeriodicalIF":2.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346179","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}
引用次数: 0
Predictors of nursing home conveyances to emergency department. 养老院转送急诊的预测因素。
IF 2
International Journal of Emergency Medicine Pub Date : 2024-09-27 DOI: 10.1186/s12245-024-00697-z
Keerthana, Yee Har Liew, Mui Hua Jean Lee, Chong Yau Ong
{"title":"Predictors of nursing home conveyances to emergency department.","authors":"Keerthana, Yee Har Liew, Mui Hua Jean Lee, Chong Yau Ong","doi":"10.1186/s12245-024-00697-z","DOIUrl":"https://doi.org/10.1186/s12245-024-00697-z","url":null,"abstract":"<p><strong>Background: </strong>With increasing rates of patient conveyances from nursing homes to emergency departments worldwide, we aim to examine factors causing high rates of conveyances from nursing homes to the emergency department (ED) of an acute tertiary hospital.</p><p><strong>Methods: </strong>This was a prospective study involving presentation of ED attendances from nursing home residents during out-of-hours over a 23-month period from April 2020 to February 2022. Data was collected from a standardized manual form used by the Emergency Department to document nursing home conveyances.</p><p><strong>Results: </strong>A total of 338 pre-conveyance forms were reviewed. The most common reasons for conveyances to ED were neurological symptoms (16%), unstable hemodynamics (12%), fever (11%) and falls (10%). The peak conveyances occurred between 1600 and 1900 h on weekends. Respiratory rate, oxygenation requirements and high National Early Warning Score (NEWS) were significantly associated with increased conveyances to the emergency department. When the components of NEWS were analyzed individually, decision for ambulance conveyance to emergency department was significantly associated with respiratory rate (p < .001), oxygen saturation (p < .001), and the use of oxygen supplementation (p < .005).</p><p><strong>Conclusions: </strong>Unstable hemodynamics and falls were among the leading factors for nursing home conveyances to the emergency department, which highlights the need to implement better fall prevention strategies and standardized parameters monitoring in nursing homes. Future research should focus on outcomes of conveyances and the characteristics of nursing home with higher conveyance rates. This would aid to assess the appropriateness of conveyances and to identify strategies to decrease preventable conveyances.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"127"},"PeriodicalIF":2.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346184","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}
引用次数: 0
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