Journal of acute medicine最新文献

{"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}

{"title":"Should I Supplement Vitamin D in a Patient With Sepsis?","authors":"Vedran Kovacic","doi":"10.6705/j.jacme.202403_14(1).0001","DOIUrl":"10.6705/j.jacme.202403_14(1).0001","url":null,"abstract":"<p><p>Sepsis is a potentially fatal organ failure produced by the host's immune response to infection. It is critical to identify risk factors associated with a poor prognosis in septic patients in order to develop new therapy options. Vitamin D deficiency (25-hydroxyvitamin cholecalciferol < 20 ng/mL) is common in critical and septic patients. Serum vitamin D concentrations are associated with an increased incidence of mortality in critically ill adult patients. In critically ill patients, vitamin D supplementation (a very high vitamin D ₃ or cholecalciferol loading dosage as a single bolus dose ranging from 400,000 to 540,000 IU) is feasible and safe. Some of the trials and their post-hoc analyses evaluating vitamin D supplementation in severely sick individuals, including septic patients, suggested possible benefits in mortality (reduced 28-day mortality in the range of 8.1%-17.5%), and other outcomes (reduction in hospital length in the range from 9 to 18 days, and decrease in duration of mechanical ventilation in the range from 5 to 10 days). Despite the fact that many studies support the provision of vitamin D to septic patients, there are still many studies that contradict this opinion, and there is still debate about the recommendation to use vitamin D in sepsis. A pragmatic clinical approach in severe sepsis could be supplementation of vitamin D if serum levels are diminished (< 30 ng/mL). It appears that a single ultrahigh dose of vitamin D ₃ (cholecalciferol) could be administered to the septic patient via an enteral tube, followed by daily or monthly maintenance doses. Parenteral administration might be reserved for a subgroup of septic patients with gastrointestinal, hepatic, or renal dysfunction. Future clinical trials designed exclusively for septic patients are required to assess the potential advantages of vitamin D. Possible impacts of selective activators of vitamin D receptors, such as paricalcitol, should be elucidated in sepsis. This emphasizes the requirement for more study and confirmation of any potential beneficial effects of vitamin D in sepsis.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"14 1","pages":"1-8"},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10933588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131531","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":"Advancements in Artificial Intelligence in Emergency Medicine in Taiwan: A Narrative Review.","authors":"Bing-Hung Shih, Chien-Chun Yeh","doi":"10.6705/j.jacme.202403_14(1).0002","DOIUrl":"10.6705/j.jacme.202403_14(1).0002","url":null,"abstract":"<p><p>The rapid progression of artificial intelligence (AI) in healthcare has greatly influenced emergency medicine, particularly in Taiwan-a nation celebrated for its technological innovation and advanced public healthcare. This narrative review examines the current status of AI applications in Taiwan's emergency medicine and highlights notable achievements and potential areas for growth. AI has wide capabilities encompass a broad range, including disease prediction, diagnostic imaging interpretation, and workflow enhancement. While the integration of AI presents promising advancements, it is not devoid of challenges. Concerns about the interpretability of AI models, the importance of dataset accuracy, the necessity for external validation, and ethical quandaries emphasize the need for a balanced approach. Regulatory oversight also plays a crucial role in ensuring the safe and effective deployment of AI tools in clinical settings. As its footprint continues to expand in medical education and other areas, addressing these challenges is imperative to harness the full potential of AI for transforming emergency medicine in Taiwan.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"14 1","pages":"9-19"},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10938302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131528","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":"Hyperbaric Oxygen Therapy in Hydrogen Sulfide Poisoning: A Case Report.","authors":"Kun-Yu Yang, Chen-Ching Chen","doi":"10.6705/j.jacme.202312_13(4).0004","DOIUrl":"https://doi.org/10.6705/j.jacme.202312_13(4).0004","url":null,"abstract":"<p><p>For several decades, hydrogen sulfide (H₂S) has been a toxic gas affecting people, particularly in workplaces. However, no effective therapy is available to counteract H₂S poisoning. Herein, we report the case of a 34-year-old male field worker who experienced H₂S poisoning due to an accident at work. He presented to the emergency room with dyspnea, drowsiness, and dizziness. Computed tomography revealed a normal brain mass. An initial electrocardiogram revealed sinus tachycardia. Therefore, 10 mL nitrite was administered intravenously. However, the symptoms were not relieved as expected. Hyperbaric oxygen was promptly administered. Symptoms were relieved rapidly after three sessions of hyperbaric oxygen therapy. Subsequently, the patient completely recovered. During severe H₂S intoxication, early administration of hyperbaric oxygen therapy can prevent the disruption of aerobic cellular respiration and save lives.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"13 4","pages":"159-161"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10711363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138804993","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":"Comparison of Ventilator Mechanics and Mortality Between COVID-19 Versus Non-COVID-19 Acute Respiratory Distress Syndrome Patients: A Cross-Sectional Study.","authors":"Sadaf Hanif, Madiha Iqbal, Sher Muhammad Sethi, Amber Sabeen","doi":"10.6705/j.jacme.202312_13(4).0002","DOIUrl":"https://doi.org/10.6705/j.jacme.202312_13(4).0002","url":null,"abstract":"<p><strong>Background: </strong>We aim to assess the differences in ventilator mechanics and mortality of acute respiratory distress syndrome (ARDS) between patients with and without COVID-19. It might serve as a milestone in reshaping management protocols by providing very preliminary evidence in this direction.</p><p><strong>Methods: </strong>It was a cross-sectional study that included adult patients aged 18 years or above admitted to the medical intensive care unit of our tertiary care hospital from January to December 2021 with the diagnosis of ARDS. Patients were divided into two groups. Group I were patients who had ARDS with COVID-19 infection while group II were those who had ARDS without COVID-19 infection. Both groups were compared in terms of clinical and respiratory mechanics of mechanical ventilators and mortality.</p><p><strong>Results: </strong>The study included 135 patients, 68 of whom were in group I, and 67 were in group II. In the COVID-19 group, the median age was 60; while in the non-COVID-19 group, it was 64. There were 50% male patients in both groups. ARDS was more severe in COVID-19 (n = 44, 58%) than in the non-COVID group (n = 31, 41.3%, <i>p</i>-value = 0.030). The median PaO₂/FiO₂ ratio was 122.5 (interquartile range [IQR]: 93-160) in COVID-19 and was 180 (IQR: 127-248) in the non-COVID-19 group. Patient proning was higher (63% vs. 37%) in the COVID-19 group. In the COVID-19 group, 44 patients died compared to 32 in the non-COVID group (<i>p</i>-value = 0.060).</p><p><strong>Conclusions: </strong>COVID-19 patients had severe ARDS compared with non-COVID patients. Despite this, ventilator mechanics and mortality were not significantly different between both groups. It appears that more proning strategies were observed in the COVID-19 group and may have some positive effects.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"13 4","pages":"144-149"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10711365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138804992","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}