Journal of acute medicine最新文献

{"title":"A 44-Year-Old Man With Acute Mutism: Acute Stroke, Psychiatric Disorder, or Substance Abuse?","authors":"Po-Hsiang Liao, H. Chiu, Tse-Yao Wang, Yen-Chia Chen","doi":"10.6705/j.jacme.202203_12(1).0005","DOIUrl":"https://doi.org/10.6705/j.jacme.202203_12(1).0005","url":null,"abstract":"Mutism is a common presentation of psychiatric diseases. However, patients presenting to the emergency department with mutism should be assumed to have an organic pathology irrespective of their psychiatric history. Little is known about the causality between mutism and illicit drug use. We report a case of a 44-year-old man with acute mutism who was initially diagnosed with ischemic cerebral infarction involving the dorsolateral frontal cortex causing Broca's aphasia. He was later found to have a history of amphetamine, ketamine, and new psychoactive substance use. Substance abuse could be a precipitating factor for acute stroke, especially among patients aged below 55 years. Patients should be routinely screened and counseled regarding illicit drug use. The present case report highlights the possibility that transient ischemia could be associated with acute mutism in drug abusers. Prompt acquisition of drug abuse history or basic drug screening is especially mandatory.","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 1 1","pages":"34-38"},"PeriodicalIF":0.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44442508","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":"Management and Prognosis of Snake Envenomation Among Pediatric Patients: A National Database Study.","authors":"Lin-Chi Chiang, C. Chaou, Yi-yun Li, C. Seak, Shiuan-Ruey Yu, Chih-Chuan Lin","doi":"10.6705/j.jacme.202203_12(1).0002","DOIUrl":"https://doi.org/10.6705/j.jacme.202203_12(1).0002","url":null,"abstract":"Background\u0000Snakebites constitute a common medical emergency in tropical and subtropical regions. Pediatric snake envenomation is a special category that has not been well studied. This study investigated the management and prognostic factors of snake envenomation in children using a Taiwanese national database.\u0000\u0000\u0000Methods\u0000This observational study used the National Health Insurance database of all pediatric snake envenomation patients treated from 2005 to 2009. Patients' demographic data, antivenom types and doses, medical and surgical interventions, and prognostic variables were collected. Comparisons were made according to the envenomation types, age groups, and whether the patients were hospitalized using univariate and multivariate methods.\u0000\u0000\u0000Results\u0000A total of 106 patients' data were collected. Of the patients, 73 (68.9%) were male, 62 (58.5%) were under the age of 12, 69 (65.1%) received intravenous (IV) antibiotic treatment, 38 (35.9%) were hospitalized, 5 (4.72%) required surgical intervention, and none died. Compared with non-hospitalized patients, the patients who required hospitalization were more likely to have suffered hemorrhagic envenomation ( p = 0.035), receive IV antibiotic treatment ( p = 0.0078), and require surgical intervention ( p = 0.005). In the multivariate analysis, hemorrhagic envenomation was an independent predictor for hospitalization (odds ratio: 3.47, 95% confidence interval: 1.18-10.21) after adjusting for other covariates. No significant differences were observed between age groups in total antivenom usage ( p = 0.2880), IV antibiotic usage ( p = 0.3190), hospitalization ( p = 0.3988), and surgical intervention ( p = 0.1874).\u0000\u0000\u0000Conclusions\u0000In this Taiwanese population-based national database study, antivenom treatment of pediatric snakebite patients resulted in zero mortality and a low surgical intervention rate. Patients with hemorrhagic envenomation were associated with a higher probability of hospitalization.","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 1 1","pages":"13-22"},"PeriodicalIF":0.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43239434","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":"Shock Management Without Formal Fluid Responsiveness Assessment: A Retrospective Analysis of Fluid Responsiveness and Its Outcomes.","authors":"Andrew Hong,&nbsp;Nicholas Villano,&nbsp;William Toppen,&nbsp;Montoya Elizabeth Aquije,&nbsp;David Berlin,&nbsp;Maxime Cannesson,&nbsp;Igor Barjaktarevic","doi":"10.6705/j.jacme.202112_11(4).0002","DOIUrl":"https://doi.org/10.6705/j.jacme.202112_11(4).0002","url":null,"abstract":"<p><strong>Background: </strong>In order to quantify fluid administration and evaluate the clinical consequences of conservative fluid management without hemodynamic monitoring in undifferentiated shock, we analyzed previously collected data from a study of carotid Doppler monitoring as a predictor of fluid responsiveness (FR).</p><p><strong>Methods: </strong>This study was a retrospective analysis of data collected from a single tertiary academic center from a previous study. Seventy-four patients were included for post-hoc analysis, and 52 of them were identified as fluid responsive (cardiac output increase > 10% with passive leg raise) according to NICOMTM bioreactance monitoring (Cheetah Medical, Newton Center, MA, USA). Treating teams provided standard of care conservative fluid resuscitation but were blinded to independently performed FR testing results. Outcomes were compared between fluid responsive and fluid non-responsive patients. Primary outcome measures were volume fluids administered and net fluid balance 24- and 72-hour post-FR assessment. Secondary outcome measures included change in vasopressor requirements, mean peak lactate levels, length of hospital/intensive care unit stay, acute respiratory failure, hemodialysis requirement, and durations of vasopressors and mechanical ventilation.</p><p><strong>Results: </strong>Mean fluids administered within 72 hours were similar between fluid non-responsive and fluid responsive patients (139 mL/kg [95% confidence interval [CI]: 102.00-175.00] vs. 136 mL/kg [95% CI: 113.00-158.00], p = 0.92, respectively). We observed an insignificant trend toward higher 28-day mortality among fluid non-responsive patients (36% vs. 19%, p = 0.14). Volume of fluids administered significantly correlated with adverse outcomes such as increased hemodialysis requirements (32 patients, 43%), (odds ratio [OR] = 1.7200, p = 0.0018). Subgroup analysis suggested administering ≥ 30 mL/kg fluids to fluid responsive patients had a trend toward increased mortality (25% vs. 0%, p = 0.09) and a significant increase in hemodialysis (55% vs. 17%, p = 0.024).</p><p><strong>Conclusions: </strong>Without formal FR assessment, similar amounts of total fluids were administered in both fluid responsive and non-responsive patients. As greater volumes of intravenous fluids administered were associated with adverse outcomes, we suggest that dedicated FR assessment may be a beneficial utility in early shock resuscitation.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"11 4","pages":"129-140"},"PeriodicalIF":0.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743191/pdf/jacme-11-4-02.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39914920","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":"An Unusual Presentation of Posterior Reversible Encephalopathy Syndrome.","authors":"Yu-Chun Liu,&nbsp;Jiann Ruey Ong","doi":"10.6705/j.jacme.202112_11(4).0005","DOIUrl":"https://doi.org/10.6705/j.jacme.202112_11(4).0005","url":null,"abstract":"Epilepsy is one of the most common reasons for patients presenting to the emergency department (ED). However, epilepsy events have a variety of causes, which we tend to ignore. The leading cause is renal artery dissection with renal infarction. The case reported herein is of a patient without a medical history of epilepsy who presented to the ED with sudden epileptic seizures caused by malignant hypertension.","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"11 4","pages":"150-152"},"PeriodicalIF":0.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743192/pdf/jacme-11-4-05.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39914923","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":"A Female Patient With a Urinary Tract Infection and Multiple Vaginal Ulcers.","authors":"Min-Yi Hsieh,&nbsp;Tzen-Tak Lee,&nbsp;Jung-Mou Yang,&nbsp;Hung-Chun Chung","doi":"10.6705/j.jacme.202112_11(4).0006","DOIUrl":"https://doi.org/10.6705/j.jacme.202112_11(4).0006","url":null,"abstract":"<p><p>This report is to describe a rare case of urinary tract infection (UTI) with multiple vaginal ulcers. In the report, the 45-year-old female patient was diagnosed with a UTI, but white blood cells and neutrophil are higher than reference value. A vaginal ultrasound was performed with a positive fi nding of uterine myoma and multiple painless vaginal ulcers in the vaginal wall. Also, elevated antinuclear antibodies were found. After treated with antibiotic, self-healed vaginal ulcers were observed even without topical ointment use for vaginal ulcers. In conclusion, UTIs are a common disease in females. This is a rare case of a UTI with multiple vaginal ulcers. Observation of the genital condition is necessary if a woman has a UTI. Treating the source of the UTI is necessary, and the vaginal ulcerations also require appropriate treatment and follow up.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"11 4","pages":"153-157"},"PeriodicalIF":0.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743194/pdf/jacme-11-4-06.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39914924","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":"A Man With Right-Sided Weakness.","authors":"Jen-Chih Tsai,&nbsp;Kai-Yuan Cheng,&nbsp;Ming-Jen Tsai","doi":"10.6705/j.jacme.202112_11(4).0007","DOIUrl":"https://doi.org/10.6705/j.jacme.202112_11(4).0007","url":null,"abstract":"A-57-year-old deaf-mute male with type 2 diabetes and a history of HIV infection receiving Odefsey treatment presented to the ED with right-sided weakness, headache, poor appetite, and loss of spirit for 2 weeks. On arrival, his temperature was 38°C, the pulse was irregular at 148 beats per minute, and the blood pressure was 123/88 mmHg. Physical examination showed right-sided weakness. The muscle strength of both right upper and lower limbs was grade 3. Electrocardiogram showed atrial fibrillation with rapid ventricular response. The laboratory tests showed elevation of C-reactive protein (6.35 mg/dL), but white blood cell count (8,600/uL), procalcitonin (0.19 ng/mL), renal and liver functions tests, and urinalysis were all within normal range. The chest X-ray revealed cardiomegaly and mild pulmonary congestion. Brain computed tomography (CT) for a suspected stroke was arranged (Fig. 1).","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"11 4","pages":"158-161"},"PeriodicalIF":0.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743193/pdf/jacme-11-4-07.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39914925","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":"Pre- and Post-Implementation of One-Hour Rule for the Boarding of Referral of Critically Ill Patients in the Emergency Department.","authors":"Chia-Fen Yang,&nbsp;Kuang-Leei Chang,&nbsp;Chee-Seong Phan,&nbsp;Fei-Yi Lin,&nbsp;Yao-Dong Wang,&nbsp;Sai-Wai Ho","doi":"10.6705/j.jacme.202112_11(4).0003","DOIUrl":"https://doi.org/10.6705/j.jacme.202112_11(4).0003","url":null,"abstract":"<p><p>In 2017, the Taiwan Ministry of Health and Welfare established a regional electronic referral system in Central Taiwan to streamline transfers of critically ill patients from the intensive care unit (ICU) of a regional hospital to a medical hospital center. Moreover, in 2018, a one-hour rule for the boarding of referral of critically ill patients from emergency department (ED) to ICU was implemented. This pre- and post-implementation study enrolled consecutive critically ill referral patients from a single academic medical center hospital from January 1, 2017 to December 31, 2018. After implementation of the one-hour rule, two interventions, namely, active bed management before patient arrival and no requirement for laboratory test results to be completed before ICU admissions, were used to improve patient flow in the ED. After implementation of one-hour rule, the proportion of patients transferred to the ICU within 1 hour increased from 3.1% to 65.9% (p < 0.001). Median ED length of stay (LOS) reduced from 129.5 minutes to 52.0 minutes (p < 0.001). The overall mortality rate decreased from 34.4% to 26.8%, without a significant difference. In conclusion, the implementation of the one-hour rule for the boarding of referral of critically ill patients in the ED is safe and possible. Achieving the target significantly reduced ED LOS by 77.5 minutes without an increase in patient mortality rate.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"11 4","pages":"141-145"},"PeriodicalIF":0.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743190/pdf/jacme-11-4-03.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39914921","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":"Using Container Houses to Reduce the Risks to Health-Care Workers While Performing the Throat Swab Test and Blood Sampling for SARS-CoV-2.","authors":"Yang-Tse Lin,&nbsp;Yu-Chi Tseng,&nbsp;Chan-Peng Hsu","doi":"10.6705/j.jacme.202112_11(4).0004","DOIUrl":"https://doi.org/10.6705/j.jacme.202112_11(4).0004","url":null,"abstract":"<p><p>Coronavirus disease 2019 (COVID-19) is still pandemic all over the world. Patients requesting screening in emergency departments (ED) have continually increased. Establishing additional screening stations outside of the ED to increase the number of patients tested and protect the safety of health care workers poses an urgent challenge. We employed a container house near the entrance of an ED to create an outdoor screening station, which separates suspected patients of COVID-19 from regular emergency patients to prevent cross infections. In our experience, a container house station can not only provide additional screen area but also reduce the consumption of personal protective equipment. Container houses are sturdier than tents and can be fully assembled rapidly. Appropriate protective equipment can be installed with them to fulfi ll demands for COVID-19 screening.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"11 4","pages":"146-149"},"PeriodicalIF":0.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743189/pdf/jacme-11-4-04.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39914922","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":"Use of Opioids and Outcomes of Pneumonia: Results From the US Nationwide Inpatient Sample.","authors":"Yeongjun James Park,&nbsp;Chia-Hung Yo,&nbsp;Wan-Ting Hsu,&nbsp;Eric Po-Yang Tsou,&nbsp;Yu-Chiang Wang,&nbsp;Dean-An Ling,&nbsp;An-Fu Lee,&nbsp;Michael A Liu,&nbsp;Chien-Chang Lee","doi":"10.6705/j.jacme.202112_11(4).0001","DOIUrl":"https://doi.org/10.6705/j.jacme.202112_11(4).0001","url":null,"abstract":"<p><strong>Background: </strong>Opioids have been shown to increase risk of pneumonia among susceptible population. However, the effect of opioid abuse on the outcome of pneumonia has not been evaluated at the population level. We aimed to compare the outcomes of pneumonia among patients with opioid use disorder and patients without substance use disorder using a large population database.</p><p><strong>Methods: </strong>We assembled a pneumonia cohort composed of 11,186,564 adult patients from the National Inpatient Sample (NIS; 2005-2014). Patients with opioid disorder were identified using the International Classification of Diseases, 9th Revision, Clinical Modification codes. We compared health-related and economic outcomes between patients with and without opioid disorders using propensity score matching (PSM) analysis to balance baseline differences. The survival differences between two groups of patients were assessed using a Cox proportional hazard model. We further explored the possibility of effect modification by interaction analyses in different populations.</p><p><strong>Results: </strong>After PSM, patients with opioid use disorder were at increased risk of ventilator use (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.08 to 1.38, p = 0.0014) and associated with increased length of hospital stay by 0.59 days (95% CI: 0.35 to 0.83, p < 0.001), compared with those without substance use disorder. Patients with opioid use also had higher daily (228.00 USD, 95% CI: 180.51 to 275.49, p < 0.001) and total (1,875.72 USD, 95% CI: 1,259.63 to 2,491.80, p < 0.001) medical costs. Subgroup analyses showed similar results.</p><p><strong>Conclusions: </strong>Compared with patients without any drug dependence, patients with opioid use disorders had increased risk of complications and resource utilization. This study adds evidence for increased risk for pneumonia complications in the growing patients with opioid use disorders.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"11 4","pages":"113-128"},"PeriodicalIF":0.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8748203/pdf/jacme-11-4-01.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39741508","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":"Woman With Ptosis.","authors":"Li-Hsiu Tai,&nbsp;Sai-Wai Ho","doi":"10.6705/j.jacme.202109_11(3).0006","DOIUrl":"https://doi.org/10.6705/j.jacme.202109_11(3).0006","url":null,"abstract":"An 87-year-old woman, with a medical history of type 2 diabetes mellitus, hypertension, and dementia, reported right ptosis and ophthalmoplegia for 6 days. On arrival at the emergency department (ED), the patient was alert and oriented without acute distress. Her body temperature was 35.7°C, her heart rate was 82 beats/min, her respiratory rate was 16 breaths/min, and her blood pressure was 147/66 mm Hg. Tracing back her history, the patient had chronic nasal congestion for 1 year. There was no fever and no headache. Neurological examination showed paralysis of the right oculomotor nerve, presenting with right eye ptosis, mydriasis, and outer-down position. The blood laboratory results were unremarkable. Cranial computed tomography (CT) revealed a heterogeneous mass with calcifi cations in the right maxillary and left sphenoid sinuses with bony erosion (Fig. 1). Subsequently, contrast-enhanced magnetic resonance imaging (MRI) was performed, which showed a hypointense lesion with peripheral enhancement over the left sphenoid, right maxillary, right ethmoid sinuses, and compression of the right inferior rectus muscle (Fig. 2). After surgical debridement was performed, the pathology report of the specimen revealed aspergillosis. Antibiotics were discontinued and anti-fungal agents were started. Afrer 1 month after the initial treatment passed, she was able to the right eye halfway.","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"11 3","pages":"108-109"},"PeriodicalIF":0.6,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8440440/pdf/jacme-11-3-06.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39475500","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}