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Clinical and historical features of emergency department patients with pericardial effusions

World Journal of emergency Medicine 2017年第1期8卷 29-33页

作者： Lori Stolz Josephine Valenzuela Elaine Situ-LaCasse Uwe Stolz Nicolas Hawbaker Matthew Thompson Srikar Adhikari department of emergency Medicine University of Arizona department of emergency Medicine University of California

BACKGROUND: Diagnosing pericardial effusion is critical for optimal patient care. Typically, clinicians use physical examination ? ndings and historical features suggesting pericardial effusion to determine which patients require echocardiography. The diagnostic characteristics of these tools are not well described. The objective of this study is to determine the prevalence of historical features and sensitivity of clinical signs to inform clinicians when to proceed with ***: A retrospective review of point-of-care echocardiograms performed over a two and a half year period in two emergency departments were reviewed for the presence of a pericardial effusion. Patient charts were reviewed and abstracted for presenting symptoms, historical features and clinical findings. The prevalence of presenting symptoms and historical features and the sensitivity of classic physical examination ? ndings associated with pericardial effusion and tamponade were ***: One hundred and fifty-three patients with pericardial effusion were identified. Of these patients, the most common presenting complaint was chest pain and shortness of breath. Patients had no historical features that would suggest pericardial effusion in 37.5% of cases. None of the patients with pericardial effusion or pericardial tamponade had all of the elements of Beck's triad. The sensitivity of Beck's triad was found to be 0(0%–19.4%). The sensitivity for one ? nding of Beck's triad to diagnose pericardial tamponade was 50%(28.0%–72.0%).CONCLUSION: History and physical examination findings perform poorly as tests for the diagnosis of pericardial effusion or pericardial tamponade. Clinicians must liberally evaluate patients suspected of having a pericardial effusion with echocardiography.

关键词： Pericardial effusion Ultrasound Echocardiography Cardiac tamponade Physical examination

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Evaluation of disease burden and symptom scores in patients with acute atrial fi brillation in the emergency department

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World Journal of emergency Medicine 2024年第5期15卷 397-400页

作者： Nikola Schütz Dominik Roth Michael Prinz Filippo Cacioppo Sebastian Schnaubelt Alexander O.Spiel Hans Domanovits Harald Herkner department of emergency Medicine Medical University of ViennaVienna 1090Austria department of emergency Medicine Clinic OttakringVienna 1160Austria

Atrial fibrillation(AF)is a major public health problem and poses a substantial economic burden on healthcare systems worldwide.[1-4]The emergency department(ED)serves as the first point of contact with the healthcare system and plays a key role in the management of patients with AF,which accounts for 3%-10%of all hospital admissions.[5]Treatment plans are often discussed and initiated at the ED.

关键词： patients atrial acute

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Diagnostic accuracy of the tongue blade test combined with clinical signs to detect maxillary and mandibular fractures in the emergency department

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World Journal of emergency Medicine 2023年第2期14卷 122-127页

作者： Jee Yen Kuck Abdul Muhaimin Noor Azhar Neena Wee Rishya Manikam emergency department University of MalayaKuala Lumpur 50603Malaysia

BACKGROUND: To evaluate the diagnostic accuracy of clinical signs combined with the tongue blade test(TBT) to detect maxillary and mandibular ***: A cross-sectional study enrolled patients with maxillary and mandibular injuries in the emergency department. Physical examination and the TBT were performed, followed by radiological imaging(facial X-ray or computed tomography [CT]). The diagnostic accuracy was calculated for individuals and a combination of clinical findings at predicting maxillary and mandibular ***: A total of 98 patients were identified, of whom 31.6% had maxillary fractures and9.2% had mandibular fractures. The combination of malocclusion, tenderness on palpation and swelling with positive TBT had 100% specificity to detect maxillary and mandibular fractures. In the absence of malocclusion, the combination of tenderness on palpation and swelling with positive TBT produced a specificity of 97.8% for maxillary fracture and a specificity of 96.2% for mandibular fracture. A clinical decision tool consisting of malocclusion, tenderness on palpation, swelling and TBT revealed a specificity of 100% and a positive predictive value of 100%.CONCLUSION: The clinical decision tool is potentially useful to rule out mandibular fractures,thus preventing unnecessary radiation exposure.

关键词： Maxillary fractures Mandibular fractures Tongue blade test Diagnostic accuracy Clinical decision tool emergency department

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Sub-dissociative dose ketamine administration for managing pain in the emergency department

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World Journal of emergency Medicine 2018年第4期9卷 249-255页

作者： Sergey Motov Jefferson Drapkin Antonios Likourezos Joshua Doros Ralph Monfort John Marshall department of emergency Medicine Maimonides Medical Center

BACKGROUND： We describe our experience of utilizing sub-dissociative dose ketamine （SDK） in managing a variety of acute and chronic painful conditions in the emergency department （ED）. METHODS： A descriptive study was conducted in our ED over a period of seven years （2010-2016） by retrospectively reviewing charts of patients aged 18 and older presenting to the ED with painful complaints and receiving SDK analgesia. Primary data analyses included type of SDK administration （intravenous push [IVP], short-infusion [SI] or continuous infusion [CI]）, dosing, rates of analgesic utilization before and after SDK administration, and adverse effects. RESULTS： Three hundred sixty-two patients were enrolled in the study. Mean ketamine doses given by IVP, St and CI were 26.3 rag, 23.4 rag, and 11.3 rag. The mean duration of CI was 135.87 minutes. The percentage of patients not requiring post-SDK analgesia increased by 16%, 18%, and 37% in IVP, SI and CI groups. Adverse effects were recorded for 13% of patients. CONCLUSION： SDK administered by IVP, SI, and CI in the ED for a variety of painful conditions is a feasible analgesic modality in the ED that is associated with a decrease in overall requirements of post-ketamine analgesia and opioid sparing.

关键词： Ketamine Analgesia emergency department Sub-dissociative Infusion

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Hypoxia-preconditioned bone marrow-derived mesenchymal stem cells protect neurons from cardiac arrest-induced pyroptosis

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Neural Regeneration Research 2025年第4期20卷 1103-1123页

作者： Xiahong Tang Nan Zheng Qingming Lin Yan You Zheng Gong Yangping Zhuang Jiali Wu Yu Wang Hanlin Huang Jun Ke Feng Chen Shengli Clinical Medical College of Fujian Medical University Fujian Medical UniversityFuzhouFujian ProvinceChina department of emergency Fujian Provincial HospitalFuzhouFujian ProvinceChina Fujian Provincial Key Laboratory of emergency Medicine FuzhouFujian ProvinceChina The Second department of Intensive Care Unit Fujian Provincial Hospital South BranchFuzhouFujian ProvinceChina

Cardiac arrest can lead to severe neurological impairment as a result of inflammation,mitochondrial dysfunction,and post-cardiopulmonary resuscitation neurological *** preconditioning has been shown to improve migration and survival of bone marrow–derived mesenchymal stem cells and reduce pyroptosis after cardiac arrest,but the specific mechanisms by which hypoxia-preconditioned bone marrow–derived mesenchymal stem cells protect against brain injury after cardiac arrest are *** this end,we established an in vitro co-culture model of bone marrow–derived mesenchymal stem cells and oxygen–glucose deprived primary neurons and found that hypoxic preconditioning enhanced the protective effect of bone marrow stromal stem cells against neuronal pyroptosis,possibly through inhibition of the MAPK and nuclear factor κB ***,we transplanted hypoxia-preconditioned bone marrow–derived mesenchymal stem cells into the lateral ventricle after the return of spontaneous circulation in an 8-minute cardiac arrest rat model induced by *** results showed that hypoxia-preconditioned bone marrow–derived mesenchymal stem cells significantly reduced cardiac arrest–induced neuronal pyroptosis,oxidative stress,and mitochondrial damage,whereas knockdown of the liver isoform of phosphofructokinase in bone marrow–derived mesenchymal stem cells inhibited these *** conclude,hypoxia-preconditioned bone marrow–derived mesenchymal stem cells offer a promising therapeutic approach for neuronal injury following cardiac arrest,and their beneficial effects are potentially associated with increased expression of the liver isoform of phosphofructokinase following hypoxic preconditioning.

关键词： bone marrow–derived mesenchymal stem cells cardiac arrest cardiac resuscitation hypoxic preconditioning liver isoform of phosphofructokinase mitochondria neuroinflammation oxidative stress pyroptosis reactive oxygen species

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Effects of a general practitioner cooperative co-located with an emergency department on patient throughput

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World Journal of emergency Medicine 2016年第4期7卷 270-273页

作者： Michiel J.van Veelen Crispijn L.van den Brand Resi Reijnen M.Christien van der Linden department of emergency Medicine University of BotswanaSchool of Medicine department of emergency Medicine Medical Center Haaglanden

BACKGROUND:In 2013 a General Practitioner Cooperative(GPC) was introduced at the emergency department(ED) of our *** of the aims of this co-located GPC was to improve throughput of the remaining patients at the *** determine the change in patient flow,we assessed the number of self-referrals,redirection of self-referrals to the GPC and back to the ED,as well as ward and ICU admission rates and length of stay of the remaining ED ***:We conducted a four months' pre-post comparison before and after the implementation of a co-located GPC with an urban ED in the ***:More than half of our ED patients were *** triage,54.5%of these selfreferrals were redirected to the *** assessment at the GPC,8.5%of them were referred back to the *** number of patients treated at the ED declined with 20.3%after the introduction of the *** the remaining ED population,there was a significant increase of highly urgent patients(P<0.001),regular admissions(P<0.001),and ICU admissions(P<0.001).Despite the decline of the number of patients at the ED,the total length of stay of patients treated at the ED increased from 14 682 hours in the two months' control period to 14 962 hours in the two months' intervention period,a total increase of 270 hours in two months(P<0.001).CONCLUSION:Introduction of a GPC led to efficient redirection of self-referrals but failed to improve throughput of the remaining patients at the ED.

关键词： emergency Service,hospital General practitioners Crowding Length of stay

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Intranasal ketamine for the treatment of patients with acute pain in the emergency department

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World Journal of emergency Medicine 2016年第1期7卷 19-24页

作者： Roshana Shrestha Samita Pant Ashis Shrestha Kabita Hada Batajoo Rashmi Thapa Sumana Vaidya department of General Practice and emergency Medicine Manmohan Medical College and Teaching Hospital department of General Practice and emergency Medicine Patan Academy of Health Sciences department of General Practice and emergency Medicine KIST Medical College Hospital department of General Practice and emergency Medicine KMC Medical College Hospital

BACKGROUND:Pain in the emergency department(ED)is common but *** objective of this study was to examine the efficacy and safety of intranasal(IN)ketamine used as an analgesic for patients with acute injury with moderate to severe ***:This study was a cross sectional,observational study of patients more than 8 years old experiencing moderate to severe pain[visual analog score(VAS)>50 mm].The initial dose of IN ketamine was 0.7 mg/kg with an additional dose of 0.3 mg/kg if VAS was more than 50 mm after *** scores and vital signs were recorded at 0,15,30 and 60 ***-effects,sedation level and patient's satisfaction were also *** primary outcome was the number of patients achieving≥20 mm reductions in VAS at 15 *** secondary outcome measures were median reduction in VAS at 15,30 and 60 minutes,changes of vital signs,adverse events,satisfaction of patients,and need for additional ***:Thirty-four patients with a median age of 29.5 years(IQR 17.5–38)were enrolled,and they had an initial median VAS of 80 mm(IQR 67–90).The VAS decreased more than 20 mm at15 minutes in 27(80%)*** reduction of VAS from baseline to 40 mm(IQR 20–40),20 mm(IQR 14–20)and 20 mm(IQR 10–20)respectively at 15,30 and 60 minutes(P<0.001).No critical changes of vital signs were noted and adverse effects were mild and ***:This study showed that IN ketamine is an analgesic choice for patients with acute injury in moderate to severe pain in an overcrowded and resource limited ED.

关键词： Analgesia Intranasal Ketamine Pain Visual analog score

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A young lady presenting to the emergency department with blue lips: A case study with review of literature

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World Journal of emergency Medicine 2020年第2期11卷 122-124页

作者： Debkumar Chowdhury emergency department University Hospital AyrScotlandUK

Dear editor,A young lady in her early 20s presented acutely with shortness of breath with her oxygen saturations on room noted to be mid to 70%with normal respiratory rate,and blue discolouration of the lips(Figure 1).The relevant past medical history and surgical history included well controlled asthma and a laparoscopic salpingectomy for ectopic pregnancy approximately 3 weeks *** only relevant recent history was use of cocaine over the preceding 48 hours.

关键词： acute respiratory asthma

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Keeping nephrotic syndrome on the emergency department edema differential: A case report

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World Journal of emergency Medicine 2019年第2期10卷 116-118页

作者： Joshua Goodwin Bijon Das department of emergency Medicine Dalhousie University Faculty of Medicine

Dear editor,Nephrotic syndrome is defined by the presence of peripheral edema,heavy proteinuria(greater than 3.5 g/24h),and hypoalbuminemia(less than 3 g/dL).^[1]Nephrotic syndrome is relatively rare,with an incidence of 3 new patients per 100,000 per year in adults.^[1]Despite being a known cause for new onset edema in patients at any age,nephrotic syndrome is often neglected in considering differential diagnoses for this presentation in primary care settings,and initial workups often focus on ruling out cardiac and hepatic causes of edema.^[1-3]In this case report,we describe a 25-year-old male patient who presented to the emergency department(ED)complaining of a 10-day history of *** was later diagnosed with nephrotic syndrome secondary to minimal change *** case served as a reminder to include the differential diagnosis of nephrotic syndrome early in the workup of an adult with peripheral edema presenting to the ED.

关键词： Dear editor Nephrotic syndrome peripheral edema

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Role of Ultrasound Lung Comets in the Diagnosis of Acute Heart Failure in emergency department: A Systematic Review and Meta-analysis

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Biomedical and Environmental Sciences 2018年第8期31卷 596-607页

作者： LIAN Rui ZHANG Guo Chao YAN Sheng Tao SUN Li Chao ZHANG Su Qiao ZHANG Guo Qiang department of emergency Medicine China-Japan Friendship Hospital department of General Surgery China-Japan Friendship Hospital

Objective A new technique of transthoracic lung ultrasonography(TLS) has emerged and demonstrated promising results in acute heart failure diagnosis at an early stage. However, the diagnostic value of ultrasound lung comets(ULCs) for acute heart failure(AHF) performed in busy emergency department(ED) is uncertain. The present meta-analysis aimed to assess the diagnostic efficiency of ULCs in AHF. Methods We conducted a search on online journal databases to collect the data on TLS performed for diagnosing AHF published up to the end of July 2017. The sensitivity, specificity, positive likelihood ratio(PLR), negative likelihood ratio(NLR), and summary receiver operating characteristic(SROC) curve were calculated. The post-test probability of AHF was calculated by using Bayes analysis. Results We enrolled a total of 15 studies involving 3,309 patients. The value of sensitivity, specificity, PLR, NLR, DOR, area under the SROC curve, and Q* index was 85%, 91%, 8.94, 0.14, 67.24, 0.9587, and 0.9026, respectively. We detected significant heterogeneity among included studies, and therefore, all these results were analyzed under the random-effect model. We also explored possible sources of heterogeneity among the studies by using meta-regression analysis. Results suggest that the time interval between patient’s admission to bedside TLS examination was closely related to TLS accuracy. Conclusion This meta-analysis demonstrated that detecting ULCs is a convenient bedside tool and has high accuracy for early AHF diagnosis in ED. TLS could be recommended to be applied for early diagnosis of AHF in ED.

关键词： Transthoracic lung ultrasonography Lung comets sign Dyspnea Acute heart failure Diagnostic test Meta-analysis

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