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emergency department management of acute agitation in the reproductive age female and pregnancy

World Journal of emergency Medicine 2024年第2期15卷 83-90页

作者： Ariella Gartenberg Kayla Levine Alexander Petrie department of emergency Medicine Jacobi Medical Center and Montefiore Medical CenterNY 10461USA department of Psychiatry and Behavioral Sciences Albert Einstein College of Medicine and Montefiore Medical CenterNY 10461USA department of emergency Medicine Jacobi Medical Center and North Central Bronx HospitalNY 10461USA

BACKGROUND:Agitation is a common presentation within emergent departments(EDs).Agitation during pregnancy should be treated as an obstetric emergency,as the distress may jeopardize both the patient and fetus.The safety of psychotropic medications in the reproductive age female has not been well established.This review aimed to explore a summary of general agitation recommendations with an emphasis on ED management of agitation during pregnancy.METHODS:A literature review was conducted to explore the pathophysiology of acute agitation and devise a preferred treatment plan for ED management of acute agitation in the reproductive age or pregnant female.RESULTS:While nonpharmacological management is preferred,ED visits for agitation often require medical management.Medication should be selected based on the etiology of agitation and the clinical setting to avoid major adverse effects.Adverse effects are common in pregnant females.For mild to moderate agitation in pregnancy,diphenhydramine is an effective sedating agent with minimal adverse effects.In moderate to severe agitation,high-potency typical psychotropics are preferred due to their neutral effects on hemodynamics.Haloperidol has become the most frequently utilized psychotropic for agitation during pregnancy.Second generation psychotropics are often utilized as second-line therapy,including risperidone.Benzodiazepines and ketamine have demonstrated adverse fetal outcomes.CONCLUSION:While randomized control studies cannot be ethically conducted on pregnant patients requiring sedation,animal models and epidemiologic studies have demonstrated the effects of psychotropic medication exposure in utero.As the fetal risk associated with multiple doses of psychotropic medications remains unknown,weighing the risks and benefits of each agent,while utilizing the lowest effective dose remains critical in the treatment of acute agitation within the EDs.

关键词： Agitation Pregnancy Haloperidol Ketamine Benzodiazepines

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Current state and influencing factors in airbag management among emergency department nurses:A multicenter study

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World Journal of Clinical Cases 2024年第18期12卷 3417-3427页

作者： Xiao-Hui Wei Li-Jin Zhou Rui Li Xin-Yuan Li Ye Zhang Hai-Yue Zhang Si-Meng Wang Jia Zhang Wuxi School of Medicine Jiangnan UniversityWuxi 214122Jiangsu ProvinceChina department of Nursing emergency Tongren HospitalShanghai Jiao Tong University School of MedicineShanghai 200335China department of Nursing Tongren HospitalShanghai Jiao Tong University School of MedicineShanghai 200335China department of Neurosurgery Tongren HospitalShanghai Jiao Tong University School of MedicineShanghai 200335China department of Nursing Bengbu Medical UniversityBengbu 233030Anhui ProvinceChina

BACKGROUND The emergency department(ED)plays a critical role in establishing artificial airways and implementing mechanical ventilation.Managing airbags in the ED presents a prime opportunity to mitigate the risk of ventilator-associated pneumonia.Nonetheless,existing research has largely overlooked the understanding,beliefs,and practical dimensions of airway airbag management among ED nurses,with a predominant focus on intensive care unit nurses.AIM To investigate the current status of ED nurses'knowledge,beliefs,and practical behaviors in airway airbag management and their influencing factors.METHODS A survey was conducted from July 10th to August 10th,2023,using convenience sampling on 520 ED nurses from 15 tertiary hospitals and 5 sary hospitals in Shanghai.Pathway analysis was utilized to analyze the influencing factors.RESULTS The scores for ED nurses'airway airbag management knowledge were 60.26±23.00,belief was 88.65±13.36,and behavior was 75.10±19.84.The main influencing factors of airbag management knowledge included participation in specialized nurse or mechanical ventilation training,department,and work experience in the department.Influencing factors of airbag management belief comprised knowledge,department,and participation in specialized nurse or mechanical ventilation training.Primary influencing factors of airbag management behavior included knowledge,belief,department,participation in specialized nurse or mechanical ventilation training,and professional title.The belief in airbag management among ED nurses acted as a partial mediator between knowledge and behavior,with a total effect value of 0.513,and an indirect effect of 0.085,constituting 16.6%of the total effect.CONCLUSION ED nurses exhibit a positive attitude toward airbag management with relatively standardized practices,yet there remains room for improvement in their knowledge levels.Nursing managers should implement interventions tailored to the characteristics of ED nurses'airbag management knowledge,beliefs,and practices to enhance t

关键词： Artificial airway management Health knowledge Attitudes Practice Airbag management Pathway analysis Nurses

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emergency department operations and management education in emergency medicine training

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World Journal of emergency Medicine 2012年第2期3卷 98-101页

作者： Bret A Nicks Darrell Nelson department of emergency Medicine Wake Forest Baptist Medical Center department of emergency Medicine Forsyth Medical Center

BACKGROUND:This study was undertaken to examine the current level of operations and management education within US-based emergency Medicine Residency programs.METHODS:Residency program directors at all US-based emergency Medicine Residency programs were anonymously surveyed via a web-based instrument.Participants indicated their levels of residency education dedicated to documentation,billing/coding,core measure/quality indicator compliance,and operations management.Data were analyzed using descriptive statistics for the ordinal data/Likert scales.RESULTS:One hundred and six(106)program directors completed the study instrument of one hundred and fifty-six(156)programs(70%).Of these,82.6%indicated emergency department(ED)operations and management education within the training curriculum.Dedicated documentation training was noted in all but 1 program(99%).Program educational offerings also included billing/coding(83%),core measure/quality indicators(78%)and operations management training(71%).In all areas,the most common means of educating came through didactic sessions and direct attending feedback or 69%-94%and 72%-98%respectively.Residency leadership was most confident with resident understanding of quality documentation(80%)and less so with core measures(72%),billing/coding/RVUs(58%),and operations management tools(23%).CONCLUSIONS:While most EM residency programs integrate basic operational education related to documentation and billing/coding,a smaller number provide focused education on the dayto-day management and operations of the ED.Residency leadership perceives graduating resident understanding of operational management tools to be limited.All respondents value further resident curriculum development of ED operations and management.

关键词： Core measures Operations management emergency medicine residency Resident education

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Disaster Awareness and Preparedness Among Older Adults in Canada Regarding Floods, Wildfires, and Earthquakes

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International Journal of Disaster Risk Science 2024年第2期15卷 198-212页

作者： Evalyna Bogdan Rachel Krueger Julie Wright Kyle Woods Shaieree Cottar School of Administrative Studies Disaster and Emergency Management Program York University Partners for Action Faculty of Environment University of Waterloo department of Geography and Environmental management University of Waterloo

Older adults are significantly impacted by natural hazards and disasters that are exacerbated by climate change. Understanding their awareness and preparedness is essential for enhancing disaster resilience. This study investigated the attitudes, actions, and recommendations of older adults regarding natural hazards that pose risks in their geographic area—specifically floods, wildfires, and/or earthquakes in Canada. Methods for this study included survey and focus groups with older adults(n = 161 and n = 10, respectively) and other high-risk groups from across Canada, that are vulnerable to these natural hazards. The main findings from this study are that current awareness and preparedness among older adults is low, though stronger perceptions of risks are associated with risks specific to geographic locations where respondents live. Several barriers, such as hazard vulnerability misperceptions, cost-related reasons, and lack of hazard awareness have resulted in low awareness and preparedness among these populations. The two main recommendations arising from this research are:(1) improve awareness and preparedness with tailor-made emergency preparedness materials for older adults; and(2) adopt community-based approaches to disaster preparedness through existing community groups to strengthen social connections with a focus on locally specific hazards. The findings from this research can be applied to other hazards, including heatwaves and pandemics.

关键词： Canada Community-based disaster risk management Disaster awareness and preparedness Disaster resilience Natural hazards Older adults

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Evolution of tribo-magnetization during sliding of ferromagnetic materials

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Friction 2024年第5期12卷 906-918页

作者： Fumin GAO Laibin ZHANG Jin ZHOU Yi XIONG Jing WU Jianchun FAN China University of Petroleum-Beijing Beijing102249China Key Laboratory of Oil and Gas Safety and emergency Technology Ministry of Emergency ManagementBeijing102249China

Sliding-induced subsurface microstructure evolution is believed to be decisive for determining the friction and wear performance of metallic contacts as well as the development of tribo-magnetization.This expects to develop a new prediction method of wear state by elucidating the correlation between subsurface microstructure evolution and corresponding magnetic domain changes.Herein,subsurface microstructure evolution including crystal and magnetic domain under tribological action is investigated experimentally.Our results demonstrate that dislocation mediated plastic deformation decisively influences microstructural changes during tribological contact,further determining the magnetic domain structure.Specifically,sliding-induced plastic deformation causes an increase in the width of magnetic domains,but depth-dependent derived microstructure formed under severe plastic deformation such as the refined grains and sub-grains,in turn,promoted the refinement of magnetic domains and their discontinuity,forming depth-dependent magnetic domain structure.These results are helpful to clarify the evolution of tribo-magnetization and the pinning effect of dislocations on magnetic domains.

关键词： tribology magnetic domain microstructure tribo-magnetization dislocations

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Effect of relative humidity on the desulfurization performance of calcium-based desulfurizer

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Journal of Environmental Sciences 2024年第4期138卷 179-188页

作者： Juan Lǖ Yu Fu Haiyan Yu HuanWang Zhe Wang Haiyan Chen School of Environment and Resource Southwest University of Science and TechnologyMianyang 621010China Guangyuan emergency management bureau Guangyuan 628000China

Low desulfurization efficiency impedes the wide application of dry desulfurization technology,which is a low-cost and simple process,and one significant solution is the development and manufacture of high-performance desulfurizers.In this study,firstly,a steam jet mill was used to digest quicklime;then,we utilized numerical simulation to study the flow field distribution and analyze the driving factors of quicklime digestion;and lastly,the desulfurization performance of the desulfurizer was evaluated under different relative humidities.The results show that the desulfurizer prepared via the steam jet mill had better apparent activity than traditional desulfurizers.Also,the entire jet flow field of the steam jet mill is in a supersonic and highly turbulent flow state,with high crushing intensity and good particle acceleration performance.Sufficient contact with the nascent surface maximizes the formation of slaked lime.The experiments demonstrated that the operating time with 100%desulfurization efficiency and the“break-through”time for the desulfurizer prepared via the steam jet mill is longer than that of traditional desulfurizers,and has significant advantages,especially at low flue gas relative humidity.Compared with traditional desulfurizers,the desulfurizer prepared via steam jet mill expands the range of acceptable flue gas temperature,and the failure temperature is 1.625 times that of traditional desulfurizers.This work breaks through the technical bottleneck of low dry desulfurization efficiency,which is an important step in pushing forward the application of dry desulfurization.

关键词： Dry desulfurization Relative humidity Desulfurization efficiency High-efficiency desulfurizer Quicklime digestion

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Effi cacy of partial and complete resuscitative endovascular balloon occlusion of the aorta in the hemorrhagic shock model of liver injury

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World Journal of emergency Medicine 2024年第1期15卷 10-15页

作者： Yi Shan Yang Zhao Chengcheng Li Jianxin Gao Guogeng Song Tanshi Li department of emergency Medicine Chinese PLA Medical SchoolBeijing 100853China department of emergency Medicine the Sixth Medical Center of PLA General HospitalBeijing 100048China department of emergency Medicine School of MedicineSouth China University of TechnologyGuangzhou 510006China department of emergency Medicine the First Medical Center of PLA General HospitalBeijing 100853China

BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains unknown.Hence,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)groups.In the cREBOA and C-pREBOA groups,the balloon was inflated for 60 min.The hemodynamic and laboratory values were compared at various observation time points.Tissue samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent hemorrhage.Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.

关键词： Non-compressible torso hemorrhage Liver injury Ischemia-reperfusion injury Resuscitative endovascular balloon occlusion of the aorta

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Predicting Hurricane Evacuation Decisions with Interpretable Machine Learning Methods

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International Journal of Disaster Risk Science 2024年第1期15卷 134-148页

作者： Yuran Sun Shih‑Kai Huang Xilei Zhao department of Civil and Coastal Engineering University of FloridaGainesvilleFL 32611USA department of emergency management and Public Administration Jacksonville State UniversityJacksonvilleAL 36265USA

Facing the escalating effects of climate change,it is critical to improve the prediction and understanding of the hurricane evacuation decisions made by households in order to enhance emergency management.Current studies in this area often have relied on psychology-driven linear models,which frequently exhibited limitations in practice.The present study proposed a novel interpretable machine learning approach to predict household-level evacuation decisions by leveraging easily accessible demographic and resource-related predictors,compared to existing models that mainly rely on psychological factors.An enhanced logistic regression model(that is,an interpretable machine learning approach) was developed for accurate predictions by automatically accounting for nonlinearities and interactions(that is,univariate and bivariate threshold effects).Specifically,nonlinearity and interaction detection were enabled by low-depth decision trees,which offer transparent model structure and robustness.A survey dataset collected in the aftermath of Hurricanes Katrina and Rita,two of the most intense tropical storms of the last two decades,was employed to test the new methodology.The findings show that,when predicting the households’ evacuation decisions,the enhanced logistic regression model outperformed previous linear models in terms of both model fit and predictive capability.This outcome suggests that our proposed methodology could provide a new tool and framework for emergency management authorities to improve the prediction of evacuation traffic demands in a timely and accurate manner.

关键词： Artifcial Intelligence(AI) Decision-making modeling Hurricane evacuation Interpretable machine learning Nonlinearity and interaction detection

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Trends in oxycodone and oxycodone-containing analgesics administration for back pain in emergency departments in the USA(2007–2018)

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World Journal of emergency Medicine 2024年第3期15卷 169-174页

作者： Jonathan Chabon Jemer Garrido Deanna Schreiber-Gregory Jefferson Drapkin Sergey Motov department of emergency Medicine Maimonides Medical CenterBrooklyn 11219USA

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to 2018.METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS) from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period.RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3% from 2007(244,000 visits) to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8% to 57.6%),female patients(from 54.5% to 62.0%),black patients(from 22.5% to 30.4%),and Hispanic/Latino patients(from 9.4% to 19.6%).Oxycodone/acetaminophen was most prescribed and accounted for 90.2% of all oxycodone-containing analgesics in 2007,with a decrease to 68.5% in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1% in 2007 and 31.5% in 2018.CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.

关键词： Oxycodone Back pain emergency department

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Preliminary geological interpretation of long-wavelength magnetic anomalies over China and surrounding regions

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Earth and Planetary Physics 2024年第3期8卷 445-458页

作者： Jie Wang YanYan Yang ZhiMa Zeren Jian Wang Xin Wang YuXin Luo XuHui Shen National Institute of Natural Hazards Ministry of Emergency Management of ChinaBeijing 100085China Key Laboratory of Compound and Chained Natural Hazards Dynamics Ministry of Emergency Management of ChinaBeijing 100085China School of emergency management Science and Engineering University of Chinese Academy of SciencesBeijing 100049China National Space Science Center Chinese Academy of SciencesBeijing 100190China

Long-wavelength(>500 km)magnetic anomalies originating in the lithosphere were first found in satellite magnetic surveys.Compared to the striking magnetic anomalies around the world,the long-wavelength magnetic anomalies in China and surrounding regions are relatively weak.Specialized research on each of these anomalies has been quite inadequate;their geological origins remain unclear,in particular their connection to tectonic activity in the Chinese and surrounding regions.We focus on six magnetic high anomalies over the(1)Tarim Basin,(2)Sichuan Basin(3)Great Xing’an Range,(4)Barmer Basin,(5)Central Myanmar Basin,and(6)Sunda and Banda Arcs,and a striking magnetic low anomaly along the southern part of the Himalayan-Tibetan Plateau.We have analyzed their geological origins by reviewing related research and by detailed comparison with geological results.The tectonic backgrounds for these anomalies belong to two cases:either ancient basin basement,or subduction-collision zone.However,the geological origins of large-scale regional magnetic anomalies are always subject to dispute,mainly because of limited surface exposure of sources,later tectonic destruction,and superposition of multi-phase events.

关键词： long-wavelength magnetic anomaly lithospheric magnetic anomaly lithospheric magnetic field model satellite magnetic survey CSES

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