Journal of Emergency Medicine最新文献

{"title":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(24)00264-6","DOIUrl":"10.1016/S0736-4679(24)00264-6","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 3","pages":"Pages e325-e326"},"PeriodicalIF":1.2,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0736467924002646/pdfft?md5=d6b2d6bb864e04435cdef4067ff4ba62&pid=1-s2.0-S0736467924002646-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of Early Mortality Among Deaths at Adult Emergency Departments in Southern Ethiopia","authors":"Gelane Geleto Gobena MSc ,&nbsp;Fikru Tadesse MSc ,&nbsp;Bereket Beyene MSc ,&nbsp;Tomas Yeheyis MSc ,&nbsp;Wegene Jemebere MSc ,&nbsp;Aklile Tsega Chekol MSc ,&nbsp;Yacob Abraham Borie MSc ,&nbsp;Ezedin Molla MSc ,&nbsp;Yared Reta MSc ,&nbsp;Mastewal Aschale Wale MSc ,&nbsp;Zelalem Mekonen MSc ,&nbsp;Yunuka Marufa Tunushe MSc ,&nbsp;Beyene Feleke MSc ,&nbsp;Amdehiwot Aynalem MSc","doi":"10.1016/j.jemermed.2024.07.018","DOIUrl":"10.1016/j.jemermed.2024.07.018","url":null,"abstract":"<div><h3>Background</h3><p>In Ethiopia, the first 3 days (72 h) after admission to the emergency department (ED) account for more than half (59.8%) of all deaths. However, little is known about the prevalence of early mortality and its associated factors in southern Ethiopia.</p></div><div><h3>Objective</h3><p>The main objective of this study is to assess the prevalence and associated factors of early mortality among deaths in adult EDs at selected public hospitals in Hawassa, southern Ethiopia.</p></div><div><h3>Methods</h3><p>An institutional-based retrospective cross-sectional study design was applied. A systematic random sampling technique was used to select 369 charts of patients who died in the adult EDs of selected public hospitals in the past 2 years. The data were collected using a standardized and pretested data abstraction tool using the Kobo Toolbox data collection tool. Logistic regression analyses were carried out to assess the strength of the association. Statistical significance was declared at <em>p</em>-value &lt; 0.05, and an adjusted odds ratio (AOR) with a 95% confidence interval was used to report the strength of the association.</p></div><div><h3>Result</h3><p>According to the results of the current study, 288 patients, or 78% of the total, passed away within 72 h of admission to the ED. The following variables were significantly associated with early mortality: delayed initial intervention (AOR 2.338), red triage categories (AOR 3.9), lack of investigation (AOR 3.4), comorbid illness (AOR 3.2), absence of prehospital treatment (AOR 4.2), and road traffic accidents (AOR 4.1).</p></div><div><h3>Conclusion</h3><p>There was an increased early mortality rate seen in this investigation. The following factors were significantly associated with an early death in the ED: comorbidity, delayed intervention, red warning score, road traffic accidents, absence of prehospital treatment, and lack of diagnostic testing. By addressing the variables that are strongly linked to an early mortality, every intervention should be undertaken to reduce the risk of an early death.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 5","pages":"Pages e464-e474"},"PeriodicalIF":1.2,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Teenager with Bleeding Lips","authors":"Laila Azan MD ,&nbsp;Megan Patton MD ,&nbsp;Rosibell Arcia-Diaz MD ,&nbsp;Alisa McQueen MD","doi":"10.1016/j.jemermed.2024.07.019","DOIUrl":"10.1016/j.jemermed.2024.07.019","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 5","pages":"Pages e454-e455"},"PeriodicalIF":1.2,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cluster-Randomized Control Study Comparing a New Cue “Two Compressions per Second” with “100–120 Compressions per Minute” in Training of Bystander Cardiopulmonary Resuscitation","authors":"Ming-Ju Hsieh M.D., Ph.D. ,&nbsp;Hao-Yang Lin M.D., MSc ,&nbsp;Ying‑Chih Ko M.D. ,&nbsp;Chih-Wei Yang M.D., Ph.D. ,&nbsp;Wen-Chu Chiang M.D., Ph.D. ,&nbsp;Matthew Huei-Ming Ma M.D., Ph.D.","doi":"10.1016/j.jemermed.2024.07.011","DOIUrl":"10.1016/j.jemermed.2024.07.011","url":null,"abstract":"<div><h3>Background</h3><p>Chest compression at a rate of 100–120 compressions per minute (cpm) during cardiopulmonary resuscitation (CPR) is associated with the highest survival rates. Performing compressions at a faster rate may exhaust the rescuers.</p></div><div><h3>Objectives</h3><p>To compare a new cue of ‘two compressions per second’ to the traditional cue of ‘100–120 compressions per minute’ on compression rate in CPR training.</p></div><div><h3>Methods</h3><p>In this cluster-randomized study, students from two senior high schools were assigned into two groups. For the experimental group, the cue for the compression rate was ‘two compressions per second’. For the control group, the cue was ‘100–120 cpm’. Except the different cues, all participants underwent the same standardized CPR training program. Verbal compression rate-related feedback was not obtained during practice. Quality indicators of chest compressions were recorded by a sensorized manikin. The primary outcome measure was mean compression rate at course conclusion. The secondary outcome measures were individual compression quality indicators at course conclusion and 3 months after training.</p></div><div><h3>Results</h3><p>We included 164 participants (85 participants, experimental group; 79 participants, control group). Both groups had similar characteristics. The experimental group had a significantly lower mean compression rate at course conclusion (144.3 ± 16.17 vs. 152.7 ± 18.38 cpm, <em>p</em> = 0.003) and at 3 months after training (<em>p</em> = 0.09). The two groups had similar mean percentage of adequate compression rate (≥ 100 cpm), mean compression depth, and mean percentage of complete recoil at course conclusion and 3 months after training.</p></div><div><h3>Conclusion</h3><p>The new cue of ‘two compressions per second’ resulted in participants having a lower compression rate, although it still exceeded 120 cpm.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 5","pages":"Pages e425-e431"},"PeriodicalIF":1.2,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining Emergency Medical Services: Delay Time, Response Time, On-Scene Time In Six Peaks of the COVID-19 Pandemic in Eastern Iran","authors":"Kheizaran Miri PhD ,&nbsp;Mohammadreza Sabbaghi MS ,&nbsp;Mohammad Namazinia MS","doi":"10.1016/j.jemermed.2024.07.008","DOIUrl":"10.1016/j.jemermed.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><p>Time indices are key elements in prehospital medical emergencies. The number of calls to Emergency Medical Services (EMS) and the number of missions they have undertaken have been impacted by the COVID-19 epidemic.</p></div><div><h3>Objectives</h3><p>This study's goal was to evaluate prehospital EMS time indices at the apex of the COVID-19 outbreak.</p></div><div><h3>Methods</h3><p>Data were extracted retrospectively from the Asayar Automation System, which records details on all emergency medical calls resulting in patient transport. The study period was from March 2018 to March 2021, covering the pre-COVID period and the first through sixth peaks of the pandemic in Iran. Standardized data extraction procedures were used to minimize bias in this retrospective review.</p></div><div><h3>Results</h3><p>In this study, most transport missions occurred during the fifth peak (n = 2811). In addition, the most missions were related to the age group above 60 years (31.1%), and the highest rate of patient transport (65.9%) was observed in male patients. Traumatic events, cardiac emergencies, impaired consciousness, and psychiatric disorders were, respectively, the main causes of patient transport. Moreover, a significant difference was observed between time indices of various COVID-19 peaks (<em>p</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>Even though the structure of Iran's emergency system is based on the American-Anglo model, and rapid patient transfers to medical facilities are prioritized, the COVID-19 epidemic resulted in increased calls and missions and affected time indices. Therefore, it is suggested that the method and type of service provision be modified during similar crises.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 5","pages":"Pages e475-e485"},"PeriodicalIF":1.2,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a bleeding arteriovenous fistula task trainer","authors":"Emily K. Pauw MD,&nbsp;Ryan Walsh MD","doi":"10.1016/j.jemermed.2024.07.010","DOIUrl":"10.1016/j.jemermed.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><p>As end-stage renal disease becomes more prevalent in the United States, the number of Americans with arteriovenous (AV) fistulas continues to increase. One of the most feared complications of AV fistulas is life-threatening hemorrhage, as patients can exsanguinate within minutes.</p></div><div><h3>Objectives</h3><p>As frontline healthcare workers, emergency medicine (EM) providers need to be able to provide rapid and effective treatment for this rare presentation. We developed a task trainer model to simulate AV fistula hemorrhage to prepare and train EM residents.</p></div><div><h3>Methods</h3><p>This task trainer model was constructed with readily available materials and takes about 30 minutes to make. Twenty-one EM residents participated in the training session. The session consisted of a brief didactic on AV fistula hemorrhage control followed by hands on usage of the task-trainer model. The participants filled out an anonymous survey afterwards rating the model.</p></div><div><h3>Results</h3><p>Residents completed anonymous postcourse surveys rating the session on a five-point Likert scale. Both the overall teaching session and the task trainer were rated very highly. Compared to precourse ratings, residents reported statistically significant postcourse improvements in their level of confidence in managing AV fistula hemorrhage.</p></div><div><h3>Conclusions</h3><p>To our knowledge, this is the first published task trainer model to simulate a bleeding AV fistula for EM residents. The model was well received by our trainees, is relatively inexpensive, and made from easily sourced materials. We believe this model can be used for trainees of all disciplines to prepare them for this potentially catastrophic patient presentation.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 5","pages":"Pages e456-e463"},"PeriodicalIF":1.2,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leg Pain—An Unexpected Twist","authors":"Rahul Gupta MD ,&nbsp;Cameron Gaines BA ,&nbsp;Catherine Ginty MD","doi":"10.1016/j.jemermed.2024.07.017","DOIUrl":"10.1016/j.jemermed.2024.07.017","url":null,"abstract":"<div><h3>Background</h3><p>Obturator hernia is a rare condition, often presenting with non-specific symptoms, such as thigh pain, groin pain, nausea, or vomiting. Obturator hernias are most common in thin, elderly women. Oftentimes, they are diagnosed late in the disease course resulting in complications and high morbidity and mortality.</p></div><div><h3>Case Report</h3><p>We present the case of a 75-year-old female who presented with right thigh pain with no other symptoms. After computed tomography (CT) of the abdomen/pelvis, the patient was found to have an incarcerated obturator hernia complicated by a small bowel obstruction, ultimately requiring urgent surgical intervention.</p></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><p>Given the very general symptoms associated with the condition, the diagnosis of obturator hernia can easily be missed, leading to a delayed diagnosis, more complications, and a higher morbidity and mortality rate. Due to the risk associated with a delayed diagnosis, it is important for emergency physicians to maintain a high clinical suspicion for the diagnosis.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 5","pages":"Pages e442-e445"},"PeriodicalIF":1.2,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Fetal Head Injury after Maternal Motor Vehicle Crash","authors":"Shreela Natarajan MD,&nbsp;Tonya S. Wright MD","doi":"10.1016/j.jemermed.2024.07.014","DOIUrl":"10.1016/j.jemermed.2024.07.014","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 5","pages":"Pages e451-e453"},"PeriodicalIF":1.2,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality Outcomes with Tenecteplase Versus Alteplase in the Treatment of Massive Pulmonary Embolism","authors":"Luke R. Murphy MD ,&nbsp;Adam Singer MD ,&nbsp;Brandon Okeke BS ,&nbsp;Krishna Paul BS ,&nbsp;Matthew Talbott DO ,&nbsp;Dietrich Jehle MD","doi":"10.1016/j.jemermed.2024.07.007","DOIUrl":"10.1016/j.jemermed.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary embolism (PE) leads to many emergency department visits annually. Thrombolytic agents, such as alteplase, are currently recommended for massive PE, but genetically modified tenecteplase (TNK) presents advantages. Limited comparative studies exist between TNK and alteplase in PE treatment.</p></div><div><h3>Objective</h3><p>The aim of this study was to assess the safety and mortality of TNK compared with alteplase in patients with PE using real-world evidence obtained from a large multicenter registry. Primary outcomes included mortality, intracranial hemorrhage, and blood transfusions.</p></div><div><h3>Methods</h3><p>This retrospective cohort study used the TriNetX Global Health Research Network. Patients aged 18 years or older with a PE diagnosis (International Classification of Diseases, 10^th Revision, Clinical Modification code I26) were included. The following two cohorts were defined: TNK-treated (29 organizations, 266 cases) and alteplase-treated (22,864 cases). Propensity matching controlled for demographic characteristics, anticoagulant use, pre-existing conditions, and vital sign abnormalities associated with PE severity. Patients received TNK or alteplase within 7 days of diagnosis and outcomes were measured at 30 days post thrombolysis.</p></div><div><h3>Results</h3><p>Two hundred eighty-three patients in each cohort were comparable in demographic characteristics and pre-existing conditions. Mortality rates at 30 days post thrombolysis were similar between TNK and alteplase cohorts (19.4% vs 19.8%; risk ratio 0.982; 95% CI 0.704–1.371). Rates of intracerebral hemorrhages and transfusion were too infrequent to analyze.</p></div><div><h3>Conclusions</h3><p>This study found TNK to exhibit a similar mortality rate to alteplase in the treatment of PE with hemodynamic instability. The results necessitate prospective evaluation. Given the cost-effectiveness and ease of administration of TNK, these findings contribute to the ongoing discussion about its adoption as a primary thrombolytic agent for stroke and PE.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 5","pages":"Pages e432-e441"},"PeriodicalIF":1.2,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Infection Site as a Predictor of Sepsis Development in Emergency Department Patients","authors":"","doi":"10.1016/j.jemermed.2024.01.016","DOIUrl":"10.1016/j.jemermed.2024.01.016","url":null,"abstract":"<div><h3>Background</h3><p>Sepsis is a life-threatening condition but predicting its development and progression remains a challenge.</p></div><div><h3>Objective</h3><p>This study aimed to assess the impact of infection site on sepsis development among emergency department (ED) patients.</p></div><div><h3>Methods</h3><p><span><span><span>Data were collected from a single-center ED between January 2016 and December 2019. Patient encounters with documented infections, as defined by the Systematized Nomenclature of Medicine-Clinical Terms for upper respiratory tract (URI), </span>lower respiratory tract (LRI), </span>urinary tract<span> (UTI), or skin or soft-tissue infections were included. Primary outcome was the development of sepsis or septic shock, as defined by Sepsis-1/2 criteria. Secondary outcomes included hospital disposition and length of stay, blood and </span></span>urine culture<span><span> positivity, antibiotic administration, vasopressor use, in-hospital mortality, and 30-day mortality. Analysis of variance and various different </span>logistic regression approaches were used for analysis with URI used as the reference variable.</span></p></div><div><h3>Results</h3><p><span>LRI was most associated with sepsis (relative risk ratio [RRR] 5.63; 95% CI 5.07–6.24) and septic shock (RRR 21.2; 95% CI 17.99–24.98) development, as well as hospital admission rates (odds ratio [OR] 8.23; 95% CI 7.41–9.14), </span>intensive care unit admission (OR 4.27; 95% CI 3.84–4.74), in-hospital mortality (OR 6.93; 95% CI 5.60–8.57), and 30-day mortality (OR 7.34; 95% CI 5.86–9.19). UTIs were also associated with sepsis and septic shock development, but to a lesser degree than LRI.</p></div><div><h3>Conclusions</h3><p><span>Primary infection sites including LRI and </span>UTI were significantly associated with sepsis development, hospitalization, length of stay, and mortality among patients presenting with infections in the ED.</p></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 2","pages":"Pages e128-e137"},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139759185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}