Open Access Emergency Medicine最新文献

{"title":"Deadly Injuries Sustained From a Hyena Attack: The Importance of Timely Diagnosis and Treatment - A Case Report.","authors":"Abdullahi Ahmed Ahmed, Ismail Gedi Ibrahim, Ismail Mohamoud Abdullahi, Abdihakim Artan Abdi, Mohamed Dahir Omar, Abdulkadir Ahmed Mohamed","doi":"10.2147/OAEM.S509826","DOIUrl":"10.2147/OAEM.S509826","url":null,"abstract":"<p><p>Animal bites represent a significant global public health concern, with hyena attacks being rare but highly destructive. This report details the case of a 22-year-old male who was attacked by a hyena while herding camels in rural Qardho, Somalia. The attack resulted in traumatic amputation of both testicles and the penis, finger loss, extensive muscle damage, and a jawbone fracture. The patient initially received local care and was subsequently transferred to Mogadishu for advanced treatment. Key interventions included wound closure, tracheotomy, broad-spectrum antibiotics, and tetanus prophylaxis. This case highlights the complexities of managing severe trauma in resource-limited settings and underscores the necessity of timely, multidisciplinary care. Long-term rehabilitation, along with psychological support, are essential components of the patient's recovery. Furthermore, the case emphasizes the importance of trauma prevention strategies and ensuring access to specialized medical care in remote regions.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"121-127"},"PeriodicalIF":1.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494084","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":"Ketamine Versus Haloperidol/Lorazepam/Diphenhydramine Combination Treatment for Management of Acute Agitation in the Emergency Department.","authors":"Nicole Sunshine, Jenny Martinez, Alexandra Bazan, William R Wolowich, Tony Zitek","doi":"10.2147/OAEM.S486208","DOIUrl":"10.2147/OAEM.S486208","url":null,"abstract":"<p><strong>Purpose: </strong>Appropriate use and timing of agents for chemical management of patient agitation is critical for the safety of patients and providers. Ketamine may have a preferable safety profile in acutely agitated patients, especially those with an unknown medication history given that it does not carry the same cardiovascular and respiratory risks as other sedative agents currently used in practice. This study aimed to evaluate subsequent chemical sedation requirements and the incidence of adverse events following the use of ketamine for agitation as compared to combination antipsychotic/sedative use in the ED.</p><p><strong>Methods: </strong>This was a retrospective, single-center, observational cohort study of 102 adult patients who received chemical sedation for agitation/aggression/combative behavior from January 2018 to December 2023 at the Mount Sinai Medical Center Emergency Department. Patients who received at least one dose of ketamine (n = 51) were compared to patients who received at least one dose of the B52 combination (diphenhydramine (Benadryl) 25 mg, haloperidol (Haldol) 5 mg, and lorazepam (Ativan) 2 mg) (n = 51) for management of aggression. The primary endpoint was restricted mean survival time (RMST) to next sedative given. Secondary endpoints included the number of additional sedatives needed, adverse events, and length of stay.</p><p><strong>Results: </strong>The use of ketamine was associated with patients requiring additional sedation both more often and sooner than patients who received the B52 combination (RMST to next sedative: 2.1 hours ketamine vs 4 hours B52; <i>p</i> = 0.032, median additional doses: 3 doses ketamine group vs 0 doses B52 group; <i>p</i> < 0.00).</p><p><strong>Conclusion: </strong>In agitated patients within the ED, the administration of ketamine demonstrated inadequate duration of sedation and increased need for supplemental sedative use compared to B52.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"113-120"},"PeriodicalIF":1.5,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469540","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":"Are Saudi Radiological Sciences Students Prepared for Emergencies? Exploring Knowledge, and Attitudes Towards Basic Life Support and Cardiopulmonary Resuscitation.","authors":"Khalid M Alshamrani, Alaa A Alkhayyat, Rimaz N Arif, Adnan A S Alahmadi, Shrooq T Aldahery, Walaa M Alsharif, Abdulaziz A Qurashi","doi":"10.2147/OAEM.S507046","DOIUrl":"10.2147/OAEM.S507046","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to evaluate the preparedness of Saudi radiological sciences students for emergencies by assessing their awareness of cardiac arrest evaluation criteria, knowledge of Cardiopulmonary Resuscitation (CPR) and defibrillators, and attitudes towards performing CPR.</p><p><strong>Methods: </strong>A cross-sectional descriptive study was conducted among students from the radiological sciences program at three Saudi universities. Using a well-established questionnaire, the study employed non-probability convenient sampling. Descriptive statistics were generated, and chi-square test examined associations between categorical variables and Basic Life Support (BLS) training status.</p><p><strong>Results: </strong>Out of 367 students contacted, 261 participated (71.1% response rate). BLS training markedly enhances knowledge of the correct chest compression rate, with 50.9% of trained students demonstrating accurate understanding compared to 27.5% of untrained students (P < 0.0001). A significant correlation was found between BLS training and the ability to perform cardiac massage during cardiac arrest and respiratory standstill, with 44.1% of students demonstrating this knowledge (P < 0.0001). Notably, 80.8% of students without BLS training lacked knowledge of cardiac massage, compared to only 30.4% of those with training. Additionally, 30.6% of students were familiar with defibrillators, and 44.1% knew AED locations (P = 0.0007). Hesitation to perform CPR was mainly due to fear of mistakes (53.6%) and harm concerns (31.1%).</p><p><strong>Conclusion: </strong>Our findings reveal significant gaps in knowledge, confidence, and preparedness for cardiac emergencies among Saudi radiological sciences students, with only 41.4% having completed BLS training. These results highlight the urgent need for comprehensive BLS education to.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"91-103"},"PeriodicalIF":1.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434077","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":"An Effective Triage Education Method for Triage Nurses: An Overview and Update.","authors":"Sofia-Chrysovalantou Zagalioti, Mairi Ziaka, Aristomenis Exadaktylos, Barbara Fyntanidou","doi":"10.2147/OAEM.S498085","DOIUrl":"10.2147/OAEM.S498085","url":null,"abstract":"<p><strong>Background: </strong>Accurate decision-making in triage largely determines the amount of time required for a patient to be evaluated and treated while in the emergency department. Nursing staff worldwide have similar learning characteristics with similar working hours and common goals, despite the fact that different triage scales are used globally. The aim of this mini review is to present the different educational methods and identify the most effective for triage training of triage nurses.</p><p><strong>Materials and methods: </strong>We screened studies concerning triage education for nurses in Emergency Department, in databases including PubMed, CENTRAL and CINAHL. From November 12, 2023 to February 15, 2024, databases were searched for relevant literature. \"Triage education\" OR \"triage training\" AND \"emergency nurses\" OR \"triage nurses\" were the MeSH terms.</p><p><strong>Results: </strong>There are various educational methods, including traditional, web-based, audiovisual, simulation-based, blended learning, and other specialized approaches. Almost all of the studies that are currently available demonstrate how effectively an educational intervention might improve nurses' comprehension of triage. Except for one, every study concluded that the educational intervention significantly improved nurses' triage knowledge. Comparing the included studies is challenging due to their heterogeneity, and applying the results in practice requires caution.</p><p><strong>Conclusion: </strong>The majority of studies reported that educational interventions effectively increased nurses' triage knowledge. Blended learning in conjunction with refresher courses enhanced triage-related knowledge and decision-making; however, additional research is required to ascertain whether this approach is superior to the others and whether these improvements will last.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"105-112"},"PeriodicalIF":1.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434074","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 Cutaneous Leishmaniasis Presenting to the Emergency Department.","authors":"Anne Gordon, Adrienne N Malik","doi":"10.2147/OAEM.S499748","DOIUrl":"10.2147/OAEM.S499748","url":null,"abstract":"<p><p>In this case, we describe a case of cutaneous leishmaniasis, a protozoan disease not typically found in the United States, that presented to our emergency department (ED). The diagnosis was confirmed by the Center for Disease Control and Prevention (CDC) through a polymerase chain reaction (PCR) sample from the presenting skin lesion. The patient was a 43-year-old woman with history of a bite by an unknown organism while traveling by foot through Panama. She presented with a large, ulcerated lesion on her lower left shin. She was admitted on suspicion of leishmaniasis, and physicians of several specialties initiated a broad laboratory workup, collected wound cultures, prescribed antibiotics, and surgically repaired the lesion. The rapid recognition of leishmaniasis allowed for the patient to begin treatment before the definitive diagnosis returned, emphasizing the importance of knowledge of worldwide diseases and their presenting features for the ED physician.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"85-89"},"PeriodicalIF":1.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399949","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":"Traffic Patterns and Emergency Medical Services Prenotification Transport Estimates in Trauma Activations [Letter].","authors":"Sari Luthfiyah, Triwiyanto Triwiyanto, Mohammed Ismath","doi":"10.2147/OAEM.S502924","DOIUrl":"10.2147/OAEM.S502924","url":null,"abstract":"","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"65-66"},"PeriodicalIF":1.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383758","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":"Anemia, Hyperglycemia, and Reduced Left Ventricular Ejection Fraction Improve the GRACE Score's Predictability for In-hospital Mortality in Acute Coronary Syndrome; Single-Centre Cross-Sectional Study.","authors":"Iswandy Janetputra Turu' Allo, Miftah Pramudyo, Mohammad Rizki Akbar","doi":"10.2147/OAEM.S493878","DOIUrl":"10.2147/OAEM.S493878","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigates the predictive value of incorporating anemia, hyperglycemia, and left ventricular ejection fraction (LVEF) into the Global Registry of Acute Coronary Events (GRACE) score for in-hospital mortality in Acute Coronary Syndrome (ACS).</p><p><strong>Patients and methods: </strong>We conducted a single-center, cross-sectional study involving 634 ACS patients admitted to Dr. Hasan Sadikin General Hospital between 2021 and 2023. Anemia was defined as hemoglobin <13 g/dL in men and <12 g/dL in women, while hyperglycemia was indicated with random blood glucose (RBG) ≥200 mg/dL at admission. Patients with LVEF <50% were classified as having reduced LVEF. The primary outcome was in-hospital mortality. Model goodness-of-fit was assessed using R² and the Hosmer-Lemeshow's test. The predictive accuracy of the GRACE score alone and combined with these parameters were evaluated through receiver operating characteristic curve analysis, an area under the curve (AUC), and concordance (C)-statistics. Reclassification improvement was quantified using continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI).</p><p><strong>Results: </strong>Among 634 patients (mean age 58.10±11.08 years old; 80.3% male), anemia, hyperglycemia, and reduced LVEF were observed in 197 (31.1%), 123 (19.4%), and 364 (57.4%) patients, respectively. The in-hospital mortality rate was 6.6%. Regression analysis identified nine predictors of mortality, with anemia, hyperglycemia, and reduced LVEF confirmed as independent predictors. The GRACE score showed an AUC of 0.839 (95% confidence interval/CI 0.77-0.0.90). Incorporating anemia, hyperglycemia, and reduced LVEF increased the AUC to 0.862 (95% CI 0.81-0.91), enhancing predictive accuracy (p = 0.590). Combining these variables yielded an NRI of 0.075 (p = 0.070) and an IDI of 0.035 (p = 0.029).</p><p><strong>Conclusion: </strong>Incorporating anemia, hyperglycemia, and reduced LVEF into the GRACE score improves its predictive capacity for in-hospital mortality in ACS patients. The modified GRACE score offers a more robust risk stratification tool for clinical practice and decision-making.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"67-83"},"PeriodicalIF":1.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383745","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":"Impact of Traffic Patterns on Trauma Response Prenotification [Response to Letter].","authors":"Sophia Gorgens, Eric N Klein, Matthew A Bank, Daniel Jafari","doi":"10.2147/OAEM.S517871","DOIUrl":"10.2147/OAEM.S517871","url":null,"abstract":"","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"63-64"},"PeriodicalIF":1.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383753","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":"Examining the Use of Machine Learning Algorithms to Enhance the Pediatric Triaging Approach.","authors":"Hussain J Aljubran, Maitham J Aljubran, Ahmed M AlAwami, Mohammad J Aljubran, Mohammed A Alkhalifah, Moayd M Alkhalifah, Ahmed S Alkhalifah, Tawfik S Alabdullah","doi":"10.2147/OAEM.S494280","DOIUrl":"10.2147/OAEM.S494280","url":null,"abstract":"<p><strong>Purpose: </strong>Triage systems play a vital role in effectively prioritizing patients according to the seriousness of their condition. However, conventional emergency triage systems in pediatric care predominantly rely on subjective evaluations. Machine learning technologies have shown significant potential in various medical fields, including pediatric emergency medicine. Therefore, this study seeks to employ pediatric emergency department records to train machine learning algorithms and evaluate their effectiveness and outcomes in the triaging system. This model will improve accuracy in pediatric emergency triage by categorizing cases into three urgency levels (nonurgent, urgent, and emergency).</p><p><strong>Patients and methods: </strong>This is a retrospective observational cohort study that used emergency patient records obtained from the Emergency Department at King Faisal Specialist Hospital & Research Centre. Using the emergency severity index (a scale of 1 to 5), various machine learning techniques were employed to build different machine learning models, such as regression, instance-based, regularization, tree-based, Bayesian, dimensionality reduction, and ensemble algorithms. The accuracy of these models was compared to reach the most accurate and precise model.</p><p><strong>Results: </strong>A total of 38,891 pediatric emergency patient records were collected. However, due to numerous outliers and incorrectly labeled data, clinical knowledge and a confident learning algorithm were employed to preprocess the dataset, leaving 18,237 patient records. Notably, ensemble algorithms surpassed other models in all evaluation metrics, with CatBoost achieving an F-1 score of 90%. Importantly, the model never misclassified an urgent patient as nonurgent or vice versa.</p><p><strong>Conclusion: </strong>The study successfully created a machine learning model to classify pediatric emergency department patients into three urgency levels. The model, tailored to the specific needs of pediatric patients, shows promise in improving triage accuracy and patient care in pediatric emergency departments. The implication of this model in the real-life sitting will increase the accuracy of the pediatric emergency triage and will reduce the possibilities of over or under triaging.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"51-61"},"PeriodicalIF":1.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190891","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":"Understanding Code Blue Activations: Insights From Early Warning and Palliative Scores in a Tertiary Hospital.","authors":"Gezy Weita Giwangkancana, Yani Gezy Setiasih, Anisa Hasanah, Yunita Persiyawati, Wawan","doi":"10.2147/OAEM.S487687","DOIUrl":"10.2147/OAEM.S487687","url":null,"abstract":"<p><strong>Background: </strong>In-hospital cardiac arrest (IHCA) is a critical emergency, occurring at rates of 1-6 events per 1000 hospital admissions, necessitating immediate and efficient resuscitation efforts. This study aims to determine the frequency, demographic characteristics, and outcomes of Code Blue activations in a tertiary teaching hospital in a low-middle-income country.</p><p><strong>Methods: </strong>This retrospective observational study was conducted at in National Referral and Teaching Hospital in a middle income country in Asia, covering data from January 1, 2017, to December 31, 2023. The study included 2184 Code Blue activations, with data on Early Warning Scores (EWS) and palliative scores available from 2021 onwards. Statistical analyses were performed to evaluate the relationship between these scores and patient outcomes.</p><p><strong>Results: </strong>Out of 2184 Code Blue activations, 713 cases included both EWS and palliative scores. The highest number of activations was recorded in 2019 (535 cases), and the lowest in 2021 (152 cases). Calculated incidence where 5.46 per 1000 visits. The return of spontaneous circulation (ROSC) rates ranged from 11% to 27.6%, with an average of 17.7% per year. The mean EWS and palliative scores for Code Blue activations were 9.2 (SD ± 2.3) and 7.8 (SD ± 1.9), respectively.</p><p><strong>Discussion: </strong>The findings highlight trends in IHCA incidence, causes, and outcomes, emphasizing the importance of early identification and management of patients at risk. The study underscores the need for continuous monitoring and early intervention, particularly for patients with high EWS. Additionally, the integration of palliative care considerations into hospital protocols is crucial for improving patient outcomes and resource allocation.</p><p><strong>Conclusion: </strong>Early warning system and palliative care scoring may predict code blue activation and if managed can reduce its number.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"43-50"},"PeriodicalIF":1.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081607","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}