Journal of acute medicine最新文献

{"title":"Left Shoulder Pain After a Motorcycle Accident.","authors":"Hao-Hsuan Wang, Choon-Bing Chua","doi":"10.6705/j.jacme.202406_14(2).0006","DOIUrl":"10.6705/j.jacme.202406_14(2).0006","url":null,"abstract":"","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"14 2","pages":"98-99"},"PeriodicalIF":0.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11153315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296098","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":"Fenitrothion (Sumithion) Poisoning-Related Fasciculations Successfully Managed With Levetiracetam: A Case Report.","authors":"Hiroshi Ito, Toshiya Nakashima, Satoshi Kobanawa, Jura Oshida, Taisuke Kodama, Sayato Fukui, Daiki Kobayasi","doi":"10.6705/j.jacme.202406_14(2).0004","DOIUrl":"10.6705/j.jacme.202406_14(2).0004","url":null,"abstract":"<p><p>Fenitrothion is one of the most globally used organophosphorus pesticides, which can cause neurological symptoms, including involuntary movements. However, due to the limited number of case report, information on its treatment is also scarce. Here we presented a 74-year-old Japanese woman who was admitted to our hospital due to a persistent nausea and vomiting after ingesting 200 mL of 50% fenitrothion for a suicidal attempt. She received continuous intravenous infusion of atropine and 2-pyridine aldoxime methiodide under mechanical ventilation and continuous hemodiafiltration. However, she developed fasciculations of the face and right arm on day 11, which raised suspicions of delayed neuropathy associated with organophosphorus poisoning. To reduce the risk of respiratory depression, she received intravenous levetiracetam at a dosage of 1,000 mg/day. However, as her fasciculations persisted, the levetiracetam dosage was adjusted to 2,000 mg/day on day 14. On the following day, her fasciculations subsided. Neurologic symptoms of lipid-soluble organophosphorus poisoning, including fenitrothion, can sometimes delay following ingestion. Temporary administration of levetiracetam may prove effective in alleviating fasciculations.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"14 2","pages":"90-93"},"PeriodicalIF":0.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11153314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296097","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":"Toxic Epidermal Necrolysis After COVID-19 Vaccination: A Case Report and Review of Literature.","authors":"Sachin Wali, Shreyas Gutte, Gaurav Pandey, Ajit Kumar, Mohan Gurjar, Jitendra Singh Chahar","doi":"10.6705/j.jacme.202406_14(2).0005","DOIUrl":"10.6705/j.jacme.202406_14(2).0005","url":null,"abstract":"<p><p>Following vaccination for COVID-19, various cutaneous adverse reactions (CARs) are reported. Here is an Asian male in late 50's who developed necrotic skin with mucosal involvement 10 days following booster dose of ChAdOx1 nCov-19 vaccination. Based on disease course and morphology, toxic epidermal necrolysis (TEN) was suspected. The patient developed respiratory distress and was intubated, intravenous immunoglobulin (IVIG) administered at 2 g/kg body weight following which skin lesions healed in fourth week, the patient was discharged after 50 days of intensive care unit (ICU) stay. Severe CARs are rare following vaccination, of two components in ChAdOx1nCoV-19 adenoviral vector vaccine, virotopes cause T-cell mediated granulysin and granzyme B release leading to epidermal detachment and mucosal involvement of conducting airways causing respiratory failure. CARs can also occur in whom first and second dose was uneventful. Supportive therapy and prevention of sepsis are mainstay of management. Though the use of IVIG has shown conflicting results, our case was successfully managed with IVIG.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"14 2","pages":"94-97"},"PeriodicalIF":0.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11153313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296100","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":"Point-of-Care Ultrasound in the Emergency Department: Training, Perceptions, Applications, and Barriers from Different Healthcare Professionals.","authors":"Jack Healy, Ching-Fang Tiffany Tzeng, Jon Wolfshohl, Andrew Shedd, Judy Lin, Chinmay Patel, Eric H Chou","doi":"10.6705/j.jacme.202406_14(2).0003","DOIUrl":"10.6705/j.jacme.202406_14(2).0003","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) is a valuable tool that assists in diagnosis and management of patients in the emergency department (ED) while being cost-efficient and without the use of ionizing radiation. To discern the opinions and perceptions of ED staff about POCUS applications and barriers, we conducted a cross-sectional survey of employees of 12 EDs in North Texas.</p><p><strong>Methods: </strong>Participants completed a 20-item online survey about POCUS with questions pertaining to four domains: (1) employee and training information, (2) perceived benefits, (3) common applications, and (4) barriers to use. Out of 805 eligible ED employees, 103 completed the survey (16.1% response rate).</p><p><strong>Results: </strong>The results indicated a generally positive perception of POCUS among all employee types. Physician had significant exposure and training of POCUS than non-physician group ( <i>p</i> < 0.001). Physicians tend to find cardiac assessments more useful for clinical management than non-physicians (47% vs. 23%, <i>p</i> = 0.01), while non-physicians find soft tissue/abscess assessments more useful (27% vs. 9%, <i>p</i> = 0.01).</p><p><strong>Conclusion: </strong>The most significant barriers to POCUS use were time constraints for physicians and a lack of training for non-physician employees. Our study provides valuable insights into the perceptions of multiple ED professionals, serving as a foundation for promoting POCUS use in the ED.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"14 2","pages":"74-89"},"PeriodicalIF":0.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300720","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":"Multi-Organ Systems Involvement in COVID-19 is Associated With a Worse Prognosis.","authors":"Eric Lam, Sandra Gomez-Paz, Luis Fernando Gonzalez-Mosquera, Steven Mirabella, Diana Cardenas-Maldonado, Joshua Fogel, Sofia Rubinstein","doi":"10.6705/j.jacme.202406_14(2).0002","DOIUrl":"10.6705/j.jacme.202406_14(2).0002","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 (COVID-19) has multiple organ system involvement but the association of organ system involvement with disease prognosis has not been reported. We study the association of organ systems involved with in-hospital mortality and hospital length of stay (LOS) in COVID-19.</p><p><strong>Methods: </strong>Retrospective study of 808 consecutive patients with confirmed-laboratory diagnosis of COVID-19 in a New York hospital from March 1-May 15, 2020.</p><p><strong>Results: </strong>Increased number of organs systems involved was associated with increased odds for in-hospital mortality (odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.11-1.66, <i>p</i> < 0.01) and increased LOS (B = 0.02, SE = 0.01, <i>p</i> < 0.05). Increased platelet count was associated with decreased odds for mortality (OR: 0.996, 95% CI: 0.994-0.998, <i>p</i> < 0.001). Increased white blood cell count was associated with increased odds for mortality (OR: 14.00, 95% CI: 3.41-57.38, <i>p</i> < 0.001). Increased creatinine and glucose were each associated with increased LOS (B = 0.11, SE = 0.04, <i>p</i> < 0.01, and B = 0.12, SE = 0.05, <i>p</i> < 0.05, respectively). Increased odds for mortality were also found in high FiO2 oxygen requirement (OR: 11.63, 95% CI: 3.90-34.75, <i>p</i> < 0.001) and invasive mechanical ventilation (OR: 109.93, 95% CI: 29.44-410.45, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Multiple organ systems involvement in COVID-19 is associated with worse prognosis. Clinical/laboratory values corresponding to each organ system may be used as prognostic tools in clinical settings to tailor treatments for COVID-19 patients.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"14 2","pages":"61-73"},"PeriodicalIF":0.6,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11153311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296099","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":"Urgent Management of Penetrating Ocular Injury: A Case Report and Review of the Literature.","authors":"Chang-Han Wu, Chi-Wei Chen, Liang-Chi Kuo","doi":"10.6705/j.jacme.202403_14(1).0005","DOIUrl":"10.6705/j.jacme.202403_14(1).0005","url":null,"abstract":"<p><p>Ocular globe injury is a severe ophthalmic emergency that requires immediate attention in the emergency department. In this case report, we present a 35-year-old male who suffered a penetrating ocular injury and globe rupture caused by a nail puncture. The patient presented with severe pain and visual loss and was treated with tetanus vaccination, empirical antibiotics, and pain control, followed by an urgent orbital computed tomography (CT) scan and consultation with an ophthalmologist. The CT scan revealed a retained nail in the ocular space, and an urgent operation was performed to repair the eyeball rupture, remove the intraocular foreign body, and perform an anterior vitrectomy. The patient was discharged 6 days after the operation with a visual acuity of 20/400 and an ocular trauma score of 34. This case highlights the importance of initial emergency physician decision-making and the need for a thorough history-taking and examination when encountering penetrating ocular injuries.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"14 1","pages":"39-41"},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10933586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131492","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":"Overdrive Pacing for Persistent Torsades de Pointes and Pulseless Ventricular Tachycardia.","authors":"Ewe Jin Koh, Xiao Qi Yee, Ming Lee Chin, Nisa Liyana Bt Abdul Latib","doi":"10.6705/j.jacme.202403_14(1).0006","DOIUrl":"10.6705/j.jacme.202403_14(1).0006","url":null,"abstract":"<p><p>A 53-year-old presented to the emergency department following a fall and was found to have recurrent episodes of torsades de pointes and pulseless ventricular tachycardia on cardiac monitoring. He had been abusing nimetazepam for sleep issues over the preceding one month. Despite correction of electrolytes, the arrhythmias were persistent which necessitated temporary overdrive pacing. The patient made an uneventful recovery and the temporary pacing was successfully removed with no recurrence of the malignant arrhythmias prior to discharge.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"14 1","pages":"42-47"},"PeriodicalIF":0.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10933591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131530","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":"The White Cerebellum Sign.","authors":"Yu-Nong Lai, Jui-Yuan Chung","doi":"10.6705/j.jacme.202403_14(1).0007","DOIUrl":"10.6705/j.jacme.202403_14(1).0007","url":null,"abstract":"","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"14 1","pages":"48-49"},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10933587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131491","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":"Combined Use of Alkaline Agents With Low-Flow Extracorporeal Carbon Dioxide Removal in Carbon Dioxide Inhalation Models Preserving Inspiratory Efforts.","authors":"Tomonori Yamashita, Akinori Uchiyama, Yusuke Enokidani, Takeshi Yoshida, Yuji Fujino","doi":"10.6705/j.jacme.202403_14(1).0004","DOIUrl":"10.6705/j.jacme.202403_14(1).0004","url":null,"abstract":"<p><strong>Background: </strong>Low-flow extracorporeal CO ₂ removal (ECCO ₂ R), managed using a renal replacement platform, is useful in achieving lung-protective ventilation with low tidal volume. However, its capacity for CO ₂ elimination is limited. Whether this system is valuable in reducing strong inspiratory efforts in respiratory failure is unclear. The combined use of alkaline agents with low-flow ECCO ₂ R might be useful in hypercapnic subjects preserving inspiratory efforts.</p><p><strong>Methods: </strong>This study examined the effects of low-flow ECCO ₂ R on respiratory status and investigated the effects of NaHCO ₃ , trometamol, and saline on respiratory status during low-flow ECCO ₂ R in CO ₂ inhalation models.</p><p><strong>Results: </strong>Although low-flow ECCO ₂ R did not significantly change the respiratory rate (92.2% ± 24.3% [mean ± standard deviation] of that before ECCO ₂ R), it reduced minute ventilation (MV) (78.9% ± 13.5% of that before ECCO ₂ R). The addition of NaHCO ₃ improved acidemia but did not change MV compared with that of the saline group (0.451 ± 0.026 L/min/kg body weight [BW] vs. 0.556 ± 0.138 L/min/kg BW, respectively). The addition of trometamol improved acidemia and reduced MV compared with that of the saline group (0.381 ± 0.050 L/min/kg BW vs. 0.556 ± 0.138 L/min/kg BW, respectively). The total amounts of CO ₂ removed during ECCO ₂ R in the NaHCO ₃ group were lower than those in the saline and trometamol groups.</p><p><strong>Conclusion: </strong>The low-flow ECCO ₂ R reduced MV in subjects preserving spontaneous breathing efforts with CO ₂ overload. The addition of NaHCO ₃ improved acidemia but did not change MV, whereas the addition of trometamol improved acidemia and reduced MV.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"14 1","pages":"28-38"},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10933589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131529","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":"The Effect of Out-of-Hours Admission on Mortality in Patients Who Underwent Thrombectomy Due to Ischemic Stroke.","authors":"Kadir Küçükceran, Mustafa Kürşat Ayrancı, Abdullah Sadık Girişgin, Sedat Koçak, Zerrin Defne Dündar, Osman Koç","doi":"10.6705/j.jacme.202403_14(1).0003","DOIUrl":"10.6705/j.jacme.202403_14(1).0003","url":null,"abstract":"<p><strong>Background: </strong>It is important to investigate the factors that may delay the diagnosis and treatment process of ischemic stroke. The aim of this study was to investigate whether in-hospital mortality increased in patients who presented to the emergency department out-of-hours and underwent thrombectomy.</p><p><strong>Methods: </strong>A total of 59 patients who applied to the emergency department between January 1, 2018 and November 1, 2021 and underwent thrombectomy due to ischemic stroke were included in the study. Patient age, gender, thrombectomy success (successful recanalization), in-hospital mortality status, intracranial hemorrhage status after thrombectomy, and out-of-hours admission status were recorded and compared according to out-of-hours admission status.</p><p><strong>Results: </strong>Twenty-seven (45.8%) patients were male, and the median age was 74 (61-81) years. Forty-two (71.2%) patients applied to the emergency department out-of-hours. In-hospital mortality occurred in 27 (45.8%) patients. There was no statistically significant difference in out-of-hours admission status between the non-survivor group and the survivor group (non-survivor: 24 [75%]; survivor: 18 [66.7%], <i>p</i> = 0.481). Nor was a statistically significant difference found in the intracranial hemorrhage complication rate of the patients admitted out-of-hours compared to the patients admitted during working hours (out-of-hours: 17 [40.5%]; during working hours: 6 [35.3%], <i>p</i> = 0.712).</p><p><strong>Conclusion: </strong>No statistically significant difference was found in the rate of in-hospital mortality and intracranial bleeding complications in patients who underwent thrombectomy out of working hours compared to during working hours.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"14 1","pages":"20-27"},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10933590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131490","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}