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Evaluation of hand infections in the emergency department using point-of-care ultrasound

World Journal of emergency medicine 2024年第4期15卷 283-288页

作者： David Ahmad Haidar David Mintz Brandon M Wubben Omar Rizvi Srikar Adhikari Department of emergency medicine Michigan MedicineAnn Arbor 48109-1382USA University of Arizona college of medicine Tucson 85724USA Department of emergency medicine University of IowaIowa City 52242-1009USA Department of Surgery University of Arizona College of MedicineTucson 85724USA Department of emergency medicine University of Arizona College of MedicineTucson 85724USA

BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient ***:We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections(SSTI)of the hand between December 2015 and December *** trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the *** then reviewed patients’electronic health records(EHR)for demographic characteristics,history,physical examination findings,ED course,additional imaging studies,consultations,impact of POCUS on patient care and final ***:We included a total of 50 cases(28 male,22 female)in the final *** most common presenting symptoms and exam findings were pain(100%),swelling(90%),and erythema(74%).The most common sonographic findings were edema(76%),soft tissue swelling(78%),and fluid surrounding the tendon(57%).POCUS was used in medical decision making 68%of the time(n=34),with the use of POCUS leading to changes in management 38%of the time(n=19).POCUS use led to early antibiotic use(11/19),early consultation(10/19),and led to the performance of a required procedure(8/19).The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times,abscess 12/16 times,and cellulitis 14/20 ***:POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.

关键词： Ultrasound Point-of-care ultrasound Cellulitis Abscess Flexor tenosynovitis

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Performance of the EDACS-ADP incorporating high-sensitivity troponin assay:Do components of major adverse cardiac events matter?

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World Journal of emergency medicine 2024年第3期15卷 175-180页

作者： Yedalm Yoo Shin Ahn Bora Chae Won Young Kim Department of emergency medicine Asan Medical CenterUniversity of Ulsan College of MedicineSeoul 05505Republic of Korea

BACKGROUND:The accelerated diagnostic protocol(ADP)using the emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin *** study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and II,respectively).METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was *** performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive ***:Of the 1,304 patients prospectively enrolled,399(30.6%;95%confidence interval[95%CI]:27.7%–33.8%)were considered low-risk using the *** them,the rates of MACE I and II were 1.3%(5/399)and 1.0%(4/399),*** EDACS-ADP showed sensitivities and negative predictive values of 98.8%(95%CI:97.2%–99.6%)and 98.7%(95%CI:97.0%–99.5%)for MACE I and 98.7%(95%CI:96.8%–99.7%)and 99.0%(95%CI:97.4%–99.6%)for MACE II,***:EDACS-ADP could help identify patients as safe for early ***,when unstable angina was added to the outcome,the 30-day MACE rate among the designated lowrisk patients remained above the level acceptable for early discharge without further evaluation.

关键词： Chest pain Major adverse cardiac event Acute coronary syndrome emergency department

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Utilization of biomarkers for the prognostic prediction of cardiac arrest survivors using a multi-modal approach

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World Journal of emergency medicine 2024年第2期15卷 131-134页

作者： Changshin Kang Yeonho You Jung Soo Park Byeong Kwon Park Jae Kwang Lee Byung Kook Lee Department of emergency medicine College of MedicineChungnam National UniversityDaejeon 35015Republic of Korea Department of emergency medicine Chungnam National University HospitalDaejoen 35015Republic of Korea Department of emergency medicine Konyang University HospitalCollege of MedicineDaejeon 35015Republic of Korea Department of emergency medicine Chonnam National University Medical SchoolChonnam National University HospitalGwangju 61469Republic of Korea

International guidelines for post-cardiac arrest care recommend using multi-modal strategies to avoid the withdrawal of life-sustaining therapy(WLST)in patients with the potential for neurological recovery.[1]However,a clear methodology for multi-modal approaches has yet to be ***-specific enolase(NSE)is currently the only recommended biomarker,and the European Resuscitation Council(ERC)and the European SocietyofIntensiveCaremedicine(ESICM)have proposed a cutoff value of 60μg/L at 48 and/or 72 h after the return of spontaneous circulation(ROSC)as a multimodal prognostic tool for predicting poor neurological outcomes.

关键词： cardiac modal return

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Self-adhesive pads in defi brillation or cardioversion: risks due to unfamiliarity and recommendations

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World Journal of emergency medicine 2024年第1期15卷 64-66页

作者： Hansol Chung Department of emergency medicine Yeungnam University College of MedicineDaegu 42415Republic of Korea

During cardiopulmonary resuscitation(CPR),defibrillation,or cardioversion,the use of self-adhesive pads instead of conventional paddles has gradually become *** particular,it was recommended during the COVID-19 pandemic,as it allows defibrillation or cardioversion to be performed without close contact between the rescuer and patient.[1,2]Self-adhesive pads can minimize the downtime of chest compressions before and after defibrillation and protect the patient from electric arc formation,skin burns,and fi *** the pads are attached,electrocardiographic rhythm analysis,defibrillation,synchronous cardioversion,and cardiovascular support are all *** paddles,self-adhesive pads can save time because the application of conductive jelly,repeated positioning,and application of 10-12 kg of pressure on the chest are not *** European Resuscitation Council(ERC)Guidelines 2021 state that the use of self-adhesive pads is recommended in advanced cardiovascular life support(ACLS).[3]Nevertheless,some medical staff still tend to prefer the use of conventional paddles instead of self-adhesive pads in hospitals.

关键词： attached cardio conductive

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Protective mechanism of quercetin in alleviating sepsis-related acute respiratory distress syndrome based on network pharmacology and in vitro experiments

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World Journal of emergency medicine 2024年第2期15卷 111-120页

作者： Weichao Ding Wei Zhang Juan Chen Mengmeng Wang Yi Ren Jing Feng Xiaoqin Han Xiaohang Ji Shinan Nie Zhaorui Sun Department of emergency medicine Jinling HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjing 210002China Department of emergency medicine Jinling Clinical Medical College of Nanjing University of Chinese MedicineNanjing 210002China Department of emergency medicine the Affiliated Hospital of Xuzhou Medical UniversityXuzhou 221002China Department of emergency medicine Xuzhou Municipal Hospital Affiliated to Xuzhou Medical UniversityXuzhou 221000China

BACKGROUND:Sepsis-related acute respiratory distress syndrome(ARDS)has a high mortality rate,and no effective treatment is available *** is a natural plant product with many pharmacological activities,such as antioxidative,anti-apoptotic,and anti-inflammatory *** study aimed to elucidate the protective mechanism of quercetin against sepsis-related ***:In this study,network pharmacology and in vitro experiments were used to investigate the underlying mechanisms of quercetin against sepsis-related *** targets and signaling pathways of quercetin against sepsis-related ARDS were screened and were verified by in vitro ***:A total of 4,230 targets of quercetin,360 disease targets of sepsis-related ARDS,and 211 intersection targets were obtained via database *** the 211 intersection targets,interleukin-6(IL-6),tumor necrosis factor(TNF),albumin(ALB),AKT serine/threonine kinase 1(AKT1),and interleukin-1β(IL-1β)were identified as the core targets.A Gene Ontology(GO)enrichment analysis revealed 894 genes involved in the inflammatory response,apoptosis regulation,and response to *** Encyclopedia of Genes and Genomes(KEGG)enrichment analysis identified 106 *** eliminating and generalizing,the hypoxia-inducible factor-1(HIF-1),TNF,nuclear factor-κB(NF-κB),and nucleotide-binding and oligomerization domain(NOD)-like receptor signaling pathways were *** docking revealed that quercetin had good binding activity with the core ***,quercetin blocked the HIF-1,TNF,NF-κB,and NODlike receptor signaling pathways in lipopolysaccharide(LPS)-induced murine alveolar macrophage(MH-S)*** also suppressed the inflammatory response,oxidative reactions,and cell ***:Quercetin ameliorates sepsis-related ARDS by binding to its core targets and blocking the HIF-1,TNF,NF-κB,and NOD-like receptor signaling pathways to reduce inflammation,cell apoptosis,and oxidative

关键词： Quercetin Sepsis-related acute respiratory distress syndrome Network pharmacology

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A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study

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World Journal of emergency medicine 2024年第1期15卷 16-22页

作者： Jing Yang Hanqi Tang Shihuan Shao Feng Xu Yangyang Fu Shengyong Xu Chen Li Yan Li Yang Liu Joseph Harold Walline Huadong Zhu Yuguo Chen Xuezhong Yu Jun Xu emergency Department State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China emergency Department Peking University People’s HospitalBeijing 100044China Department of emergency and Chest Pain Center Shandong Provincial Clinical Research Center for Emergency and Critical Care MedicineKey Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceQilu Hospital of Shandong UniversityJinan 250012China emergency Department Beijing Jishuitan HospitalBeijing 100035China emergency Department Tianjin Medical University General HospitalTianjin 300052China Department of emergency medicine Penn State Health Milton S.Hershey Medical Center and Penn State College of MedicineHershey 17033USA

BACKGROUND:Unsustained return of spontaneous circulation(ROSC)is a critical barrier to survival in cardiac arrest *** study examined whether end-tidal carbon dioxide(ETCO_(2))and pulse oximetry photoplethysmogram(POP)parameters can be used to identify unsustained ***:We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to ***’general information,ETCO_(2),and POP parameters were collected and statistically ***:The included 105 ROSC episodes(from 80 cardiac arrest patients)comprised 51 sustained ROSC episodes and 54 unsustained ROSC *** 24-hour survival rate was significantly higher in the sustained ROSC group than in the unsustained ROSC group(29.2%vs.9.4%,P<0.05).The logistic regression analysis showed that the difference between after and before ROSC in ETCO_(2)(ΔETCO_(2))and the difference between after and before ROCS in area under the curve of POP(ΔAUCp)were independently associated with sustained ROSC(odds ratio[OR]=0.931,95%confi dence interval[95%CI]0.881-0.984,P=0.011 and OR=0.998,95%CI 0.997-0.999,P<0.001).The area under the receiver operating characteristic curve ofΔETCO_(2),ΔAUCp,and the combination of both to predict unsustained ROSC were 0.752(95%CI 0.660-0.844),0.883(95%CI 0.818-0.948),and 0.902(95%CI 0.842-0.962),***:Patients with unsustained ROSC have a poor *** combination ofΔETCO_(2) andΔAUCp showed signifi cant predictive value for unsustained ROSC.

关键词： Return of spontaneous circulation Pulse oximetry photoplethysmogram End-tidal carbon dioxide Cardiac arrest Cardiopulmonary resuscitation

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Glucose metabolic reprogramming-related parameters for the prediction of 28-day neurological prognosis and all-cause mortality in patients after cardiac arrest:a prospective single-center observational study

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World Journal of emergency medicine 2024年第3期15卷 197-205页

作者： Subi Abudurexiti Shihai Xu Zhangping Sun Yi Jiang Ping Gong Department of emergency medicine Ruijin Hospital Affi liated to Shanghai Jiaotong University School of MedicineShanghai 200025China Department of emergency medicine Shenzhen People's Hospital(the Second Clinical Medical CollegeJinan Universitythe First Affi liated HospitalSouthern University of Science and Technology)Shenzhen 518020China Department of emergency medicine the First Affi liated Hospital of Dalian Medical UniversityDalian 116011China Department of emergency medicine General Hospital of Tianjin Medical UniversityTianjin 300052China

BACKGROUND:We aimed to observe the dynamic changes in glucose metabolic reprogrammingrelated parameters and their ability to predict neurological prognosis and all-cause mortality in cardiac arrest patients after the restoration of spontaneous circulation(ROSC).METHODS:Adult cardiac arrest patients after ROSC who were admitted to the emergency or cardiac intensive care unit of the First Aflliated Hospital of Dalian Medical University from August 1,2017,to May 30,2021,were *** to 28-day survival,the patients were divided into a non-survival group(n=82) and a survival group(n=38).Healthy adult volunteers(n=40) of similar ages and sexes were selected as *** serum levels of glucose metabolic reprogrammingrelated parameters(lactate dehydrogenase [LDH],lactate and pyruvate),neuron-specific enolase(NSE) and interleukin 6(IL-6) were measured on days 1,3,and 7 after *** Acute Physiology and Chronic Health Evaluation II(APACHE II) score and Sequential Organ Failure Assessment(SOFA) score were *** Cerebral Performance Category(CPC) score was recorded on day 28 after ***:Following ROSC,the serum LDH(607.0 U/L vs.286.5 U/L),lactate(5.0 mmol/L vs.2.0 mmol/L),pyruvate(178.0 μmol/L vs.70.9 μmol/L),and lactate/pyruvate ratio(34.1 vs.22.1) significantly increased and were higher in the non-survivors than in the survivors on admission(all P<0.05).Moreover,the serum LDH,pyruvate,IL-6,APACHE II score,and SOFA score on days 1,3 and 7 after ROSC were significantly associated with 28-day poor neurological prognosis and 28-day all-cause mortality(all P<0.05).The serum LDH concentration on day 1 after ROSC had an area under the receiver operating characteristic curve(AUC) of 0.904 [95% confidence interval [95% CI]:0.851–0.957]) with 96.8% specificity for predicting 28-day neurological prognosis and an AUC of 0.950(95% CI:0.911–0.989) with 94.7% specificity for predicting 28-day all-cause mortality,which was the highest among the glucose metabo

关键词： Glucose metabolic reprogramming Lactate dehydrogenase Cardiac arrest Prognosis

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Phrenic nerve block: the key to managing acute biliary pain?

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World Journal of emergency medicine 2024年第1期15卷 62-63页

作者： Michael Shalaby Joshua Luftig Department of emergency medicine and Critical Care Herbert Wertheim College of Medicine at Florida International UniversityMiami 33199USA Advanced emergency Ultrasound Mount Sinai Medical CenterMiami Beach 33140USA Department of emergency medicine Highland HospitalAlameda Health SystemOakland 94602USA

Over the past two decades,the USA has witnessed a steep rise in the incidence of acute cholecystitis(AC),[1]even among children,[2]with over 200,000 cases annually.[3]Patients with AC often present to the emergency department(ED)experiencing severe distress,with most describing their pain level as“intolerable.”[4]Furthermore,there is usually a considerable delay before surgery,with a median time from diagnosis of AC to surgery of 28.5 h,[5]and a substantial percentage of patients wait as long as 10 d.[6]Prolonged delays before surgery lead to increased opioid use,which is associated with extended hospital stays and higher rates of readmission after cholecystectomy.[7]Furthermore,opioids can lead to vomiting,respiratory depression,delirium,and ultimately addiction.[8]We propose a novel regional anesthesia technique for managing AC:right phrenic nerve *** method could offer improved pain control and a more favorable risk profile in selected patients when compared to current ED practices.

关键词： pain anesthesia diagnosis

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Loculated pericardial hematoma diagnosed with point-of-care ultrasound

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World Journal of emergency medicine 2024年第3期15卷 241-242页

作者： Joaquín Valle Alonso Esther Montoro Leandro Noblia emergency Department Royal Bournemouth HospitalBournemouth 14450UK emergency Department Hospital Santa LuciaCartagena 30202Spain

Pericardial hematoma is a rare but potentially lifethreatening consequence following cardiac surgery that requires prompt recognition and *** can present with symptoms such as chest pain,dyspnea,tachycardia,and hypotension,which may mimic other post-operative *** pericardial hematoma compressing the atria might be difficult to *** and hematoma are more common in patients receiving early anticoagulant therapy.A focused cardiac ultrasound (Fo CUS) plays a pivotal role in the diagnosis,revealing the presence of pericardial effusion and signs of cardiac *** aim of this report was to provide a prompt diagnosis of loculated pericardial hematoma via Fo CUS in the emergency department (ED).

关键词： hematoma diagnosis cardiac

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Efficacyand Safetyof Huashi Baidu Granules in Treating Patients with SARS-CoV-2Omicron Variant: A Single-Center Retrospective Cohort Study

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Chinese Journal of Integrative medicine 2024年第2期30卷 107-114页

作者： CHEN Cai-yu ZHANG Wen XU Xiang-ru PU Yu-ting TU Ya-dan PENG Wei YAO Xuan ZHOU Shuang FANG Bang-jiang Department of emergency Longhua HospitalShanghai University of Traditional Chinese MedicineShanghai(200032)China Department of Classical Traditional Chinese medicine Chongqing Hospital of Traditional Chinese MedicineChongqing(400021)China Acupuncture and Massage college Shanghai University of Traditional Chinese MedicineShanghai(201203)China Institute of emergency and Critical Care medicine Shanghai University of Traditional Chinese MedicineShanghai(200032)China

Objective:To evaluate the efficacy and safety of Huashi Baidu Granules(HSBD)in treating patients with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron ***:A single-center retrospective cohort study was conducted during COVID-19 Omicron epidemic in the Mobile Cabin Hospital of Shanghai New International Expo Center from April 1st to May 23rd,*** COVID-19 patients with asymptomatic or mild infection were assigned to the treatment group(HSBD users)and the control group(non-HSBD users).After propensity score matching in a 1:1 ratio,496 HSBD users of treatment group were matched by propensity score to 496 non-HSBD *** in the treatment group were administrated HSBD(5 g/bag)orally for 1 bag twice a day for 7 consecutive *** in the control group received standard care and routine *** primary outcomes were the negative conversion time of nucleic acid and negative conversion rate at day *** outcomes included the hospitalized days,the time of the first nucleic acid negative conversion,and new-onset symptoms in asymptomatic *** events(AEs)that occurred during the study were *** subgroup analysis was conducted in vaccinated(378 HSBD users and 390 non-HSBD users)and unvaccinated patients(118 HSBD users and 106 non-HSBD users).Results:The median negative conversion time of nucleic acid in the treatment group was significantly shortened than the control group[3 days(IQR:2-5 days)vs.5 days(IQR:4-6 days);P<0.01].The negative conversion rate of nucleic acid in the treatment group were significantly higher than those in the control group at day 7(91.73%vs.86.90%,P=0.014).Compared with the control group,the hospitalized days in the treatment group were significantly reduced[10 days(IQR:8-11 days)vs.11 days(IQR:10.25-12 days);P<0.01].The time of the first nucleic acid negative conversion had significant differences between the treatment and control groups[3 days(IQR:2-4 days)vs.5 days(IQR:

关键词： Huashi Baidu Granule severe acute respiratory syndrome coronavirus 2 Omicron variant retrospective cohort trial Chinese medicine

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