Emergency and critical care medicine最新文献

{"title":"Potential impact of specific therapy on pregnant women with pulmonary arterial hypertension without cardiac shunt: a descriptive study in northern China","authors":"Weida Lu, Min Li, Fuqing Ji, Hua Feng, Guo Li, Qiushang Ji, Hongyu Zhang, Xiaopei Cui","doi":"10.1097/ec9.0000000000000103","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000103","url":null,"abstract":"Abstract Background Pregnancy in women with pulmonary arterial hypertension (PAH) is a fatal condition, despite the effectiveness of PAH-specific therapies. The coverage status and effect of specific therapies in pregnant patients with PAH without cardiac shunts in China remain unclear. To investigate this issue, we conducted a multicenter retrospective study in northern China. Methods The study included 85 patients who were admitted to 4 clinical centers in Shandong Province between October 2010 and August 2020. Maternal endpoint events included (1) maternal death and/or (2) major adverse cardiac events, both occurring during pregnancy or within 6 weeks postpartum. Results Although the overall mortality rate was encouraging (11.8%), the number of patients receiving PAH-specific therapies was extremely low (28.2%). Moreover, only 15.3% of patients received adequate duration of PAH-specific therapy (≥4 weeks) before delivery, and this subgroup showed the lowest major adverse cardiac events rate (7.7%) compared with that in the untreated (19.7%) and short-time treated groups (<4 weeks; 54.5%). Conclusion Pregnant patients with PAH without cardiac shunts face significantly increased mortality risks. Short-term PAH-specific therapy does not guarantee favorable maternal outcomes. Prepregnancy screening, early identification, and timely intervention are expected to improve maternal outcomes in pregnant women with PAH.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"2015 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136238562","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":"Emergency Care and Medicine, 2023","authors":"R. Lunevicius","doi":"10.3390/ecm1010001","DOIUrl":"https://doi.org/10.3390/ecm1010001","url":null,"abstract":"The most recent global emergency medicine 56-question survey highlighted challenges and gaps in providing emergency care [...]","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81767941","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":"COVID-19 and cardiovascular complications: updates of emergency medicine.","authors":"Jianli Zhao, Yaoli Xie, Zhijun Meng, Caihong Liu, Yalin Wu, Fujie Zhao, Xinliang Ma, Theodore A Christopher, Bernard J Lopez, Yajing Wang","doi":"10.1097/ec9.0000000000000095","DOIUrl":"10.1097/ec9.0000000000000095","url":null,"abstract":"<p><p>Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV-2 variants, has become a global pandemic resulting in significant morbidity and mortality. Severe cases of COVID-19 are characterized by hypoxemia, hyper-inflammation, cytokine storm in lung. Clinical studies have reported an association between COVID-19 and cardiovascular disease (CVD). Patients with CVD tend to develop severe symptoms and mortality if contracted COVID-19 with further elevations of cardiac injury biomarkers. Furthermore, COVID-19 itself can induce and promoted CVD development, including myocarditis, arrhythmia, acute coronary syndrome, cardiogenic shock, and venous thromboembolism. Although the direct etiology of SARS-CoV-2 induced cardiac injury remains unknown and under-investigated, it is suspected that it is related to myocarditis, cytokine-mediated injury, microvascular injury, and stress-related cardiomyopathy. Despite vaccinations having provided the most effective approach to reducing mortality overall, an adapted treatment paradigm and regular monitoring of cardiac injury biomarkers is critical for improving outcomes in vulnerable populations at risk for severe COVID-19. In this review, we focus on the latest progress in clinic and research on the cardiovascular complications of COVID-19 and provide a perspective of treating cardiac complications deriving from COVID-19 in Emergency Medicine.</p>","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"104-114"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45496001","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":"Trauma systems in Canada: striving for quality across an expansive landmass","authors":"Natasha G. Caminsky, Evan G. Wong","doi":"10.1097/ec9.0000000000000102","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000102","url":null,"abstract":"Although Canada has a universal health care program that provides free in-hospital services to all citizens, its vast landmass and nonstandardized prehospital and posthospital systems make delivering quality trauma care challenging, particularly to resource-limited rural regions. This article summarizes the strengths of the prehospital system, facility-based care, trauma network, trauma registry, rehabilitation, and governance/financing/quality assurance components of Canada’s trauma system. Future directions, including the use of telemedicine, standardization of practices, and resource optimization, are also explored. Canada’s trauma system is well developed, yet geography impedes equitable access. More standardization and resource optimization are needed.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49665808","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":"Early sodium bicarbonate infusion was associated with improved outcome in critically ill patients with acute moderate metabolic acidosis: a retrospective observational study","authors":"Saijia Huang, Bo Yang, Yaojun Peng, Libo Wang, Li-li Wang, J. Wang, Xuan Zhou, Hanyu Zhu, Li Chen, Cong Feng","doi":"10.1097/ec9.0000000000000101","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000101","url":null,"abstract":"\u0000 \u0000 \u0000 Sodium bicarbonate (SB) infusion is widely administered for severe metabolic acidosis (MA). However, evidence supporting its effect on mortality in patients with acute moderate MA (MMA) has not yet been established. This study investigated the effect of early SB administration on mortality in critically ill patients with acute MMA and in other subgroups.\u0000 \u0000 \u0000 \u0000 We retrospectively analyzed a large intensive care unit (ICU) database, Medical Information Mart for Intensive Care (MIMIC)-IV. Patients with acute MMA were identified using MIMIC-IV. Propensity score analysis (PSA) was performed to explain baseline differences in the probability of receiving SB. The marginal structural Cox model (MSCM) was developed to adjust for both baseline and time-varying confounding variables. The primary outcome was ICU mortality, and the secondary outcome was hospital mortality.\u0000 \u0000 \u0000 \u0000 In total, 1738 patients with acute MMA were identified; 484 were enrolled in the SB group and 1254 in the non-SB group. In the PSA, early SB infusion was not associated with reduced ICU mortality (hazard ratio [HR]: 0.88; 95% confidence interval [CI]: 0.67–1.14; P = 0.33) in the overall cohort. However, it was associated with improved ICU survival in patients with sepsis (HR: 0.69; 95% CI: 0.48–0.99; P < 0.05), sepsis shock (HR: 0.61; 95% CI: 0.40–0.93; P < 0.05), and sepsis and lactic acidosis (lactate >2.2 mmol/L; HR: 0.69; 95% CI: 0.48–0.99; P < 0.05). The results from MSCM were similar to those obtained for PSA.\u0000 \u0000 \u0000 \u0000 Early SB infusion was associated with improved ICU survival outcomes in critically ill adult patients with sepsis, septic shock, and sepsis and lactic acidosis and acute MMA. Further large randomized controlled trials are required to confirm these results.\u0000","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48799340","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":"Successful fiberoptic orotracheal intubation by lifting large thyroid mass and tongue protrusion in left lateral position: a case report","authors":"Sarfaraz Ahmad, Neeraj Kumar, Ajeet Kumar, Saravanan Palasevam","doi":"10.1097/ec9.0000000000000100","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000100","url":null,"abstract":"\u0000 \u0000 \u0000 Awake fiberoptic bronchoscopy has long been considered the criterion standard for the management of difficult airways because of large thyroid malignancies. After an unsuccessful attempt to intubate with a fiberoptic bronchoscope in the supine position, the decision to switch to the left lateral position was made. We present this case to propose the utilization of the lateral position for awake intubation.\u0000 \u0000 \u0000 \u0000 We report a rare case of a patient with a large papillary carcinoma of the thyroid planned for surgical excision. The patient presented to our hospital with complaints of difficulty breathing while lying down in the supine position and oozing blood from the necrotic tissue. The breathing difficulties subsided in the lateral position.\u0000 \u0000 \u0000 \u0000 We demonstrated how the left lateral position with an adjunct maneuver facilitates intubation in large thyroid malignancies.\u0000","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49639500","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":"Advancing emergency preparedness in a postpandemic world: global collaboration and innovative approaches for hospitals","authors":"Krzysztof Goniewicz, D. Barten","doi":"10.1097/ec9.0000000000000099","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000099","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44734106","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":"Use of ketamine for severe asthma exacerbation in a pregnant patient with persistent bronchospasm: a case report","authors":"Melanie Johnson, M. Abbas, Jaber Abdo, M. Mansour, Jessica Jones","doi":"10.1097/ec9.0000000000000098","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000098","url":null,"abstract":"\u0000 \u0000 \u0000 Estimated 4%–8% of pregnancies are complicated by asthma. Adequate management in this population is critical to minimize complications. Patients presenting with asthma exacerbation are typically managed with standard bronchodilators and systemic corticosteroids. However, additional agents may be used in patients with refractory asthma exacerbation. Ketamine has been used in refractory bronchospasm, although its efficacy in published literature is heterogeneous.\u0000 \u0000 \u0000 \u0000 We present a case of a pregnant patient with severe asthma exacerbation refractory to standard and salvage treatment who achieved termination of bronchospasm with ketamine infusion.\u0000 \u0000 \u0000 \u0000 After receiving ketamine infusion for several days, the patient had improved air flow and achieved successful extubation, without experiencing rebound bronchospasm. Although this individual clinical case alone cannot change guidelines or directives to use in refractory asthma exacerbations, it offers a possible treatment option to patients and providers in unusually severe cases with extenuating risk factors.\u0000","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42787628","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":"Vaspin alleviates pathological cardiac hypertrophy by regulating autophagy-dependent myocardial senescence","authors":"Huaxiang Yu, Haiying Rui, Dan Zou, Kai Chi, Ping Xu, Xiaoshuai Song, Lulu Liu, Xuting Wu, Jinxin Wang, Li Xue","doi":"10.1097/ec9.0000000000000097","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000097","url":null,"abstract":"Abstract Background Visceral adipose tissue–derived serine protease inhibitor (vaspin), a secretory adipokine, protects against insulin resistance. Recent studies have demonstrated that serum vaspin levels are decreased in patients with coronary artery disease and that vaspin protects against myocardial ischemia-reperfusion injury and atherosclerosis. However, it remains unclear whether vaspin exerts specific effects on pathological cardiac hypertrophy. Methods An in vivo study was conducted using a cardiac hypertrophy model established by subcutaneous injection of isoproterenol (ISO) in C57BL/6 and vaspin-ko mice. Rapamycin was administered intraperitoneally to mice, for further study. H9c2 cells and neonatal rat ventricular myocytes (NRVMs) were treated with ISO to induce hypertrophy. Human vaspin fusion protein, the proteasome inhibitor MG132, and chloroquine diphosphate were used for further mechanistic studies. Results Here, we provide the first evidence that vaspin knockdown results in markedly exaggerated cardiac hypertrophy, fibrosis, and cardiomyocyte senescence in mice treated with ISO. Conversely, the administration of exogenous recombinant human vaspin protected NRVMs in vitro against ISO-induced hypertrophy and senescence. Furthermore, vaspin significantly potentiated the ISO-induced decrease in autophagy. Both rapamycin and chloroquine diphosphate regulated autophagy in vivo and in vitro, respectively, and participated in vaspin-mediated cardioprotection. Moreover, the PI3K-AKT-mTOR pathway plays a critical role in vaspin-mediated autophagy in cardiac tissues and NRVMs. Our data showed that vaspin downregulated the p85 and p110 subunits of PI3K by linking p85 and p110 to NEDD4L-mediated ubiquitination degradation. Conclusion Our results show, for the first time, that vaspin functions as a critical regulator that alleviates pathological cardiac hypertrophy by regulating autophagy-dependent myocardial senescence, providing potential preventive and therapeutic targets for pathological cardiac hypertrophy.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136287246","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":"A novel machine learning-assisted clinical diagnosis support model for early identification of pancreatic injuries in patients with blunt abdominal trauma: a cross-national study","authors":"Saijia Huang, Xuan Zhang, Bo Yang, Y. Teng, Li Mao, Li-li Wang, J. Wang, Xuan Zhou, Li Chen, Yuan Yao, Cong Feng","doi":"10.1097/ec9.0000000000000096","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000096","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49374122","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}