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Urinary Tract Infection in Pediatric Emergency department of Mohamed VI Hospital in Marrakech: Epidemiological Profile and Antibiotic Resistance

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Journal of Biosciences and Medicines 2024年第6期12卷 85-93页

作者： Radia Laanait Soufiane Elmoussaoui Widad Lahmini Mounir Bourrous Pediatric Emergency department Mother and child hospital University Hospital Mohammed VI Marrakesh Morocco Laboratory Childhood Health and Development Faculty of Medicine and Pharmacy Cadi Ayyad University Marrakech Morocco Laboratory for Infectious Disease Control Faculty of Medicine and Pharmacy Cadi Ayad University Marrakech Morocco

Background: Urinary tract infection (UTI) is one of the most frequent bacterial infections in pediatrics. The aim of our work was to establish the epidemiological and bacteriological profile of UTIs in children and then to study the sensitivity of the bacterial strains isolated to antibiotics. Materials and methods: This is a retrospective descriptive study over 3 years (2019-2022), including all cytobacteriological examination of urine (CBEU), performed in children aged 3 months to 14 years, admitted and treated for UTI, in the pediatric emergency department of Mohamed VI University Hospital. Results: A total of 239 children were included in our study. The mean age was 26 months. The sex ratio was 1.08. Escherichia coli was the most isolated bacterial strain in 79% of samples. The tested strains showed a high level of sensitivity to susceptibility rate toward amikacin (91%) and ciprofloxacin (100%) and whereas the level of resistance was high to the most current recommended antibiotics, mainly beta-lactams. Management was based, in severe forms of pyelonephritis, dual antibiotic therapy based on Third-generation cephalosporins combined with gentamycin. Favorable outcome was noted in 94% of children. Conclusion: Awareness-raising on the proper use of antibiotics, issuing national recommendations for the treatment of urinary tract infections in order to standardize therapeutic regimens is strongly recommended. Effective control of these infections requires a global prevention strategy that implies close collaboration between epidemiologists, clinicians, bacteriologists, hygienists and the health care team.

关键词： Child Urinary Tract Infection Bacteria Antibiotics Resistances

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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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Clinical and historical features of emergency department patients with pericardial effusions

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世界急诊医学杂志(英文) 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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Potential impact of early physiotherapy in the emergency department for non-traumatic neck and back pain

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世界急诊医学杂志(英文) 2017年第2期8卷 110-115页

作者： Pothiawala Sohil Pua Yong Hao Leong Mark department of Emergency Medicine Singapore General Hospital Singapore department of Physiotherapy Singapore GeneralHospital Singapore

BACKGROUND: Musculoskeletal complaints, especially non-traumatic neck and back pain, are routinely encountered in the emergency department(ED) and lead to ED overcrowding, a burgeoning wait time for physiotherapy and outpatient orthopedic reviews. The study aimed to evaluate the impact of early physiotherapy evaluation and treatment(EPET) vs. standard care(SC) on clinical outcomes for patients presenting to the ED with non-traumatic neck and back ***: A retrospective observational study of 125 patients who presented to the ED with non-traumatic neck and back pain with/without peripheral symptoms from July 2010 to February 2011. Neck Disability Index(NDI), Modifi ed Oswestry Low Back Pain Disability Questionnaire(MODI) and 11-point Numeric Pain Rating Scale were used as outcome measures and compared between groups at a mean of 34 days from their initial ED ***: We identifi ed a total of 125 patients. EPET group comprised 62 patients(mean age, 45 years; men, 63%) and SC group comprised 63 patients(mean age, 45 years; men, 43%). The EPET and SC groups received physiotherapy at a median of 4 and 34 days respectively from their fi rst ED visit. EPET patients had signifi cantly lower levels of disability(9.0% vs. 33.4%, Welch t-test, P<0.001) and pain(median value, 1 vs. 4 points, Mann-Whitney U-test, P<0.001) compared with SC ***: Early access to physiotherapy in ED was associated with reduced pain and disability levels. EPET protocol can potentially decrease the demand on outpatient orthopedic services, thereby freeing up available resources to treat patients who are more likely to benefi t from it.

关键词： Physiotherapy Emergency department Non-traumatic neck and back pain

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COVID-19:Masks do not influence neurocognitive performance during a shift at the emergency department

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World Journal of Emergency Medicine 2023年第4期14卷 317-321页

作者： Jürgen Grafeneder Verena Fuhrmann Katharina Tscherny Maximilian Niederer Wolfgang Schreiber Harald Herkner Dominik Roth Calvin Lukas Kienbacher department of Emergency Medicine Medical University of ViennaWien 1090Austria department of Anaesthesiology and Intensive Care Hospital ScheibbsScheibbs 3270Austria

The COVID-19 pandemic has led to the widespread mandatory use of personal protective equipment(PPE),including filtering face pieces(FFP).Emergency medical care providers now commonly use this equipment.

关键词： COV Mask protective

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Epidemiology of burns and scalds in children presenting to the emergency department of a regional burns unit: a 7-year retrospective study

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Burns & Trauma 2016年第3期4卷 245-250页

作者： Ceri Elisabeth Battle Vanessa Evans Karen James Katherine Guy Janet Whitley Phillip Adrian Evans department of Emergency Medicine NISCHR Haemostasis Biomedical Research UnitMorriston HospitalSwanseaUK department of Physiotherapy Morriston HospitalSwanseaUK department of Emergency Medicine NISCHR Haemostasis Biomedical Research UnitMorriston HospitalSwanseaUK department of Physiotherapy Morriston HospitalSwanseaUK department of Emergency Medicine Morriston HospitalSwanseaWales SA66NLUK

Background:Variation in the incidence and mechanism of thermal injury has been reported in different age groups in *** aim of this study was to report the incidence,mechanisms,and environmental factors of all burns presentations to the emergency department(ED)of a regional burns centre over a 7-year ***:A retrospective,chart review study of all burns presentations to the ED of a regional burns centre in South Wales was *** children recorded as having sustained a burn or scald,aged less than 16 years were included in the ***’demographics were analysed using descriptive statistics,and comparisons were made between patients aged less than 5 and patients aged 5-16 using chi-square test and Mann-Whitney U ***:A total of 1387 cases were included in the final *** were the most common thermal injury with 569(41.0%)reported,followed by contact burns in 563(40.6%)*** patients requiring hospitalisation were significantly younger(2 vs 3 years;p<0.001)and had a higher rate of non-accidental injury(10 vs 4;p<0.001).The most commonly injured site in both age groups was a hand or ***:Scalds and contact burns were the most commonly reported thermal injury in children aged less than *** mechanisms were hot beverages,hobs and hair straighteners,highlighting further burn prevention strategies are needed and good-quality prospective studies that investigate the effectiveness of such strategies.

关键词： Burns epidemiology Paediatrics 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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The Emergency department Crash Cart: A systematic review and suggested contents

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World Journal of Emergency Medicine 2018年第2期9卷 93-98页

作者： Gabrielle A.Jacquet Bachar Hamade Karim A.Diab Rasha Sawaya Gilbert Abou Dagher Eveline Hitti Jamil D.Bayram department of Emergency Medicine Boston University School of Medicine Center for Global Health and Development Boston University School of Public Health department of Critical Care Medicine University of Pittsburgh Medical Center department of Pediatrics Rush University Medical Center department of Emergency Medicine American University of Beirut Medical Center

BACKGROUND: As the field of Emergency Medicine grows worldwide, the importance of an Emergency department Crash Cart(EDCC) has long been recognized. Yet, there is paucity of relevant peer-reviewed literature specifically discussing EDCCs or proposing detailed features for an EDCC suitable for both adult and pediatric patients. METHODS: The authors performed a systematic review of EDCC-specific literature indexed in Pubmed and Embase on December 20, 2016. In addition, the authors reviewed the 2015 American Heart Association(AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, the 2015 European Resuscitation Council(ERC) guidelines for resuscitation, and the 2013 American College of Surgeons(ACS) Advanced Trauma Life Support(ATLS) 9 th ***: There were a total of 277 results, with 192 unique results and 85 duplicates. After careful review by two independent reviewers, all but four references were excluded. None of the four included articles described comprehensive contents of equipment and medications for both the adult and pediatric populations. This article describes in detail the final four articles specific to EDCC, and proposes a set of suggested contents for the EDCC. CONCLUSION: Our systematic review shows the striking paucity of such a high impact indispensable item in the ED. We hope that our EDCC content suggestions help enhance the level of response of EDs in the resuscitation of adult and pediatric populations, and encourage the implementation of and adherence to the latest evidence-based resuscitation guidelines.

关键词： Resuscitation Crash cart Emergency department

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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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Presenting patterns of dermatology conditions to an Australian emergency department

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World Journal of Emergency Medicine 2020年第2期11卷 74-78页

作者： Emily Shao Chantelle Judge Erin McMeniman Tina Bazianas Rob Eley Emergency department Princess Alexandra HospitalBrisbaneAustralia Faculty of Medicine University of QueenslandBrisbaneAustralia Dermatology department Princess Alexandra HospitalBrisbaneAustralia

BACKGROUND: Approximately 5%–8% of emergency department(ED) presentations are due to a dermatological *** study aimed to identify and characterise patients with skin conditions presenting to a busy ***: A 5-year retrospective study on patients with dermatological conditions presenting to the Princess Alexandra Hospital ED in Brisbane, Australia was *** medical records were used to compare demographics and admission status of the dermatology group and the total ED group presentations.A prospective survey was conducted on low priority triage(triage 4 and 5) patients identifying reasons presenting to the ***: Of a total 281,718 ED presentations, 11,748 dermatology presentations were identified between January 2012 to December *** the dermatology presentations, 41.5% were female and had an average age of *** most common dermatology presentations were cellulitis, abscess, rash unspecified, and *** those admitted, 36% were female, average age was 53, mean length of stay of 294 minutes and 83.1% had an infectious *** triage 4 and 5 presentations, 66% patients we approached had been seen by a health practitioner prior to coming to the ***: Within the population presenting with a skin related condition to the Princess Alexandra Hospital ED, characteristics associated with admission include male sex, older age, and an infectious *** data may help ED clinicians decide on the discharge disposition of these *** may be a role for streamlined admissions for skin related infections, or improved hospital in the home services to support this group.

关键词： Pcellulitis Skin Dermatology Emergency department

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