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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 *** there have been advances in treatment modalities,survival rates for TCA patients remain *** narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating ***:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,*** search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English *** the search,943 articles were retrieved,and two independent reviewers conducted a screening ***:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable *** were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital *** thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt *** 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 *** implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality ***-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,*** the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ***:TCA remains a signifi cant challenge for emergency medical services due to its high m

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 *** 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 *** article aims to review clinical presentation,diagnosis,and prevention and treatment strategies on mpox,providing the basic knowledge for prevention and control for emergency ***:We conducted a review of the literature using PubMed and SCOPUS databases from their beginnings to the end of July *** 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 *** that were not published in English were ***:We included 50 studies in this *** initial symptoms of mpox are non-specific:fever,malaise,myalgias,and sore ***,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 ***-threatening complications such as pneumonia,sepsis,encephalitis,myocarditis,and death can *** are documented co-occurrences of human immunodeficiency virus(HIV) and other sexually transmitted infections that can worsen ***:The initial presentation of mpox is *** preferred treatment included tecovirimat in patients with severe illness or at high risk of developing severe disease and vaccination with two doses of ***,careful history and physical examination can raise the clinicians’ suspicion and point toward a prompt *** 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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World Journal of Emergency Medicine 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 ***,appropriate and efficient care for patients during the process of transport between two hospitals(interfacility transfer)is an essential part of patient *** 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 ***:We conducted searches from the PubMed,Cumulative Index of Nursing and Allied Health(CINAHL),and Scopus databases up to June *** reviewers independently screened the titles and abstracts for *** that were not in the English language and did not involve critically ill patients were ***:The search identified 75 articles,and we included 48 studies for our narrative *** studies were observational ***: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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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 ***: 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 ***: 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 *** 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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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 *** arterial BP(IABP)is more accurate than non-invasive BP(NIBP),although the clinical signifi cance of this diff erence is *** hypothesized that IABP would result in a change of management(COM)among patients with non-hypertensive diseases in the acute phase of ***:This prospective study included adults admitted to the Critical Care Resuscitation Unit(CCRU)with non-hypertensive disease from February 1,2019,to May 31,*** 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/*** and regression tree analysis identified significant variables associated with a COM and assigned relative variable importance(RVI)***:Among the 206 patients analyzed,a COM occurred in 94(45.6%[94/206])*** 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 *** complications were identifi ed with IABP ***:A COM occurred in 94(45.6%)non-hypertensive patients in the *** vasopressors was the greatest factor associated with *** should consider IABP monitoring more often in non-hypertensive patients requiring norepinephrine in the acute resuscitation *** 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 *** neurosurgical intervention can mitigate negative ***,variable mechanisms of injury may be associated with inappropriate transport(IAT),which may delay necessary surgical *** with near shore spinal injuries(NSSI)presented with unique mechanisms,so we investigated factors associated with IAT in patients with ***:We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between *** excluded patients transferred to other facilities,and those not injured in the *** outcome was IAT,defined as patients with NSSI requiring transfer to another trauma *** avoid heterogeneity in our analysis,we further excluded patients without NSSI who were inappropriately transported to a level I trauma *** used multivariable logistic regression to assess association of independent variables(such as demographic,environmental,and clinical factors)with ***:We analyzed 278 patients with suspected NSSI,and found 14(5.0%)had *** 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 ***:Rate of IAT for patients with NSSI was ***,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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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 ***,sickle cell nephropathy(SCN)is a common complication of SCD and results in chronic *** 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 *** 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 ***,amultidisciplinary approach which involves cardiology,nephrology,medicine and obstetrics consultations should be utilized to help direct *** 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 *** 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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Comparative visual analytics for assessing medical records with sequence embedding

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Visual Informatics 2020年第2期4卷 72-85页

作者： Rongchen Guo Takanori Fujiwara Yiran Li kelly M.Lima Soman Sen Nam k.tran kwan-Liu Ma Department of Computer Science Beihang UniversityBeijingChina Department of Computer Science University of CaliforniaDavisUnited States Department of Pathology and Laboratory Medicine University of CaliforniaDavisUnited States Department of Surgery University of CaliforniaDavisUnited States

Machine learning for data-driven diagnosis has been actively studied in medicine to provide better *** analysis of a patient cohort similar to a patient under treatment is a key task for clinicians to make decisions with high ***,such analysis is not straightforward due to the characteristics of medical records:high dimensionality,irregularity in time,and *** address this challenge,we introduce a method for similarity calculation of medical *** method employs event and sequence *** we use an autoencoder for the event embedding,we apply its variant with the self-attention mechanism for the sequence ***,in order to better handle the irregularity of data,we enhance the self-attention mechanism with consideration of different time *** have developed a visual analytics system to support comparative studies of patient *** make a comparison of sequences with different lengths easier,our system incorporates a sequence alignment *** its interactive interface,the user can quickly identify patients of interest and conveniently review both the temporal and multivariate aspects of the patient *** demonstrate the effectiveness of our design and system with case studies using a real-world dataset from the neonatal intensive care unit of UC Davis.

关键词： Electronic medical records Event sequence data Autoencoder Self-attention Sequence similarity Visual analytics

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Assessing adequacy of emergency provider documentation among interhospital transferred patients with acute aortic dissection

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World Journal of Emergency Medicine 2019年第2期10卷 94-100页

作者： Mark Rose Carina Newton Benchaa Boualam Nancy Bogne Adam ketchum Umang Shah Jordan Mitchell Safura Tanveer Tucker Lurie Walesia Robinson Rebecca Duncan Stephen Thom quincy khoi tran Department of Emergency Medicine University of Maryland School of Medicine University of Maryland at College Park University of Maryland School of Medicine Program of Trauma The R Adams Cowley Shock Trauma Center University of Maryland School of Medicine

BACkGROUND: Acute aortic dissection(AoD) is a hypertensive emergency often requiring the transfer of patients to higher care hospitals; thus, clinical care documentation and compliance with the Emergency Medical Treatment and Active Labor Act(EMTALA) is crucial. The study assessed emergency providers(EP) documentation of clinical care and EMTALA compliance among interhospital transferred AoD ***: This retrospective study examined adult patients transferred directly from a referring emergency department(ED) to a quaternary academic center between January 1, 2011 and September 30, 2015. The primary outcome was the percentage of records with adequate documentation of clinical care(ADoCC). The secondary outcome was the percentage of records with adequate documentation of EMTALA compliance(ADoEMTALA). RESULTS: There were 563 electronically identified patients with 287 included in the final analysis. One hundred and five(36.6%) patients had ADoCC while 166(57.8%) patients had ADoEMTALA. Patients with inadequate documentation of EMTALA(IDoEMTALA) were associated with a higher likelihood of not meeting the American Heart Association(AHA) ED Departure SBP guideline(OR 1.8, 95% CI 1.03–3.2, P=0.04). Male gender, handwritten type of documentation, and transport by air were associated with an increased risk of inadequate documentation of clinical care(IDoCC), while receiving continuous infusion was associated with higher risk of ***: Documentation of clinical care and EMTALA compliance by Emergency Providers is poor. Inadequate EMTALA documentation was associated with a higher likelihood of patients not meeting the AHA ED Departure SBP guideline. Therefore, Emergency Providers should thoroughly document clinical care and EMTALA compliance among this critically ill group before transfer.

关键词： Acute aortic dissection EMTALA Interhospital transfer Documentation Compliance

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