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World Journal of Clinical Cases 2023年第6期11卷 1310-1317页

作者： Bassant S Moussa Zeinab M Abd Elatiff Ghada M Kamal Eldin Elhadary emergency medicine Department Suez Canal UniversityFaculty of MedicineIsmailia 41522Egypt

BACKGROUND Disorders of consciousness including coma in non-trauma patients can be caused by a wide variety of pathologies affecting the central nervous *** represent a frequent challenge in emergency medicine and are combined with a very high in-hospital ***,early treatment of these patients is vital and increases the likelihood of a good *** To identify the causes of altered consciousness presentation to the emergency Department at Suez Canal University *** This was a descriptive cross-sectional study conducted on 87 patients with acute non-traumatic disturbed level of consciousness(DLOC)at the emergency *** The mean age of the studied patients was 60.5±13.6 *** them,60%were males and 40%were *** most common cause of acute non-traumatic DLOC was systemic infection,such as sepsis and septic shock(25.3%),followed by respiratory causes(24.1%)and neurological causes(18.4%).CONCLUSION The most common cause of acute non-traumatic DLOC was systemic infections followed by respiratory and neurological causes.

关键词： Disturbed level of consciousness Non-traumatic emergency department

Comparison of intravenous pantoprazole and ranitidine in patients with dyspepsia presented to the emergency department: a randomized, double blind, controlled trial

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World Journal of emergency medicine 2016年第1期7卷 30-34页

作者： Engin Senay Cenker Eken Murat Yildiz Derya Yilmaz Erhan Alkan Mete Akin Mustafa Serinken Department of emergency medicine School of Medicine Akdeniz University Department of Gastroenterology School of Medicine Akdeniz University Department of Gastroenterology Burdur Government Hospital Pamukkale University Hospital Department of Emergency Medicine

BACKGROUND:This study aimed to compare pantoprazole,a proton-pomp inhibitors(PPIs),and ranitidine,a H2 receptor antagonists(H2RA),in ceasing dyspeptic symptoms in the emergency department(ED).METHODS:This randomized,double-blinded study compared the effectiveness of 50 mg ranitidine(Ulcuran®)and 40 mg pantoprazole(Pantpas®),given in a 100 m L saline solution by an intravenous rapid infusion within 2–4 minutes in patients with dyspepsia presented to the *** intensity was measured at baseline,30 and 60 minutes after the drug ***:A total of 72 patients were eligible for the *** these patients,2 were excluded from the study because the initial visual analogue scale(VAS)scores were under 20 mm and 4 were excluded from the statistical analysis because of being diagnosed as having other causes of epigastric pain despite being allocated to one of the study ***-three patients in the pantoprazole group and 33 patients in the ranitidine group were analyzed *** mean age of the patients was36.6±15 years,and 26(39.4%)patients were *** of the groups reduced pain effectively at 30[27.6±28(18 to 37)vs.28.3±23(20 to 37),respectively]and 60 minutes[39.6±39(26 to 53)vs.42.3±25(33 to 51),respectively].There were 13(39.4%)patients in the pantoprazole group and 8(24.2%)patients in the ranitidine group who required additional drug at the end of the study(P=0.186).CONCLUSION:Intravenous pantoprazole and ranitidine are not superior to each other in ceasing dyspeptic symptoms at 30 and 60 minutes in the ED.

关键词： Dyspepsia Pantoprazole Ranitidine emergency department

The Affordable Care Act: Disparities in emergency department use for mental health diagnoses in young adults

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World Journal of emergency medicine 2017年第3期8卷 206-213页

作者： Justin Yanuck Bryson Hicks Craig Anderson John Billimek Shahram Lotfi pour Bharath Chakravarthy Division of emergency medicine University of California Division of General Internal medicine and Department of Family medicine Irvine School of Medicine

BACKGROUND: There is little consensus as to the effects of insurance expansion on emergency department(ED) utilization for mental health purposes. We aimed to study the race specifi c association between the dependent coverage provision of the Affordable Care Act(ACA) and changes in young adults' usage of emergency department services for psychiatric ***: We utilized a Quasi-Experimental analysis of ED use in California from 2009–2011 for behavioral health diagnoses of individuals aged 19 to 31 years. Analysis used a difference-indifferences approach comparing those targeted by the ACA dependent provision(19–25 years) and those who were not(27 to 31 years), evaluating changes in ED visit rates per 1 000 in California. Primary outcomes measured included the quarterly ED visit rates with any psychiatric diagnosis. Subgroups were analyzed for differences based on race and ***: The ACA dependent provision was associated with 0.05 per 1 000 people fewer psychiatric ED visits among the treatment group(19–25 years) compared to the control group(27–31 years). Hispanics and Asian/Pacific Islanders were the only racial subgroups who did not see this significant reduction and were the only racial subgroups that did not see significant gains in the proportion of psychiatric ED visits covered by private ***: The ACA dependent provision was associated with a modest reduction in the growth rate of ED use for psychiatric reasons, however, racial disparities in the effect of this provision exist for patients of Hispanic and Asian/Pacifi c Islander racial groups.

关键词： Affordable Care Act Mental health Disparities Health Policy

The effectiveness of emotion-focused art therapy on the resilience and self-image of emergency physicians

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World Journal of emergency medicine 2022年第6期13卷 479-484页

作者： Soo Kyung Eo Chanwoong Kim Kyung Hye Park Eun Kyung Eo Graduate School of Art Therapy at CHA University Pocheon 11160Republic of Korea Department of emergency medicine Chung-Ang University College of MedicineSeoul 06974Republic of Korea Department of Medical Education Yonsei University Wonju College of MedicineWonju 26426Republic of Korea Department of emergency medicine Wonju Severance Christian HospitalWonju 26426Republic of Korea Department of emergency medicine Soonchunhyang University Bucheon HospitalBucheon 14584Republic of Korea

INTRODUCTION Resilience refers to the quality of being able to overcome adversity.[1]Studies conducted in the United States[2]and China[3]following the 2019 coronavirus disease(COVID-19)pandemic reported reduced resilience levels among medical *** resilience levels are associated with low burnout levels among residents.[4]Physician burnout affects patients’safety and quality of care.[5]In particular,emergency physicians(EPs)are more prone to exhaustion or poor resilience,as their turnover intention tends to be higher.[6]Therefore,improving EPs’resilience is imperative.

关键词： image physician overcome

Can emergency physicians perform extended compression ultrasound for the diagnosis of lower extremity deep vein thrombosis?

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World Journal of emergency medicine 2019年第4期10卷 205-209页

作者： Elaine Situ-LaCasse Helpees Guirguis Lucas Friedman Asad E.Patanwala Seth E.Cohen Srikar Adhikari Department of emergency medicine College of Medicine&Banner University Medical CenterUniversity of ArizonaPO Box 245057TucsonAZ 85724USA College of medicine University of ArizonaTucsonAZ 85724USA emergency medicine Residency University of California RiversideRiversideCA 92501USA College of Pharmacy University of ArizonaTucsonAZ 85721USA Department of emergency medicine College of MedicineUniversity of ArizonaPO Box 245057TucsonAZ 85724USA

BACKGROUND:Current point-of-care ultrasound protocols in the evaluation of lower extremity deep vein thrombosis (DVT) can miss isolated femoral vein *** compression ultrasound (ECUS) includes evaluation of the femoral vein from the femoral vein/deep femoral vein bifurcation to the adductor *** objective is to determine if emergency physicians (EPs) can learn ECUS for lower extremity DVT evaluation after a focused training ***:Prospective study at an urban academic *** with varied ultrasound experience received instruction in ECUS prior to *** live models with varied levels of difficult sonographic anatomy were intentionally chosen for the *** participant scanned both ***-and post-study surveys were ***:A total of 96 ultrasound examinations were performed by 48 participants (11 attendings and 37 residents).Participants' assessment scores averaged 95.8% (95% CI 93.3%-98.3%) on the easier anatomy live model and averaged 92.3% (95% CI 88.4%-96.2%) on the difficult anatomy *** were no statistically significant differences between attendings and *** the model with easier anatomy,all but 1 participant identified and compressed the proximal femoral vein successfully,and all participants identified and compressed the mid and distal femoral *** the difficult anatomy,97.9% (95% CI93.8%-102%) identified and compressed the proximal femoral vein,whereas 93.8% (95% CI 86.9%-100.6%) identified and compressed the mid femoral vein,and 91.7% (95% CI83.9%-99.5%) identified and compressed the distal femoral ***:EPs at our institution were able to perform ECUS with good reproducibility after a focused training session.

关键词： emergency medicine Point-of-care ultrasound Deep vein thrombosis

Improving the approach to non-cardiac syncope in the emergency department observation unit

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World Journal of emergency medicine 2023年第2期14卷 128-132页

作者： Filippo Numeroso Ivo Casagranda emergency Department University Hospital of ParmaParma 43126Italy Academy of emergency medicine and Care(AcEMC) Pavia 27100Italy

Syncope is a rather frequent condition,responsible for1.0%–1.5%of emergency department (ED) visits.[1]Even if the development of clinical guidelines has improved the ED management of syncope,[2]the hospitalization rate is still very high (up to 50%),especially compared with the incidence of short-term adverse events,which is11%globally,but decreases to less than 4%when events already diagnosed in the ED are excluded,[1]meaning that most patients will not benefit from admission.

关键词： globally department syncope

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

Analysis of Mad Honey (Grayanotoksin) Cases Admitted to Duzce University School of medicine emergency Department

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Open Journal of emergency medicine 2017年第1期5卷 13-24页

作者： Ahmet Tekinsoy Seher Orbay Yasli Ayhan Saritas Harun Gunes Ertugrul Kaya Feruza Turan Sonmez emergency Service &Ouml mer Halis Demir Training Research Hospital medicine Nigde Turkey Division of Anesthesiology Kaman State Hospital Kirsehir Turkey emergency Service Duzce Medical Faculty Duzce Turkey Department of Pharmacology Duzce Medical Faculty Nigde Turkey

Background: Mad honey is the type of honey made by bees that are nourished from the plants of Rhododendron (Rh.) family, and it contains grayanotoksin (GTX). The most significant types of Rh family, which contain GTX, are Rh. The purpose of this study was to analyze the cases which came to the emergency room because of GTX intoxication in detail in order to help diagnosis, treatment, follow-up and prognosis in daily emergency medicine practice. A total of 36 patients with the symptoms and diagnosis of intoxication after consuming mad honey, were included in the study. Ten healthy individuals who did not have a history of taking mad honey were included in the control group. The study is designed as a prospective case control study. The average GTX level of the group who ate mad honey (studygroup) was 7.88 ng/ml (min: 0.00/max: 30.47). At control group, GTX level was 0 ng/ml. There was no statistically significant relationship between the symptoms (dizziness, nausea, vomiting, weakness, deterioration, angina) and blood GTX level in the study group. Also statistic value reflects relationship between kidney function tests, troponin and control troponin levels in case group. The patients who have absolute decrease in blood pressure and pulse should be questioned by emergency medicine doctors about consuming mad honey. Further studies are needed to demonstrate the relationship between symptoms and GTX poisoning.

关键词： Grayanotoxin Mad Honey Rhododendron

Nutritional status and prognostic factors for mortality in patients admitted to emergency department observation units:a national multi-center study in China

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World Journal of emergency medicine 2023年第1期14卷 17-24页

作者： Hai-jiang Zhou Dong-jing Zuo Da Zhang Xin-hua He Shu-bin Guo Nutrition School of Education College of Chinese emergency medicine Beijing Key Laboratory of Cardio-pulmonary Cerebral ResuscitationEmergency Medicine Clinical Research CenterBeijing Chao-yang HospitalCapital Medical UniversityBeijing 100020China

BACKGROUND:Nutritional risk is common among patients admitted to the emergency department and is associated with adverse clinical *** its large population,few comprehensive studies have been conducted in China concerning the nutritional status of patients admitted to emergency department observation units(EDOUs).METHODS:Patients admitted to EDOUs of 90 tertiary hospitals in China between June 2020 and December 2020 were *** information,laboratory parameters,nutritional support therapies,and 28-day mortality were *** factors for mortality were examined using multi-variateadjusted logistic regression *** operating characteristic(ROC)curves for each predictor of mortality were plotted,and the area under the ROC(AUROC)curves was ***:A total of 2,005 eligible patients were finally *** the 28-day follow-up,1,911 patients survived,and 94 *** group with a Nutritional Risk Screening 2002(NRS 2002)score of 3-4 points was the largest(52.01%).The number of patients receiving oral nutritional supplements,enteral nutrition(EN),parenteral nutrition(PN),and the combination of EN and PN was 425,314,853,and 413,*** the total,77.55%of patients had nutritional risk(NRS 2002≥3).The proportion of patients with high nutritional risk(NRS2002≥5)in the age group>80 years was significantly higher than that in the age group 66-80 years(29.00%vs.23.93%,P=0.032),but not significantly higher than that in the age group 18-65 years(29.00%vs.26.54%,P=0.449).Logistic regression analysis revealed that heart failure(odds ratio[OR]1.856,95%confidence interval[CI]1.087-3.167,P=0.023),consciousness(OR 2.967,95%CI 1.894-4.648,P<0.001),Acute Physiology and Chronic Health Evaluation II(APACHE II)score(OR 1.037,95%CI 1.017-1.058,P<0.001),NRS 2002 score(OR 1.286,95%CI 1.115-1.483,P=0.001),and Mini Nutritional Assessment-Short Form score(OR 0.946,95%CI 0.898-0.997,P=0.039)were all independent risk factors for 28-day m

关键词： Nutritional risk Malnutrition Nutritional Risk Screening 2002 Mini Nutritional Assessment-Short Form

Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department

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World Journal of emergency medicine 2024年第4期15卷 273-282页

作者： Rex Pui Kin Lam Zonglin Dai Eric Ho Yin Lau Carrie Yuen Ting Ip Ho Ching Chan Lingyun Zhao Tat ChiTsang Matthew Sik Hon Tsui Timothy Hudson Rainer Department of emergency medicine School of Clinical MedicineLi Ka Shing Faculty of Medicinethe University of Hong KongHong KongChina School of Public Health Li Ka Shing Faculty of Medicinethe University of Hong KongHong KongChina Accident and emergency Department Queen Mary HospitalHong KongChina

BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong *** primary outcome was sepsis(Sepsis-3 definition)within 48 h of ED *** c-statistics and the DeLong test,we compared 11 EWSs,including the National Early Warning Score 2(NEWS2),Modified Early Warning Score,and Worthing Physiological Scoring System(WPS),etc.,and three shock indices(the shock index[SI],modified shock index[MSI],and diastolic shock index[DSI]),with Systemic Inflammatory Response Syndrome(SIRS)and quick Sequential Organ Failure Assessment(qSOFA)in predicting the primary outcome,intensive care unit admission,and mortality at different time ***:We analyzed 601 patients,of whom 166(27.6%)developed ***2 had the highest point estimate(area under the receiver operating characteristic curve[AUROC]0.75,95%CI 0.70-0.79)and was significantly better than SIRS,qSOFA,other EWSs and shock indices,except WPS,at predicting the primary ***,the pooled sensitivity and specificity of NEWS2≥5 for the prediction of sepsis were 0.45(95%CI 0.37-0.52)and 0.88(95%CI 0.85-0.91),*** discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time ***:NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.

关键词： Sepsis emergency department Clinical prediction rule Early warning score Shock index