BMC Emergency Medicine最新文献

{"title":"Assessment of prehospital tracheal intubation technique using initial direct laryngoscopy during videolaryngoscopy: randomized controlled simulated trial.","authors":"Cédric Cibotto, Mathieu Pasquier, Nicolas Beysard, Frédéric Rouyer, Olivier Grosgurin, Laurent Bourgeois, Elio Erriquez, Ely Braun, Birgit Andrea Gartner, Thibaut Desmettre, Laurent Suppan","doi":"10.1186/s12873-025-01266-0","DOIUrl":"https://doi.org/10.1186/s12873-025-01266-0","url":null,"abstract":"<p><strong>Background: </strong>In critically ill patients, tracheal intubation may be required in the prehospital setting, where airway management presents unique technical and logistical challenges. While videolaryngoscopy has emerged as a potential alternative to direct laryngoscopy by providing a better and easier visualization of the glottis, the improved view of anatomical structures does not necessarily correlate with successful tracheal tube placement. Intubation may be harder because novice providers performing videolaryngoscopy may only look at the screen and only obtain a two-dimensional representation of the patient's airways. By directly visualizing the airways, these providers may obtain a better 3D apprehension and an improved mental visualization of the patient's anatomy. We compared the impact of an unrestricted videolaryngoscopy use with a sequence consisting in direct visualization of the airway followed by videolaryngoscopy (\"Direct Laryngoscopy-to-VideoLaryngoscopy sequence\" or \"DL-VL sequence\") on time to intubation among novice providers.</p><p><strong>Methods: </strong>This was a parallel group simulated randomized controlled superiority trial. Participants were medical students or junior residents with an experience of less than 10 intubations. After a presentation and workshop on direct laryngoscopy and videolaryngoscopy, participants were randomized in two groups. In the control group, participants were free to use of the videolaryngoscope as they intended. In the other group (DL-VL sequence), participants were told to perform an initial direct laryngoscopy without looking at the video screen until they reached the epiglottis. All intubations were conducted in a simulated prehospital environment, with a high-fidelity manikin placed supine on the floor. Each participant performed three intubations of increasing levels of difficulty. The primary outcome was the time to intubation. Secondary outcomes included first-pass success, time to ventilation, and number of intubation attempts. The chi-squared test was used to compare categorical variables while the t-test was used to compare continuous variables.</p><p><strong>Results: </strong>Time to intubation was shorter in the control group (22±8 s vs. 27±11 s, p < 0.001). This difference was consistent in all levels of difficulties. First-pass success rates were similar (99/111, 89% in the control group vs. 85/105, 81%, p = 0.089). Time to ventilation was significantly shorter in the control group (37±9 vs. 41±11 s, p = 0.008). The mean number of intubation attempts was similar between groups (p = 0.231).</p><p><strong>Conclusion: </strong>In this simulated study among novice providers, direct airway visualization prior to videolaryngoscopy did not improve time to intubation or to ventilation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, Registration Number: NCT06918717, registered on April 8th, 2025. Retrospectively registered.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"112"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modelling the potential clinical benefit of mobile stroke units in England.","authors":"Anna Laws, Michael Allen, Jason Scott, Lisa Moseley, Kerry Pearn, Gary A Ford, Chris Price, Phil White, Graham McClelland, Lisa Shaw, Daniel Phillips, Dave Wilson, Peter McMeekin, Martin James","doi":"10.1186/s12873-025-01242-8","DOIUrl":"https://doi.org/10.1186/s12873-025-01242-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are well-established emergency reperfusion treatments for stroke caused by clots. Both reduce disability but effectiveness is highly time-dependent, declining in the first few hours after stroke onset. Mobile stroke units (MSUs) have been proposed as a way of improving outcomes after stroke. MSUs enable on-scene brain imaging and delivery of IVT, and can allow for better choice of destination hospital. The primary objective of the study was to model the likely effect of MSUs on clinical outcomes (the ability to live independently, modified Rankin Scale 0-2) across all of England assuming no resource restrictions during deployment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used modelling of times to treatment and outcomes. Modelling was performed for Lower Super Output Areas (LSOAs) in England. Admission numbers were based on Hospital Episode Statistics and travel times estimated from data from Open Street Map. Outcomes were predicted based on times to IVT and MT; we report outcomes as utility or the proportion of patients able to live independently at 3-6 months after stroke. We assumed MSUs and stroke units all had the same propensity to use IVT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For every 100 patients suitable for IVT or MT, there will likely be 1-3 more people who can live independently following MSU care. The benefit comes from both earlier IVT and the direct transfer of patients likely to benefit from MT to their closest MT-centre by avoiding inter-hospital transfers that would be used in usual care. If, as is likely, about 1 in 5 stroke patients are suitable candidates for IVT or MT, an MSU would need to attend approximately 250 stroke patients for every one extra independent-living outcome. If about half of the patients to whom an MSU is dispatched are actual strokes (the others being stroke mimics), an MSU would need to attend approximately 500 patients for every one extra independent-living outcome. Some areas, furthest from where MSUs are based, will receive no benefit from MSU care, whereas other areas may have up to 4 additional independent-living outcomes for every 100 patients suitable for IVT or MT. Quick MSU dispatch and fast on-scene treatment are crucial to achieving the benefit of MSUs, otherwise use of MSUs may have no overall benefit, or worse outcomes, than usual care. The above benefits do not include any other possible benefits unrelated to earlier IVT or MT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study suggests that the overall benefit of MSU care if deployed across all of England is likely to be modest. Selective use of MSUs in specific areas is likely to be more effective than widespread implementation. Rapid dispatch, fast on-scene treatment of patients, and careful selection of which patients to dispatch the MSU to (by location and confidence in that person being a confirmed stroke patient), are all critical for maximising benefit","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"111"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of positive expiratory pressure device versus non-invasive ventilation on outcomes in acute exacerbation of chronic obstructive pulmonary disease in the emergency department.","authors":"Emine Sarcan, Ahmet Burak Erdem, Merve Yazla, Şerife Büşra Uysal, Elif Çelikel","doi":"10.1186/s12873-025-01267-z","DOIUrl":"https://doi.org/10.1186/s12873-025-01267-z","url":null,"abstract":"<p><strong>Background: </strong>Acute exacerbations of chronic obstructive pulmonary disease (COPD) are among the most common reasons for emergency department visits. In patients who develop hypercapnic respiratory failure, non-invasive mechanical ventilation (NIV) is generally the preferred treatment. However, in overcrowded emergency departments, the number of mechanical ventilation devices may be insufficient. In such situations, positive expiratory pressure (PEP) devices can be utilized. This study aims to evaluate the clinical efficacy of the PEP device (EzPAP^®) compared to NIV for the management of exacerbations of COPD in the emergency department.</p><p><strong>Methods: </strong>This prospective, randomized controlled study was conducted on 103 patients who presented to the emergency department with exacerbations of COPD and acute hypercapnic respiratory failure between November 2023 and April 2024. Patients were divided into two groups: EzPAP^® (E) and NIV (N). Spirometric parameters, arterial blood gas values, hospital admission rates, and 30-day mortality rates were compared before and after treatment in both groups.</p><p><strong>Results: </strong>A total of 103 patients were included in the study (N: 49, E: 54). In Group N, no statistically significant increase was observed in FEV₁ and FVC after treatment (p = 0.120). A statistically significant increase in FEV₁ and FVC was detected in the EzPAP group (p < 0.001). An increase in oxygen saturation and an improvement in PaCO₂ and lactate levels were observed in both groups (p < 0.001). The difference in blood gas values before and after treatment (delta = Δ) was not statistically significant between the two groups. However, ΔFEV₁ and ΔFVC were significantly higher in the EzPAP group compared to the NIV group (p = 0.007, p = 0.022). The hospital admission rate was higher in the NIV group than in the EzPAP^® group (p = 0.04).</p><p><strong>Conclusion: </strong>EzPAP^® may be a suitable option for use in overcrowded emergency departments, as it demonstrates efficacy comparable to NIV in the management of exacerbations in COPD. Additionally, it can also be considered as a treatment alternative in situations where the number of mechanical ventilation devices for NIV is insufficient, such as during a pandemic.</p><p><strong>Trial registration: </strong>ClinicalTrials Number: NCT06561464 Registration Date: 07/08/2024.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"110"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of return of spontaneous circulation prediction scores in patients with cardiac arrest during ambulance transport.","authors":"Neslihan Ergün Süzer, Gülbin Aydoğdu Umaç, Süleyman Alpar, Sarper Yılmaz","doi":"10.1186/s12873-025-01265-1","DOIUrl":"https://doi.org/10.1186/s12873-025-01265-1","url":null,"abstract":"<p><strong>Background: </strong>Cardiac arrest during ambulance transport is a complex situation that has features of both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) but lacks a clear classification. This study aimed to evaluate the diagnostic performance of prehospital and in-hospital ROSC prediction tools in patients experiencing cardiac arrest during ambulance transport.</p><p><strong>Methods: </strong>A retrospective study was conducted with patients experiencing cardiac arrest during transport. Demographic, clinical, and treatment data were collected, including pre-arrest consciousness, arrest rhythm, and cardiopulmonary resuscitation duration. Four ROSC prediction scores (Prehospital-ROSC, the ROSC after cardiac arrest, Utstein-Based ROSC, and The Cardiac Arrest Survival Post-Resuscitation In-Hospital scores) were used to assess the patients. The AUROCs of the scores were compared to evaluate their diagnostic accuracy.</p><p><strong>Results: </strong>Patients were categorized into two groups based on ROSC: No-ROSC (n = 248, 75.2%) and ROSC (n = 82, 24.8%). The ROSC group had significantly more shockable rhythms (81.7% vs. 22.2%, p < 0.001) and a higher proportion of cardiac etiology (p = 0.015) compared to the No-ROSC group. The time for the ambulance to reach the patient did not significantly differ between groups (p = 0.140), but the time spent in the ambulance before arrest was significantly shorter in the ROSC group (p = 0.026). The prehospital-ROSC score had the highest diagnostic performance (AUROC 0.791), followed by The ROSC after cardiac arrest score (0.754) and The Utstein-Based ROSC score (0.716). The Cardiac Arrest Survival Post-Resuscitation In-Hospital score had the lowest performance (0.658). Prehospital-ROSC score outperformed the Utstein-Based ROSC score (p = 0.005), and the Cardiac Arrest Survival Post-Resuscitation In-Hospital score was significantly lower than both ROSC after cardiac arrest score (p = 0.031) and the prehospital-ROSC score (p < 0.001).</p><p><strong>Conclusion: </strong>Prehospital-ROSC score was the most accurate predictor of ROSC in patients experiencing cardiac arrest during ambulance transport, while the Cardiac Arrest Survival Post-Resuscitation In-Hospital score demonstrated lower predictive accuracy.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"107"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of VExUS scores for predicting mortality among patients followed up in the emergency department due to congestive heart failure: a prospective cross-sectional study.","authors":"Fatih Burak Senay, Murtaza Kaya, Sahinde Atlanoglu, Mehmed Ulu","doi":"10.1186/s12873-025-01271-3","DOIUrl":"https://doi.org/10.1186/s12873-025-01271-3","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"101"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of media on surge capacity in emergency departments: a study on rabies vaccination uptake.","authors":"Suleyman Alpar, Figen Unal Colak, Bulent Kaya, Sarper Yilmaz","doi":"10.1186/s12873-025-01270-4","DOIUrl":"https://doi.org/10.1186/s12873-025-01270-4","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore the influence of media coverage on rabies vaccination practices and emergency department (ED) visits in Turkey, a country characterized by a substantial volume of patient admissions to EDs. Additionally, the study examines the impact of media-driven public concern on ED surge capacity, highlighting the challenges emergency physicians face in managing sudden patient influxes.</p><p><strong>Methods: </strong>This retrospective, descriptive, cross-sectional study was conducted at a single center. To assess the influence of media on vaccination practices in EDs and its effect on ED surge capacity, the Causal Impact package and interrupted time-series analysis using autoregressive integrated moving average (ARIMA) modeling were employed.</p><p><strong>Results: </strong>A total of 27,293 rabies vaccinations were administered at the study center within one year, with distribution as follows: 37.3% for the first dose, 33.4% for the second dose, and 29.2% for the third dose. Following rabies-related news, there was an average increase in the daily number of administered doses. The applied model indicated variances of 41.8%, 39.4%, and 38.5% for the respective doses, corresponding to daily increases of 7.73, 10.25, and 9.07 vaccinations. In the absence of rabies news, the expected daily doses would have been approximately 29 ± 1.7, 27 ± 1.4, and 24 ± 1.4, respectively. Rabies-related news resulted in absolute effects of 11 ± 1.7, 9 ± 1.4, and 9 ± 1.4 vaccinations and relative effects of 38 ± 8%, 35 ± 7.3%, and 38 ± 8.5% for the first, second, and third doses, respectively.</p><p><strong>Conclusion: </strong>The presence of a rabies-related news story, coupled with an increase in rabies-related Google searches, was associated with a significant rise in rabies vaccinations administered in EDs. Media coverage of attention-captivating events can contribute to increased ED visits. Media plays a significant role in influencing ED utilization.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"102"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-design of a Mobile Stroke Unit pathway highlights uncertainties and trade-offs for viable system-wide implementation in the English and Welsh NHS.","authors":"L Moseley, P McMeekin, M Allen, G A Ford, M James, A Laws, S McCarthy, G McClelland, L J Park, K Pearn, D Phillips, C Price, L Shaw, P White, D Wilson, J Scott","doi":"10.1186/s12873-025-01243-7","DOIUrl":"10.1186/s12873-025-01243-7","url":null,"abstract":"<p><strong>Background: </strong>Mobile stroke units (MSUs) are specialist ambulances equipped with scanning and point of care testing that can identify patients eligible for intravenous thrombolysis - medication to dissolve a clot used in ischaemic strokes - and provide this on location. While benefits of MSUs have been demonstrated, this is context dependent. Routine use of MSUs across the English and Welsh National Health Service (NHS) has not yet been considered, and as such no pathway for their operation exists. This study aimed to co-design a viable pathway, detailing dispatch, staffing and treatment decisions, for MSUs within the NHS context.</p><p><strong>Methods: </strong>The study used interdisciplinary co-design alongside Nominal Group Technique (NGT) to generate consensus. Participants were recruited using a combination of purposive, opportunistic and snowball sampling. Data collection took place in online workshops, across three rounds, with supplemental interviews conducted where required. Data were analysed as an ongoing process, with participants checking interpretations after each round, and then further analysed deductively to identify key uncertainties following all the rounds. Consensus threshold for the NGT was set a priori at ≥ 80%.</p><p><strong>Results: </strong>An MSU pathway that reached consensus for being viable within the NHS was developed with consideration for current systems and pressures. Key uncertainties were identified such as where to base the MSU. We also identified where participants had to make trade-offs in the co-designed pathway, such as staffing considerations. Together, the uncertainties and trade-offs represent challenges to MSU implementation and are presented alongside the process to reach the finalised pathway. Future developments which may have implications for the implementation of MSUs were also explored.</p><p><strong>Conclusions: </strong>The co-designed MSU pathway provides a foundation for MSU implementation in the English and Welsh NHS and can be subjected to local and regional modifications required for implementation. However, optimal implementation is likely hindered by several uncertainties and trade-offs, including the geographical base of the MSU and staffing, that represent challenges to implementation of MSUs at scale. Future developments in acute stroke care may help to mitigate these challenges, such as developments in artificial intelligence to read scans and improved access to telemedicine.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"97"},"PeriodicalIF":2.3,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using an audiovisual feedback device improves cardiopulmonary resuscitation performance during day and night - a randomized controlled simulation study.","authors":"Melanie Preuss, Rainer Röhrig, Christian Hübel, Clara Vos, Jenny Unterkofler, Jörg Christian Brokmann, Klaus Willmes, Christopher Plata","doi":"10.1186/s12873-025-01249-1","DOIUrl":"10.1186/s12873-025-01249-1","url":null,"abstract":"<p><strong>Background: </strong>Survival of in-hospital-cardiac-arrests is lower when they occur at night and at weekends than when they occur during the day. Despite numerous studies, there is little evidence regarding the cardiopulmonary resuscitation quality at night and the influence of a feedback device depending on time of day. The present study investigates the differences between chest compressions at night and during the day, with and without the use of a feedback device.</p><p><strong>Methods: </strong>The study was approved by the local Ethics Committee and registered in the German Clinical Trials Register on 22nd of February 2022 (DRKS00027309) prior to inclusion of the first participant. 158 medical professionals were randomized into one of two groups: \"no feedback\" and \"feedback\"-group. In both groups, participants carried out three two-minute intervals of cardiopulmonary resuscitation on a manikin at day and at night. Members of the \"feedback\"-group received guidance by a feedback device. Primary endpoint was the mean compression depth at two time-intervals at the beginning (t₁ = 30-60 s) and the end (t₂ = 480-540 s) of the experience at night. Secondary endpoints included mean compression depth, adequate compression depth (%), compression rate and effective compressions (%).</p><p><strong>Results: </strong>At night, mean compression depth was significantly higher in the \"feedback\"-group at t₁ (47.7 ± 7.9 mm, 95% CI [45.6-49.8] vs 42.9 ± 11.0 mm, 95% CI [40.8-45.0]) and t₂ (46.2 ± 7.9 mm, 95% CI [44.0-48.4] vs 39.6 ± 11.6 mm, 95% CI [37.3-41.8]). There was no significant difference in mean compression depth between day and night in the \"no feedback\"-group (41.4 ± 10.8 mm, 95% CI [39.3-43.5] vs 42.2 ± 10.8 mm, 95% CI [40.1-44.3]) nor in the \"feedback-group\" (47.4 ± 7.6 mm, 95% CI [45.3-49.4] vs 47.4 ± 7.5 mm; 95% CI [45.4-49.5]).</p><p><strong>Conclusion: </strong>The use of a real-time audiovisual feedback significantly improved compression depth during the day and night in a manikin-based simulation study with medical professionals.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"95"},"PeriodicalIF":2.3,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose-dependent side effects of prehospital analgesia with ketamine for winter sports injuries - an observational study.","authors":"Richard Steffen, David Werlen, Markus Huber, Jürgen Knapp","doi":"10.1186/s12873-025-01252-6","DOIUrl":"10.1186/s12873-025-01252-6","url":null,"abstract":"<p><strong>Background: </strong>Ketamine is one of the most used drugs in trauma patients after skiing accidents. However, the environmental conditions for these patients are often rough, with numerous unpleasant sensory impressions (e.g. noise from the helicopter, cold, wind, etc.), raising concerns about the adverse psychological side effects of ketamine. Moreover, it has not yet been established whether these side effects are dose-dependent, and the supplementary administration of benzodiazepines remains controversial. We analysed the subjective perception of side effects after administration of ketamine during helicopter emergency medical service missions involving trauma patients after ski accidents.</p><p><strong>Methods: </strong>In this retrospective observational study, data was collected from emergency services protocols and questionnaires filled out by patients. The primary outcome was defined as the patients' subjective perceptions of ketamine-associated side effects. The subjective intensity of twelve common classes of side effects was recorded on a five-point Likert scale. In addition, we conducted a linear regression analysis, with side effect intensity as the outcome and gender, age, type of injury, use of midazolam and fentanyl, ketamine dosage and relative pain reduction as covariates.</p><p><strong>Results: </strong>A total of 69 patients were identified who were treated with ketamine during the winter months of 2023/2024, after suffering trauma while doing alpine winter sports. Of these, 49 patients (71%) could be included. The side effects reported were mostly mild, with two-thirds of the patients describing them as \"no [side effects]\" or \"mild\". Only 6% described them as \"barely tolerable\" or \"unbearable\". No statistically significant association could be demonstrated between the ketamine dose and the total reported side effect score. The regression model identified the additional administration of midazolam as a significant covariate for fewer side effects. With regard to prehospital care, 85% of the patients stated that they had always felt safe, while two-thirds were satisfied with the prehospital pain therapy.</p><p><strong>Conclusion: </strong>Ketamine seems to be a suitable option for pain therapy in the case of injuries during alpine winter sport activities. Side effects reported by patients in this study were rare, not dose-dependent and described by most patients as subjectively well tolerable. The supplementary administration of midazolam could potentially further reduce these side effects.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"92"},"PeriodicalIF":2.3,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the PEACE score for predicting abnormal echocardiographic findings in pulmonary embolism patients.","authors":"Kazım Ersin Altınsoy","doi":"10.1186/s12873-025-01259-z","DOIUrl":"10.1186/s12873-025-01259-z","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary embolism (PE) is a life-threatening condition requiring rapid risk stratification for optimal management. The Pulmonary Embolism Advanced Cardiac Evaluation (PEACE) Score is a novel tool integrating clinical, laboratory, and echocardiographic parameters to assess disease severity. This study aimed to evaluate the correlation between PEACE Score and echocardiographic abnormalities in PE patients, and to determine its effectiveness as a rapid risk assessment tool in emergency settings.</p><p><strong>Methods: </strong>Between June 2020 and June 2024, 120 patients were prospectively screened and enrolled in the study after being diagnosed with pulmonary embolism via CT angiography in the emergency department. Patients were categorized into three groups according to PEACE score as low risk (< 3 points, n = 42), intermediate risk (3-5 points, n = 52) and high risk (> 5 points, n = 26). Echocardiographic findings were not used for stratification but rather analyzed as outcome variables to assess the discriminative validity of the PEACE Score. Demographic data, laboratory findings and echocardiographic parameters were recorded. Patients were followed up for at least 1 year. Follow-up from 3 months to 6 months was evaluated and mortality rates at the end of 1 year were determined.</p><p><strong>Results: </strong>PEACE Score was strongly correlated with echocardiographic abnormalities (r = 0.685, p < 0.001) and inflammatory markers, including CRP (r = 0.524, p < 0.001). The PEACE Score had the highest diagnostic value for predicting echocardiographic abnormalities, with an AUC of 0.82 (95% CI: 0.74-0.90, p < 0.001). Specifically, in predicting right ventricular dysfunction, the PEACE Score achieved an AUC of 0.85 (95% CI: 0.77-0.93, p < 0.001). A cutoff of > 5 points showed a sensitivity of 84.6% and specificity of 79.2% for detecting severe echocardiographic abnormalities. One-year survival rates were 45% in the high-risk group, 65% in the intermediate-risk group, and 85% in the low-risk group. Kaplan-Meier analysis confirmed significant differences in survival among risk groups (p < 0.001).</p><p><strong>Conclusion: </strong>The PEACE Score demonstrated a strong association with echocardiographic abnormalities and patient survival in emergency department PE cases. These findings suggest that PEACE may serve as a valuable tool for rapid risk stratification, aiding emergency physicians in early clinical decision-making. Specifically, high PEACE Scores were associated with a greater need for thrombolytic therapy and ICU admission, suggesting its potential utility in guiding treatment escalation and resource allocation in critically ill PE patients.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"96"},"PeriodicalIF":2.3,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}