Open Access Emergency Medicine最新文献

{"title":"Impact of the Implementation of a Low-Complexity Emergency Care Protocol in the Patient Experience at a Level 3 Academic Institution in Colombia.","authors":"German Devia Jaramillo, Juan Pablo Vargas Gallo, Nathalia Maria Esmeral-Zuluaga","doi":"10.2147/OAEM.S478196","DOIUrl":"10.2147/OAEM.S478196","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department overcrowding is a universal problem. It is associated not only with poor clinical outcomes but also with a decrease in patient satisfaction, especially in patients with low complexity emergencies or triage 4 and 5, who tend to have a longer waiting time.</p><p><strong>Objective: </strong>This study aims to determine whether the implementation of a care strategy for patients with low complexity emergencies called \"The special Line\" in the emergency department of a third level academic institution in Colombia, has a positive impact on the level of satisfaction with the care received by the patient and the number of people who leave without being seen.</p><p><strong>Methods: </strong>This is a retrospective analytical observational study that looks at the effect on the rate of patients who leave without being seen and the net promoter score (NPS) of the entire emergency department of establishing a protocol for the care of patients with low complexity emergencies.</p><p><strong>Results: </strong>Of a total of 22,743 patients divided into the two comparison groups, it was found that after the implementation of the care protocol, a non-significant reduction in the median rate of patients without care from 2.35% to 1.85% was documented, as well as a significant improvement in the median value of the NPS from 44 to 53, p: 0.001.</p><p><strong>Conclusion: </strong>The implementation of a protocol for the care of patients with low-complexity emergencies demonstrated a significant improvement in the experience of care for all users in the emergency service, additionally, indirectly influencing the leave without being seen of the entire emergency service.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"16 ","pages":"329-336"},"PeriodicalIF":1.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11663371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878081","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":"Variability of Prehospital Pain Management Protocols: A Review of Prehospital Care Protocols in the United States.","authors":"Timmy Li, Daniel Koloden, Jonathan Berkowitz, Dee Luo, Howard Luan, Charles Gilley, Gregory Kurgansky, Devin M Howell, Paul Barbara","doi":"10.2147/OAEM.S480680","DOIUrl":"10.2147/OAEM.S480680","url":null,"abstract":"<p><strong>Purpose: </strong>We describe emergency medical services (EMS) protocols for pain management in the United States to elucidate systemic variability in protocols. We describe types of pain medications included in protocols, routes of administration, indications for use, standing orders for dosing, and use in pediatric patients.</p><p><strong>Methods: </strong>We performed a review of all publicly accessible EMS protocols from the website http://www.emsprotocols.org, supplemented with internet searches. Data were abstracted into a data collection form from June 2021 to January 2022. We developed categories of responses to summarize the data, using frequencies and proportions to describe outcome measures.</p><p><strong>Results: </strong>We reviewed 104 EMS protocols, spanning 43 states. The most common pain management medications include fentanyl (94.2%), morphine (70.2%), ketamine (61.5%), ketorolac (40.4%), oral acetaminophen (36.5%), oral ibuprofen (22.1%), and nitrous oxide (19.2%). The most common route of administration across all protocols and medications is intravenous. Severe pain, without a specified level, is the most common indication for fentanyl (65.3%), morphine (61.6%), ketorolac (50.0%), and nitrous oxide (40.0%). Musculoskeletal injuries and burns are the most common indications for morphine, 15.1% and 19.2% of protocols, respectively. The majority of protocols dictate the weight-based dosing of fentanyl (74.5%), morphine (64.4%), ketamine (87.3%), oral acetaminophen (56.8%), and oral ibuprofen (59.1%). However, 97.6% and 100.0% of protocols dictate a fixed dose of ketorolac and nitrous oxide, respectively. Fentanyl, morphine, oral acetaminophen, and oral ibuprofen can be administered to pediatric patients based on standing orders among >90.0% of protocols. However, only 46.2% and 75.0% of protocols allow the use of ketorolac and nitrous oxide in pediatric patients, respectively.</p><p><strong>Conclusion: </strong>We found variability in EMS pain management protocols including the types of allowed medications, routes of administration, dosing, and indications for use. Further studies may assess whether standardized protocols across EMS systems could improve patient safety and quality of care.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"16 ","pages":"337-345"},"PeriodicalIF":1.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11663377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878087","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 Atypical Presentation of Acute Cholecystitis with Left Sided Chest Pain and ST Elevation - A Case Report.","authors":"Helene G Meyer, Kristina Fäh, Michael Christ","doi":"10.2147/OAEM.S478102","DOIUrl":"10.2147/OAEM.S478102","url":null,"abstract":"<p><strong>Background: </strong>ST elevation combined with typical chest pain is an indication for acute coronary vascularization and is usually associated with acute myocardial infarction. Herein, we present an unusual case of ST elevation.</p><p><strong>Case presentation: </strong>A 57-year-old male patient presented to the emergency department with chest pain radiating to both arms and the back. Typical clinical presentation and inferolateral ST elevations were suggestive of ST elevation myocardial infarction. Interestingly, coronary occlusion was excluded by coronary angiography. Despite extensive diagnostic workup, no underlying diagnosis was made. Four days later, the patient returned and reported pain in the right upper abdomen. Clinical presentation, laboratory analysis, and imaging features led to a diagnosis of calculous acute cholecystitis. Laparoscopic cholecystectomy was performed, and the diagnosis was confirmed. Electrocardiographic changes and pain resolved completely.</p><p><strong>Conclusion: </strong>Acute calculous cholecystitis is initiated by gallbladder distension due to biliary duct occlusion caused by gallstones. ST elevations in response to gallbladder distension have been demonstrated in animal models. We hypothesize that the ST elevations observed in this patient with chest pain were linked to stone-mediated distension of the gallbladder, leading to reflex coronary vasoconstriction.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"16 ","pages":"323-328"},"PeriodicalIF":1.5,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829558","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":"Reliability Evaluation of Temnography for Early Detection of Intracranial Lesions in Mild Traumatic Brain Injury Patient: A Preliminary Report of a New Portable, Non-Invasive Device.","authors":"Sara Montemerani, Cosimo Fabrizi, Cecilia Sacchi, Antoine Belperio, Lorenzo Moriani, Samuele Pacchi, Cinzia Garofalo, Giovanni Sbrana, Duccio Venezia, Maurizio Zanobetti, Simone Nocentini","doi":"10.2147/OAEM.S475328","DOIUrl":"10.2147/OAEM.S475328","url":null,"abstract":"<p><strong>Purpose: </strong>Mild Traumatic brain injury is classified based on Glasgow Coma Scale (GCS 13-15), it also involves transient alteration of brain function, which may lead to severe short- and long-term sequelae. When treating a patient with a mild head injury outside the hospital, it is of crucial importance to decide whether to transport him to a center without neurosurgery or to a center equipped with neurosurgery (primary centralization). Recent decades have seen exploration of portable, non-invasive devices for intracranial injury and stroke detection, with microwave frequency electromagnetic field technology showing promising clinical outcomes. This clinical investigation aims to assess the diagnostic accuracy of the TES HT100 medical device, utilizing electromagnetic fields for endocranial lesion screening.</p><p><strong>Patients and methods: </strong>Patients with mild traumatic brain injury were randomly enrolled according to inclusion criteria. Twenty-three patients recruited from the Intensive Short-Term Observation (ISTO) unit at San Donato Hospital in Arezzo. The sensitivity and specificity of the TES HT were evaluated statistically against cranial computed tomography (CT), the gold standard.</p><p><strong>Results: </strong>A preliminary analysis shows a sensitivity of 100% and a specificity of 100%. Based on these results, there is maximum concordance between the two examinations, and the AUC is 1. No adverse events related to the use of TES HT100 or the examination.</p><p><strong>Conclusion: </strong>The device's ability to differentiate patients with intracranial lesions from those without can streamline the diagnostic and therapeutic process, potentially leading to improved patient outcomes. If Temnography will maintain high standards of sensitivity and specificity with the expansion of the enrolled population, it could be considered as a stable screening tool in the Emergency Room (ER). We could think to apply this technology to reduce the length of stay that patients with mTBI have to spend in ER for observation. Temnography could also be useful in special categories of patients such as pregnant women or the pediatric population. Moreover, another front of future development of this technology could be extending the study to include Territorial Emergency. In this context, Temnography could aid centralized decision-making in patient care.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"16 ","pages":"313-321"},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808218","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 Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency Department.","authors":"Pavel Goriacko, Ladan Golestaneh, Katherine E Di Palo","doi":"10.2147/OAEM.S478693","DOIUrl":"10.2147/OAEM.S478693","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical utility of administering patiromer as an adjunct to insulin for potassium reduction in patients presenting to the emergency department (ED) with hyperkalemia.</p><p><strong>Methods: </strong> This retrospective cohort study used electronic health record data to identify adults treated with at least one intravenous dose of regular insulin for hyperkalemia within the ED. Patients who were administered patiromer within one hour before or after their insulin dose were categorized as the intervention group. Matching was performed at a 1:1 ratio. The primary outcome, mean change in potassium from baseline to the latest value within the 4-12 hour interval, was compared. Secondary outcomes included net clinical benefit, defined as the mean difference in the number of potassium-lowering interventions minus the change in potassium.</p><p><strong>Results: </strong>The final analysis included 133 patients treated with patiromer plus insulin and 133 patients treated with insulin alone. Participants had a mean age of 71 years; 43% were female, 31% self-identified as Black, and 38% self-identified as Latinx. No significant changes were observed in potassium from baseline (mean levels 6.2 mEq/L in each group) to the 4-12 hour time frame (patiromer: -0.90 mEq/L, n=78 vs insulin-only: -0.98 mEq/L, n=81; p = 0.51). The calculated net clinical benefit of potassium reduction was -0.25 in favor of the patiromer plus insulin group; however, this difference did not reach statistical significance. In the subgroup of eGFR >30 mL/min, patiromer group received numerically less potassium-lowering interventions (0.63 vs 1.12, p = 0.057).</p><p><strong>Conclusion: </strong>In this study of patients with acute hyperkalemia in the ED setting, concurrent administration of patiromer did not result in more sustained potassium reduction compared to insulin alone in the overall cohort. The trend in favor of adjunct patiromer in the subgroup with adequate renal function warrants further investigation.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"16 ","pages":"305-312"},"PeriodicalIF":1.5,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802754","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.","authors":"Sophia Gorgens, Ella R Rastegar, Manuel Beltran Del Rio, Cristy Meyer, Daniel M Rolston, Maria Sfakianos, Eric N Klein, Timmy Li, Rashmeet Gujral, Matthew A Bank, Daniel Jafari","doi":"10.2147/OAEM.S480081","DOIUrl":"10.2147/OAEM.S480081","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether traffic patterns affect the accuracy of emergency medical services (EMS) prediction of transport interval to the emergency department (ED).</p><p><strong>Methods: </strong>Using a retrospective study, we examined all trauma activations at a level one, urban trauma center in Manhasset, New York, between 5/22/2021 and 3/30/2022. Inclusion criteria included patients ≥18 years and arrival by EMS. Field trauma activations involve prenotification communication through a government intermediary. Transport during \"peak hours\" was defined as hospital arrival of EMS between 06:00-10:00 and 16:00-20:00, Monday through Friday. ETI and actual transit interval (ATI) were extracted from the recorded prenotification calls and hospital records respectively. In instances with a time range, the arithmetic mean was used. ATI was defined as the time from prenotification call to arrival at the hospital. A 25% difference between EMS ETI and ATI was chosen to categorize each arrival as overestimated (ATI/ETI < 0.75), accurate (ATI/ETI within 0.75-1.25), and underestimated (ATI/ETI > 1.25). Fisher's exact and Wilcoxon Rank Sum tests were used for comparative analysis as appropriate.</p><p><strong>Results: </strong>Of the 369 trauma transports, 117 had prenotification reports with an ETI and were included in our analysis. Of those, 29 (25%) occurred during peak hours. Overall, EMS more often underestimated ETI (55%) than exactly (32%), or overestimated ETI (12%) (p<0.0001). This was true during peak and off-peak hours with underestimated, accurate, and overestimated arrivals being 59%, 31%, 10% (p<0.01); and 54%, 33%, 12% (p<0.001), respectively. There was no statistically significant difference between peak vs off-peak hours when comparing the proportion of under vs over-estimated times of arrival (p=0.263).</p><p><strong>Conclusion: </strong>While our hypothesis was not borne out, further research on the antecedents of underestimated transport intervals in traumas is warranted. This will allow for targeted solutions to best support EMS clinicians in communicating transport times back to the ED.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"16 ","pages":"297-303"},"PeriodicalIF":1.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773425","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":"Prognostic Impact of Therapeutic Agents for Septic-Associated Disseminated Intravascular Coagulation According to Different Sources of Infection.","authors":"Makoto Kobayashi, Kyohei Sakurai, Yoshimatsu Ehama","doi":"10.2147/OAEM.S484602","DOIUrl":"10.2147/OAEM.S484602","url":null,"abstract":"<p><strong>Purpose: </strong>Sepsis can be caused by various infectious sources; however, treatment strategies for secondary disseminated intravascular coagulation (DIC) differ between countries. The Japanese sepsis guidelines recommend the use of two drugs for DIC but do not specify which drugs should be used and under which conditions. No clear reports have compared the outcomes of DIC treatments based on the source of infection. This is the first study to clarify the difference in prognosis by the source of infection and compare the effect of the treatment of choice for DIC on prognosis.</p><p><strong>Patients and methods: </strong>This single-center, retrospective, nonrandomized cohort study included 411 patients with a confirmed diagnosis of sepsis-associated DIC who were initiated on DIC therapies. Recombinant thrombomodulin (rTM) preparation and antithrombin (AT) replacement therapy were the DIC therapies used. The patients were divided into five groups determined to be the primary source of infection for treatment: intestine-related, biliary tract, respiratory tract, urinary tract, and catheter-related bloodstream infections (CRBSIs). In addition to differences in DIC treatment, we evaluated the following three covariates that may influence mortality, considering the influence of background interactions at the infection source: serum albumin concentration, APACHE-II score, and blood antithrombin activity. A Cox proportional hazards model was used to assess the association between the covariates and compare their effect on 60-day survival.</p><p><strong>Results: </strong>Univariate analysis of the DIC drug choice results showed that survival was statistically significantly higher in the rTM arm for biliary tract infections (P = 0.002) and CRBSI (P = 0.021). However, multivariate analysis with other covariates showed that AT replacement therapy was statistically effective for respiratory tract infections (hazard ratio, 0.353; P = 0.027).</p><p><strong>Conclusion: </strong>Our study showed that the pathogenesis of severe sepsis with DIC differs depending on the source of infection which should be considered when developing treatment strategies. Particularly, the importance of anti-DIC drug selectivity based on the source of infection was confirmed.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"16 ","pages":"285-295"},"PeriodicalIF":1.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11611707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773414","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":"Droperidol Plus Diphenhydramine for Symptom Improvement in Suspected Cannabinoid Hyperemesis Syndrome: A Prospective Cohort Study.","authors":"Quincy Chopra, Vincent Peyko, Jessica Annie Lee, Leo Puhalla, David J Gemmel, Todd Bolotin","doi":"10.2147/OAEM.S473627","DOIUrl":"https://doi.org/10.2147/OAEM.S473627","url":null,"abstract":"<p><strong>Background: </strong>Cannabinoid Hyperemesis Syndrome (CHS) is characterized by recurrent, paroxysmal episodes of nausea, vomiting, and abdominal discomfort in chronic cannabis users. Optimized CHS treatment data remain limited. Recent prospective evidence have demonstrated haloperidol superiority over ondansetron. Retrospective data suggest the utility of droperidol, a dopamine antagonist like haloperidol, for treating acute CHS.</p><p><strong>Objective: </strong>To prospectively assess the utility of droperidol plus diphenhydramine to mitigate common CHS symptoms.</p><p><strong>Methods: </strong>This was a multicenter, prospective interventional study in the emergency department (ED). Participants were administered a study regimen of droperidol and diphenhydramine to treat CHS after enrollment. The primary outcome measure was the change in VAS scores within the droperidol prospective cohort. Symptoms of nausea, vomiting, and abdominal pain were measured using a visual analogue scale (VAS) up to 120 minutes. Secondary measures assessed include repeat visits to the ED within seven days.</p><p><strong>Results: </strong>Amongst 47 droperidol participants, VAS for nausea and vomiting declined from baseline 8.3±2.0 to 3.1±3.3 at 30 minutes post treatment (p < 0.05), and 1.4±2.4 at 120 minutes (p < 0.05). For abdominal pain, VAS mean was 7.8±2.4 at baseline declining to 3.6±2.9 at 30 minutes (p < 0.05) and 1.7±2.9 at 120 minutes (p < 0.05). Return to the ED within 7 days following droperidol was 12.9% (n=47).</p><p><strong>Conclusion: </strong>This trial shows significant improvement in symptoms from baseline, 30 and 120 minutes post-treatment and return to the ED within a week post treatment with the study regimen.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"16 ","pages":"267-273"},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773408","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":"Epidemiological Trends and Characteristics of Dermatological Conditions Presenting to a Saudi Major Emergency Department.","authors":"Nouf F Bin Rubaian, Reem S AlOmar, Ahmed S Alzahrani, Faleh M Alotaibi, Mohammed A Alharbi, Bader S Alanazi, Serene R Almuhaidib, Nawaf F Alsaadoon, Dunya Alfaraj, Nouf A AlShamlan","doi":"10.2147/OAEM.S468288","DOIUrl":"https://doi.org/10.2147/OAEM.S468288","url":null,"abstract":"<p><strong>Background: </strong>Numerous dermatological conditions present in the emergency department (ED). Some have subtle presentations, yet most provoke patient suffering. Such conditions need to be identified and managed properly. This study aims to epidemiologically describe the patterns and characteristics of dermatological conditions presenting to a secondary teaching hospital's ED.</p><p><strong>Methods: </strong>This retrospective chart review study analyses data on dermatological conditions that have presented to the ED between January 2021 and May 2023. The data gathered included sociodemographic variables, date and shift of visit, triage level, dermatological complaint characteristics, management, and discharge status. Comparative analysis was performed, and the level of significance was set at 0.05.</p><p><strong>Results: </strong>The total number of cases was 301. The median age was 12 years (IQR = 4-30 years), with similar distribution between males and females (50.17% and 49.83% respectively). Most cases had presented to the ED during the morning shift (49.83%). Triage levels IV and V made up 94.69%, and only 5.32% belonged to triage level III. Most presented during the winter season (32.89%). The median visit duration was 312 minutes, and of all cases treated, only 10 required a return visit to the ED. Also, 41.53% were discharged and 58.47% required further management. Maculopapular rashes were the most common finding (35.55%). Bullae/blisters and erythroderma accounted for those that most often required further management. The two most prescribed medications were topical steroids and antihistamines, followed by emollients (32.09% and 15.81%, respectively). Viral infections were the most reported complaint (22.26%) and only two patients complained of erythema multiforme (0.66%).</p><p><strong>Conclusion: </strong>This study found that the majority of cases could have been managed by family physicians at a primary care setting. Also, epidemiological seasonal variations were observed where the majority of patients requiring further management had presented during the autumn season.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"16 ","pages":"275-284"},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773411","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":"Clinical Features of Severe Deep Neck Space Infection: Five Clinical Cases and Our Experience in Their Management.","authors":"Ling Jin, Yongjun Chang, Yihua Zhao, Kai Fan, Jiawei Lu, Yang Wang, Shaoqing Yu","doi":"10.2147/OAEM.S476737","DOIUrl":"https://doi.org/10.2147/OAEM.S476737","url":null,"abstract":"<p><strong>Background: </strong>Deep neck space infection (DNSI) is an acute and severe condition, with severe cases being relatively rare but considerably more critical. Consequently, in clinical practice, there is a limited understanding and lack of comprehensive reviews on severe DNSI.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the diagnosis and treatment of five cases of severe DNSI admitted to our department.</p><p><strong>Results: </strong>All five patients were diagnosed via neck CT and surgical exploration. Bacterial cultures predominantly revealed mixed infections of Klebsiella and other gram-negative bacilli, along with anaerobic bacteria. Three patients had diabetes, two presented with diabetic ketoacidosis, and three had mediastinal involvement. Three patients underwent tracheotomy, while two required tracheal intubation. All patients were treated with neck incision, drainage, regular dressing changes, and targeted antibiotic therapy. They had an average hospital stay of 35.8 days, and all were discharged fully recovered.</p><p><strong>Conclusion: </strong>Severe DNSI tends to occur in patients with diabetes and other underlying systemic conditions. Infections involving multiple deep neck spaces, such as the parapharyngeal, pretracheal, and prevertebral spaces, leading to high-risk complications like airway obstruction, cervical necrotizing fasciitis, mediastinitis, and sepsis, are considered severe DNSI. Early diagnosis, timely surgical exploration, drainage to maintain airway patency, and targeted antibiotic therapy are crucial to effective management.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":"16 ","pages":"257-266"},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773349","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}