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Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers

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World Journal of Emergency Medicine 2024年第1期15卷 3-9页

作者： Rashed Alremeithi quincy k.tran Megan T.Quintana Soroush Shahamatdar Ali Pourmand Department of Emergency Medicine George Washington University School of Medicine and Health SciencesWashington DC 20037USA Department of Emergency Medicine University of Maryland School of MedicineBaltimore 21201USA Program in Trauma the R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA Center for Trauma and Critical Care Department of Surgerythe George Washington University School of Medicine&Health SciencesWashington DC 20037USA

BACkGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arres

关键词： Traumatic cardiac arrest Emergency thoracotomy Resuscitative endovascular balloon occlusion of the aorta

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Emergency department approach to monkeypox

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World Journal of Emergency Medicine 2023年第5期14卷 341-348页

作者： Catherine V.Levitt quincy k.tran Hashem Hraky Maryann Mazer-Amirshahi Ali Pourmand Department of Emergency Medicine George Washington University School of Medicine and Health SciencesWashington DC 20037USA Department of Emergency Medicine University of Maryland School of MedicineBaltimore 21201USA Program in Trauma The R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA Department of Emergency Medicine MedStar Washington Hospital Center and Georgetown University School of MedicineWashington DC 20037USA

BACkGROUND:Monkeypox(mpox) is a viral infection that is primarily endemic to countries in Africa,but large outbreaks outside of Africa have been historically rare.In June 2022,mpox began to spread across Europe and North America,causing the World Health Organization(WHO) to declare mpox a public health emergency of international concern.This article aims to review clinical presentation,diagnosis,and prevention and treatment strategies on mpox,providing the basic knowledge for prevention and control for emergency providers.METHODS:We conducted a review of the literature using PubMed and SCOPUS databases from their beginnings to the end of July 2023.The inclusion criteria were studies on adult patients focusing on emerging infections that described an approach to a public health emergency of international concern,systematic reviews,clinical guidelines,and retrospective studies.Studies that were not published in English were excluded.RESULTS:We included 50 studies in this review.The initial symptoms of mpox are non-specific:fever,malaise,myalgias,and sore throat.Rash,a common presentation of mpox,usually occurs 2–4 weeks after the prodrome,but the presence of lymphadenopathy may distinguish mpox from other infections from the Poxviridae family.Life-threatening complications such as pneumonia,sepsis,encephalitis,myocarditis,and death can occur.There are documented co-occurrences of human immunodeficiency virus(HIV) and other sexually transmitted infections that can worsen morbidity.CONCLUSION:The initial presentation of mpox is non-specific.The preferred treatment included tecovirimat in patients with severe illness or at high risk of developing severe disease and vaccination with two doses of JYNNEOS.However,careful history and physical examination can raise the clinicians’ suspicion and point toward a prompt diagnosis.There are diff erent modalities to prevent and treat mpox infection.

关键词： Monkeypox Emergency medicine Human immunodefi ciency virus Infection

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Patient care during interfacility transport:a narrative review of managing diverse disease states

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世界急诊医学杂志(英文) 2023年第1期14卷 3-9页

作者： quincy k.tran Francis O’Connell Andrew Hakopian Marwa SH Abrahim kamilla Beisenova Ali Pourmand Department of Emergency Medicine University of Maryland School of MedicineBaltimore 21201USA Program in Trauma the R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA Department of Emergency Medicine George Washington University School of Medicine and Health SciencesWashington DC 20037USA

BACkGROUND:When critically ill patients require specialized treatment that exceeds the capability of the index hospitals,patients are frequently transferred to a tertiary or quaternary hospital for a higher level of care.Therefore,appropriate and efficient care for patients during the process of transport between two hospitals(interfacility transfer)is an essential part of patient care.While medical adverse events may occur during the interfacility transfer process,there have not been evidence-based guidelines regarding the equipment or the practice for patient care during transport.METHODS:We conducted searches from the PubMed,Cumulative Index of Nursing and Allied Health(CINAHL),and Scopus databases up to June 2022.Two reviewers independently screened the titles and abstracts for eligibility.Studies that were not in the English language and did not involve critically ill patients were excluded.RESULTS:The search identified 75 articles,and we included 48 studies for our narrative review.Most studies were observational studies.CONCLUSION:The review provided the current evidence-based management of diverse disease states during the interfacility transfer process,such as proning positioning for respiratory failure,extracorporeal membrane oxygenation(ECMO),obstetric emergencies,and hypertensive emergencies(aortic dissection and spontaneous intracranial hemorrhage).

关键词： Critically ill patients Interfacility transfer Interhospital transfer Extracorporeal membrane oxygenation Obstetric emergencies Hypertensive emergencies

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Most patients with non-hypertensive diseases at a critical care resuscitation unit require arterial pressure monitoring: a prospective observational study

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World Journal of Emergency Medicine 2023年第3期14卷 173-178页

作者： Emily Engelbrecht-Wiggans Jamie Palmer Grace Hollis Fernando Albelo Afrah Ali Emily Hart Dominique Gelmann Iana Sahadzic James Gerding quincy k.tran Daniel J.Haase University of Maryland School of Medicine Baltimore 21201USA The Research Associate Program in Emergency Medicine and Critical Care Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimore 21201USA Department of Emergency Medicine University of Maryland School of MedicineBaltimore 21201USA Program in Trauma the R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA

BACkGROUND:Blood pressure(BP)monitoring is essential for patient care.Invasive arterial BP(IABP)is more accurate than non-invasive BP(NIBP),although the clinical signifi cance of this diff erence is unknown.We hypothesized that IABP would result in a change of management(COM)among patients with non-hypertensive diseases in the acute phase of resuscitation.METHODS:This prospective study included adults admitted to the Critical Care Resuscitation Unit(CCRU)with non-hypertensive disease from February 1,2019,to May 31,2021.Management plans to maintain a mean arterial pressure>65 mmHg(1 mmHg=0.133 kPa)were recorded in real time for both NIBP and IABP measurements.A COM was defined as a discrepancy between IABP and NIBP that resulted in an increase/decrease or addition/discontinuation of a medication/infusion.Classification and regression tree analysis identified significant variables associated with a COM and assigned relative variable importance(RVI)values.RESULTS:Among the 206 patients analyzed,a COM occurred in 94(45.6%[94/206])patients.The most common COM was an increase in current infusion dosages(40 patients,19.4%).Patients receiving norepinephrine at arterial cannulation were more likely to have a COM compared with those without(45[47.9%]vs.32[28.6%],P=0.004).Receiving norepinephrine(relative variable importance[RVI]100%)was the most signifi cant factor associated with a COM.No complications were identifi ed with IABP use.CONCLUSION:A COM occurred in 94(45.6%)non-hypertensive patients in the CCRU.Receiving vasopressors was the greatest factor associated with COM.Clinicians should consider IABP monitoring more often in non-hypertensive patients requiring norepinephrine in the acute resuscitation phase.Further studies are necessary to confi rm the risk-to-benefi t ratios of IABP among these high-risk patients.

关键词： Non-hypertensive diseases Invasive arterial blood pressure Non-invasive blood pressure

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Predictors associated with inappropriate transport of near shore spinal injuries

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Chinese Journal of Traumatology 2021年第5期24卷 286-290页

作者： Tucker Lurie Timothy Traynor Maira Sher Bano quincy k.tran University of Maryland School of Medicine BaltimoreMD21201USA Research Associate Program in Emergency Medicine&Critical Care University of Maryland School of MedicineBaltimoreMD21201USA Department of Emergency Medicine University of Maryland Schoo of MedicineBatimoreMD21201USA Program in Trauma The R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimoreMD21201USA

Purpose:Spinal injuries resulting in neurological damage cause significant morbidity.Swift neurosurgical intervention can mitigate negative outcomes.However,variable mechanisms of injury may be associated with inappropriate transport(IAT),which may delay necessary surgical interventions.Patients with near shore spinal injuries(NSSI)presented with unique mechanisms,so we investigated factors associated with IAT in patients with NSSI.Methods:We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between 2006-2017.We excluded patients transferred to other facilities,and those not injured in the water.Primary outcome was IAT,defined as patients with NSSI requiring transfer to another trauma center.To avoid heterogeneity in our analysis,we further excluded patients without NSSI who were inappropriately transported to a level I trauma center.We used multivariable logistic regression to assess association of independent variables(such as demographic,environmental,and clinical factors)with outcome.Results:We analyzed 278 patients with suspected NSSI,and found 14(5.0%)had IAT.Compared to appropriately transported patients,diving was associated with higher percentages of IAT(28.6%vs.3.9%,p=0.014)and more were transported by air(50.0%vs.20.6%,p=0.01).In multivariable regression,patients'oxygenation saturation(odds ratio[OR]=0.8,95%confidence intervals[Cl]:077-0.98)and diving(OR=7.5,95%Cl:1.2-46)were significantly associated with IAT.Conclusion:Rate of IAT for patients with NSSI was low.However,first responders and emergency medicine providers should be aware that diving is associated with a higher likelihood of IAT.

关键词： transport Spinal injury Near shore spinal injury Wave riding Shallow water diving

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Factors associated with refractory pain in emergency patients admitted to emergency general surgery

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World Journal of Emergency Medicine 2021年第1期12卷 12-17页

作者： William Gilliam Jackson FBarr Brandon Bruns Brandon Cave Jordan Mitchell Tina Nguyen Jamie Palmer Mark Rose Safura Tanveer Chris Yum quincy k.tran Johns Hopkins University Baltimore 21218USA Research Associate Program in Emergency Medicine and Critical Care Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimore 21201USA R Adams Cowley Shock Trauma Center University of Maryland School of MedicineBaltimore 21201USA Department of Surgery University of Maryland School of MedicineBaltimore 21201USA Louisiana State University Louisiana 70803USA University of Maryland School of Medicine Baltimore 21201USA Department of Emergency Medicine University of Maryland School of MedicineBaltimore 21201USA

BACkGROUND: Oligoanalgesia in emergency departments (EDs) is multifactorial. A previousstudy reported that emergency providers did not adequately manage patients with severe paindespite objective findings for surgical pathologies. Our study aims to investigate clinical andlaboratory factors, in addition to providers’ interventions, that might have been associated witholigoanalgesia in a group of ED patients with moderate and severe pains due to surgical pathologies.METHODS: We conducted a retrospective study of adult patients who were transferred directlyfrom referring EDs to the emergency general surgery (EGS) service at a quaternary academic centerbetween January 2014 and December 2016. Patients who were intubated, did not have adequaterecords, or had mild pain were excluded. The primary outcome was refractory pain, which wasdefi ned as pain reduction kelihood of refractory pain.CONCLUSIONS: In ED patients transferring to EGS service, elevated serum lactate levelswere associated with a higher likelihood of refractory pain.

关键词： Serum lactate Refractory pain Emergency general surgery Emergency department

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Outcome predictors for severely brain-injured patients directly admitted or transferred from emergency departments to a trauma center

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World Journal of Emergency Medicine 2020年第2期11卷 120-121页

作者： Ryne Jenkins Nicholas A.Morris Bryce Haac Richard Van Besien Deborah MStein Neeraj Badjatia Amir Medic Gaurika Mester quincy k.tran Program in Trauma The R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimoreMDUSA Section of Neurocritical Care and Emergency Neurology Department of NeurologyUniversity of Maryland School of MedicineBaltimoreMDUSA University of Maryland School of Medicine BaltimoreMDUSA University of Maryland at College Park College ParkMDUSA Department of Emergency Medicine University of Maryland School of MedicineBaltimoreMDUSA

Dear editor,After sustaining severe traumatic brain injury(TBI),patients frequently require invasive mechanical ventilation(MV).However,up to 26%of patients require tracheostomy due to failure to wean from the ventilator.[1]The decision of when to perform tracheostomy is important as it balances the risk between avoiding prolonged MV and avoiding risk of tracheostomy.Early predictors for tracheostomy,i.e.,clinical factors when patients first present to an Emergency Department after trauma or when patient fi rst arrive at a regional trauma center,can help clinicians’medical decision-making process.

关键词： patients admitted trauma

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Hypertensive emergency versus preeclampsia in a patient with sickle cell disease:a case report

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World Journal of Emergency Medicine 2023年第4期14卷 329-331页

作者： Jigar Patel Juan A Reyes Ivan Berezowski quincy k.tran Sarah E Frasure Ali Pourmand Division of Hospital Medicine Department of Medicinethe George Washington UniversityWashington DC 20037USA Department of Emergency Medicine University of Maryland School of MedicineBaltimore 21201-1544USA Program in Trauma the R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA Department of Emergency Medicine the George Washington University School of Medicine and Health SciencesWashington DC 20037USA

Sickle cell disease(SCD)is strongly associated with severe preeclampsia and has also been linked to poor pregnancy-related outcomes.Moreover,sickle cell nephropathy(SCN)is a common complication of SCD and results in chronic proteinuria.Pregnant patients with SCD who present to the emergency department(ED)with pulmonary edema,hypertension,and proteinuria may suffer from a hypertensive emergency with or without preeclampsia.Without prior lab work to determine whether a patient’s proteinuria or kidney dysfunction is new or at baseline,it may be impossible for the emergency physician to determine which diagnosis is more likely.Thus,amultidisciplinary approach which involves cardiology,nephrology,medicine and obstetrics consultations should be utilized to help direct treatment.We present the case of a 39-yearold patient with SCD,who was also 26 weeks pregnant,and presented to the ED with markedly elevated blood pressure and dyspnea.Although she was initially admitted to the obstetrics ward for blood pressure management given concern for preeclampsia,she was ultimately diagnosed with hypertensive emergency and sickle cell nephropathy.

关键词： hypertensive admitted markedly

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Influence of different land-use types on selected soil properties related to soil fertility in A Luoi District,Thua Thien Hue,Vietnam

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Soil Ecology Letters 2024年第1期6卷 131-140页

作者： khoa Phuc Nguyen Tan Trong tran Huy Dinh Le Phuong Thuy Nguyen Hien Thao Thi Pham Dien Thanh Nguyen Ngu Huu Nguyen University of Agriculture and Forestry Hue UniversityHue CityThua Thien Hue 52000Vietnam School of Biotechnology Tan Tao UniversityTan Duc ECityDuc HoaLong An850000Vietnam

Land use type affects the physicochemical properties of soil.The value of OM and TN is high in acacia soils.Strong acidity of soil is considered a serious constraint for agriculture.Suitable cash crops are acacia,cassava,banana,rice and maize.Soil fertility is affected by land-use types and land management,which exacerbates soil erosion and various other forms of soil degradation in the mountainous regions of Viet-nam.This study was conducted in A Luoi District,Thua Thien Hue,Vietnam to identify the effects of land-use types on specific soil physicochemical characteristics related to soil fertility.Soil physicochemical properties,such as organic matter(OM),total nitrogen(TN),total phosphorous(TP),and k+were significantly affected by land-use type.The results showed that the soils were sandy in rice but clay loam for acacia and cassava.The mean bulk density value of acacia soil was significantly greater than that of other soils.TN were higher in the acacia soils than those in the rice,maize,and banana soils.The OM content was significantly higher in the acacia,cassava,and banana soils than those in the rice and maize soils.The mean of exchangeable k+in the rice soil was higher compared to those in other soils and was affected by land-use type.The high exchangeable acidity content in the soils was probably due to intensive precipitation.However,both land use type and management did not affect the CEC value.Overall,the inappropriate land use caused the disturbance of soil physicochemical properties,indicating that the conditions of rice and maize soils are becoming worse than acacia soils.Therefore,lowering the intensity of cultivation,adopting incorporated soil fertility management,and applying organic fertilizer should preserve the existing conditions and enhance soil properties.

关键词： Land-use types soil characteristics soil frility suitable crop Vietnam

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Health behavior outcomes in stroke survivors prescribed wearables for atrial fibrillation detection stratified by age

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Journal of Geriatric Cardiology 2024年第3期21卷 323-330页

作者： Joanne Mathew Jordy Mehawej Ziyue Wang Taylor Orwig Eric Ding Andreas Filippaios Syed Naeem Edith Mensah Otabil Alex Hamel kamran Noorishirazi IrinaRadu Jane Saczynski David D.McManus khanh-Van tran Division of Cardiovascular Medicine Department of MedicineUniversity of Massachusetts Chan Medical SchoolLake Avenue NorthWorcesterUSA Department of Internal Medicine Central Michigan UniversityMount PleasantUSA Department of Pharmacy and Health Systems Sciences School of PharmacyNortheastern UniversityBostonUSA Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical SchoolLake Avenue NorthWorcesterUSA

BACkGROUND Smartwatches have become readily accessible tools for detecting atrial fibrillation(AF).There remains limited data on how they affect psychosocial outcomes and engagement in older adults.We examine the health behavior outcomes of stroke survivors prescribed smartwatches for AF detection stratified by age.METHODS We analyzed data from the Pulsewatch study,a randomized controlled trial that enrolled patients(≥50 years)with a history of stroke or transient ischemic attack and CHA2DS2-VASc≥2.Intervention participants were equipped with a cardiac patch monitor and a smartwatch-app dyad,while control participants wore the cardiac patch monitor for up to 44 days.We evaluated health behavior parameters using standardized tools,including the Consumer Health Activation Index,the Generalized Anxiety Disorder questionnaire,the 12-Item Short Form Health Survey,and wear time of participants categorized into three age groups:Group 1(ages 50-60),Group 2(ages 61-69),and Group 3(ages 70-87).We performed statistical analysis using a mixedeffects repeated measures linear regression model to examine differences amongst age groups.RESULTS Comparative analysis between Groups 1,2 and 3 revealed no significant differences in anxiety,patient activation,perception of physical health and wear time.The use of smartwatch technology was associated with a decrease in perception of mental health for Group 2 compared to Group 1(β=-3.29,P=0.046).CONCLUSION Stroke survivors demonstrated a willingness to use smartwatches for AF monitoring.Importantly,among these study participants,the majority did not experience negative health behavior outcomes or decreased engagement as age increased.

关键词： prescribed stratified wear

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