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Evaluation of hand infections in the emergency department using point-of-care ultrasound

World Journal of emergency Medicine 2024年第4期15卷 283-288页

作者： David Ahmad Haidar David Mintz Brandon M Wubben Omar Rizvi Srikar Adhikari Department of emergency Medicine Michigan MedicineAnn Arbor 48109-1382USA University of Arizona College of Medicine Tucson 85724USA Department of emergency Medicine University of IowaIowa City 52242-1009USA Department of Surgery University of Arizona College of MedicineTucson 85724USA Department of emergency Medicine University of Arizona College of MedicineTucson 85724USA

BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient ***:We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections(SSTI)of the hand between December 2015 and December *** trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the *** then reviewed patients’electronic health records(EHR)for demographic characteristics,history,physical examination findings,ED course,additional imaging studies,consultations,impact of POCUS on patient care and final ***:We included a total of 50 cases(28 male,22 female)in the final *** most common presenting symptoms and exam findings were pain(100%),swelling(90%),and erythema(74%).The most common sonographic findings were edema(76%),soft tissue swelling(78%),and fluid surrounding the tendon(57%).POCUS was used in medical decision making 68%of the time(n=34),with the use of POCUS leading to changes in management 38%of the time(n=19).POCUS use led to early antibiotic use(11/19),early consultation(10/19),and led to the performance of a required procedure(8/19).The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times,abscess 12/16 times,and cellulitis 14/20 ***:POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.

关键词： Ultrasound Point-of-care ultrasound Cellulitis Abscess Flexor tenosynovitis

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Mobile Pods:Technology to Support the Delivery of Community-Based Urgent care 17th

Mobile Pods:Technology to Support the Delivery of Community-...

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第十七届国际工效学大会暨中国人类工效学会成立20周年庆祝大会

作者： Anna Jones Sue Hignett Jonathan Benger Healthcare Ergonomics and Patient Safety Unit Loughborough University academic dept of emergency care University of the West of England

In the last five years UK government policy has moved towards increasing the provision of urgent care in the *** meet these changes the emergency ambulance service is shifting from an organization designed to convey patients to hospital to a professional group capable of assessing urgency and delivering the appropriate treatment to the patient;’providing the right response,first time,in time’.This paper reports an ergonomic analysis of urgent care provision in acute and primary care ***-five patients presenting with six complaints(breathing difficulty,chest pain,head injury,laceration,neck pain and injury as a result of a fall) were observed at two emergency departments(acute) and one minor injuries unit(primary care).Data were collected and analysed using Link Analysis(LA) to explore layout and spatial issues affecting the treatment space and Hierarchical Task Analysis(HTA) to analyse procedural issues and equipment *** LA and HTA data were triangulated to identify requirements for the mobile treatment unit.A recommendation for a new mobile treatment unit(mobile pod) has been developed by comparing the clinical environments,tasks and technologies used to provide assessment,diagnosis and treatment for six urgent healthcare *** proposed mobile pod has been critically reviewed by a national group of ambulance managers with positive *** research will include a wider range of clinical complaints and the development of a full size mock-up to test and evaluate the efficiency and safety of the new clinical *** mobile pod development is part of the Smart Pods project which is also exploring the operational systems(macro) and portable pods(micro) to support the change in clinical activities.

关键词： Medical device Mobile patient treatment Pods Urgent care Obstetric Delivery

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The “July Effect” in the intensive care units revisited:A bi-institutional 6-year experience of 57,160 patients

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World Journal of emergency Medicine 2022年第3期13卷 215-218页

作者： Leon Naar Ander D.Gallastegi Raghu R.Seethala B.Christian Renne Michael E.Billington Jasmine Kannikal Haytham M.A.Kaafarani Jarone Lee Division of Trauma Emergency Surgery&Surgical Critical CareDepartment of SurgeryMassachusetts General HospitalHarvard Medical SchoolBoston 02114-2696USA Division of emergency Critical care Medicine Department of Emergency MedicineBrigham and Women's HospitalHarvard Medical SchoolBoston 02115-6195USA Department of emergency Medicine Massachusetts General HospitalHarvard Medical SchoolBoston 02115-6195USA

July coincides with the beginning of the academic year in teaching hospitals across the United States of America (USA).The increased responsibility assumed by trainees transitioning to a higher role in the healthcare team is hypothesized to lead to poorer patient outcomes,termed the“July Effect”.The consequence of a“July Effect”might be more severe in critical care settings,where the complexity of patients requires a higher level of experience and *** only studies evaluating the“July Effect”in the ICU were published in the early 2000’s.;Since that time,several resident work-hour regulations have been implemented by the Accreditation Council for Graduate Medical Education (ACGME).;These regulations have resulted in more frequent sign-outs,reduced continuity of care,and less clinical time for trainees,which in theory could increase the risk of errors among young trainees at the time they are most vulnerable.

关键词： sized academic assumed

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Wernicke Encephalopathy Following Nutritional Deficiency In A Patient With Multiple Trauma:A Case Report And Systematic Review Of The Literature

Wernicke Encephalopathy Following Nutritional Deficiency In ...

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中华医学会急诊医学分会第17次全国急诊医学学术年会

作者： Linhao Ma Zhaofen Lin Dechang Chen Xingyi Yang dept.of Critical care & emergency Medicine Shanghai Changzheng Hospital

Objective To report a case of Wernicke’s encephalopathy following nutritional deficiency after multiple *** A nonalcoholic male was rendered unconscious for 8 hours after a traffic accident in which he sustained traumatic head,thoracic and abdominal *** was admitted in the intensive care unit after splenectomy,where he received prolonged total

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Effects of fluid balance on prognosis of acute respiratory distress syndrome patients secondary to sepsis

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World Journal of emergency Medicine 2020年第4期11卷 216-222页

作者： Yu-ming Wang Yan-jun Zheng Ying Chen Yun-chuan Huang Wei-wei Chen Ran Ji Li-li Xu Zhi-tao Yang Hui-qiu Sheng Hong-ping Qu En-qiang Mao Er-zhen Chen Department of emergency Ruijin Hospital Affi liated to Shanghai Jiao Tong University School of MedicineShanghaiChina Department of Critical care Medicine Ruijin Hospital Affi liated to Shanghai Jiao Tong University School of MedicineShanghaiChina

BACKGROUND:Fluid management is crucial to acute respiratory distress syndrome(ARDS)secondary to ***,choices of fluid resuscitation strategies and fluid input volumes remain a thorny *** study aimed to elucidate the relationship between fluid balance and prognosis of ARDS patients secondary to ***:Our study included 322 sepsis patients from Ruijin Hospital between 2014 and 2018,and 84 patients were diagnosed as ARDS within 72 hours after onset of sepsis according to Berlin ARDS Defi ***:Among the 322 sepsis patients,84(26.1%)were complicated with ARDS within 72 *** patients had a lower oxygenation index(PaO2/FiO2166.4±71.0 vs.255.0±91.2,P<0.05),longer duration of mechanical ventilation(11[6-24]days vs.0[0-0]days,P<0.05)than those without *** patients with ARDS showed daily positive net fl uid balance during seven days compared with those without ARDS who showed daily negative net fluid balance since the second day with signifi cant statistical *** the 84 sepsis patients with ARDS,58(69.0%)*** daily fl uid input volumes were much lower in survivors than in non-survivors(43.2±16.7 mL/kg vs.51.0±25.2 mL/kg,P<0.05)while output volumes were much higher in survivors(45.2±19.8 mL/kg vs.40.2±22.7 mL/kg,P<0.05).Using binary logistic regression analysis,we found that the mean daily fl uid balance was independently associated with mortality of sepsis patients complicating with ARDS(P<0.05).CONCLUSIONS:Early negative fluid balance is independently associated with a better prognosis of sepsis patients complicated with ARDS.

关键词： Sepsis Acute respiratory distress syndrome Fluid balance Prognosis

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Comparison of Charlson＇s weighted index of comorbidities with the chronic health score for the prediction of mortality in septic patients

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Chinese Medical Journal 2014年第14期127卷 2623-2627页

作者： Cui Yunliang Wang Tao Bao Jun Tian Zhaotao Lin Zhaofen Chen Dechang Jinan Mil Gen Hosp Dept Crit Care Med Jinan 250031 Shandong Peoples R China Chinese Peoples Liberat Army Gen Hosp Dept Emergency & Intens Care Unit Hainan Branch Sanya 572013 Hainan Peoples R China Second Mil Med Univ Dept Emergency Med Changzheng Hosp Shanghai 200003 Peoples R China

Background Comorbidity is one of the most important determinants ot short-term and long-term outcomes in septic patients. Charlson＇s weighted index of comorbidities （WIC） and the chronic health score （CHS）, which is a component of the acute physiology and chronic health evaluation （APACHE） II, are two frequently-used measures of comorbidity. In this study, we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit （ICU） patients with sepsis. Methods A total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012. Clinical data were collected, including age, gender, underlying diseases, key predisposing causes, severity-of- sepsis, and hospital mortality. The APACHE II, CHS, acute physiology score （APS）, sequential organ failure assessment （SOFA） and WIC scores were assessed within the first 24 hours of admission. Univariate and multiple Logistic regression analyses were used to compare the performance of WlC and CHS. The area under the receiver operating characteristic curve （AUC） was used to predict hospital mortality over classes of risk. Results Of all the enrolled patients, 224 patients survived and 114 patients died. The surviving patients had significantly lower WlC, CHS, APACHE II, and SOFA scores than the non-surviving patients （P 〈0.05）. Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age, severe sepsis, key predisposing causes such as pneumonia, a history of underlying diseases such as hypertension and congestive cardiac failure, and WlC, CHS and APS scores （P 〈0.05）. The AUC for the hospital mortality were 0.564 （95% confidence interval （CO 0.496-0.631） of CHS, 0.663 （95% CI 0.599-0.727） of WIC, 0.770 （95% CI 0.718-0.822） of APACHE II, 0.856 （95% Cl 0.815-0.897） of the CHS combined with other administrative data, and 0.857 （95% CI 0.817-0.897） of the WlC combined with other administrative data

关键词： Charlson's weighted index of comorbidities acute physiology and chronic health evaluation II sequential organ failure assessment sepsis outcome

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The Effectiveness of Antiviral Treatment in Severe COVID-19 Patients in Wuhan,China:A Multicenter Study

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Biomedical and Environmental Sciences 2022年第1期35卷 58-63页

作者： ZHOU Xian Long DING Guo Yong YANG Lu Yu LIU Rui Ning HOU Hai Feng WANG Ping MA Min HU Zhuan Zhuan HUANG Lei XU Xi Zhu HU Quan ZHAO Yan XING Wei Jia ZHAO Zhi Gang emergency Center Zhongnan Hospital of Wuhan UniversityWuhan 430071HubeiChina School of Public Health Shandong First Medical University&Shandong Academy of Medical SciencesTai’an 271016ShandongChina Intensive care Unit Wuhan Third HospitalWuhan 430060HubeiChina Intensive care Unit Huazhong University of Science and Technology Union Jiangbei HospitalWuhan 430100HubeiChina Intensive care Unit The first people's Hospital of Jiangxia DistrictWuhan 430200HubeiChina Hubei Clinical Research Center for emergency and Resuscitation Zhongnan Hospital of Wuhan UniversityWuhan 430071HubeiChina

Coronavirus disease 2019(COVID-19)has inarguably caused the most challenging *** less than 2 years,greater than 200 million cases of COVID-19 and 4.5 million deaths have been reported worldwide[1].The treatment strategy of an emerging infectious disease is a huge challenge for clinical practitioners because of missing key knowledge about the disease.

关键词： Patients clinical COV

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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 <2 units on the 0–10 pain scale between triage and ED ***: We analyzed 200 patients, and 58 (29%) had refractory pain. Patients with refractory painhad signifi cantly higher disease severity, serum lactate (3.4±2.0 mg/dL vs. 1.4±0.9 mg/dL, P=0.001), and lessfrequent pain medication administration (median [interquartile range], 3 [3–5] vs. 4 [3–7], P=0.001), whencompared to patients with no refractory pain. Multivariable logistic regression showed that the number of painmedication administration (odds ratio [OR] 0.80, 95% confi dence interval [95% CI] 0.68–0.98) and ED serumlactate levels (OR 3.80, 95% CI 2.10–6.80) were signifi cantly associated with the likelihood 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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An automated dispensing system for improving medication timing in the emergency department

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World Journal of emergency Medicine 2012年第2期3卷 102-107页

作者： Michael J.Ward Jeremy S.Boyd Nicole J.Harger John M.Deledda Carol L.Smith Susan M.Walker Jeffrey D.Hice Kimberly W.Hart Christopher J.Lindsell Stewart W.Wright Department of emergency Medicine University of Cincinnati Pharmacy Division University of Cincinnati Air care and Mobile care University HospitalUniversity of Cincinnati

BACKGROUND:Numerous medical conditions require timely medication administration in the emergency department(ED).Automated dispensing systems(ADSs)store premixed common doses at the point-of-care to minimize time to administration,but the use of such automation to improved time to medication administration has not been *** vancomycin is a commonly used empiric antimicrobial,we sought to quantify the effect of using an ADS on time to drug delivery in patients presenting to the *** study aimed to determine the efficacy of utilizing an ADS to improve time to administration of vancomycin and determine any negative effects on dosing ***:The institional review board approved the retrospective quality improvement study took place in a single,urban academic tertiary care ED with an annual census of 80 *** subjects were all patients receiving vancomycin for the management of sepsis between March 1 to September 30,2008 and the same time period in *** primary outcome was the proportion of patients who received vancomycin within one hour of bed placement and the secondary outcome was dosing ***:Sixty-three patients had weight and dosing information available(29 before and 34after intervention)and were included in the *** intervention,no patient received vancomycin in less than 60 minutes,while after intervention 14.7%of the patients received it in less than 60minutes(difference in proportions 14.7%,95%CI 0.39%-30.0%,P=0.04).A similar proportion of the patients received correct dosing before and after intervention(44.8%vs.41.2%,difference in proportions 3.7%,95%CI-20.0%-26.7%,P=0.770).CONCLUSION:The use of an ADS may improve the timing of medication administration in patients presenting to the ED without affecting dosing appropriateness.

关键词： Automatic dispensing system Pharmaceutical Process improvement Efficiency

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Perinatal testicular torsion—An emergency with grave consequences

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Case Reports in Clinical Medicine 2013年第1期2卷 66-69页

作者： Dietrich Doll Josef Erkel Thomas Erhart Christian Honemann Department of Surgery Marienhospital VechtaAcademic Teaching Hospital of the Hannover UniversityVechtaGermany Department of Visceral Thoracic and Vascular SurgeryPhilipps-University of MarburgMarburgGermany Department of Neonatology and Pediatric care Marienhospital VechtaAcademic Teaching Hospital of the Hannover UniversityVechtaGermany Department of Anaesthesiology and Intensive care Marienhospital VechtaAcademic Teaching Hospital of the Hannover UniversityVechtaGermany

Introduction: Perinatal testicular torsion is not a frequent, but a grave finding finding. As only immediate surgical retorsion may save the viability of the testicle, time is of essence. We report the case of a newborn where delayed diagnosis led to an unnecessary loss of one testicle. Presentation of Case: The newborn was presented one day after delivery with a swollen left blue scrotal pouch. The left testicle was little tender, higher in position and enlarged. Ultrasound revealed a globular, enlarged testicle left, showing hypodense necrotic areas within. Doppler sound could not detect any perfusion of the spermatic vessels. Scrotal fluid was present bilaterally. At operation, the testicle was considered unsalvageable, and left orchiectomy and right orchidopexy were performed. Discussion: In the new-born, it is more than convenient to perfom ultrasound of both testicles at the same time, which allows to compare texture and perfusion easily. Immediate surgical exploration should be performed at any time, even if in diagnostic doubt. The very most important step though is to professionally recognise and to react to this pediatric emergency, as time is of paramount essence. Conclusion: A case of a male newborn with unilateral perinatal testicular torsion is presented, where typical clinical signs and ultrasound features can be seen. Early exploration with orchiectomy of the necrotic testicle and orchidopexy of the healthy side may save the endocrine function and fertility.

关键词： Neonatal Perinatal Testicular Torsion Testicular Necrosis Orchidopexy Acute Scrotal Swelling

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