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emergency department operations and management education in emergency medicine training

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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Community emergency medicine:Benefits and challenges of screening for elder abuse in the emergency department of a developing country

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World Journal of emergency medicine 2015年第4期6卷 261-264页

作者： Muhammad Akbar Baig Asad Mian Erfaan Hussain Shahan Waheed Department of Emergency Medicine Aga Khan University Hospital departments of emergency medicine Aga Khan University Hospital Adult Critical Care Services Aga Khan University Hospital

As people live longer and fewer babies are born,the elderly became the fastest and largest growing population of the world,expected to increase further from 86 million in 2005 to 394 million in 2050 worldwide.Older patients represent a large bulk of the population arriving in emergency departments(EDs)all over the world.^([1])They use hospitals more frequently than younger patients。

关键词： Community emergency medicine

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Management of difficult intravenous access: a qualitative review

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World Journal of emergency medicine 2022年第6期13卷 467-478页

作者： Mingwei Ng Leong Kwok Fai Mark Lateef Fatimah Department of Emergency Medicine Singapore General Hospital

BACKGROUND: A perennial challenge faced by clinicians and made even more relevant with the global obesity epidemic, difficult intravenous access(DIVA) adversely impacts patient outcomes by causing significant downstream delays with many aspects of diagnoses and therapy. As most published DIVA strategies are limited to various point-of-care ultrasound techniques while other “tricks-of-the-trade” and pearls for overcoming DIVA are mostly relegated to informal nonpublished material, this article seeks to provide a narrative qualitative review of the iterature on DIVA and consolidate these strategies into a practical algorithm. METHODS: We conducted a literature search on PubMed using the keywords “difficult intravenous access”, “peripheral vascular access” and “peripheral venous access” and searched emergency medicine and anaesthesiology resources for relevant material. These strategies were then categorized and incorporated into a DIVA algorithm. RESULTS: We propose a Vortex approach to DIVA that is modelled after the Difficult Airway Vortex concept: starting off with standard peripheral intravenous cannulation(PIVC) techniques, progressing sequentially on to ultrasound-guided cannulation and central venous cannulation and finally escalating to the most invasive intraosseous access should the patient be in extremis or should best efforts with the other lifelines fail. CONCLUSION: DIVA is a perennial problem that healthcare providers across various disciplines will be increasingly challenged with. It is crucial to have a systematic stepwise approach such as the DIVA Vortex when managing such patients and have at hand a wide repertoire of techniques to draw upon.

关键词： Difficult intravenous access Venepuncture Vortex Peripheral intravenous cannulation

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Assessment of the patients’outcomes after implementation of South African triage scale in emergency department,Egypt

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Chinese Journal of Traumatology 2022年第2期25卷 95-101页

作者： Adel Hamed Elbaih Ghada Kamal Elhadary Magda Ramdan Elbahrawy Samar Sami Saleh emergency medicine department Faculty of MedicineSuez Canal UniversityIsmailiaEgypt

Purpose:Overcrowding in emergency department(ED)is a concerning global problem and has been identified as a national crisis in some countries.Several emergency sorting systems designed successfully in the world.Launched in 2004,a group of branches in South African triage scale(SATS)developed.The effectiveness of the case sorting system of SATS was evaluated to reduce the patient's length of stay(LOS)and mortality rate within the ED at Suez Canal University Hospital.Methods:The study was designed as an intervention study that included a systematic random sample of patients who presented to the ED in Suez Canal University Hospital.This study was implemented in three phases:pre-intervention phase,115 patients were assessed by the traditional protocols;intervention phase,a structured training program was provided to the ED staff,including a workshop and lectures;and post-intervention phase,230 patients were assessed by SATS.All the patients were retriaged 2 h later,calculating the LOS per patient and the mortality.Data was collected and entered using Microsoft Excel software.Collected data from the triage sheet were analyzed using the SPSS software program version 22.0.Results:The LOS in the ED was about 183.78 min before the intervention;while after the training program and the application of SATS,it was reduced to 51.39 min.About 15.7%of the patients died before the intervention;however,after the intervention the ratio decreased to 10.7%deaths.Conclusion:SATS is better at assessing patients without missing important data.Additionally,it resulted in a decrease in the LOS and reduction in the mortality rate compared to the traditional protocol.

关键词： emergency service Triage Length of stay Mortality South African triage score

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A retrospective analysis of gender among patients admitted to a clinical decision unit at risk for acute coronary syndrome

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World Journal of emergency medicine 2023年第2期14卷 133-137页

作者： Joby Thoppil Lauren Kraut Collin Montgomery Wilfrido Castillo Robert Silverman Sanjey Gupta Frederick Davis Department of Emergency Medicine University of Texas Southwestern Medical CenterTexas 75002USA Department of Emergency Medicine Long Island Jewish Medical CenterQueens NY 11040USA Department of Emergency Medicine South Shore HospitalBay Shore NY 11706USA

INTRODUCTION Chest pain is a common chief complaint and encompasses nearly 5.2% of all patients seen in emergency departments(ED). In the United States, this accounts for approximately six million annual visits.[1-4]The evaluation of patients with chest pain in the ED is a time-consuming and challenging process because the physician must identify those with life-threatening cardiac chest pain, while avoiding unnecessary and costly evaluations of those with non-cardiac chest pain.

关键词： admitted consuming patients

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Development and evaluation of a predictive nomogram for survival in heat stroke patients: a retrospective cohort study

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World Journal of emergency medicine 2022年第5期13卷 355-360页

作者： Fei Shao Xian Shi Shu-hua Huo Qing-yu Liu Ji-xue Shi Jian Kang Ping Gong Sheng-tao Yan Guo-xing Wang Li-jie Qin Fei Wang Ke Feng Feng-ying Chen Yong-jie Yin Tao Ma Yan Li Yang Wu Hao Cui Chang-xiao Yu Song Yang Wei Gan Sai Wang Liu-ye-zi Du Ming-chen Zhao Zi-ren Tang Shen Zhao Department of Emergency Medicine Beijing Chaoyang HospitalCapital Medical UniversityBeijing 100020China Department of Emergency Medicine Hebei Yanda HospitalLangfang 065201China Department of Emergency Medicine Beijing Huairou HospitalBeijing 101400China Department of Emergency Medicine the Second Hospital of Hebei Medical UniversityShijiazhuang 050000China Department of Emergency Medicine the Second Affi liated Hospital of Shandong First Medical UniversityTai’an 271000China Department of Emergency Medicine the First Affi liated Hospital of Dalian Medical UniversityDalian 116011China Department of Emergency Medicine China-Japan Friendship HospitalBeijing 100029China Department of Emergency Medicine Beijing Friendship HospitalBeijing 100050China Department of Emergency Medicine Henan Provincial People’s HospitalZhengzhou 450003China Department of Emergency Medicine Beijing Tsinghua Changung HospitalBeijing 102218China Department of Emergency Medicine General Hospital of Ningxia Medical UniversityYinchuan 750004China Department of Emergency Medicine the Affi liated Hospital of Inner Mongolia Medical UniversityHohhot 010050China Department of Emergency Medicine the Second Hospital of Jilin UniversityChangchun 130021China Department of Emergency Medicine the First Hospital of China Medical UniversityShenyang 110001China Department of Emergency Medicine the Second Hospital of Shanxi Medical UniversityTaiyuan 030001China department of Big Data Research Goodwill Hessian Health Technology Co.Ltd.Beijing 100085China School of Public Health Peking UniversityBeijing 100083China Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation Beijing 100020China department of Critical Care medicine Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND:This study aimed to establish an eff ective nomogram to predict the survival of heat stroke(HS)based on risk factors.METHODS:This was a retrospective,observational multicenter cohort study.We analyzed patients diagnosed with HS,who were treated between May 1 and September 30,2018 at 15 tertiary hospitals from 11 cities in Northern China.RESULTS:Among the 175 patients,32 patients(18.29%)died before hospital discharge.After the univariate analysis,mechanical ventilation,initial mean arterial pressure<70 mmHg,maximum heart rate,lab results on day 1(white blood cell count,alanine aminotransferase,creatinine),and Glasgow admission prediction score were included in multivariate analysis.Multivariate Cox regression showed that invasive ventilation,initial mean arterial pressure<70 mmHg(1 mmHg=0.133 kPa),and Glasgow admission prediction score were independent risk factors for HS.The nomogram was established for predicting 7-d and 14-d survival in the training cohort.The nomogram exhibited a concordance index(C-index)of 0.880(95%confidence interval[95%CI]0.831-0.930)by bootstrapping validation(B=1,000).Furthermore,the nomogram performed better when predicting 14-d survival,compared to 7-d survival.The prognostic index cut-off value was set at 2.085,according to the operating characteristic curve for overall survival prediction.The model showed good calibration ability in the internal and external validation datasets.CONCLUSION:A novel nomogram,integrated with prognostic factors,was proposed;it was highly predictive of the survival in HS patients.

关键词： Heat stroke Nomogram Survival Prognosis

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Increasing angiotensin-converting enzyme(ACE)2/ACE axes ratio alleviates early pulmonary vascular remodeling in a porcine model of acute pulmonary embolism with cardiac arrest

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World Journal of emergency medicine 2022年第3期13卷 208-214页

作者： Hong-li Xiao Lian-xing Zhao Jun Yang Nan Tong Le An Guo-xing Wang Miao-rong Xie Chun-sheng Li Department of Emergency Medicine Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China department of emergency Internal medicine the Affiliated Hospital of Qingdao UniversityQingdao 266000China Department of Emergency Medicine Beijing Chaoyang HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND:Acute pulmonary embolism(APE)with cardiac arrest(CA)is characterized by high mortality in emergency due to pulmonary arterial hypertension(PAH).This study aims to determine whether early pulmonary artery remodeling occurs in PAH caused by massive APE with CA and the protective effects of increasing angiotensin-converting enzyme(ACE)2-angiotensin(Ang)(1-7)-Mas receptor axis and ACE-Ang II-Ang II type 1 receptor(AT1)axis(ACE2/ACE axes)ratio on pulmonary artery lesion after return of spontaneous circulation(ROSC).METHODS:To establish a porcine massive APE with CA model,autologous thrombus was injected into the external jugular vein until mean arterial pressure dropped below 30 mmHg(1 mmHg=0.133 kPa).Cardiopulmonary resuscitation and thrombolysis were delivered to regain spontaneous circulation.Pigs were divided into four groups of five pigs each:control group,APE-CA group,ROSC-saline group,and ROSC-captopril group,to examine the endothelial pathological changes and expression of ACE2/ACE axes in pulmonary artery with or without captopril.RESULTS:Histological analysis of samples from the APE-CA and ROSC-saline groups showed that pulmonary arterioles were almost completely occluded by accumulated endothelial cells.Western blotting analysis revealed a decrease in the pulmonary arterial ACE2/ACE axes ratio and increases in angiopoietin-2/angiopoietin-1 ratio and expression of vascular endothelial growth factor(VEGF)in the APE-CA group compared with the control group.Captopril significantly suppressed the activation of angiopoietin-2/angiopoietin-1 and VEGF in plexiform lesions formed by proliferative endothelial cells after ROSC.Captopril also alleviated endothelial cell apoptosis by increasing the B-cell lymphoma-2(Bcl-2)/Bcl-2-associated X(Bax)ratio and decreasing cleaved caspase-3 expression.CONCLUSION:Increasing the ACE2/ACE axes ratio may ameliorate pulmonary arterial remodeling by inhibiting the apoptosis and proliferation of endothelial cells after ROSC induced by APE.

关键词： Acute pulmonary embolism Cardiac arrest Early pulmonary vascular remodeling Angiotensin-converting enzyme

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Initial venous lactate levels as a predictor of mortality in severe sepsis: a single-center retrospective cohort study

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World Journal of emergency medicine 2022年第5期13卷 396-399页

作者： Thidathit Prachanukool Pitsucha Sanguanwit Karn Suttapanit Chaiyaporn Yuksen Piraya Vichiensanth Department of Emergency Medicine Faculty of Medicine Ramathibodi HospitalBangkok 10400Thailand

Sepsis is the most common cause of death among critically ill patients.[1]Accordingly,most patients with sepsis are diagnosed and initially treated in the emergency department(ED).[2]Moreover,some studies have shown t... 详细信息

关键词： sepsis patients death

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Age-appropriateness of decision for brain CT scan in elderly patients with mild traumatic brain injury

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World Journal of emergency medicine 2023年第3期14卷 227-230页

作者： Kasamon Aramvanitch Korawee Khachornwattanakul Piraya Vichiensanth Chetsadakon Jenpanitpong Ponlawat Kanchayawong Sorawich Watcharakitpaisan Chaiyaporn Yuksen Department of Emergency Medicine Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkok 10400Thailand

Traumatic brain injury(TBI)is a prevalent issue among patients presenting in emergency departments(EDs),with mild TBI being the most common form.[1,2]Mild TBI is characterized by symptoms such as loss of consciousness,amnesia,disorientation,or a Glasgow Coma Scale(GCS)score of 13–15.[3]Although most patients with mild TBI can be safely discharged,Yuksen et al[4]reported that about 14.12%of all mild TBI patients were found to be positive for intracranial hemorrhage on a head CT scan.Computed tomography(CT)scans are widely used as a diagnostic tool for TBI,as they provide a quick and reliable diagnosis.[5]

关键词： patients Glasgow injury

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A case of persistent refractory hypoglycemia from polysubstance recreational drug use

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World Journal of emergency medicine 2023年第1期14卷 75-77页

作者： Jie Er Janice Soo Mingwei Ng Terence Kee Liem Chong Boon Kiat Kenneth Tan R Ponampalam Department of Emergency Medicine Singapore General Hospital169608Singapore

Dear editor,Studies have revealed a significant prevalence of mixed substance abuse,[1-3]and a focused approach towards polysubstance use has been emphasized.[4]Among recreational drugs,cases of hypoglycemia from ecstasy,[5]amphetamine,[6]eutylone,[7]and cannabinoid[8]use have been reported,but none of these cases have had persistent refractory hypoglycemia.

关键词： drugs cases prevalence

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