Emergency Care and Medicine最新文献

{"title":"Mental Health Response to Disasters in Healthcare Including the COVID-19 Pandemic","authors":"Traci N. Adams, Haley Belt, Roma M. Mehta, Hetal J. Patel, R. Ruggiero, Carol S. North","doi":"10.3390/ecm1030025","DOIUrl":"https://doi.org/10.3390/ecm1030025","url":null,"abstract":"Healthcare workers were substantially impacted by the COVID-19 pandemic. Front-line workers continue to suffer higher rates of distress and burnout than they had before the pandemic. In order to heal the front-line workforce and plan for the next disaster in healthcare, it is necessary to carefully reflect on the COVID-19 pandemic and integrate that experience with the existing literature on disaster mental health. In this narrative review, the disaster MH framework for community disasters is adapted to the healthcare setting. The first principle of disaster mental health is to distinguish between normative distress and psychopathology. The second step in the framework includes stabilization, triage, and referral to psychiatry. The third step in disaster mental health framework is intervention for psychological distress and psychiatric illness. Interventions for emotional distress may include psychological first aid (PFA), psychological debriefing, crisis counseling, and psychoeducation, whereas interventions for psychopathology include pharmacotherapy and/or psychotherapy. Unfortunately, many front-line HCWs were indeed damaged by the pandemic and continue to report high levels of burnout and distress, in part because the MH response to the pandemic was lacking or otherwise inadequate. Screening, triage and referral to MH resources, and interventions are fundamental aspects of an MH response to disaster and may be coordinated with formal operational procedures within incident command structures. Setting up these structures in advance, preferentially, and establishing networks of psychiatrists and crisis MH responders who will implement them are essential. By reflecting on the pandemic and learning from prior disasters, we can care for those who care for our sickest patients.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":"6 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141928845","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":"Nursing Care at Critical Care Patient Inter-Hospital Transfer: The Construction of a Checklist through a Scoping Review","authors":"Catarina Carvalho, C. Costeira, Joana Pereira Sousa","doi":"10.3390/ecm1030023","DOIUrl":"https://doi.org/10.3390/ecm1030023","url":null,"abstract":"Background: Safe inter-hospital transport of critically ill patients is a complex procedure where nurses are integral to maintaining patient safety. A structured checklist is pivotal to ensuring the transfer process mitigates potential complications. Objective: The objective of this scoping review was to devise and implement a detailed checklist to enhance patient safety during the transfer of critically ill patients. Methods: A comprehensive literature review was conducted by Joanna Briggs Institute’s guidelines across several databases including MEDLINE, CINAHL Complete, LILACS, and Scopus. The search considered works published in Portuguese, English, or Spanish from 2008 onwards. A total of eight studies met our inclusion criteria and were selected for detailed analysis. Results: Our analysis delineated the critical clinical information necessary to compose an effective transfer checklist. This checklist was developed through iterative refinement, informed by the literature and appraised during a focus group meeting with experts. Subsequent to its development, the checklist was implemented in the emergency department of a Central Portuguese hospital. Conclusions: This scoping review emphasizes the significance of evidence-based protocols and clear communication in safeguarding patient welfare during critical transfers. The developed checklist is a tool that standardizes care processes, supports clinical decision-making, and is instrumental in minimizing adverse events during inter-hospital transfers.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":"62 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141806952","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":"Cardiopulmonary Resuscitation Training and Automatic External Defibrillators Deployment: Strengthening Community Response to Cardiac Arrest","authors":"J. Giamello, Chiara Barile, Lorella Flego, G. Lauria, Luigi Silimbri, Simona Garrone, Marco Nannini, R. Melchio, Emanuela Racca, Beatrice Aimar, M. Gallo, Luca Bertolaccini","doi":"10.3390/ecm1030022","DOIUrl":"https://doi.org/10.3390/ecm1030022","url":null,"abstract":"The most effective strategy to save the life of a victim of out-of-hospital cardiac arrest (OHCA) is to provide aid as early as possible. To achieve this objective, widespread dissemination of knowledge on basic life support and defibrillation (BLSD) in the general population is necessary. In recent years, evidence has been emerging supporting the effectiveness of public-access defibrillation (PAD) programs; the diffusion of automatic external defibrillators (AEDs) and the knowledge of their correct use among lay rescuers are associated with a higher survival rate and better neurological outcomes among OHCA victims. This study aims to implement and monitor a BLSD training program involving an entire city in Italy. Since 2016, a PAD program has been implemented in Busca (CN), a small town in the northwest of Italy. The project was divided into three phases: (1) the diffusion of AEDs in the most-frequented places in the city; (2) BLSD training aimed at reaching the most significant possible number of citizens; (3) the training of all schoolchildren in the basics of first aid. The retention of the concepts learned was assessed via a multiple-choice questionnaire proposed months after the training events. From 2016 to 2023, 42 BLSD courses were held, which trained 1302 adults (12.8% of citizens) with a female/male ratio of 0.9 and a median age of 46 (range: 32–59 years). The participants in the courses were volunteers from associations (59%), athletes (16%), ordinary citizens (13%), school staff (10%), and municipal employees (2%). At the start of the project in 2016, the first 11 AEDs were positioned. To date, the municipal area can count on 25 always-available defibrillators to reach each area within 4 minutes. Furthermore, 1500 school pupils were trained. The retention of the learned notions was excellent. After training, 92% of adult participants and 90% of the schoolchildren reported being willing to provide help in the event of cardiac arrest. The project combined the widespread diffusion of AEDs with a significant number of citizens able to use them, effectively providing cardiopulmonary resuscitation. This project ensured that an entire community shared the goal of saving the lives of people affected by OHCA.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141677300","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":"Risk Factors for Emergency Room Visits in Patients with Digestive Bleeding Associated with Direct-Acting Anticoagulants","authors":"Jesús Ruiz-Ramos, María Carmenza Pérez-Méndez, Catalina Maria Socias-Cañellas, L. Lozano-Polo, Adrián Plaza-Diaz, M. Puig-Campmany, A. Juanes-Borrego","doi":"10.3390/ecm1030021","DOIUrl":"https://doi.org/10.3390/ecm1030021","url":null,"abstract":"Gastrointestinal bleeding is the main cause of admission to the emergency services of patients taking direct-acting oral anticoagulants (DOACs). Little is known about the effects of treatment modification on the risk of readmission, especially in elderly patients. This retrospective observational study included elderly patients with atrial fibrillation who were on DOACs and who were admitted to the emergency department due to gastrointestinal bleeding from 2018 to 2023. To evaluate the risk factors for readmission 90 days after discharge, a multivariate analysis was conducted, which included patient comorbidities, concomitant treatment, changes in anticoagulant treatment, and the prescription of DOACs at discharge. One hundred and thirty-nine patients were included. At discharge, anticoagulant therapy was modified in 44 (31.6%) patients, 16 (36.3%) patients were switched from one DOAC to another, 23 (52.2%) to heparins, and 5 (11.3%) to vitamin K antagonists. A total of 21 (15.1%) patients returned to the emergency department within 90 days after discharge due to new bleeding events. No significant differences were observed depending on the modification of treatment at discharge. The presence of cognitive impairment was the only factor associated with readmission at 90 days. Patients who undergo treatment with DOACs and have gastrointestinal bleeding at discharge are at risk of readmission to the emergency room due to new bleeding events. No benefit was observed in modifying anticoagulant treatment at discharge.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":"4 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141681605","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":"Burnout in Medical Specialists Redeployed to Emergency Care during the COVID-19 Pandemic","authors":"Carol Nash","doi":"10.20944/preprints202404.1083.v1","DOIUrl":"https://doi.org/10.20944/preprints202404.1083.v1","url":null,"abstract":"Burnout represents a concern for all healthcare providers, particularly emergency medical care specialists for whom burnout outcomes have been well documented. What remains unknown is the effect of burnout on redeployed medical specialists during the COVID-19 pandemic from an appointment-centered practice to emergency care directed by public health considerations. This research aims to identify and assess the burnout responses of fourteen medical specialties noted in the search returns of the four most cited articles published since 2020 about non-emergency physicians regarding their burnout, which was brought on by unanticipated emergency care delivery during the recent pandemic, using qualitative case study-like methodology. The hypothesis is that medical specialists accustomed to planning for emergency possibilities in their appointment-centered practice would demonstrate the least burnout regarding COVID-19-related emergencies. Considering coping as a process based on Lazarus’s research, comparing and ranking the COVID-19 emergency responses across the various normally appointment-centered medical specialties in their employed coping strategies determines the outcome. With the results supporting the hypothesis, suggested interventions for future pandemics—when these specialists are, again, redeployed to emergency care directed by public health considerations—are the coping strategies identified as the most effective in reducing burnout while maintaining the viability of the medical specialty and excellent patient care.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":"46 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141345254","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":"Predictive Characteristics of Childhood Emergency Injury Presentations in a Non-Urban Area of Victoria, Australia","authors":"Blake Peck, Daniel Terry, K. Kloot","doi":"10.3390/ecm1020018","DOIUrl":"https://doi.org/10.3390/ecm1020018","url":null,"abstract":"Injury is the leading cause of death and disability amongst those between 0 and 16 years of age. Routinely associated with a social gradient of health, childhood injury is reportedly higher in rural and regional areas. A retrospective cross-sectional study collected deidentified emergency injury presentation data from nine health services in regional Victoria for children aged 0–14 years between 2017 and 2022. Emergency injury presentation incidence rates and predictor variables were analysed using hierarchical multiple regression. Significance was determined at p < 0.05. Amongst the 15,884 emergency injury presentations, 35.2% (n = 5597) occurred at health services that did not routinely report data to government datasets. Although some findings are consistent with current research, this study highlights specific factors that are predictive of injury amongst 0–4-year-old children who require deeper investigation, including general practitioner access and health literacy-related elements such as preschool health assessment attendance rates, parent education levels, and overseas birth. These findings provide more comprehensive insights for healthcare workers and policymakers as they seek to support people with injuries and accurately address health inequities.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":"1 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266798","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 Tasmanian Emergency Care Outcomes Registry (TECOR) Protocol","authors":"V. Tran, Giles Barrington, Simone Page","doi":"10.3390/ecm1020017","DOIUrl":"https://doi.org/10.3390/ecm1020017","url":null,"abstract":"Emergency Departments (ED) play a vital role within the health system, representing the ‘front door’ to hospitals, the first point of hospital contact for patients who are undifferentiated and may be critically ill. They also serve as a safety net for the healthcare system. Together with ED overcrowding, this patient care environment is highly vulnerable to the provision of suboptimal care and breaches in patient safety. Government agencies in Australia currently collect data that are broad and administratively focused and are limited in capacity to identifying clinical quality. Clinical quality registries (CQR) help fill this gap but are often funded by not-for-profit organisations or research grants. There is no emergency care CQR in Tasmania, Australia. We propose the establishment of the Tasmanian Emergency Care Outcomes Registry (TECOR) to monitor emergency care processes and outcomes. The primary objective of TECOR is to monitor the unexpected 30-day mortality of patients who are cared for in the ED as well as 30-day safety events where emergency care was the primary contributor. The TECOR is expected to provide ongoing data on other important processes of emergency care in Tasmania such as length of stay in EDs, 28-day representation to EDs and hospital length of stay. The registry was designed to national standards and will meet the needs of the clinical community and have a positive impact on the communities it serves.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":"20 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140979958","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":"Implementation of Inhaled Methoxyflurane for the Reduction of Distal Radius Fractures in a Third-Level Hospital: A Descriptive Cohort Study","authors":"Roberto R. Albavera-Gutierrez, Francisco J. Paredes-Herrera, Gilberto A. Gasca-López, Zuri Waldo-Castañón, Manuel A. Espinosa-Ramos, O. E. Valencia-Ledezma, C. A. Castro-Fuentes","doi":"10.3390/ecm1020016","DOIUrl":"https://doi.org/10.3390/ecm1020016","url":null,"abstract":"Orthopedic emergencies due to fractures are one of the main reasons for surgical intervention. The distal radius is a structure prone to fractures, particularly in young people. The main objective of this study was to evaluate the success rate of methoxyflurane in the reduction in distal radius fractures that required conservative treatment. The medical records of all the patients with Frykman type I and type II distal radius fractures who underwent fracture reduction with methoxyflurane or propofol from December 2021 to January 2023 were reviewed. The success rate of distal radius fracture reduction with methoxyflurane was analyzed, and the secondary outcomes, such as the recovery time and length of stay in the orthopedic emergency department, were assessed and compared with propofol. A total of 145 patients with distal radius fractures presented to the emergency department during the study period. Seventy-five patients met our inclusion criteria. Fifty patients had a fracture reduction with methoxyflurane, while twenty patients received propofol. The median recovery time and reduction duration were 30 min and 65.5 min, respectively, resulting in a shorter period for the methoxyflurane group. Methoxyflurane was successfully used in 48 of the 82 patients undergoing Frykman type I and type II distal radius fracture reduction while improving the recovery time due to its easy self-delivery and rapid effectiveness in the patient, as well as being able to estimate the level of pain so that the amount of anesthetic needed can be estimated and adverse effects avoided. Methoxyflurane represents a great candidate for surgical interventions like the reduction in distal radius fractures.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":"50 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140980643","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":"Indigestible Trichobezoar Mimicking Inflammatory Bowel Disease: A Case Report and a Literature Review","authors":"Tommaso Bellini, Daniele Franzone, Federico Pezzotta, Valentina Andreottola, Barbara Lionetti, Clelia Formigoni, Elena Fueri, Paolo Gandullia, E. Piccotti, Girolamo Mattioli","doi":"10.3390/ecm1020015","DOIUrl":"https://doi.org/10.3390/ecm1020015","url":null,"abstract":"A 15-year-old girl was admitted to the Pediatric Emergency Department due to abdominal discomfort, anorexia, diarrhea, emesis, and weight loss. An inflammatory bowel disease diagnosis was suspected and a complete endoscopic investigation was deemed necessary. Initially, only colonoscopy with ileoscopy was performed, with evidence of widespread ileal ulcers, whereas a subsequent esophagogastroduodenoscopy revealed a huge trichobezoar that was further surgically removed. Trichobezoars are intraluminal conglomerates composed of ingested hair and are typically associated with underlying psychiatric disorders. Bezoars can be asymptomatic or present with various gastrointestinal symptoms, mimicking, among other conditions, inflammatory bowel disease. They may extend through the pylorus into the jejunum leading to Rapunzel Syndrome, which may cause intestinal obstruction. The treatment of trichobezoar depends on its location and volume. An endoscopic approach is possible for small-sized trichobezoars, but to avoid bezoar tail migration along the intestine, causing obstruction, conventional laparotomy is the only valid treatment for patients with Rapunzel Syndrome. Due to the increasing incidence of psychiatric disorders in pediatric age during the SARS-CoV-2 pandemic and their relationship with trichobezoars, an increase in cases of trichobezoars was observed. Thus, interdisciplinary collaboration between psychiatrists, pediatricians, and surgeons is crucial not only during the acute phase but also for long-term management and prevention of recurrence.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140997296","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":"Video Laryngoscopy vs. Direct Laryngoscopy in Adult Patients with Difficult Airways Who Require Emergency Intubation","authors":"Iktimal Alwan, Maria Alwan, Ibrahim Mahgoub, Ansam Eghzawi, Abeer Gharaibeh, Anita V. Goyal","doi":"10.3390/ecm1020011","DOIUrl":"https://doi.org/10.3390/ecm1020011","url":null,"abstract":"This review compares the efficacy of video laryngoscopy (VL) with that of direct laryngoscopy (DL) in adult patients with difficult airways who require emergency intubation. Intubation and laryngoscopy are critical in emergency settings, and VL has emerged as an alternative to DL, particularly in difficult airway cases and when performed by non-experienced practitioners. VL demonstrates advantages such as a wider field of view, enhanced glottic visibility, and higher first-pass success rates, particularly in difficult airway scenarios. However, it also presents limitations, including potential view obstruction and technical complexity. While the evidence points to the advantages of VL, particularly in achieving higher first-pass success rates and minimizing adverse events in adult patients with difficult airways, the inconclusive findings from randomized trials emphasize the importance of future research in refining practices and improving patient outcomes.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":"42 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140701754","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}