Journal of acute medicine最新文献

{"title":"Resuscitative Endovascular Balloon Occlusion of the Aorta for Traumatic Cardiopulmonary Arrest in the Emergency Department: The First Case With Successful Return of Spontaneous Circulation in Taiwan.","authors":"Shuo-Ting Hsu,&nbsp;Yi-Kai Fu,&nbsp;Hao-Yang Lin,&nbsp;Wen-Chu Chiang,&nbsp;Yu-Chen Chiu,&nbsp;Jen-Tang Sun,&nbsp;Matthew Huei-Ming Ma","doi":"10.6705/j.jacme.202209_12(3).0006","DOIUrl":"https://doi.org/10.6705/j.jacme.202209_12(3).0006","url":null,"abstract":"<p><p>Exsanguinating torso hemorrhage is a leading cause of death in trauma patients. Bleeding leads to hypothermia, acidosis, and coagulopathy, the so-called \"lethal triad,\" and creates a vicious cycle. Therefore, bleeding control tops the priority list in the management of trauma patients. Placement of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with traumatic non-compressible torso hemorrhage is a developing technique in the emergency departments (EDs) in Taiwan, and it is a possible solution for abdominal and pelvic trauma patients with hemodynamic instability. It not only temporarily controls bleeding below the inflation site but also increases cerebral and coronary circulation. It can create a bridge for definitive care such as an operation or an embolization, possibly preventing death. Compared to thoracotomy followed by an aortic cross clamp, REBOA is a less invasive and possibly, a more efficient way to control the hemorrhage and may lead to better overall survival. The use of REBOA has been proven to be associated with improved survival-to-discharge in severely injured trauma patients. We report a case of out-of-hospital cardiac arrest caused by penetrating injury wherein return of spontaneous circulation was successfully achieved after 39-minute cardiopulmonary resuscitation and REBOA placement in the ED. The REBOA balloon was deflated after bleeding was stopped during the laparotomy operation. The patient was then transferred to the intensive care unit for postoperative care. Unfortunately, the patient passed away approximately 12 hours after the surgery.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 3","pages":"126-130"},"PeriodicalIF":0.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9561488/pdf/jacme-12-3-06.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40438600","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":"Comprehensive Geriatric Assessment in the Emergency Department for Identifying Elderly Individuals at Risk of Hip Fracture.","authors":"Pei-Ying Lin,&nbsp;Hsien-Hao Huang,&nbsp;David Hung-Tsang Yen","doi":"10.6705/j.jacme.202209_12(3).0004","DOIUrl":"https://doi.org/10.6705/j.jacme.202209_12(3).0004","url":null,"abstract":"<p><strong>Background: </strong>Hip fracture (HF) is a major challenge for healthcare systems in terms of increased costs and lengths of stay, and it has been estimated that by 2050, half of the projected 6.26 million global HFs will occur in Asia. Owing to the high morbidity and mortality associated with HF in elderly individuals, it is crucial to recognize at-risk elderly patients in the ED so that special precautions and preventive measures can be taken. While comprehensive geriatric assessment (CGA) has been shown to improve outcomes and prevent secondary fractures in elderly individuals with HF in outpatient settings, there is a lack of data to identify elderly Asian patients who are at risk of HF via using CGA in the emergency department (ED). The aim of this study is to identify the characteristics of elderly Asian patients in the ED who have an increased risk of HF via CGA.</p><p><strong>Methods: </strong>A case-control study was conducted in the ED at Taipei Veterans General Hospital, a medical center located in Taipei, Taiwan, from October 2018 to December 2019. Patients > 75 years old with and without HF were compared using data obtained from CGAs conducted by trained nurses.</p><p><strong>Results: </strong>A total of 85 HF patients (cases) and 680 non-HF patients were enrolled, among whom 340 non-HF control individuals (controls) were selected by simple random sampling. HF occurred more frequently in women and in patients with depressive symptoms. An association between decreased handgrip strength and HF risk, especially in men, was also identified ( <i>p</i> = 0.011). The variables independently associated with the presence of HF in the multivariate analysis were female sex (odds ratio [OR]: 2.229; 95% confidence interval [CI]: 1.332-3.728) and decreased handgrip strength (OR: 2.462; 95% CI: 1.155-5.247).</p><p><strong>Conclusions: </strong>By performing CGAs in the ED, we found that female sex and decreased handgrip strength were associated with HF risk. Therefore, we propose that targeted assessment of handgrip strength in female patients aged > 75 years in the ED may identify those at greatest risk of HF, resulting in improved emergency care for geriatric patients.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 3","pages":"113-121"},"PeriodicalIF":0.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9561485/pdf/jacme-12-3-04.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40438603","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":"Case Report: Clinical Presentation of Toad Venom-Induced Cardiac Intoxication.","authors":"Chia-Yi Lu,&nbsp;Yung-Yih Chang,&nbsp;Tzu-Heng Hsu,&nbsp;Chih-Yun Yeh,&nbsp;Pei-Fang Lai","doi":"10.6705/j.jacme.202206_12(2).0005","DOIUrl":"https://doi.org/10.6705/j.jacme.202206_12(2).0005","url":null,"abstract":"<p><p>Six people made the mistake of eating toad soup, and one of them died before arriving hospital. Five patients presented conscious change, gastrointestinal upset, or bradycardia. We checked their blood and electrocardiography to monitor the cardiac intoxication from toad venom. This experience revealed that the serum level of digoxin does not indicate the severity of intoxication but has the diagnostic value. And, serum potassium level is useful to provide valuable therapeutic information.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 2","pages":"75-78"},"PeriodicalIF":0.6,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283113/pdf/jacme-12-2-05.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40622094","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":"Guidelines for COVID-19 Laboratory Testing for Emergency Departments From the New Diagnostic Technology Team of the Taiwan Society of Emergency Medicine.","authors":"Chien-Chang Lee,&nbsp;Yi-Tzu Lee,&nbsp;Chih-Hung Wang,&nbsp;I-Min Chiu,&nbsp;Weide Tsai,&nbsp;Yan-Ren Lin,&nbsp;Chih-Huang Li,&nbsp;Chin Wang Hsu,&nbsp;Pei-Fang Lai,&nbsp;Jiann-Hwa Chen,&nbsp;Jeffrey Che-Hung Tsai,&nbsp;Shih-Hung Tsai,&nbsp;Chorng-Kuang How","doi":"10.6705/j.jacme.202206_12(2).0001","DOIUrl":"https://doi.org/10.6705/j.jacme.202206_12(2).0001","url":null,"abstract":"<p><p>COVID-19 tests have different turnaround times (TATs), accuracy levels, and limitations, which emergency physicians should be aware of. Nucleic acid amplification tests (NAATs) can be divided into standard high throughput tests and rapid molecular diagnostic tests at the point of care (POC). The standard NAAT has the advantages of high throughput and high accuracy with a TAT of 3-4 hours. The POC molecular test has the same advantages of high accuracy as standard high throughput PCR, but can be done in 13-45 minutes. Roche cobas Liat is the most commonly used machine in Taiwan, displaying 99%-100% sensitivity and 100% specificity, respectively. Abbott ID NOW is an isothermal PCR-based POC machine with a sensitivity of 79% and a specificity of 100%. A high rate of false positives and false negatives is associated with rapid antigen testing. Antibody testing is mostly used as part of public health surveys and for testing for immunity.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 2","pages":"45-52"},"PeriodicalIF":0.6,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283118/pdf/jacme-12-2-01.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40622096","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 Role of NEWS2 + Lactate + D-Dimer in Predicting Intensive Care Unit Admission and In-Hospital Mortality of COVID-19 Patients.","authors":"Kadir Küçükceran, Mustafa Kürşat Ayrancı, Zerrin Defne Dündar, Muhammed İdris Keklik, Hülya Vatansev","doi":"10.6705/j.jacme.202206_12(2).0003","DOIUrl":"10.6705/j.jacme.202206_12(2).0003","url":null,"abstract":"<p><strong>Background: </strong>We investigated the parameters of National Early Warning Score 2 (NEWS2) + lactate + D-dimer in predicting the intensive care unit (ICU) admission and in-hospital mortality in patients hospitalized with COVID-19.</p><p><strong>Methods: </strong>Patients, who applied to the emergency department of a tertiary university hospital and were taken to the COVID-19 zone with suspected COVID-19 between March 2020 and June 2020, were retrospectively examined. In this study, 244 patients, who were hospitalized and had positive polymerase chain reaction test results, were included. NEWS2, lactate, and D-dimer levels of the patients were recorded. Patients were grouped by the states of in-hospital mortality and ICU admission.</p><p><strong>Results: </strong>Of 244 patients who were included in the study, 122 (50%) were male, while their mean age was 53.76 ± 17.36 years. 28 (11.5%) patients were admitted to the ICU, while in-hospital mortality was seen in 14 (5.7%) patients. The levels of D-dimer, NEWS2, NEWS2 + lactate, NEWS2 + D-dimer, NEWS2 + lactate + D-dimer were statistically significantly higher in patients with in-hospital mortality and admitted to ICU ( <i>p</i> < 0.05). The area under the curve (AUC) values of D-dimer, lactate, NEWS2, NEWS2 + lactate, NEWS2 + D-dimer, NEWS2 + lactate + D-dimer in predicting ICU admission were as 0.745 (0.658-0.832), 0.589 (0.469-0.710), 0.760 (0.675-0.845), 0.774 (0.690-0.859), 0.776 (0.692-0.860), and 0.778 (0.694-0.862), respectively; while the AUC values of these parameters in predicting in-hospital mortality were found to be as 0.768 (0.671-0.865), 0.695 (0.563-0.827), 0.735 (0.634-0.836), 0.757 (0.647-0.867), 0.752 (0.656-0.848), and 0.764 (0.655-0.873), respectively.</p><p><strong>Conclusions: </strong>Compared to using the NEWS2 value alone, a combination of NEWS2, lactate, and D-dimer was found to be more valuable in predicting in-hospital mortality and ICU admission.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 2","pages":"60-70"},"PeriodicalIF":0.8,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283119/pdf/jacme-12-2-03.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40622097","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":"Not-So-Simple Wrist Injury After Fall On Outstretched Hand: Dorsal Intercalated Segment Instability.","authors":"James Siu Ki Lau,&nbsp;Stephanie Dorothy Pui Ming Yu,&nbsp;Chi Kit Yuen","doi":"10.6705/j.jacme.202206_12(2).0006","DOIUrl":"https://doi.org/10.6705/j.jacme.202206_12(2).0006","url":null,"abstract":"","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 2","pages":"79-80"},"PeriodicalIF":0.6,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283117/pdf/jacme-12-2-06.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40609984","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 Stigmatization and Mental Health Between Physicians and Nurses in the Early COVID-19 Pandemic Outbreak.","authors":"Cheng-Yi Fan,&nbsp;Chih-Wei Sung,&nbsp;James Chien-Tai Huang,&nbsp;Cheng-Heng Liu,&nbsp;Chi-Hsin Chen,&nbsp;Jia-How Chang,&nbsp;Jiun-Wei Chen,&nbsp;Shou-Kuen Huang,&nbsp;Tony Szu-Hsien Lee,&nbsp;Edward Pei-Chuan Huang","doi":"10.6705/j.jacme.202206_12(2).0007","DOIUrl":"https://doi.org/10.6705/j.jacme.202206_12(2).0007","url":null,"abstract":"","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 2","pages":"81-83"},"PeriodicalIF":0.6,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283114/pdf/jacme-12-2-07.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40622095","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":"Report of a Patient With Anti-Jo-1 Syndrome With Loss of Consciousness.","authors":"Chun Chen,&nbsp;Yu-Jang Su,&nbsp;Chiong-Hee Wong","doi":"10.6705/j.jacme.202206_12(2).0004","DOIUrl":"https://doi.org/10.6705/j.jacme.202206_12(2).0004","url":null,"abstract":"<p><p>A 51-year-old febrile woman presented to the emergency department because of loss of consciousness while worshipping at a temple. She experienced muscle weakness and blurred vision before fainting. She also felt pain in her left shoulder and suffered from dry cough and shortness of breath during the previous week. The chest radiograph (CXR) showed bilateral reticular infiltration, indicating interstitial lung disease (ILD), and chest computed tomography revealed reticular, nodular, and reticulonodular patterns of infiltration that were compatible with ILD. Blood tests showed a creatinine kinase level of 3,307 IU/L and an Anti-Jo-1 autoantibody level of 586 AU/mL. It was found via right thigh biopsy results 8 days later that she had polymyositis with perivascular inflammation and degenerative muscle fiber change. Pulse therapy with methylprednisolone (1 gm/day for 3 days) was administered. After 4 days, she felt better and was discharged. Around 25.0%-34.1% of myositis patients have anti-Jo-1 autoantibodies, and ILD was noted in 65%-68% of anti-Jo-1-positive patients. A ground glass pattern may be observed in the CXRs of anti-Jo-1 ILD patients, and some articles described multiple pulmonary nodules mimicking lung metastasis or concomitant with pleural effusion. The conditions of approximately 42%-66% of ILD patients are controlled or are not worsened after treatment with corticosteroid and immunosuppressive drug treatment. However, some rapidly progressive cases are not sensitive to corticosteroid therapy alone.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 2","pages":"71-74"},"PeriodicalIF":0.6,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283115/pdf/jacme-12-2-04.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40609982","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 STONE Score to Predict Urolithiasis in an Asian Emergency Department.","authors":"Joo Shiang Ang,&nbsp;Su Yee Vanice Wong,&nbsp;Chee Kheong Ooi","doi":"10.6705/j.jacme.202206_12(2).0002","DOIUrl":"https://doi.org/10.6705/j.jacme.202206_12(2).0002","url":null,"abstract":"<p><strong>Background: </strong>The STONE score was developed to predict uncomplicated ureteral stones in patients so that they can be managed without imaging. Validation studies had been conducted previously but the results were varied. This study aims to investigate the utility of the STONE score in an emergency department in Singapore.</p><p><strong>Methods: </strong>We retrospectively analyzed the records of adult patients presenting with ureteric colic in the emergency department in 2015. STONE score as well as the proportion of urolithiasis diagnosed on advanced imaging in each STONE score group were calculated. Logistic regression was used to calculate the odds ratios (ORs) for the STONE score components in our study and compared with the ORs obtained in the original study. Measures of diagnostic accuracy for a high STONE score were also calculated.</p><p><strong>Results: </strong>753 cases were included in the final analysis. Among patients with a high STONE score, 66.7% had urolithiasis and 2.6% had significant alternative diagnoses. Compared to original studies, ORs for the STONE score components obtained for our study were different. From our study, the sensitivity of a high STONE score was 47.0%, specificity was 68.7%, positive predictive value was 66.7%, negative predictive value was 49.3%, positive likelihood ratio was 1.50, and negative likelihood ratio was 0.77.</p><p><strong>Conclusion: </strong>The STONE score is not expected to perform well in Singapore based on our study. It should be used with caution in similar Asian populations.</p>","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 2","pages":"53-59"},"PeriodicalIF":0.6,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9283116/pdf/jacme-12-2-02.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40609983","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":"Who Can Be the Standardized Patient in Disaster Medical Full-Scale Exercise, Freshman, or Professional?","authors":"Yung-Chang Chen, M. Cheng, Chien-Hao Lin, Fuh-Yuan Shih, W. Chou","doi":"10.6705/j.jacme.202203_12(1).0003","DOIUrl":"https://doi.org/10.6705/j.jacme.202203_12(1).0003","url":null,"abstract":"Background\u0000Disasters cannot be predicted, so being well-prepared is important before a disaster strike. Good preparation needs constant practice and improvement, and full-scale exercise can provide both. The standardized patients (SPs) in a full-scale exercise to simulate patients are vital because they can provide realistic effects to exercise participants. However, there was no literature about who is capable of being an SP. We investigated the relationship between the SPs' current occupation and previous experience with their fidelity and participants' performance.\u0000\u0000\u0000Methods\u0000Three identically designed full-scale exercises were conducted for three different emergency medical teams (EMTs) with the scenario of post-earthquake mass casualty incidents. Forty SPs were used in each exercise. Exercise objective and detail scenario were told to the SPs before exercise, and mock wound makeup was applied to the SPs. Each SP's occupation and previous experience were recorded before exercise. The SP's previous experience was defined as previous exercise experience and previous disaster medicine education. The SPs' fidelity (SPF) was rated using a 5-point Likert scale (1 = poor and 5 = excellent). The participants' performance (PP) was also rated using a 5-point Likert scale (1 = poor and 5 = excellent) according to the accuracy of each SP's triage result and management. The SPF and the PP were evaluated by clinicians with disaster medicine specialties using the same standard. The relationship between the SPs' occupation and the SPF along with occupation, and the PP were analyzed by analysis of variance (ANOVA). The data of the SPF and the PP in the SP groups divided by previous experience were analyzed by the Student's t -test.\u0000\u0000\u0000Results\u0000The SPs' occupations were medical student, nurse, physician, and members of EMT. There was no significant difference in the SPF and the PP between occupations ( p = 0.382 and 0.416, respectively). Both the experienced and the inexperienced SP groups show no significant difference in the SPF ( p = 0.339). Significantly better PP was noted in the inexperienced SP group ( p < 0.001).\u0000\u0000\u0000Conclusions\u0000The SPs' background does not influence the performance of either SPs or exercise participants. We proposed that the success of using freshmen as SPs in full-scale exercise depends on the pre-exercise design and the SP instruction and training.","PeriodicalId":14846,"journal":{"name":"Journal of acute medicine","volume":"12 1 1","pages":"23-28"},"PeriodicalIF":0.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71330658","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}