Emergency Care and Medicine最新文献_第2页

Irrigation and Débridement of the Thumb Flexor Sheath for Tenosynovitis—An Anatomic Study for the Optimisation of Surgical Techniques in Cadaveric Specimens 拇指屈肌鞘腱鞘炎的冲洗和去骨膜术--一项在尸体标本中优化手术技术的解剖学研究

Emergency Care and Medicine Pub Date : 2024-04-09 DOI: 10.3390/ecm1020010

James W. Grant, Louis LeBlond, S J Woodley

{"title":"Irrigation and Débridement of the Thumb Flexor Sheath for Tenosynovitis—An Anatomic Study for the Optimisation of Surgical Techniques in Cadaveric Specimens","authors":"James W. Grant, Louis LeBlond, S J Woodley","doi":"10.3390/ecm1020010","DOIUrl":"https://doi.org/10.3390/ecm1020010","url":null,"abstract":"Background: Treatment of a flexor tendon sheath infection of the thumb usually involves prompt surgical irrigation and debridement (ID). There are few descriptions of this procedure despite the unique anatomy of the thumb flexor sheath. The aim of this study was to investigate thumb flexor sheath ID and explore the relevant anatomy. Methods: The current ID technique was performed on eight embalmed cadaveric hands. Coloured latex was injected into the sheath, and the surrounding region was dissected. Outcomes of interest were the distribution of latex, the success of the procedure, and the anatomy of the radial bursa. Results: Latex was successfully injected into all specimens, although A1 pulley stenosis caused significant resistance to flow. Latex filled the radial bursa (four specimens), reached the distal boundary of the transverse carpal ligament (three), or did not pass the A1 pulley (one); in addition, latex was found in the deep spaces of the hand and wrist (five specimens). The radial bursa was located at a median (range) of 33.2 (23.9–34.5) mm proximal to the carpometacarpal joint and at 7.8 (0–14.0) mm distal to the distal border of the pronator quadratus. Conclusion: These findings contribute to the existing body of knowledge on the anatomy of the thumb flexor sheath and radial bursa, and will help guide hand surgeons to perform thorough ID for infection. A modified surgical technique is presented, which may help further inform the treatment of pyogenic flexor tenosynovitis and other serious hand conditions.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":"21 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140725222","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}

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Traumatic Cardiac Arrest: Navigating the Spectrum of Fundamentals and Advances 创伤性心脏骤停：驾驭基本原理与进展的光谱

Emergency Care and Medicine Pub Date : 2024-03-13 DOI: 10.3390/ecm1010008

F. Epelde

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Resuscitative Endovascular Balloon Occlusion of the Aorta in Non-Traumatic Out-of-Hospital Cardiac Arrest: A State-of-the-Art Review 非创伤性院外心脏骤停的主动脉血管内球囊闭塞复苏：最新进展回顾

Emergency Care and Medicine Pub Date : 2024-03-01 DOI: 10.3390/ecm1010007

Andrea Breglia, Pietro Pettenella, Laura Cervino, Claudio Fossa, Mirko Zanatta

{"title":"Resuscitative Endovascular Balloon Occlusion of the Aorta in Non-Traumatic Out-of-Hospital Cardiac Arrest: A State-of-the-Art Review","authors":"Andrea Breglia, Pietro Pettenella, Laura Cervino, Claudio Fossa, Mirko Zanatta","doi":"10.3390/ecm1010007","DOIUrl":"https://doi.org/10.3390/ecm1010007","url":null,"abstract":"Out-of-hospital cardiac arrest (OHCA) is one of the most important causes of death worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an interesting new device that has been developed as a bridge therapy to treat trauma patients with non-compressible torso hemorrhage. REBOA has also been tested in non-traumatic OHCA, but the results are inconclusive. The aim of this review is to describe the state of the art in the use of REBOA for the management of non-traumatic out-of-hospital cardiac arrest. We performed a state-of-the-art review of the literature, searching for the therapeutic role of REBOA in the management of non-traumatic OHCA. We interviewed PubMed, Central, and Embase, and searched for citations before May 2023 using these criteria: “non-traumatic out-of-hospital cardiac arrest” and “resuscitative endovascular balloon occlusion of the aorta”. We selected only observational studies because controlled trials have not been published yet. All studies demonstrated the feasibility of REBOA placement in the management of non-traumatic OHCA and the improvement of all perfusion markers. Although some important uncertainties still remain, REBOA has the potential to become a new cornerstone in the therapy of OHCA and change the management of cardiac arrest, especially in remote locations which require a long time for scene arrival and an even longer time for metropolitan hospital arrival, where an ECPR is available.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":"4 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140084674","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}

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A Ten-Year before–after Study on the Impact of the Affordable Care Act Health Insurance Expansion on Emergency Department Visits in California, U.S. 美国加利福尼亚州 "平价医疗法案 "扩大医疗保险范围对急诊就诊量影响的十年前后研究

Emergency Care and Medicine Pub Date : 2024-01-29 DOI: 10.3390/ecm1010005

Theodore C. Chan, J. Brennan, Edward M. Castillo

{"title":"A Ten-Year before–after Study on the Impact of the Affordable Care Act Health Insurance Expansion on Emergency Department Visits in California, U.S.","authors":"Theodore C. Chan, J. Brennan, Edward M. Castillo","doi":"10.3390/ecm1010005","DOIUrl":"https://doi.org/10.3390/ecm1010005","url":null,"abstract":"The Affordable Care Act (ACA) implemented in the U.S. aimed to improve healthcare access by expanding insurance coverage. To study the impact of ACA on Emergency Departments (Eds), we conducted a multi-center observational retrospective study of ED visits from all nonfederal acute care hospitals in California over a 10-year period (2009 and 2018), 5 years before and after ACA implementation. Primary outcome measures included total ED visits, health insurance, disposition, and diagnoses, including ambulatory-care-sensitive conditions (ACSCs), and were analyzed each year to assess for trends during the 10-year study period. Overall, ED visits increased from 8,475,330 (30,791/100,000 population) in 2009 to 11,389,384 in 2018 (37,255/100,000 population), an increase of 21.0%, with the largest increase in 2014, the first year of ACA. The payer mix also dramatically changed, with a significant drop in uninsured patient visits (21.5% to 7.8%) and an increase in government-funded Medicaid visits (18.9% to 35.7%). There was a slight decrease in visits resulting in hospitalization or transfer (21.2% to 18.1% of all D visits) and ASCS visits (173.2 to 144.3 per 1000 ED visits). In conclusion, ED visits increased significantly in California following ACA, with a decrease in uninsured patients and small decreases in both hospitalizations/transfers.","PeriodicalId":511311,"journal":{"name":"Emergency Care and Medicine","volume":"66 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140486522","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}

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