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Handheld bedside ultrasound in the diagnosis of myocarditis

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World Journal of emergency medicine 2024年第1期15卷 73-74页

作者： Frank Wheeler Robin Lahr James Espinosa Alan Lucerna Henry Schuitema department of emergency medicine Rowan University School of Osteopathic MedicineStratford 08084USA emergency medicine residency program Jeff erson HealthStratford 08084USA department of emergency medicine and Associate Chief Medical Offi cer Stratford 08084USA

Myocarditis is a disease process that every emergency physician fears *** severity can be mild to life-threatening,and many cases are likely undetected because they are subclinical with nonspecifi c signs.[1]Subtle cardiac signs may be overshadowed by systemic symptoms of the underlying infectious ***,myalgias,lethargy,symptoms commonly associated with viral syndrome,can mask the life-threatening myocarditis that may be *** fact,in the United States Myocarditis Treatment Trial,almost 90%of patients reported symptoms consistent with a viral prodrome.[2]Ammirati et al[3]reported that 27%of patients with myocarditis had either reduced left ventricular ejection fraction,ventricular arrhythmias,or low cardiac ***,we present a case report,in which handheld point-of-care ultrasound was utilized at the bedside to aid in the critical diagnosis of *** the additional information provided through this imaging modality,this patient was able to be transferred to the appropriate tertiary care facility in an expeditious manner and receive possible defi nitive treatment.

关键词： diagnosis myocarditis Fever

Venous thromboembolism in a healthy young man:An unintended consequence of coronavirus disease 2019 pandemic lockdown

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World Journal of emergency medicine 2020年第4期11卷 255-257页

作者： Jenshen Cheng Susmita Roy Chowdhury Aliviya Dutta R Ponampalam SingHealth emergency medicine residency programme Singapore Health ServicesSingapore department of emergency medicine Singapore General HospitalSingapore

Dear editor,The coronavirus disease 2019(COVID-19)pandemic has enveloped the globe with ferocious pace,prompting lockdowns of countries and ***,up to one-third of the world’s population is living in some forms of coronavirus mass quarantine,which brings new and unprecedented challenges to healthcare systems *** of these is the potentially deleterious effects of physical inactivity due to enacted restrictions.

关键词： consequence prompt editor

A cadaveric model for transesophageal echocardiography transducer placement training: A pilot study

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World Journal of emergency medicine 2022年第1期13卷 18-22页

作者： Ryan W.Horton Kian R.Niknam Viveta Lobo Kathryn H.Pade Drew Jones Kenton L.Anderson department of emergency medicine Stanford University School of MedicinePalo Alto 94304USA emergency medicine residency program University of Texas at Austin Dell Medical SchoolAustin 78756USA University of California San Francisco School of medicine San Francisco 94143USA department of emergency medicine Rady Children’s HospitalSan Diego 92123USA department of emergency medicine University of Central Florida/HCA Ocala RegionalOcala 34471USA

BACKGROUND: Transesophageal echocardiography(TEE) is used in the emergency department to guide resuscitation during cardiac arrest. Insertion of a TEE transducer requires manual skill and experience, yet in some residency programs cardiac arrest is uncommon, so some physicians may lack the means to acquire the manual skills to perform TEE in clinical practice. For other infrequently performed procedural skills, simulation models are used. However, there is currently no model that adequately simulates TEE transducer insertion. The aim of this study is to evaluate the feasibility and efficacy of using a cadaveric model to teach TEE transducer placement among novice ***: A convenience sample of emergency medicine residents was enrolled during a procedure education session using cadavers as tissue models. A pre-session assessment was used to determine prior knowledge and confidence regarding TEE manipulation. Participants subsequently attended a didactic and hands-on education session on TEE placement. All participants practised placing the TEE transducer until they were able to pass a standardized assessment of technical skill(SATS). After the educational session, participants completed a post-session assessment. RESULTS: Twenty-five residents participated in the training session. Mean assessment of knowledge improved from 6.2/10 to 8.7/10(95% confidence interval [CI] of knowledge difference 1.6–3.2, P<0.001) and confidence improved from 1.6/5 to 3.1/5(95% CI of confidence difference 1.1–2.0, P<0.001). There was no relationship between training level and the delta in knowledge or ***: In this pilot study, the use of a cadaveric model to teach TEE transducer placement methods among novice users is feasible and improves both TEE manipulation knowledge and confidence levels.

关键词： Cardiopulmonary resuscitation Echocardiography Education Simulation

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

Persistent alterations in gray matter in COVID-19 patients experiencing sleep disturbances:a 3-month longitudinal study

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Neural Regeneration Research 2025年第10期20卷 3013-3024页

作者： Kaixuan Zhou Gaoxiong Duan Ying Liu Bei Peng Xiaoyan Zhou Lixia Qin Lingyan Liang Yichen Wei Qingping Zhang Xiaocheng Li Haixia Qin Yinqi Lai Yian Lu Yan Zhang Jiazhu Huang Jinli Huang Yinfei Ouyang Bolin Bin Mingming Zhao Jun Liu Jianrong Yang Demao Deng Guangxi Key Laboratory of Special Biomedicine School of MedicineGuangxi UniversityNanningGuangxi Zhuang Autonomous RegionChina department of Radiology the People’s Hospital of Guangxi Zhuang Autonomous RegionGuangxi Academy of Medical SciencesNanningGuangxi Zhuang Autonomous RegionChina department of Sleep medicine the People’s Hospital of Guangxi Zhuang Autonomous RegionNanningGuangxi Zhuang Autonomous RegionChina department of Radiology The Second Xiangya HospitalCentral South UniversityChangshaHunan ProvinceChina Guangxi Clinical Research Center for Sleep medicine the People’s Hospital of Guangxi Zhuang Autonomous RegionNanningGuangxi Zhuang Autonomous RegionChina

Sleep disturbances are among the most prevalent neuropsychiatric symptoms in individuals who have recovered from severe acute respiratory syndrome coronavirus 2 *** studies have demonstrated abnormal brain structures in patients with sleep disturbances who have recovered from coronavirus disease 2019(COVID-19).However,neuroimaging studies on sleep disturbances caused by COVID-19 are scarce,and existing studies have primarily focused on the long-term effects of the virus,with minimal acute phase *** a result,little is known about the pathophysiology of sleep disturbances in the acute phase of *** address this issue,we designed a longitudinal study to investigate whether alterations in brain structure occur during the acute phase of infection,and verified the results using 3-month follow-up data.A total of 26 COVID-19 patients with sleep disturbances(aged 51.5±13.57 years,8 women and 18 men),27 COVID-19 patients without sleep disturbances(aged 47.33±15.98 years,9 women and 18 men),and 31 age-and gender-matched healthy controls(aged 49.19±17.51 years,9 women and 22 men)were included in this *** COVID-19 patients with sleep disturbances were included in a longitudinal *** found that COVID-19 patients with sleep disturbances exhibited brain structural changes in almost all brain *** cortical thicknesses of the left pars opercularis and left precuneus were significantly negatively correlated with Pittsburgh Sleep Quality Index ***,we observed changes in the volume of the hippocampus and its subfield regions in COVID-19 patients compared with the healthy *** 3-month follow-up data revealed indices of altered cerebral structure(cortical thickness,cortical grey matter volume,and cortical surface area)in the frontal-parietal cortex compared with the baseline in COVID-19 patients with sleep *** findings indicate that the sleep disturbances patients had altered morphology in the cortical an

关键词： brain structure cortical gray matter volume cortical surface area cortical thickness hippocampus magnetic resonance imaging Pittsburgh Sleep Quality Index severe acute respiratory syndrome coronavirus 2 infections sleep disturbances sub-cortical volume

Perceptions of emergency medicine residents on the quality of residency training in the United States and Saudi Arabia

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World Journal of emergency medicine 2018年第1期9卷 5-12页

作者： Ahmad Aalam Mark Zocchi Khalid Alyami Abdullah Shalabi Abdullah Bakhsh Asaad Alsufyani Abdulrahman Sabbagh Mohammed Alshahrani Jesse M.Pines department of emergency medicine King Abdulaziz University department of emergency medicine The George Washington University Center for Healthcare Innovation and Policy Research The George Washington University department of Pediatrics University of Dammam department of emergency medicine King Abdulaziz Medical City National Guard Hospital department of emergency medicine University of Toledo department of emergency medicine King Fahad Medical City

BACKGROUND: We compare educational environments(i.e. physical, emotional and intellectual experiences) of emergency medicine(EM) residents training in the United States of America(USA) and Saudi Arabia(SA).METHODS: A cross-sectional survey study was conducted using an adapted version of the validated Postgraduate Hospital Educational Environment Measure(PHEEM) survey instrument from April 2015 through June 2016 to compare educational environments in all emergency medicine residency programs in SA and three selected programs in the USA with a history of training Saudi physicians. Overall scores were compared across programs, and for subscales(autonomy, teaching, and social Support), using chi-squared, t-tests, and analysis of ***: A total of 219 surveys were returned for 260 residents across six programs(3 SA, 3 USA), with a response rate of 84%. program-specific response rates varied from 79%–100%. All six residencies were qualitatively rated as "more positive than negative but room for improvement". Quantitative PHEEM scores for the USA programs were significantly higher: 118.7 compared to 109.9 for SA, P=0.001. In subscales, perceptions of social support were not different between the two countries(P=0.243); however, role autonomy(Pprograms. There were no significant differences by post-graduate training ***: EM residents in all three emergency medicine residency programs in SA and the three USA programs studied perceive their training as high quality in general, but with room for improvements. USA residency programs scored higher in overall quality. This was driven by more favorable perceptions of role autonomy and teaching. Understanding how residents perceive their programs may help drive targeted quality improvement efforts.

关键词： emergency medicine residents residency training United States of America Saudi Arabia

Outcomes and impact of an advanced clinical ultrasound track in an emergency medicine residency

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World Journal of emergency medicine 2024年第6期15卷 486-489页

作者： Charles W.Kropf David A.Haidar Ryan V.Tucker William Peterson Neil Khanna Rob D.Huang Christopher M.Fung Nik Theyyunni department of emergency medicine University of Michigan Medical SchoolMichigan 48109USA department of emergency medicine University of ColoradoColorado 80045USA department of emergency medicine Henry Ford Health SystemMichigan 48109USA

Point-of-care ultrasound(POCUS)is a core component of emergency medicine(EM)residency training used to guide medical decision making and to enhance procedural competence.[1-3]Many repetitions of POCUS exams are required to achieve competency,and it is difficult to quantify a minimum needed to achieve mastery.[4,5]For EM residents whose career goals require greater depth of knowledge and skill in POCUS,educators can consider expanded training through a professional development track.

关键词： repetition expanded impact

The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

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World Journal of emergency medicine 2017年第3期8卷 170-176页

作者： Emily Shao James Hughes Rob Eley Royal Brisbane and Women's Hospital emergency department Princess Alexandra Hospital emergency medicine Research program The University of Queensland Faculty of Medicine

BACKGROUND: Migraine is a common neurological condition that frequently presents to the emergency department(ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this ***: This study is a retrospective database interrogation of clinical records, used to collect quantitative data on patient demographics and medication prescriptions in the ***: A total of 2 228 patients were identified as being treated for migraine over a 10-year period. The proportion of the ED population presenting with migraine steadily increased in this time. Females(71%) more commonly presented to the ED with migraine than males. The migraine population was signifi cantly younger(M=37.05, SD=13.23) than the whole ED population(M=46.17 SD=20.50)(P<0.001). A variety of medications were used in the treatment of migraine in the ED. Simple analgesics such as paracetamol and ibuprofen, anti-emetics and intravenous(IV) fluids with phenothiazine additives were commonly used. Over 20% of patients were prescribed oral or parenteral opiates(42 of 194 initial medication prescriptions, and 64 of 292 as required medication prescriptions). Triptans were very rarely ***: Migraine is an increasingly common presentation to the ED. People presenting to the ED with migraine are more likely to be younger and female than the general ED population. Peak presentations for migraines occurred in January and February. The medications that are prescribed in the ED for migraine is varied and are not always in line with current evidence for the treatment of migraine. The excessive reliance on opiates and lack of the use of triptans denotes a signifi cant variation from published guidelines.

关键词： Migraine Headache Pain emergency department Analgesia

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