Open Access Emergency Medicine最新文献

{"title":"Using an in-situ Simulation Model to Identify Deviations from Guideline-Based Management of Pediatric Status Epilepticus in Community Emergency Departments.","authors":"Eliza T Firn, Rinat Jonas, Laurie M Douglass, Barbara M Walsh","doi":"10.2147/OAEM.S507770","DOIUrl":"https://doi.org/10.2147/OAEM.S507770","url":null,"abstract":"<p><strong>Background: </strong>Children with epilepsy are often presented to Community Emergency Departments (CEDs) for acute treatment of status epilepticus (SE). Timely medical management is imperative to prevent morbidity and mortality, and adherence to evidence-based guidelines improves outcomes for high stakes/low frequency events. Barriers to guideline adherent management in the CED setting are understudied; in-situ simulation (ISS) can be used to identify gaps in care for events such as pediatric SE.</p><p><strong>Objective: </strong>The primary objective was to assess for deviations from evidence-based guidelines in the management of pediatric SE. A secondary objective was to explore potential barriers to practice within the evidence-based guidelines.</p><p><strong>Methods: </strong>We conducted a prospective observational ISS pilot study examining representative CED teams caring for a simulated child in SE. The primary outcome was overall adherence to the pediatric SE guidelines as measured by 12 metrics: 5 non-pharmacologic (for example: delays in vital sign assessment, failure to time seizure) and 7 pharmacologic (for example: incorrect benzodiazepine dose, delay in benzodiazepine administration or escalation to antiseizure medication). Additional metrics including provider knowledge (recognition of status epilepticus) and resources (antiseizure medications stocked) were analyzed as process measures. We enrolled 4 interprofessional teams at 4 participating ED sites.</p><p><strong>Results: </strong>Overall, 0 of the 4 teams adhered to all 12 metrics. A barrier to timely administration of benzodiazepines for two of the sites came from attempting IV access repeatedly. No team referenced an up-to-date treatment algorithm based on current evidence-based guidelines.</p><p><strong>Conclusion: </strong>Standardized ISS scenarios identified variability in adherence to the pediatric SE guideline across a pilot sample of local CEDs. Barriers to guideline-adherent care occurred at both individual and systems levels. The study was limited in scope to 4 pilot sites.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"165-171"},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032009","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":"Reducing Unnecessary Venous Blood Gas (VBG) Testing in the Emergency Department Through Targeted Education.","authors":"Kelly Mullins, Kate Urie, Kate Wallis, Brendan Morrissey, Sam Freeman, Christina M Trambas, Hamed Akhlaghi","doi":"10.2147/OAEM.S505114","DOIUrl":"https://doi.org/10.2147/OAEM.S505114","url":null,"abstract":"<p><strong>Objective: </strong>Our objective was to evaluate the amount of unnecessary Venous Blood Gas (VBG) tests initiated in the Emergency Department (ED) and to assess the effectiveness of clinical intervention, such as education, in reducing VBG tests.</p><p><strong>Methods: </strong>497 consecutive patients were selected between 1 August and 30 September 2019. For Phase 1, 10 volunteer nurses were randomly assigned to 50 cases each and assessed whether they would perform a VBG. A brief educational intervention was then implemented regarding specific clinical indications to perform VBGs. After the education, they were asked the same questions. For Phase 2, the entire ED team was subjected to intervention and education (Phase 2). A monthly prospective audit of VBG testing numbers in St Vincent's Melbourne Emergency Department was compared from March 2022 to December 2022.</p><p><strong>Results: </strong>The phase 1 educational intervention saw a significant reduction in unnecessary VBG of 24% (p-value < 0.001, odd ratio of 15.8 [confidence interval (CI): 8.5-29.1]). During Phase two, a sustained reduction in absolute VBG testing in the ED was observed of 33.7% (9% adjusted reduction). This simple intervention would save around $22,000 in our ED based on an annual presentation of ~50,000.</p><p><strong>Conclusion: </strong>Our study highlights the importance of education to support the \"Choosing wisely\" campaign to reduce VBG testing in EDs. By reducing the number of VBGs, we not only limit unnecessary tests for our patients, but also reduce the cost associated with frequent and unnecessary blood gas analysis.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"157-163"},"PeriodicalIF":1.5,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051575","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":"Atypical Presentation of Kikuchi-Fujimoto Disease: Diagnostic Challenges in a Case of Persistent Cervical Lymphadenopathy with Acute Onset Quadriplegia.","authors":"Abdullahi Ahmed Ahmed, Ismail Mohamoud Abdullahi, Ismail Gedi Ibrahim","doi":"10.2147/OAEM.S507693","DOIUrl":"10.2147/OAEM.S507693","url":null,"abstract":"<p><p>Kikuchi-Fujimoto disease (KFD), is rare, self-limiting disorder with necrotizing lymphadenitis as its hallmark, can be difficult to diagnose because it may have multiple nonspecific features. The study presented here describes the rare type of KFD that occurred in a young male patient suffering from quadriplegia and who was wrongly diagnosed as having tuberculous lymphadenitis, which is a common cause of lymphadenopathy in tuberculosis-endemic area. A 19-year-old man had presented with two week history of fever, quadriplegia, and cervical lymphadenopathy. On physical examination revealed cervical lymphadenopathy. A laceration procedure was performed to address the lymphadenopathy. The patient was treated with anti-tubercular medication for 11 days. Currently, his urinary and bowel functions are stable, and he is fully conscious, alert, and oriented to time, place, and person. Histopathology showed classical changes in histiocytic necrotizing lymphadenitis in the lymph nodes with no evidence of either tuberculosis or neoplasm. This KFD case is particularly glaring in terms of the obstacles it presented in making a diagnosis due to its endemicity of tuberculosis. The case actually had a complicated clinical picture with KFD's initial presentation of quadriplegia. Hence, the list of differential diagnosis should include KFD as one of the uncommon causes. Timely recognition and appropriate management of KFD can prevent unnecessary treatments and improve patient outcomes.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"151-155"},"PeriodicalIF":1.5,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781497","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 [Response to Letter].","authors":"Sophia Gorgens, Eric N Klein, Matthew A Bank, Daniel Jafari","doi":"10.2147/OAEM.S520503","DOIUrl":"https://doi.org/10.2147/OAEM.S520503","url":null,"abstract":"","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"149-150"},"PeriodicalIF":1.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543987","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 Prevalence and Management of Aerodigestive Foreign Bodies at Rwanda Military Hospital: A Six-years Retrospective Study.","authors":"John Bukuru, Agape Ngirinshuti, Pascale Ange Kamanda, Wilson Kananga, Charity Murungi Mukomeza, Olivier Sibomana","doi":"10.2147/OAEM.S493458","DOIUrl":"10.2147/OAEM.S493458","url":null,"abstract":"<p><strong>Background: </strong>Aerodigestive foreign bodies are common issue especially in children, who often place objects in their mouths, leading to inhalation or ingestion. Despite global data on this issue, no comprehensive study has been conducted in Rwanda. This study aimed to assess the prevalence, demographic factors, clinical presentations, diagnostic and management techniques of aerodigestive foreign bodies at Rwanda Military Hospital (RMH).</p><p><strong>Methods: </strong>This retrospective study reviewed patient records from ENT department of RMH over the period of six years, from January 2017 to December 2022. Data on aerodigestive foreign bodies were extracted from operating room archives and OpenClinic hospital online system, then compiled in Excel spreadsheet, and descriptively analyzed using and SPSS 23.</p><p><strong>Results: </strong>Among 39,240 patients who consulted the ENT department over the six years, 290 (0.74%) cases of aerodigestive foreign bodies were identified, with male-to-female ratio of 1.34:1. The highest incidence was in children aged 1-3 years (49.66%). Inorganic foreign bodies, especially coins (35.17%), were more common than organic ones. Clinical presentations varied, with 46.21% of cases being asymptomatic, and others showing drooling (17.93%) and dysphagia (9.66%). Chest X-rays were the most frequently used diagnostic tool (49.66%). Esophagoscopy was the primary management method for esophageal cases (45.52%), with bronchoscopy (13.10%) and forceps (34.14%) used for bronchial and nasal cases, respectively.</p><p><strong>Conclusion: </strong>Aerodigestive foreign bodies, particularly coins, are prevalent in Rwanda, especially among young children and males. This highlights the need for targeted preventive strategies and educational programs to reduce incidence and improve management.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"137-147"},"PeriodicalIF":1.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504736","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":"Spontaneous Spinal Epidural Hematoma Under Rivaroxaban and Clopidogrel: A Case Report and Literature Review.","authors":"Bruno Schoenmaekers, Imad Derraz, Nadim Tahhan, Pierre Metrailler","doi":"10.2147/OAEM.S489072","DOIUrl":"10.2147/OAEM.S489072","url":null,"abstract":"<p><p>Spontaneous spinal epidural hematoma (SSEH) is a rare pathology with potentially severe consequences for the patient. Given its uncommon incidence and frequent atypical presentation, SSEH can easily be misdiagnosed. The association between anticoagulation or antiplatelet therapy and SSEH has been described in multiple case reports and literature reviews. We present a case of a 61-year-old man on anticoagulation and antiplatelet therapy (Rivaroxaban and Clopidogrel respectively), diagnosed with spinal SSEH with good recovery after laminectomy and hematoma evacuation. However, treatment guidelines for SSEH are difficult to find and there is no clear strategy about management of anticoagulation and antiplatelet therapy. The aim of this report is to highlight the importance of rapid diagnosis and surgical therapy in selected cases and to give an insight on the anticoagulation and antiplatelet management in these patients and their prognosis.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"17 ","pages":"129-135"},"PeriodicalIF":1.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504734","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":"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":"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}