Open Access Emergency Medicine最新文献

{"title":"Electrocardiographic Abnormalities in Patients with Hyperkalemia: A Retrospective Study in an Emergency Department in Colombia.","authors":"Jaime A Quintero, Camilo A Medina, Federico Penagos, Jaime Andres Montesdeoca, Gildardo Antonio Orozco, Juan Saavedra-Castrillón, Julio Diez-Sepulveda","doi":"10.2147/OAEM.S455159","DOIUrl":"10.2147/OAEM.S455159","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperkalemia is a prevalent electrolyte disorder related to elevated serum potassium levels, resulting in diverse abnormal electrocardiographic findings and associated clinical signs and symptoms, often necessitating specific treatment. However, in some patients, these abnormal findings may not be present on the electrocardiogram even in elevated serum potassium levels. This study aims to identify electrocardiographic abnormalities related to the severity of hyperkalemia and the clinical outcomes in an emergency department in southwestern Colombia.</p><p><strong>Methodology: </strong>This is a retrospective cross-sectional descriptive study. We described the electrocardiographic findings, clinical characteristics, treatment, and outcomes related to the degrees of hyperkalemia. The potential association between the severity of hyperkalemia and electrocardiographic findings was evaluated.</p><p><strong>Results: </strong>A total of 494 patients were included. The median of the potassium level was 6.6 mEq/L. Abnormal electrocardiographic findings were reported in 61.5% of the cases. Mild and severe hyperkalemia groups reported abnormalities in 59.9% and 61.2%, respectively. The most common electrocardiography abnormalities were the peaked T wave 36.2%, followed by wide QRS 83 (16.8%). Only 1.4% of patients had adverse outcomes. The abnormal findings were registered in 61.5%. Mortality was 11.9%. The peaked T wave was the most common finding across different levels of hyperkalemia severity.</p><p><strong>Conclusion: </strong>High serum potassium levels are related with abnormal ECG. However, patients with different degrees of hyperkalemia could not describe abnormal ECG findings. In a high proportion of patients with renal chronic disease and hyperkalemia, the abnormalities in the ECG could be minimal or absent.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11215665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477644","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":"Seeking Care for Children with Intellectual and/or Developmental Disabilities in the Emergency Department: A Mixed Methods Systematic Review of Parents' Experiences and Information Needs.","authors":"Sarah A Elliott, Sholeh Rahman, Shannon D Scott, Wiliam R Craig, Lisa Knisley, Kathleen Shearer, Lisa Hartling","doi":"10.2147/OAEM.S450191","DOIUrl":"10.2147/OAEM.S450191","url":null,"abstract":"<p><p>The objective of this review was to explore parents' experiences and information needs regarding management of their child with an intellectual and/or developmental disability (IDD) in the emergency department (ED). We searched six electronic databases and grey literature to identify primary studies in English published since 2000. We synthesized quantitative and qualitative outcome data simultaneously using a convergent integrated approach and used a Mixed Methods Appraisal Tool (MMAT) to assess methodological quality of the included studies. Nine articles derived from seven studies were included (3 qualitative, 3 quantitative, 1 mixed method). Four main themes related to parents' self-reported experiences were identified: 1) appropriateness of the ED to manage and support their child; 2) acknowledgement/recognition of their child's IDD and incorporation of those considerations into overall care and management; 3) managing and navigating the ED environment; and 4) decision to disclose their child's condition when visiting the ED. Two articles provided data relevant to information needs, highlighting parents' desire to have resources supporting ED orientation and access to services within and outside of the ED setting. From the limited number of studies, it was evident that parents wanted better communication with healthcare providers and a greater understanding by ED staff around physical space settings needed to support their child. Resources supporting ED staff and parents to communicate effectively and work together can ensure that children with IDDs care needs are met. Further research into understanding parents' experiences and information needs related to managing a child with an IDD in the ED is needed to guide the development of effective resources.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11194008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443495","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":"Obesity and Penetrating Trauma: Outcomes from a Level 1 Trauma Center in New York City.","authors":"Albert Yao, Jaiden I Busso, Nisha Lakhi","doi":"10.2147/OAEM.S453589","DOIUrl":"10.2147/OAEM.S453589","url":null,"abstract":"<p><strong>Background: </strong>Obesity is associated with increased morbidity and mortality in trauma scenarios; however, there has been conflicting evidence on outcomes of obesity and penetrating injuries, specifically gunshot wounds and stab wounds. We hypothesized that obesity may be protective due to a \"cushioning effect\" attributed to increased adiposity.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients presenting to a Level 1 Trauma Center with a penetrating trauma (gunshot/stab) injury during 2008-2021. Patients with a BMI ≥ 30 were compared to those with a BMI < 30. The primary outcome was Injury Severity Score (ISS). Secondary outcomes included intensive care unit (ICU) length of stay, days on ventilation, length of hospital stay, service of admission (trauma surgery, general surgery, discharged home, general medical floor), the body region of injury(s), Abbreviated Injury Scale (AIS), OR requirement, type of surgery, and discharge status. Statistical analysis was performed using χ²-test or Fisher's exact tests for categorical data, and Student's <i>t</i>-test or Mann-Whitney <i>U</i>-test for continuous variables with <i>p</i> < 0.05 as statistically significant. Subgroup analysis was performed based on the mechanism of injury.</p><p><strong>Results: </strong>There were 721 patients that met inclusion criteria, of which 540 were classified in the non-obese group and 181 (25.1%) in the obese group. The primary outcome, mean ISS score, in obese patients (9.0, SD = 13.0) and non-obese patients (9.4, SD = 13.8) was similar between groups respectively. Secondary outcomes, which included rates of severe abdominal injury (AIS ≥ 3), rates of intra-abdominal organ injury, and rates of gastro-intestinal resection, were also similar between non-obese and obese patients.</p><p><strong>Conclusion: </strong>This study did not demonstrate the existence of a \"cushioning effect\" in the setting of penetrating traumatic injury. Patients with increased BMI had similar a ISS score and patterns of injury as their non-obese counterparts.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11144413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200761","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":"Out-of-Hospital Cardiac Arrest in the Eye of the Beholder and Emergency Medical Service","authors":"Lorka Tarnovski, Porin Šantek, Ivana Rožić, Đivo Čučević, Luka Mahečić, Jana Marić, Josip Lovaković, Dejana Martinić, Fran Rasic, Žarko Rašić","doi":"10.2147/oaem.s449157","DOIUrl":"https://doi.org/10.2147/oaem.s449157","url":null,"abstract":"Purpose: Out-of-hospital cardiac arrest (OHCA) remains a global healthcare problem, with low survival and bystander cardiopulmonary resuscitation (CPR) rates. This study aimed to identify event-related factors in OHCA and their impact on return of spontaneous circulation (ROSC) achievement and maintenance until hospital admission. Patients and Methods: All data were collected from Utstein Resuscitation Registry Template for OHCA from The Institute of Emergency Medicine of Zagreb from January 2012 to August 2022. This cross-sectional research analyzed 2839 Utstein reports, including 2001 male, 836 female, and 8 subjects of unknown gender. The average age was 65.4 ± 16.2 years. Results: The most frequent place of collapse was private residence, and 27% of collapses were unwitnessed. Dispatcher-provided CPR instructions were provided in 39.7% of cases until the arrival of the emergency service team, which showed a very strong effect on bystander-provided CPR, and were followed in 68.4% of cases, while non-instructed bystander CPR was provided in only 7.9% of cases. Bystander CPR is more likely to be provided in public places than in private residences, often with both compression and ventilation. Bystander CPR was also more likely to be provided to men. Cases with bystander CPR, and compressions with ventilation compared to compression only CPR, showed a significantly greater success in maintaining ROSC later in CPR, both with moderate effects. Conclusion: Bystander CPR has been shown to have a significant role in achieving and maintaining ROSC until hospital admission. However, our results showed a location-dependent nature of bystanders’ willingness to perform CPR as well as sex disparities in patients receiving CPR. With deficient education in basic life support in Croatia, dispatchers need to insist on and instruct bystander CPR performance.","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140757122","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}

{"title":"Lung Abscess as a Complication of Appendicitis","authors":"Molla Asnake, Suleman Hassen, Anteneh Messele, Yosef Habtemariam, Sisay Mengistu, Bizuayehu Tassew, Tsegaw Worku, W. Tadeg","doi":"10.2147/oaem.s439075","DOIUrl":"https://doi.org/10.2147/oaem.s439075","url":null,"abstract":": Appendicitis is an inflammation of the vermiform appendix (located near the base of the cecum). A lung abscess is a cavitary lesion containing necrotic lung tissue or an infected fluid component. It mainly occurs as a result of lung parenchymal disease. The patient was a 25-year-old male who first presented with a 1-week history of productive cough and chest pain associated with low-grade fever. He was diagnosed with a lung abscess as a complication of perforated retro cecal appendicitis. We report this in consideration of reducing the challenge of delay in diagnosis of this rare complication, and to avoid mistreatment specifically when the patient’s chest x-ray resembles empyema. Additionally, we encourage doing further studies on this topic.","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140762689","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}

{"title":"The Eruptive Fevers at Sixes and Sevens","authors":"Robert Petrella","doi":"10.2147/oaem.s448246","DOIUrl":"https://doi.org/10.2147/oaem.s448246","url":null,"abstract":": Sixth Disease (roseola infantum) and its primary causative agent, HHV-6, share names that numerically concur. This article examines and answers the question of whether that correspondence is by design or coincidental by briefly reviewing the history and nomenclature of the HHV viruses and the classic febrile rashes of childhood while highlighting some clinical and microbiologic features of HHV-6 infection.","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140788636","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}

{"title":"The Role of Ophthalmology in Tele-Stroke Consults for Triaging Acute Vision Loss.","authors":"Anna Artymowicz, Christina Douglas, Kimberly Cockerham","doi":"10.2147/OAEM.S395588","DOIUrl":"https://doi.org/10.2147/OAEM.S395588","url":null,"abstract":"<p><p>Advances in telemedicine have allowed physicians to provide care in areas that were previously geographically or practically inaccessible. Roughly 70% of all US hospital have less than 200 bed capacity and nearly 50% have fewer than 100 beds. These smaller hospitals often do not have specialists available for bedside patient care, making them potential beneficiaries of telemedicine medical specialty services. In 2005, the American Stroke Association proposed implementing telemedicine services in effort to increase access to acute stroke care in neurologically underserved areas such as small hospitals. Tele-stroke services have since become established across the country and are now utilized by approximately 30% of US hospitals. By reducing the time between presentation and evaluation by a stroke specialist, tele-stroke programs have successfully increased patient access to life-saving treatment with tissue-plasminogen activator (t-PA) treatments. This change has been especially profound remote and underserved community hospitals. However in the evaluation of acute vision loss, an area where ophthalmology and stroke care overlap, increased reliance on tele-stroke services has contributed to some unique challenges. Acute vision has a complex differential and is commonly a result of conditions other than stroke. When tele-stroke services are engaged for the evaluation of acute vision loss, the neurologist is asked to make medical decisions without complete information about the eye. This situation can expose patients to costly or inappropriate testing, unnecessary hospitalizations, or lead to delayed diagnosis and treatment of non-neurologic conditions of the eye. The goal of this paper is to provide an overview of the overlap between stroke and vision loss, highlight the challenges inherent in using tele-stroke in evaluating acute vision loss and to offer our comments on how increased communication between emergency medicine, ophthalmology, and neurology services can ensure that patients with vision loss receive the highest standard of care in all hospitals.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724421","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":"Chest Pain Risk Stratification in the Emergency Department: Current Perspectives.","authors":"Zeynep Yukselen, Vidit Majmundar, Mahati Dasari, Pramukh Arun Kumar, Yuvaraj Singh","doi":"10.2147/OAEM.S419657","DOIUrl":"https://doi.org/10.2147/OAEM.S419657","url":null,"abstract":"<p><p>Chest pain is the second leading cause of all emergency department (ED) visits in adults in the United States, with nearly 11 million encounters yearly. While identifying low-risk patients is crucial for early discharge, identifying high-risk patients in ED is vital in timely and appropriate acute coronary syndrome (ACS) management. Traditional methods such as physical examination, cardiac markers, or imaging tests cannot reliably confirm or rule out ACS; they cannot be singularly incorporated to risk stratify patients. Various clinical risk scores have been proposed to address this challenge for risk stratification in patients being evaluated for suspected ACS. The ideal risk score should demonstrate high sensitivity and specificity to accurately differentiate between patients with varying levels of risk, particularly in identifying those at high risk for major adverse cardiovascular events. Simultaneously, an ideal scoring system should also be able to compute information for other non-coronary etiologies of chest pain that require time-sensitive interventions and workups (eg, aortic dissection and pulmonary embolism). In this review, we have assembled major risk scores used for risk stratification in patients with acute chest pain in ED. We have abbreviated their salient features to assist readers in their clinical decision-making.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10853047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724420","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":"A Case of Severe Rhabdomyolysis, Acute Myocardial Damage and Multi-Organ Dysfunction Syndrome in a Patient with Novel Coronavirus Pneumonia.","authors":"Shuaishuai Yuan, Yuting Huang, Pailing Xie, Peijun Li","doi":"10.2147/OAEM.S446994","DOIUrl":"10.2147/OAEM.S446994","url":null,"abstract":"<p><p>In recent years, healthcare systems worldwide have faced the challenge of the severe COVID-19 pandemic. However, cases of severe rhabdomyolysis, acute myocardial damage, and multiple organ dysfunction syndrome (MODS) caused by COVID-19 are currently rare. This report presents a case of severe rhabdomyolysis, acute myocardial damage, and MODS caused by COVID-19. The patient was treated at The University of Hong Kong-Shenzhen Hospital. The purpose of this report is to aid clinicians in quickly identifying and treating similar cases, ultimately improving patient outcomes.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10840558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693139","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":"A Case Study on Unreported First Probable Human Rabies Following Honey Badger in Somalia.","authors":"Ubah Mumin Ali Osman, Selim Turfan, Mohamed Farah Yusuf Mohamud","doi":"10.2147/OAEM.S439996","DOIUrl":"10.2147/OAEM.S439996","url":null,"abstract":"<p><p>Rabies is a neglected zoonotic disease caused by a virus. It is an acute progressive neurological disease that affects people in many parts of the world, especially in low income countries including Somalia and it is always lethal once symptoms appear without immediate post-exposure prophylaxis (PEP). Nearly half of rabies cases occur in children. This case report presents a tragic and unique clinical scenario involving a 14-year-old boy from a rural area in Somalia who presented to our tertiary hospital after a bite from a honey badger. The patient's younger sister, who was also bitten by the same honey badger, sadly succumbed to the disease two weeks prior. This report aims to contribute to the medical literature by highlighting the challenges faced in diagnosing and managing rabies in resource-constrained settings.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10838048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681728","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}