Open Journal of Emergency Medicine最新文献

Cerebral Malaria: Epidemiological, Clinical and Prognosis Aspects in the Anesthesia-Resuscitation Department CHU Ignace Deen 脑疟疾:麻醉复苏科的流行病学、临床和预后

Open Journal of Emergency Medicine Pub Date : 2023-01-01 DOI: 10.4236/ojem.2023.114016

Abdoulaye Touré, Amadou Yalla Camara, Almamy Bangoura, M’mah Lamine Camara, Mohamed Soumah, Saramba Nabe

{"title":"Cerebral Malaria: Epidemiological, Clinical and Prognosis Aspects in the Anesthesia-Resuscitation Department CHU Ignace Deen","authors":"Abdoulaye Touré, Amadou Yalla Camara, Almamy Bangoura, M’mah Lamine Camara, Mohamed Soumah, Saramba Nabe","doi":"10.4236/ojem.2023.114016","DOIUrl":"https://doi.org/10.4236/ojem.2023.114016","url":null,"abstract":"Objective: To describe the epidemiological, clinical, paraclinical and prognostic aspects of cerebral malaria received in the anesthesia-resuscitation department. Methodology: This was a prospective descriptive type study carried out in the anesthesia-resuscitation department over a period of three (03) months (June 01 to August 31, 2022). All patients admitted for cerebral malaria were included. Sociodemographic, clinical and prognostic parameters were studied. Results: We collected 25 cases out of 105 admitted patients (23.8%). The average age was 27.6 ± 9.5 years with extremes of 11 and 50 years. The sex ratio was 0.7 (M/F). Students and housewives were in the majority, i.e. 52% and 24%. Neurological disorders were found on admission in all patients, dominated by impaired consciousness at 100% followed by convulsion (60%), prostration (44%), confusion (36%) associated with deep coma in (68%). Gross hemoglobinuria was present in (84%) of cases. On the blood count, anemia was present in (70%) of the patients followed by thrombocytopenia in more than half of the cases (60%) and transfusion was necessary in 19 cases. P Falciparum malaria was found in all patients (100%), the average parasite density was 60342.8 ± 30425.6 trophozoites/μl with extremes of 9000 to 100000 trophozoites/μl. All our patients were treated with intravenous injectable artesunate. Transfusion was performed in 76% of our patients. Eighty percent of the patients had benefited from dialysis. High oxygen therapy was performed in (92%) of cases. The average duration of hospitalization was 5.74 ± days with extremes of 1 to 17 days. Mortality was 48%. Conclusion: Cerebral malaria can take different clinical forms, the most important of which is cerebral involvement. Prompt initiation of appropriate resuscitation can reduce mortality.","PeriodicalId":289242,"journal":{"name":"Open Journal of Emergency Medicine","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135156043","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}

引用次数: 0

Post Antibiotic Grade IV Anaphylaxis: A Case Report from the Emergency Department of Chu Donka 抗生素后四级过敏反应:楚东卡急诊科1例报告

Open Journal of Emergency Medicine Pub Date : 2023-01-01 DOI: 10.4236/ojem.2023.113012

Amadou Yalla Camara, Abdoulaye Touré, Ernest Ahounou, Almamy Bangoura, M’mah Lamine Camara, Thierno Sadou Diallo, Alhassane Barry, Boubacar Atigou Dramé, Joseph Donamou

{"title":"Post Antibiotic Grade IV Anaphylaxis: A Case Report from the Emergency Department of Chu Donka","authors":"Amadou Yalla Camara, Abdoulaye Touré, Ernest Ahounou, Almamy Bangoura, M’mah Lamine Camara, Thierno Sadou Diallo, Alhassane Barry, Boubacar Atigou Dramé, Joseph Donamou","doi":"10.4236/ojem.2023.113012","DOIUrl":"https://doi.org/10.4236/ojem.2023.113012","url":null,"abstract":"Anaphylaxis is a serious systemic reaction that is part of the general pattern of potentially fatal hypersensitivity reactions requiring immediate management. We report the case of a patient presenting to emergency with signs of malaria and pneumonia who was diagnosed with grade 4 anaphylaxis following antibiotic injection in the emergency department. The patient was 30 years old, with no previous history of anaphylaxis, and presented to the emergency department with fever, dry cough, headache and dizziness associated with prostration. Physical examination showed stable hemodynamics (BP = 110/80 mmHg, HR = 95 p/min,) and respiratory function with SpO2 = 98%, HR = 22 c/min and crepitus rales at the base of the lungs. The laboratory work-up carried out in the emergency department revealed a biological inflammatory syndrome associated with hyperleukocytosis of 11,260/mm3, a positive thick drop with GE(+) dp = 1183 T/microlitre; blood glucose = 0.83 g/l; Covid 19 RDT = (negative). A diagnosis of malaria and pneumonia was made and antibiotic therapy (ceftriaxone) and artesunate were indicated. During the injection of ceftriaxone 1 g, the patient became agitated, followed by cardiorespiratory arrest, confirming the diagnosis of stage 4 anaphylaxis. Treatment consisted of stopping the ceftriaxone injection, external cardiac massage and ventilation, intravenous adrenaline and vascular filling, which enabled the patient to recover and stabilize. The diagnosis of anaphylaxis is clinical. Early administration of adrenaline is the mainstay of treatment.","PeriodicalId":289242,"journal":{"name":"Open Journal of Emergency Medicine","volume":"275 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135649354","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}

引用次数: 0

Evaluation of the Effectiveness and Nature of Analgesia in the Medical-Surgical Emergency Department of CHU-Donka 中东卡内科外科急诊科镇痛效果及性质评价

Open Journal of Emergency Medicine Pub Date : 2023-01-01 DOI: 10.4236/ojem.2023.114015

Amadou Yalla Camara, Abdoulaye Touré, Almamy Bangoura, M’mah Lamine Camara, Thierno Sadou Diallo, Boubacar Atigou Dramé, Joseph Donamou

{"title":"Evaluation of the Effectiveness and Nature of Analgesia in the Medical-Surgical Emergency Department of CHU-Donka","authors":"Amadou Yalla Camara, Abdoulaye Touré, Almamy Bangoura, M’mah Lamine Camara, Thierno Sadou Diallo, Boubacar Atigou Dramé, Joseph Donamou","doi":"10.4236/ojem.2023.114015","DOIUrl":"https://doi.org/10.4236/ojem.2023.114015","url":null,"abstract":"Introduction: Pain assessment is an essential step towards pain relief. In our context, however, it is insufficient in emergency departments. The aim was to assess the nature and effectiveness of the analgesia used in the emergency department of the CHU-Donka. Method: This was a single-centre prospective observational study conducted over one month (November 2020) in the medical-surgical emergency department of CHU-Donka. All patients aged 18 or over admitted to the emergency department with moderate to severe acute pain were included. Results: We enrolled 880 patients, 615 of whom (69.88%) were in pain. Males predominated (65.2%), with a sex ratio of 1.87. The average age was 44.78 ± 16.41 years, with extremes ranging from 18 to 85 years. The most represented age group was 18 - 34 years, with 66.18%. Initial assessment of pain by nursing staff in 3 cases. Initial assessment of pain by the investigator was 100%, 74% moderate and 26% severe. No reassessment of pain by nursing staff. Reassessment by the interviewer was 100% and found 5% no pain, 61% mild pain, 24% moderate pain and 10% severe pain. With an average numerical scale of 3.77 ± 2.61 and extremes from 0 to 10. Average length of stay was 2.85 ± 1.48 hours, with extremes ranging from 45 minutes to 8 hours. Analgesia was administered with paracetamol alone (43.58%), combined with tramadol or nefopam. No patient received morphine. Conclusion: This study revealed a lack of pain assessment in our department.","PeriodicalId":289242,"journal":{"name":"Open Journal of Emergency Medicine","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136366612","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}

引用次数: 0

The Reasons for Admission of Elderly Subjects in Intensive Care at the CHU Ignace Deen 中大医院重症监护老年病人入院原因分析

Open Journal of Emergency Medicine Pub Date : 2023-01-01 DOI: 10.4236/ojem.2023.113011

Abdoulaye Touré, Amadou Yalla Camara, Almamy Bangoura, Donamou Joseph, M’mah Lamine Camara

{"title":"The Reasons for Admission of Elderly Subjects in Intensive Care at the CHU Ignace Deen","authors":"Abdoulaye Touré, Amadou Yalla Camara, Almamy Bangoura, Donamou Joseph, M’mah Lamine Camara","doi":"10.4236/ojem.2023.113011","DOIUrl":"https://doi.org/10.4236/ojem.2023.113011","url":null,"abstract":"Objective: To determine the reasons for admission of elderly subjects and the prognosis in general intensive care. Patients and Methods: Observational descriptive and analytical study with prospective collection of data over a period of one year from January 1 to December 31, 2021. Patients aged 65 or over were included. Abstract: During the study period, 223 cases were collected out of 587 patients admitted, giving a prevalence of 37.9%. The average age was 74.127.39 ± years with extremes of 65 and 96 years and a male predominance (58.7%). The comorbidities were dominated by arterial hypertension (71.3%). The patients were: transferred from medical and surgical emergencies (75.8%). The average admission time was 48.8 ± 29.8 hours. One hundred and eight patients had a Glasgow score between 3 and 7. The reasons for admission were dominated by vascular causes (51.6%). Strokes of any type accounted for 43.9% of these reasons for admission. The average time for carrying out the biological assessments and imaging was 41.8 ± 27.3 hours with the extremes of 3 and 89 hours, 37.2% had a complete assessment within 24 hours. The average duration of hospitalization was 7.10 ± 8.87 days with extremes of 1 and 72 days. The mortality rate was 71.7%. Conclusion: This study has made it possible to take stock of the reasons for the admission of elderly subjects to intensive care. It appears that vascular causes are the main reasons for admission with heavy comorbidities which results in high mortality.","PeriodicalId":289242,"journal":{"name":"Open Journal of Emergency Medicine","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135446701","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}

引用次数: 0

A Case of Euglycemic Diabetic Ketoacidosis in Patient with Type 2 DM 2型糖尿病合并正糖型糖尿病酮症酸中毒1例

Open Journal of Emergency Medicine Pub Date : 2023-01-01 DOI: 10.4236/ojem.2023.114017

Lamiz Tannouri, Shahinaz Gouda, Youssef Abboud

引用次数: 0

BMI-Adjusted Tube Current in Chest CT and Comparison of Lifetime Attributable Risk (LAR) of Breast Cancer in Two Different BMI-Based Protocols 在两种不同的基于bmi的方案中，胸部CT调整bmi管电流和乳腺癌终生归因风险(LAR)的比较

Open Journal of Emergency Medicine Pub Date : 2023-01-01 DOI: 10.4236/ojem.2023.113013

Amin Shams Akhtari, Babak Heidariaghdam, Faeze Vahid, Alireza Oloumi, Latif Gachkar, Mehrdad Taghizadeh, Seyedeh Hedieh Mousavipaak

{"title":"BMI-Adjusted Tube Current in Chest CT and Comparison of Lifetime Attributable Risk (LAR) of Breast Cancer in Two Different BMI-Based Protocols","authors":"Amin Shams Akhtari, Babak Heidariaghdam, Faeze Vahid, Alireza Oloumi, Latif Gachkar, Mehrdad Taghizadeh, Seyedeh Hedieh Mousavipaak","doi":"10.4236/ojem.2023.113013","DOIUrl":"https://doi.org/10.4236/ojem.2023.113013","url":null,"abstract":"Possible strategies to reduce radiation dose during CT scanning have been investigated over recent decades; here the optimization of the tube current and its link with patient’s cancer incidence are being evaluated. 154 consecutive trauma patients with the need for chest CT scan were included. Two different BMI-adjusted CT protocols at a fixed voltage tube and the same scan length were applied. Dose estimation parameters like CT dose index (CTDI), dose length product (DLP) and effective breast dose were calculated. Breast surface dose was obtained by using thermoluminescence dosimeters (TLDs) and eventually, the life attributable risk (LAR) of cancer incidence was estimated. The mean effective dose was 4.87 ± 2.3 mSv and 5.12 ± 2.8 mSv for patients who were scanned with tube currents of 120 mAs and 200 mAs, respectively. There was no significant difference between organ surface doses for females but in males it was notable. The risk of cancer incidence is lower for protocol 1 in comparison with protocol 2. Optimizing tube current of 120 mAs reduced breast surface dose up to 50% in comparison with the tube current of 200 mAs. In trauma patients, using lower tube current based on BMI has notable impact on the absorbed dose in the breast and can reduce the breast cancer risk by nearly 33.6% for women.","PeriodicalId":289242,"journal":{"name":"Open Journal of Emergency Medicine","volume":"260 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135649357","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}

引用次数: 0

The Slippery Slope of Sepsis 败血症的滑坡

Open Journal of Emergency Medicine Pub Date : 2023-01-01 DOI: 10.4236/ojem.2023.113014

Lawrence W. Gernon

{"title":"The Slippery Slope of Sepsis","authors":"Lawrence W. Gernon","doi":"10.4236/ojem.2023.113014","DOIUrl":"https://doi.org/10.4236/ojem.2023.113014","url":null,"abstract":"Mortality, morbidity, early recognition, and treatment of sepsis remain a diagnostic dilemma for clinicians, in addition, the timely diagnosis of sepsis represents an ongoing clinical challenge. This review looks at the challenges of early recognition, the scope of the problem, the immunologic basis of the sepsis cascade, new frontiers related to interventions, and the role of antibiotics in an era of antimicrobial resistance. In Figure 1, once a patient is on the slippery slope of sepsis, the ability to reverse the momentum is challenging; hoping antibiotics, fluid resuscitation, vasopressors may buy time for the immunologic cascade to equilibrate to its homeostatic balance. While the development of septic shock is much more complex than pathogen proliferation, our understanding of the pathogenesis and ability to therapeutically intervene is in its infancy. Patients with sepsis frequently present for urgent medical care with undifferentiated infection and nonspecific symptoms. As 80% of patients with sepsis are initially treated in an Emergency Department, the burden of early recognition and intervention falls squarely on the shoulders of Emergency Department Clinicians. [1] This is an entity that occurs in all age groups, without regard to race, geography, or health status. Survival and mortality related to this clinical entity are poorly understood. Our understanding of sepsis needs to expand beyond the downstream effects and collateral damage of multiorgan dysfunction and failure. Immunologically, the antigenic triggers, be it invasive infection, severe injury, and systemic inflammation without concomitant infection, elicit similar pattern recognition receptors and innate host responses. If you are lucky enough to have survived an acute episode of sepsis, patients with sepsis often develop new adverse sequelae after treatment, a concept called persistent critical illness or post sepsis syndrome, characterized by long-term disability, and worsening chronic health conditions requiring re-hospitalization. [2]","PeriodicalId":289242,"journal":{"name":"Open Journal of Emergency Medicine","volume":"2015 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135749055","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}

引用次数: 0

Severe Head Trauma in a 39-Week Pregnant Woman with Amenorrhea (SA) Apropos of a Case at CHU Ignace Deen in Conakry 在科纳克里的CHU Ignace Deen的一个病例中，严重头部创伤的39周孕妇闭经(SA)

Open Journal of Emergency Medicine Pub Date : 2023-01-01 DOI: 10.4236/ojem.2023.113010

Abdoulaye Touré, Amadou Yalla Camara, Donamou Joseph, Almamy Bangoura, M’mah Lamine Camara

{"title":"Severe Head Trauma in a 39-Week Pregnant Woman with Amenorrhea (SA) Apropos of a Case at CHU Ignace Deen in Conakry","authors":"Abdoulaye Touré, Amadou Yalla Camara, Donamou Joseph, Almamy Bangoura, M’mah Lamine Camara","doi":"10.4236/ojem.2023.113010","DOIUrl":"https://doi.org/10.4236/ojem.2023.113010","url":null,"abstract":"Objective: Was to present the management of a pregnant woman at 39 SA received for severe head trauma in the emergency room. Severe trauma in pregnant women can have serious maternal and especially fetal consequences in the absence of a diagnostic and therapeutic strategy. We report the case of serious trauma in a 39 WA pregnant woman, nulliparous. Admitted to the emergency room for serious head trauma following a public road accident. The clinical picture was dominated by impaired consciousness with a Glasgow score of 8/15, right otorrhagia, desaturation at 89% AA and respiratory rate at 36 cycles/min. The obstetrical examination noted a fundal height of 32 cm, a fetal heart sound (BCF) of 167 beats/min, a cephalic presentation, a cervical opening of 3 cm and uterine contractures. Imaging examinations outside the hospital because not available. The abdominopelvic ultrasound shows a monofetal pregnancy without placental abruption. The cerebral scanner shows an edemato-haemorrhagic contusion intra parenchymatous frontotemporal left. Respiratory support and an indication for caesarean section allowed the extraction of a live male child, Apgar at one minute 10/10 to five minutes 10/10, weighing 3000 g without abnormality on clinical examination. The evolution was favorable after 27 days of resuscitation. Conclusion: The care of a severely traumatized pregnant woman relies above all on good multidisciplinary coordination, based on close collaboration between emergency physicians, anesthetists-resuscitators, obstetricians, pediatricians, neonatologists and biologists.","PeriodicalId":289242,"journal":{"name":"Open Journal of Emergency Medicine","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135446703","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}

引用次数: 0