BMC Emergency Medicine最新文献

{"title":"Helicopter emergency medical services in Eastern Iran: a 4-year cross-sectional study of time intervals and mission profiles.","authors":"Mohammad Hossein Esmaeilzadeh, Akram Nami, Razyeh Bajoulvand, Toktam Paykani","doi":"10.1186/s12873-024-01151-2","DOIUrl":"https://doi.org/10.1186/s12873-024-01151-2","url":null,"abstract":"<p><strong>Background: </strong>Air medical transport services play a significant role in emergency situations by providing timely transfers of critically ill patients to medical facilities. This study aimed to investigate the mission characteristics of helicopter emergency medical services (HEMS) and the associated time intervals in a geographically remote region of eastern Iran. We also compared the prehospital times of HEMS and ground transportation to determine whether dispatching a helicopter is time-efficient.</p><p><strong>Methods: </strong>This retrospective cross-sectional study was conducted at the prehospital emergency medical center in Gonabad, a remote area in eastern Iran. Data were collected using standardized electronic forms developed by the Ministry of Health and Medical Education (MOHME) in Iran. We analyzed the mission profiles and prehospital time intervals for all Gonabad HEMS missions conducted between 2021 and 2024. The mean activation time was compared to the national benchmark of three minutes, and the prehospital time intervals of air ambulances were compared to those of ground ambulances.</p><p><strong>Results: </strong>From 2021 to 2024, there were 252 HEMS missions, transporting 265 patients. Of all 252 missions, 95 (37.7%) were primary missions, and 157 (62.3%) were secondary missions. The most frequent reasons for air ambulance dispatch were trauma, acute coronary syndrome, and strokes. The mean ± SD for HEMS activation time was 9.14 ± 3.63 min, significantly exceeding the national benchmark of three minutes. HEMS prehospital time was 49.73 ± 9.67 min. The comparison of prehospital time intervals indicated that air emergency services are more time-efficient than ground ambulances.</p><p><strong>Conclusion: </strong>This study found that the mean activation time of air ambulances exceeded the national benchmark of three minutes. When comparing prehospital times for air ambulance and ground ambulance services, HEMS was faster than both ground scenarios. The current benchmark for helicopter activation time in Iran may need clarification and revision.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930669","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":"An retrospective study on the effects of deep learning model-based optimization emergency nursing on treatment compliance and curative effect of patients with acute left heart failure.","authors":"Qian Dai, Jing Huang, Hui Huang, Lin Song","doi":"10.1186/s12873-024-01156-x","DOIUrl":"10.1186/s12873-024-01156-x","url":null,"abstract":"<p><strong>Background: </strong>Based on explainable DenseNet model, the therapeutic effects of optimization nursing on patients with acute left heart failure (ALHF) and its application values were discussed.</p><p><strong>Method: </strong>In this study, 96 patients with ALHF in the emergency department of the Affiliated Hospital of Xuzhou Medical University were selected. According to different nursing methods, they were divided into conventional group and optimization group. Activity of daily living (ADL) scale was used to evaluate ADL of patients 6 months after discharge. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were employed to assess patients' psychological state. 45 min improvement rate, 60 min show efficiency, rescue success rate, and transfer rate were used to assess the effect of first aid. Likert 5-level scoring method was adopted to evaluate nursing satisfaction.</p><p><strong>Results: </strong>The optimization group showed shorter durations for first aid, hospitalization, electrocardiography, vein channel establishment, and blood collection compared to the conventional group. However, their SBP, DBP, and HR were inferior. On the other hand, LVEF and FS were significantly better in the optimization group. After nursing intervention, SAS and SDS scores were lower in the optimization group. Additionally, the optimization group had higher 45-minute improvement rates, 60-minute show efficiency, rescue success, and transfer rates. They also performed better in 6-minute walking distance and ADL scores 6 months post-discharge. The optimization group had better compliance, total effective rates, and satisfaction than the conventional group.</p><p><strong>Conclusion: </strong>It was demonstrated that explainable DenseNet model had application values in the diagnosis of ALHF. Optimization emergency method could effectively shorten the duration of first aid, relieve anxiety, and other adverse emotions, and improve rescue success rate and short-term efficacy. Nursing intervention has a positive impact on the total effective efficiency and patient satisfaction.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"240"},"PeriodicalIF":2.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11686966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906187","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":"Perceived competency requirements for emergency medical services field supervisors in managing chemical and explosive incidents - qualitative interview study.","authors":"Jussi Kauppila, Timo Iirola, Hilla Nordquist","doi":"10.1186/s12873-024-01157-w","DOIUrl":"10.1186/s12873-024-01157-w","url":null,"abstract":"<p><strong>Background: </strong>Chemical, biological, radiological, nuclear, and explosive (CBRNE) incidents present rare and complex challenges for Emergency Medical Services (EMS), necessitating effective incident command to manage occupational and patient safety risks. EMS incident commanders must make quick decisions under pressure, coordinating medical responses and ensuring personnel's safety. This study examined the perceived competence requirements of Finnish EMS field supervisors in managing C and E incidents.</p><p><strong>Methods: </strong>This study was a qualitative interview study among EMS field supervisors (n = 12) in Southwest Finland. Individual interviews utilized fictional C and E case descriptions. The data was analyzed using inductive-deductive content analysis, with the Major Incident Medical Management and Support model as the theoretical framework.</p><p><strong>Results: </strong>The results were grouped under one inductive main category, \"Being Prepared,\" and six deductive main categories: \"Command and Control,\" \"Safety,\" \"Communication,\" \"Assessment,\" \"Triage and Treatment,\" and \"Transport.\" Under the main categories, there were a total of 16 upper categories and 15 subcategories. Broadly similar content emerged from the C and E cases, although some categories had specific areas of emphasis.</p><p><strong>Conclusions: </strong>The perceived competence requirements of EMS field supervisors in managing C and E incidents align well with the Major Incident Medical Management and Support model. Also, EMS field supervisors should be mentally prepared and well-trained for handling C and E incidents. The results support the development of specific C and E training and guidelines beyond the \"all hazards\" approach. Further research should focus on assessing the current level and gaps in competence and optimizing training methods for different CBRNE situations.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"239"},"PeriodicalIF":2.3,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11668101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881166","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":"Available equipment for traumatic haemorrhage management in Austrian prehospital physician response units: a nationwide survey and analysis of guideline adherence.","authors":"Michael Eichinger, Michael Eichlseder, Gerald Schützelhofer, Alexander Pichler, Nikolaus Schreiber, Philipp Zoidl, Gabriel Honnef, Paul Zajic","doi":"10.1186/s12873-024-01150-3","DOIUrl":"10.1186/s12873-024-01150-3","url":null,"abstract":"<p><strong>Background: </strong>Traumatic injuries, particularly those involving massive bleeding, remain a leading cause of preventable deaths in prehospital settings. The availability of appropriate emergency equipment is crucial for effectively managing these injuries, but the variability in equipment across different response units can impact the quality of trauma care. This prospective survey study evaluated the availability of prehospital equipment for managing bleeding trauma patients in Austria.</p><p><strong>Methods: </strong>A nationwide survey was conducted across 139 Austrian Prehospital Physician Response Units (PRUs) to evaluate the presence and adherence to guidelines of bleeding control equipment. The digitally distributed survey included questions on equipment types, such as pelvic binders, tourniquets, haemostatic gauze, and advanced intervention sets. Data were analysed against the most recent recommendations and guidelines to assess conformity and identify gaps.</p><p><strong>Results: </strong>The survey achieved a 96% response rate, revealing that essential equipment like pelvic binders and tranexamic acid was available in all units, with tourniquets present in 99% of them. However, few services carried advanced equipment for procedures like REBOA or thoracotomy. While satisfaction with the current equipment was high, with 80% of respondents affirming adequacy, the disparities in the availability of specific advanced tools highlight potential areas for improvement, offering a promising opportunity to enhance trauma care capabilities.</p><p><strong>Conclusions: </strong>While essential emergency equipment for haemorrhage control is uniformly available across Austrian PRUs, the variation in advanced tools underscores the need for standardised equipment protocols. The urgency for regular kit updates following prehospital guidelines and training is essential to enhance trauma care capabilities and ensure that all emergency response units are equipped to manage severe injuries effectively. This standardisation could lead to improved patient outcomes nationwide.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"230"},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852170","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":"Evaluation of droperidol use in the emergency department: a retrospective analysis of QTc prolongation and adverse events.","authors":"Abdulmajeed M Alshehri, Kaitlin E Crowley, Kenneth E Lupi, Christine S Kim, Jeremy R DeGrado, Kaylee Marino","doi":"10.1186/s12873-024-01158-9","DOIUrl":"10.1186/s12873-024-01158-9","url":null,"abstract":"<p><strong>Background: </strong>Droperidol is a first-generation antipsychotic medication that has been used for various indications in the emergency department (ED); however, its use has been controversial due to reports of QT prolongation and the risk of torsades de pointes (TdP). The aim of the study is to evaluate the safety of droperidol administration in the ED.</p><p><strong>Methods: </strong>This was a retrospective study, conducted at an academic level I trauma center. System-generated reports were used to identify all droperidol administrations in the ED from the time that droperidol was reintroduced to the institutional formulary on July 1, 2019 through January 31, 2023. The major safety endpoint was a composite of the incidence of QTc interval prolongation, incidence of TdP, ventricular arrhythmia, or hypotension.</p><p><strong>Results: </strong>A total of 327 administrations of droperidol were identified in 245 patients in the ED. The composite safety endpoint occurred in 30 (9.1%) administrations. None of these events were classified as \"probable\" or \"definite\" on the Naranjo adverse drug reaction probability scale. No episodes of TdP or serious ventricular arrhythmia were reported. Higher cumulative droperidol dose and creatinine clearance < 60 mL/min were associated with an increased odds of developing QTc prolongation (OR 1.27 [CI 1.04-1.56]) and (OR 1.01 [CI 1.0-1.02]), respectively.</p><p><strong>Conclusions: </strong>The study supports the use of low dose droperidol for various indications in the ED. There were no serious adverse events reported that could be directly attributed to droperidol use; however, it is crucial to consider the potential dose dependent impact on QTc prolongation.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"232"},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852316","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":"Challenges of providing of special care services in hospitals during emergencies and disasters: a scoping review.","authors":"Mohammad Masbi, Nader Tavakoli, Mohsen Dowlati","doi":"10.1186/s12873-024-01160-1","DOIUrl":"10.1186/s12873-024-01160-1","url":null,"abstract":"<p><strong>Background: </strong>The ability of hospitals to provide special care services for critically ill or injured patients during emergencies and disasters poses very significant challenges that necessitate the response in-place plans. the increasing frequency of such events, coupled with limited hospital resources and increasing patient volumes, underscores the urgency of addressing these issues. Specifically, this study aims to identify the challenges faced by hospitals in providing special services during disasters.</p><p><strong>Method: </strong>This scoping review, conducted in 2024, based upon the framework developed by Arksey and O'Malley. An extensive search of Literature searching was performed using gray literature and databases including Google Scholar, PubMed, Web of Science, and Scopus. Applying the selection criteria, a total of 33 relevant studies were identified that discuss the challenges faced when providing special care services in hospitals during emergencies and disasters. Results are presented in accordance with the PRISMA checklist to ensure quality and transparency. Data was analyzed through a systematic coding process where common themes across the studies were identified.</p><p><strong>Results: </strong>This review identified 15 distinct challenges associated with providing special care services in hospitals during emergencies and disasters: limited resources, inadequate infrastructure, lack of pre-hospital care, financial constraints, failures in the emergency response system, triage, deficiencies in management structure, planning, and preparation, communication and coordination deficits, training and protocols development, employee welfare challenges, challenges of continuity of care, increased demand, different and complex needs of patients, ethical challenges, imbalance in distribution of service resources.</p><p><strong>Conclusions: </strong>Response in a hospital to the needs of special care during a disaster has to be responded to with more effective preparedness through comprehensive disaster preparedness plans, better communication and coordination, and training of staff and allocation of resources. In particular, standardized triage protocols and ethical frameworks will provide the foundation for the optimization of resource use in emergency responses. Better communication among departments and also with other outside organizations will improve how resources are used to better achieve good patient outcomes within emergency responses.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"238"},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11657394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852108","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":"The prehospital paediatric emergency care burden managed by a public ambulance service in the Western Cape, South Africa.","authors":"Naseef Abdullah, Naqeeb Majiet, Simpiwe Sobuwa","doi":"10.1186/s12873-024-01146-z","DOIUrl":"10.1186/s12873-024-01146-z","url":null,"abstract":"<p><strong>Background: </strong>Paediatric mortality rates in low- and middle-income countries account for over 80% of the global burden. In South Africa, one in every 33 children will not reach the age of five. Despite the high mortality rate, there is a paucity of data describing the prehospital paediatric under-five emergency care burden in South Africa. Such data are essential to inform the development of local prehospital emergency care guidelines and targeted prevention strategies.</p><p><strong>Aim: </strong>This study describes the prehospital paediatric under-five emergency care burden managed by the Western Cape Government Health and Wellness (WCGHW) Emergency Medical Services (EMS) in South Africa.</p><p><strong>Methods: </strong>A retrospective review of the prehospital records was conducted, extracting epidemiological and clinical data from the WCGHW EMS patient record database. The review included all paediatric cases under-five, managed between 1 January 2022 and 31 December 2023, in the Western Cape of South Africa.</p><p><strong>Results: </strong>In the 87 457 cases, there was a similar distribution between the primary cases (50.7%) and interfacility transfers (49.3%). Most activations emanated from rural areas (47 980, 54.9%), with respiratory emergencies (30 934, 35.4%), non-cardiac pain (11 381, 13.0%) and trauma (10 831,12.4%) being the most common presenting complaints. Most cases were prioritised as priority 2 (46 034, 52.6%), with most of these being older children between one and five years old (29 008, 63.0). Low acuity cases accounted for 67.2% (58 818) of the sample, with the highest mortality occurring between 29 days and 12 months (190, 52.9.%). Most patients spent less than one hour in the prehospital setting (64 431, 73.7%), with advanced airway management (748, 43.1%) being the most common airway intervention.</p><p><strong>Conclusion: </strong>This first description of the prehospital paediatric under-five emergency care burden managed by the WCGHW EMS reveals a unique burden, particularly regarding the high interfacility transfer rates. As illustrated in graphical abstract, these findings underscore critical considerations for healthcare planners and the prehospital training environment. Future research among this population should focus on characterising the reasons for the high interfacility transfer rates through assessments of healthcare access, EMS care quality and post-EMS follow-up.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"234"},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852320","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":"Characteristics and survival of hospitalized combat casualties during two major conflicts between Israel and Hamas: 2023 versus 2014.","authors":"Abebe Tiruneh, Ari M Lipsky, Gilad Twig, Adi Givon, Shachar Shapira, Sharon Goldman, Irina Radomislensky, Avi Benov, Eldad Katorza","doi":"10.1186/s12873-024-01149-w","DOIUrl":"10.1186/s12873-024-01149-w","url":null,"abstract":"<p><strong>Background: </strong>In the complex landscape of modern warfare, understanding combat-related injuries leading to hospitalization is crucial for optimizing injury treatment. This study aims to compare combat casualty characteristics and outcomes during the major conflicts between Israel and Hamas in 2023 and 2014 as a basis for understanding the effectiveness of trauma care practices for wounded soldiers.</p><p><strong>Methods: </strong>A cohort study of soldiers hospitalized due to combat injuries during two major wars between Israel and Hamas in 2023 and 2014, using data from the Israeli National Trauma Registry. This study did not include deaths before hospital arrival or casualties who were discharged from the Emergency Department.</p><p><strong>Results: </strong>Of the 1,198 study subjects, 67.8% belonged to the 2023 cohort and 32.2% to the 2014 cohort. The percentage of casualties with severe and critical injuries (Injury Severity Score [ISS] 16-75) was higher among the 2023 cohort (18.6% vs. 13.7%, p = 0.036), as was the percentage of casualties with multiple severe injuries (≥ 2 regions with Abbreviated Injury Score ≥ 3: 11.5% vs. 7.5%, p = 0.035) and firearm injuries (19.6% vs. 14.5%, p = 0.081). Injuries to the torso and extremities were more frequent among the 2023 cohort. Among the critically injured casualties (ISS 25-75), the mortality rates were 17.3% vs. 28.6%, respectively, for the 2023 and 2014 cohorts (p = 0.351); adjusted HR (95% CI): 0.56 (0.21-1.49). The 2023 cohort had higher rates for treatment in the trauma bay (61.5% vs. 47.9%, p < 0.001), ICU utilization (admission: 16.3% vs 11.7%, p = 0.036), surgical intervention (51.5% vs. 42.7%, p = 0.005), longer duration from arrival to surgery (median [interquartile range]: 4.6 (1.2-18.5) vs. 2.6 (1.1-10.1) hours, p = 0.037), and longer hospital stays (> 14 days: 15.5% vs. 8.8%, p < 0.001).</p><p><strong>Conclusions: </strong>Our data demonstrated that more casualties who survived to hospital arrival were severely and multiply injured in the 2023 Israel-Hamas war as compared to the 2014 war. Despite the increased severity, in-hospital survival did not worsen though there was an increase in hospital resource utilization.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"231"},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852113","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":"Self-assessment and learning motivation in emergency point-of-care ultrasound: an online pilot investigation in German physicians.","authors":"Joachim Bansbach, Michael Bentele, Matthias Bollinger, Stefanie Bentele, Ronny Langenhan, Bianka Gerber, Milena Trifunovic-Koenig, Stefan Bushuven","doi":"10.1186/s12873-024-01154-z","DOIUrl":"10.1186/s12873-024-01154-z","url":null,"abstract":"<p><strong>Introduction: </strong>Learning motivation is essential to obtain and maintain ultrasound competencies in emergency medicine. One's competencies herein and the need for ongoing training are best evaluated by self-assessment. This may be flawed by overconfidence effects - the belief to be better than others or better than tests reveal. This study aims to clarify the underinvestigated interaction of learning motivation and self-assessment in emergency point-of-care-ultrasound (POCUS).</p><p><strong>Methods: </strong>In this cross-sectional multicenter project, physicians assessed their own and others' competence and learning motivation using the Situational Motivation Scale comprising intrinsic motivation, external and identified regulation, and amotivation. In addition, we presented eight ultrasound loops of different pathologies to emergency physicians of various specialties.</p><p><strong>Results: </strong>Overall, the motivation to learn was high, while self-assessment showed no significant overconfidence in POCUS. The rate of correct diagnoses based on the loops was relatively low. As a result, we did not detect overconfidence effects in participants who completed questions (n = 86) and tests (n = 56). Overplacing oneself above peers negatively correlated with intrinsic learning motivation and identified regulation and positively correlated to amotivation. Further analyses indicated that learning motivation was associated with the interactions of the physicians' risk perception, speciality, and self-assessment.</p><p><strong>Discussion: </strong>The absence of overconfidence effects, the complexity of learning motivation and their interaction show that prior findings in other contexts may not be easily transferable to POCUS and could be highly context-sensitive. In conclusion, this study highlights high levels of learning motivation but relatively low diagnostic accuracy in POCUS, which suggests the need for ongoing education and assessment. Ensuring that physicians continue to receive objective feedback and opportunities to refine their skills is critical for maintaining high standards of care. Despite the small sample size and other limitations of the study, the results primarily served to generate hypotheses for future research on emergency ultrasound education.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"235"},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852319","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":"Association between glottis screen location and intubation difficulty: a retrospective video laryngoscopy study.","authors":"Kai-Yuan Cheng, Pang Hsu Liu, Yung-Cheng Su, Yen-Yu Chen, Ya-Ni Yeh, Jih-Chun Lin, Ming-Jen Tsai","doi":"10.1186/s12873-024-01148-x","DOIUrl":"10.1186/s12873-024-01148-x","url":null,"abstract":"<p><strong>Background: </strong>In emergency settings, difficult intubations often occur unexpectedly despite pre-intubation assessments. Traditional glottic view scoring systems for direct laryngoscope may not apply to video laryngoscopy. With video laryngoscopy, the vertical location of the glottis on the monitor can be clearly defined. If the glottis location is associated with intubation difficulty, it could serve as a simple indicator for anticipating intubation challenges. This study aimed to investigate the relationship between the glottis screen location during video laryngoscopy-guided intubation and the success and timing of the first-attempt intubation.</p><p><strong>Methods: </strong>We retrospectively analyzed laryngoscopy recordings from adult intubations in the emergency department of a tertiary teaching hospital in Chiayi, Taiwan, using the C-MAC video laryngoscope between March 2020 and April 2023. The vertical screen location of the vocal cords, determined by the arytenoid cartilage position after laryngeal blade engagement, was categorized into upper and lower locations for analysis. The primary outcome was first-attempt intubation success within 90 s, analyzed using Kaplan-Meier survival curves and multivariable Cox proportional hazard analysis.</p><p><strong>Results: </strong>Among 209 laryngoscopy records, 113 had the arytenoid in the lower field of view and 96 in the upper field. Kaplan-Meier analysis showed a significantly lower cumulative success rate for intubations with a higher arytenoid location (log-rank test, P < 0.001). Multivariable Cox models, adjusted for factors like modified Cormack-Lehane grade, blade tip engagement, and other intubation findings, confirmed the arytenoid's location as an independent predictor of successful intubation within 90 s, with an adjusted hazard ratio of 0.55 (95% confidence interval, 0.38-0.79) for the upper location group compared to the lower (P < 0.001).</p><p><strong>Conclusions: </strong>A higher screen location of the vocal cords after blade engagement is associated with reduced first-attempt intubation success. Assessing glottis location during video laryngoscopy intubation provides a quick method to anticipate intubation challenges.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"236"},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852163","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}