Hasil untuk "Medical emergencies. Critical care. Intensive care. First aid"

Fatemeh Rezabeigi Davarani, Hamid Sharif-Nia, Mahmood Nekoei-Moghadam et al.

Abstract Introduction Earthquakes may lead to fatalities and property loss often due to lack of preparedness among individuals. This study aimed to develop and assess the psychometric properies of a Household Preparedness for Earthquake Hazards Questionnaire (HPE-Q). Methods This study utilized a mixed-methods approach comprising of both qualitative and quantitative methods. The qualitative phase concentrated on item generation through semi-structured interviews conducted with Iranian households selected via purposive sampling, alongside a systematic literature review to develop a comprehensive item pool for evaluating household preparedness for earthquake hazards. The quantitative phase focused on item reduction and the assessment of the face, content, and construct validity. To evaluate the reliability of the questionnaire Cronbach’s alpha and intraclass correlation coefficients (ICC) were calculated. Results The initial item pool comprised 88 potential items. Face validity, content validity, and item analysis evaluation was performed and the number of items was reduced to 61. Exploratory Factor Analysis (EFA) further pruned the instrument by eliminating 24 items and Confirmatory Factor Analysis (CFA) mandated the removal of 1 item resulting in a finalized 36-item HPE-Q anchored by 7 main factors: knowledge, self-efficacy, social support, social participation, collective efficacy, protective motivation and behavioral intention. Cronbach’s alpha was 0.92 and Interclass Correlation Coefficient (ICC) of the total score was 0.93. Conclusion Household preparedness for earthquakes is shaped by numerous factors that can either facilitate or impede preparedness and these factors may differ across communities and households. This questionnaire can help identify key aspects of households’ preparedness for earthquakes.

Sireesha Chilakapati, Jyothi Koteswara Rao, Bharat Paliwal

Abstract We commend the authors for their insightful study on inspiratory muscle training (IMT) in mechanically ventilated patients with difficult weaning, highlighting the robust use of maximum inspiratory pressure (MIP) as a key outcome. We suggest that a lower baseline maximum inspiratory pressure cutoff could better target patients with significant inspiratory dysfunction, improving the study's precision. Additionally, alternative imputation techniques, such as multiple imputation, could strengthen the handling of missing data. While the sample size calculation was appropriate, the unbalanced group sizes raise concerns about generalisability. Future research could benefit from subgroup analyses, individual response curves, and further investigation into the unexpected adverse effects observed in the low-intensity group to refine the inspiratory muscle training protocols.

Ahmet Kutur, Mehmet Şam

Objective: Acute pancreatitis (AP) is a common disease of the gastrointestinal tract. Gallstones are the most common cause of AP etiology. Most prognosis scoring systems are non-practical in emergency departments (EDs). Harmless acute pancreatitis score (HAPS) is a scoring system that is easily used for detecting non-severe AP (SAP). Materials and Methods: In this study, patients aged >18 years and with International Classification of Diseases code K85 were retrospectively reviewed. After excluding trauma, recurrent pancreatitis, and cancer, 150 patients were included in the study. First, all patients were divided into two groups; HAPS0 and HAPS+. Radiological examination, necrosis, need for intensive care unit, mortality rates, and hospitalization durations of HAPS0 and HAPS+ were compared. Then, we calculated the HAPS and Ranson score (RS) for all patients and compared their odds ratio (OR). Results: Of all patients, 58.5% were male. Biliary pancreatitis was observed in 72% of HAPS0 patients and 66.2% of HAPS+ patients. There was no in-hospital mortality in the HAPS0 group. ORs were 4.229 and 0.885 for HAPS and the RS, respectively. Conclusion: HAPS can be useful for discriminating between non-severe and SAP at the ED.

Stephanie Bonne, Rochelle Dicker

Thijs A. Lilien, Dominic W. Fenn, Paul Brinkman et al.

Abstract Background Exhaled volatile organic compounds (VOCs), particularly hydrocarbons from oxidative stress-induced lipid peroxidation, are associated with hyperoxia exposure. However, important heterogeneity amongst identified VOCs and concerns about their precise pathophysiological origins warrant translational studies assessing their validity as a marker of hyperoxia-induced oxidative stress. Therefore, this study sought to examine changes in VOCs previously associated with the oxidative stress response in hyperoxia-exposed lung epithelial cells. Methods A549 alveolar epithelial cells were exposed to hyperoxia for 24 h, or to room air as normoxia controls, or hydrogen peroxide as oxidative-stress positive controls. VOCs were sampled from the headspace, analysed by gas chromatography coupled with mass spectrometry and compared by targeted and untargeted analyses. A secondary analysis of breath samples from a large cohort of critically ill adult patients assessed the association of identified VOCs with clinical oxygen exposure. Results Following cellular hyperoxia exposure, none of the targeted VOCs, previously proposed as breath markers of oxidative stress, were increased, and decane was significantly decreased. Untargeted analysis did not reveal novel identifiable hyperoxia-associated VOCs. Within the clinical cohort, three previously proposed breath markers of oxidative stress, hexane, octane, and decane had no real diagnostic value in discriminating patients exposed to hyperoxia. Conclusions Hyperoxia exposure of alveolar epithelial cells did not result in an increase in identifiable VOCs, whilst VOCs previously linked to oxidative stress were not associated with oxygen exposure in a cohort of critically ill patients. These findings suggest that the pathophysiological origin of previously proposed breath markers of oxidative stress is more complex than just oxidative stress from hyperoxia at the lung epithelial cellular level.

Ana Paula Agnolon Praça, RN, MSc, Antônio Paulo Nassar Junior, MD, PhD, Alexandre Miras Ferreira, RN et al.

IMPORTANCE AND OBJECTIVES:. To compare the 18-month survival between patients with newly diagnosed cancer discharged home after early unplanned ICU admission and those without early unplanned ICU admission; we also evaluated the frequency and risk factors for early unplanned ICU admission. DESIGN:. Observational study with prospectively collected data from September 2019 to June 2021 and 18 months follow-up. SETTING:. Single dedicated cancer center in São Paulo, Brazil. PARTICIPANTS:. We screened consecutive adults with suspected cancer and included those with histologically proven cancer from among 20 highly prevalent cancers. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. The exposure was early unplanned ICU admission, defined as admission for medical reasons or urgent surgery during the first 6 months after cancer diagnosis. The main outcome was 18-month survival after cancer diagnosis, and the main analysis was Cox’s proportional hazards model adjusted for confounders and immortal time bias. Propensity score matching was used in the sensitivity analysis. We screened 4738 consecutive adults with suspected cancer and included 3348 patients. Three hundred twelve (9.3%) had early unplanned ICU admission, which was associated with decreased 18-month survival both in the unadjusted (hazard ratio, 4.03; 95% CI, 2.89–5.62) and adjusted (hazard ratio, 1.84; 95% CI, 1.29–2.64) models. The sensitivity analysis confirmed the results because the groups were balanced after matching, and the 18-month survival of patients with early ICU admission was lower compared with patients without early ICU admission (87.0% vs. 93.9%; p = 0.01 log-rank test). Risk factors for early unplanned ICU admission were advanced age, comorbidities, worse performance status, socioeconomic deprivation, metastatic tumors, and hematologic malignancies. CONCLUSIONS:. Patients with newly diagnosed cancer discharged home after early unplanned ICU admission have decreased 18-month survival compared with patients without early unplanned ICU admission.

D. L. Fetlam, A. G. Chumachenko, M. D. Vyazmina et al.

The mortality rate among patients with acute suppurative lung diseases (ASLD) in the ICU reaches 30%. Early, pathogenetically relevant biomarkers are needed to ensure personification and better efficacy of ASLD treatment. Numeric variations in the counts of immune system cells in patient’s blood can be viewed as such candidate biomarkers.The aim of the study. Identification of potential markers predicting ASLD outcome after community-acquired pneumonia and COVID-19.Materials and methods. The study included 216 in-hospital patients aged 18-87 with ASLD after community-acquired pneumonia with (N=81) and without (N=135) COVID-19 history.Results. Patients survival after COVID-19 was linked to lymphocyte count on Day 1 of hospital stay (hazard ratio, HR=5.9 95%CI 0.9–37.4; P=0.0188, log-rank test). In patients who had not have COVID-19, a difference in survival was associated with lymphocyte (HR=2.9 95%CI 1.0–8.4; P=0.0184, log-rank test; N=135), and monocyte counts (HR=2.7 95% CI 0.8–9.5; P=0.0196, log-rank test) on Day 1 of hospital stay. Patients’ survival after COVID-19 infection depended on SII (systemic immune-inflammation index. HR=9.3 95%CI 1.7–49.8; P=0.0124, log-rank test; N=81, SIRI (systemic inflammatory response index, HR=7.2 95%CI 1.4–36.6; P=0.0339, log-rank test; N=81) and NLR (neutrophil-to-lymphocyte ratio, HR=9.6 95%CI 1.8–52.0; P=0.0108; log-rank test; N=81) values on Day 1 of hospital stay. In patients who did not have COVID-19 SII values had no influence on survival.Conclusion. The lymphocyte count makes it possible to predict outcomes of pleural empyema, regardless of patient’s history of COVID-19, i. e. a decrease in the lymphocyte count below 1.2×10⁹ in 1 L is associated with fatal outcome. Monocyte count carries prognostic information for cases of pleural empyema without previous COVID-19 infection. As for the relative indicators, SIRI, SII and NLR values measured on Day 1 in the hospital were predictors of ASLD outcome only in patients after COVID-19 infection, i. e., higher values were associated with increased risk of death, with NLR index being the most informative. Overall severity of illness above 10 scores by CIRS was associated with an unfavorable ASLD outcome, regardless of patient’s history of COVID-19.

Sarah Russell, Nancy Jacobson, Ashley Pavlic

Introduction: Previous studies have shown that patients in the emergency department (ED) are frequently given incomplete discharge instructions that are written at least four grade levels above the recommended sixth-grade reading level, leading to poor understanding. Our aims in this study were to implement standardized discharge instructions containing six key components written at a more appropriate reading level for common emergency department (ED) diagnoses to improve patient understanding. Methods: We conducted this study in a 20-bed ED at an urban Veteran’s Administration hospital. Data was collected via in-person patient and clinician interviews. Patient interviews were conducted after patients received their discharge instructions. We compared patient responses to clinician responses and marked them as incorrect, partially correct, or correct with a score of 0, 0.5, or 1, respectively. The maximum possible score for each interview was six. Six key components of discharge instructions were asked about: diagnosis; new medications; at-home care; duration of illness; reasons to return; and follow-up. There were 25 patients in the pre-intervention group and 20 in the intervention group with the standardized set of instructions. We performed a Mann-Whitney U test on the total interview scores in the control and intervention groups and conducted a sub-analysis on the individual scores for each of the six key components. Results: The patients in the intervention demonstrated a statistically significant increase in patient-clinician correlation when compared to the patients in the pre-intervention group overall (P < 0.05), and two of the six key components of the discharge instructions individually showed statistically significant increase in patient-clinician correlation when standardized discharge instructions were used. Conclusion: Patients who received the standardized discharge instructions had improved understanding of their discharge instructions. Future opportunities extending off this pilot study include expanding the number of diagnoses for which standardized instructions are used and investigating patient-centered outcomes related to these instructions.

Emergency Medicine International

Kedir Abdureman Hassen, Micheal Alemayehu Nemera, Andualem Wubetie Aniley et al.

Introduction. Mechanical ventilation (MV) is a backbone and major supportive modality in intensive care units (ICUs) even though it has side effects and complications. Knowledge of nurses about mechanical ventilators and good practice of nursing care for the ventilated patient plays a crucial role in improving the effectiveness of mechanical ventilation, preventing harm, and optimizing the patient outcome. This study intended to assess the knowledge regarding MV and the practice of ventilator care among nurses working in the ICU. Method. A descriptive cross-sectional study design was conducted. All nurses working in the intensive care unit of selected governmental hospitals were included in the study. The data were collected from March 1 to 30, 2021 with structured and pretested self-administered questionnaires. The collected data were evaluated with SPSS version 26 software. The variables, which have an independent association with poor outcomes, were identified based on OR, with 95% CI and a p value less than 0.05. Results. Of 146 nurses who participated in the study, 51.4% were males. About 71.4% had a BSc in nursing and 57.5% of them had training related to MV. More than half (51.4%) of nurses had poor knowledge regarding MV and the majority (58.9%) of them had poor practice in ventilatory care. The educational level (AOR, 5.1; 95% CI, 1.190–22.002) was positively associated with knowledge. Likewise, the educational level (AOR 5.0 (1.011–24.971)) and work experience (AOR 4.543 (1.430–14.435)) were positively associated with the practice of nurses. Conclusions. Knowledge regarding mechanical ventilators and the practice of ventilatory care among nurses in the selected public hospitals was poor. The educational levels were found statistically associated with both the knowledge and practice of nurses. To improve nursing care offered for MV patients, upgrading the educational level of intensive care nurses plays a vital role.

Takahiro Miyoshi, Hideki Endo, Hiroyuki Yamamoto et al.

Abstract Background The risk of choking increases with aging, and the number of cases of choking-induced cardiac arrest is increasing. However, few studies have examined the prognosis of choking-induced cardiac arrest. The aim of this study was to reveal the rates of survival and dependence on devices in the long term after choking-induced cardiac arrest. Methods We analyzed data from the Shizuoka Kokuho Database, which consists of claims data of approximately 2.2 million people, from April 2012 to September 2018. We selected patients with choking-induced cardiac arrest who received cardiopulmonary resuscitation in the hospital. Patients were excluded if they were less than 20 years old, had an upper airway tumor, received ventilation assistance, or received enteral nutrition in the month prior to cardiac arrest. The primary outcome was death, and the secondary outcomes were the rates of survival at 3-months and independence on devices. Descriptive statistics are presented and compared among age groups (20–64 years, 65–74 years, 75–84 years, 85 years and older), and survival time analysis (Kaplan-Meier method) was performed. Results In total, 268 patients were analyzed, including 26 patients in the 20–64 age group, 33 patients in the 65–74 age group, 70 patients in the 75–84 age group, and 139 patients in the ≥85 age group. The overall 3-month survival rate was 5.6% (15/268). The 3-month survival rates were 3.8% (1/26) in the 20–64 age group, 15.2% (5/33) in the 65–74 age group, 8.6% (6/70) in the 75–84 age group, and 2.2% (3/139) in the ≥85 age group. The overall 12-month survival rate was 2.6% (7/268). Of the 7 patients who survived for 12 months, 3 received ventilation management and 5 received tube or intravenous feedings at 3 months. These survivors were still receiving ventilation assistance and tube feedings in the hospital and had not been discharged at 12 months. Conclusions The prognosis of choking-induced cardiac arrest was extremely poor when patients were not resuscitated before hospital arrival. Those who survived were mostly dependent on assistive devices. Additionally, none of the survivors dependent on assistive devices had discontinued the use of the devices at the long-term follow-up.

Angela Maria Henao-Castaño, Elizabeth Fajardo-Ramos

La necesidad de servicios de atención domiciliaria especialmente para adultos mayores va en aumento, y en época de pandemia hacen de los cuidadores formales el soporte de esta atención llevándolos a presentar carga de cuidador. Objetivo. Describir la carga del cuidador y resiliencia de los enfermeros que brindan cuidado en programas de atención domiciliaria en época de pandemia. Métodos. Estudio cuantitativo, descriptivo, transversal, realizado en Institución prestadora de salud de atención domiciliaria en el mes de noviembre del 2020. La población estuvo conformada por 20 enfermeros. El muestreo fue no probabilístico por conveniencia. Se utilizó la Escala de resiliencia de Wagnild, & Young, y carga de cuidador de Zarit. Para el análisis de los datos, se empleó IBM SPSS Statistics 22, del cual se obtuvo estadística descriptiva e inferencial, como medias, desviaciones estándar, frecuencias, porcentajes y prueba de Fisher. Resultados. El 94% de los cuidadores formales eran mujeres, se evidencio carga intensa en el 20% de los cuidadores y bajo nivel de resiliencia en aquellos cuidadores que viven con sus hermanos y un alto nivel de resiliencia en cuidadores que viven solos, independientes. Conclusión. En épocas de pandemia las responsabilidades laborales en la atención domiciliaria especialmente de adultos mayores aumentan, las amenazas del medio, y los aspectos personales del cuidador formal como el número de personas a cargo hacen que en esta época las condiciones laborales y personales se tornen difíciles de llevar, acarreando una disposición para presentar carga del cuidador.

Harold Weiss, Jacob Dougherty, Charles DiMaggio

Abstract Background Pickleball is growing rapidly with a passionate senior following. Understanding and comparing players’ injury experience through analysis of a nationally representative hospital emergency department sample helps inform senior injury prevention and fitness goals. Methods A cross-sectional descriptive study was performed using 2010 to 2019 data from the U.S. Consumer Product Safety Commission’s (CPSC) National Electronic Injury Surveillance System (NEISS). Tennis was selected for comparison purposes because of the similarity of play, occasional competition for the same court space, and because many seniors play both sports. Non-fatal pickleball and tennis-related cases were identified, examined, recoded, and separated by injury versus non-injury conditions. Since over 85% of the pickleball injury-related cases were to players ≥60 years of age, we mostly focused on this older age group. Analyses consisted of descriptive statistics, injury frequency, type and trends over time, and comparative measures of risk. Results Among players ≥60 years of age, non-injuries (i.e., cardiovascular events) accounted for 11.1 and 21.5% of the pickleball and tennis-related cases, respectively. With non-injuries removed for seniors (≥60 years), the NEISS contained a weighted total of 28,984 pickleball injuries (95% confidence interval [CI] = 19,463–43,163) and 58,836 tennis injuries (95% CI = 44,861-77,164). Pickleball-related injuries grew rapidly over the study period, and by 2018 the annual number of senior pickleball injuries reached parity with senior tennis-related injuries. Pickleball-related Slip/Trip/Fall/Dive injury mechanisms predominated (63.3, 95% CI = 57.7–69.5%). The leading pickleball-related diagnoses were strains/sprains (33.2, 95% CI = 27.8–39.5%), fractures (28.1, 95% CI = 24.3–32.4%) and contusions (10.6, 95% CI = 8.0–14.1%). Senior males were three-and-a-half times more likely than females to suffer a pickleball-related strain or sprain (Odds Ratio [OR] 3.5, 95% CI = 2.2–5.6) whereas women were over three-and-a-half times more likely to suffer a fracture (OR 3.7, 95% CI = 2.3–5.7) compared to men and nine times more likely to suffer a wrist fracture (OR 9.3 95% CI = 3.6–23.9). Patterns of senior tennis and pickleball injuries were mostly similar. Conclusions NEISS is a valuable data source for describing the epidemiology of recreational injuries. However, careful case definitions are necessary when examining records involving older populations as non-injury conditions related to the activity/product codes of interest are frequent. As pickleball gains in popularity among active seniors, it is becoming an increasingly important cause of injury. Identifying and describing the most common types of injuries may can help inform prevention and safety measures.

Erik Höglund, Magnus Andersson-Hagiwara, Agneta Schröder et al.

Abstract Background There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data. Methods A descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients’ medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test. Results Out of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women. Conclusions Fewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.