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

Mohsen Sadeghi, Fatemeh Sadat Hosseini Khajouei, Nilsa Dourandish et al.

Abstract Mounier Kuhn syndrome (MKS), also known as tracheobronchomegaly (TBM), is a very rare and chronic airway disease characterized by marked dilatation of the trachea and central bronchi. Currently, there are few epidemiological studies on MKS, and most data are derived from case reports, leading to a limited understanding of the disease by clinicians. In this article, we present a 45-year-old male patient with MKS who had been symptomatic for a long time and had undergone various treatments due to a delay in diagnosis. This case highlights the importance of considering Mounier-Kuhn syndrome in patients with recurrent or unexplained respiratory infections to ensure timely diagnosis and prevent unnecessary treatments.

Alan Wang

There was an error in the original publication [...]

Siri Idland, Kristin Häikiö, Jo Kramer-Johansen et al.

Abstract Background During the recent years, emergency services in several countries have integrated video streaming into medical emergency calls, and research on the topic has gained increased focus. Video streaming during medical emergency calls may change dispatcher’s perspective of the call and can be a helpful tool for supervising bystanders’ first aid. Little research exists, however, about the caller’s perspective of video streaming during a medical emergency call. With this study, we explore the caller’s experiences with video streaming. Methods The study is a qualitative interview study. During a period of five weeks, we recruited respondents from the region of Oslo who had called the medical emergency number 113 and where video streaming had been used by the dispatcher during the call. We conducted 14 semi-structured individual interviews, in-person or digitally on Zoom/Teams, from October to December 2023. The interviews were transcribed verbatim, and we analyzed them drawing on Malterud’s systematic text condensation. Results Our material was sorted into three category headings: Increased sense of safety, the unexpected option of video streaming, and emotional discomfort. Most respondents felt comforted knowing that the dispatcher could see and assess the situation visually. Several were also positively surprised that video streaming was an option during the call. Some respondents however felt increased stress during the call due to video streaming. Other respondents reflected on the societal taboo of filming ill or injured persons. Conclusion Most respondents experienced video streaming as a positive addition to the medical emergency call and felt comforted knowing that the dispatcher could see the situation. Knowledge of the integration between video streaming and basic communication in a call is nonetheless of great importance, as to not increase stress experienced by the caller. The dispatcher should be sensitive for how the caller will handle video streaming for each call.

Coleman Burch, Alicia Webb, Eric Jorge et al.

Abstract Background Unintentional injuries are the leading cause of death in children in the United States. Studies have shown that parent adherence to safety guidelines is improved when education is provided in conjunction with safety equipment. Methods This study surveyed parents about specific injury prevention behaviors regarding medication and firearm storage and provided education and safety equipment for safe practice of these behaviors. The project took place in a pediatric emergency department (PED) and partnered with the hospital foundation and the school of medicine. Inclusion criteria were families visiting a freestanding PED in a tertiary care center. Participants completed a survey conducted by a medical student approximately 5 min in length. The student then provided each family with a medication lock box (if children ≤ 5 years old lived in the home), firearm cable lock, and education for safe storage of medications and firearms in the home. Results The medical student researcher spent a total of 20 h in the PED from June to August 2021. 106 families were approached to participate in the study, of which 99 agreed to participate (93.4%). A total of 199 children were reached with ages ranging from less than 1 year old to 18 years old. A total of 73 medication lockboxes and 95 firearm locks were distributed. The majority (79.8%) of survey participants were the mother of the patient and 97.0% of participants lived with the patient > 50% of the time. For medication storage, 12.1% of families store medications locked and 71.7% reported never receiving medication storage education from a healthcare professional. Regarding firearms, 65.2% of participants who reported having at least 1 firearm in the home stored firearms locked and unloaded with various methods of storage. 77.8% of firearm owners reported storing ammunition in a separate location from the firearm. Of all participants surveyed, 82.8% reported never receiving firearm storage education from a healthcare professional. Conclusions The pediatric ED is an excellent setting for injury prevention and education. Many families are not storing medications and firearms safely, demonstrating a clear opportunity to increase knowledge in families with young children.

Seema Meena, Sujata Chaudhary, Rashmi Salhotra et al.

Abstract Background Airway management by intubation is considered a major responsibility and vital skill for anaesthesiologists. Direct laryngoscopy and endotracheal intubation under vision continues to be the gold standard for airway management. Though conventional laryngoscopy is done with Macintosh blade, it has its own drawbacks. The Airtraq™ is a tube/guide channelled video-laryngoscope and can be used in patients with normal as well as difficult airway. On literature review, studies comparing intubation time with Airtraq™ and Macintosh laryngoscopes have shown heterogeneous results. Therefore, the present study was designed to compare the Airtraq™ video-laryngoscope and Macintosh laryngoscope for tracheal intubation in adults. Results The median time to intubation was significantly longer in group A [45 (27–77) s] than in group M [24 (21–26) s] (p < 0.001). In both groups, 96% patients had POGO score 75–100% and CL grade I. Intubation was noted to be easy in 88% cases in group A and 92% in group M (p > 0.05). Three cases in group A required a second attempt for successful intubation, whereas in group M, all cases were intubated in the first attempt (p > 0.05). Hemodynamic parameters and complications were comparable among the groups (p > 0.05). Conclusions Airtraq™ video-laryngoscope took longer time for intubation than Macintosh laryngoscope. However, both the devices were similar in terms of glottic view, ease of intubation, number of intubation attempts, incidence of failed intubation, hemodynamic changes, and complications. The overall performance of Airtraq™ video-laryngoscope was similar to Macintosh laryngoscope in patients having normal airways.

E. Wilfong, C. Lovly, E. Gillaspie et al.

Background: The COVID-19 pandemic has overwhelmed hospital systems in multiple countries and necessitated caring for patients in atypical healthcare settings. The goal of this study was to ascertain if the conventional critical care severity scores qSOFA, SOFA, APACHE-II, and SAPS-II could predict which patients admitted to the hospital from an emergency department would eventually require intensive care. Methods: This single-center, retrospective cohort study enrolled patients admitted to Vanderbilt University Hospital from the emergency room with symptomatic, confirmed COVID-19 infection between March 8, 2020 through May 15, 2020. Clinical phenotyping was performed by chart abstraction, and the correlation of the qSOFA, SOFA, APACHE-II, and SAPS-II scores for the primary endpoint of ICU admission and secondary endpoint of in-hospital mortality was evaluated. Results: During the study period, 128 patients were admitted to Vanderbilt University Hospital from the emergency room with COVID-19. Of these, 39 patients eventually required intensive care; the remaining 89 were discharged from the medical ward. All severity of illness scores demonstrated at least moderate ability to identify patients who would die or require ICU admission. Of the three severity of illness scores assessed, the APACHE-II score performed best with an AUC of 0.851 (95% CI: 0.786 to 0.917) for identifying patient that would require ICU admission. No patient with an APACHE-II score at the time of presentation less than 8 or qSOFA of 0 required intensive care unit (ICU) admission. All patients with an APACHE-II score less than 10 or qSOFA score of 0 survived to hospital discharge. Conclusions: The APACHE-II score accurately predicts the eventual need for ICU admission. This may allow for risk-stratification of patients safe to treat in alternative health care settings and prognostic enrichment to accelerate clinical trials of COVID-19 therapies.

J. Fang, W. Fu, Rui Feng et al.

Luis Ortiz‑Reyes, Jayshil J. Patel, Xuran Jiang et al.

Fahad Alsaqabi, Zubair Ahmed

Early management of burns is an essential component of achieving desirable patient outcomes. One of the earliest points of patient management in the case of burn injuries is in the prehospital setting. Unlike first aid, which can be provided by a non-healthcare worker, fluid resuscitation can be provided in the prehospital setting by emergency medical services personnel. This systematic review aims to investigate whether burn patients are receiving accurate fluid resuscitation in the prehospital setting. In addition, it will investigate if existing inaccuracies could impact patient outcomes negatively. This systematic review was completed in accordance with the guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search for eligible studies started by searching relevant databases (PubMed, Embase, Medline, and Google Scholar). The selected studies were screened, and data were extracted and analyzed using a narrative synthesis approach. Seven studies met the inclusion criteria of this review, with a total of 961 patients. All seven studies included in this review reported that the volume of fluids for resuscitation purposes received by burn patients in the prehospital setting was inaccurate. However, most reported that the patient outcomes were not affected. Most of the studies were rated as “good,” however, and further high-quality randomized control studies are required before strong recommendations can be made.

V. A. Pyzhov, K. N. Khrapov, V. M. Miroshkina

The objective: to compare effectiveness of pressure support and mandatory ventilation modes at the final stage of general anesthesia.Subjects and Methods. 58 patients were included in the study. All patients underwent laparoscopic or open surgery under combined general anesthesia with muscle relaxants and tracheal intubation. At the end of the operation, after suturing the muscle layer, patients were randomly divided into two groups, depending on the further mode of ventilation: the mandatory mode group with dual control until extubation (n = 29) and the spontaneous breathing mode group with pressure support (n = 29). The time of awakening, the severity of post-extubation cough, hemodynamic parameters and oxygenation immediately before and 5 minutes after extubation were assessed.Results. In the groups of patients, statistically significant differences were observed in the time of awakening (252 ± 67 sec and 426 ± 71 sec in PSV and PCV-VG Groups, respectively), extubation (287 ± 55 sec and 464 ± 67 sec in the PSV and PCV-VG groups, respectively), and transfer from the operating room (473 ± 60 sec and 687 ± 77 sec in the PSV and PCV-VG groups, respectively) (p &lt; 0.0001). Also, patients receiving PSV respiratory support had higher saturation levels 5 minutes after extubation (p &lt; 0.0001), and heart rate and mean arterial pressure immediately before extubation were lower than in the mandatory ventilation group (p = 0.013 and p &lt; 0.0001, respectively). In addition, in the mode of spontaneous breathing with pressure support, a lower severity of post-extubation cough was observed (p = 0.003).Conclusion. The use of a spontaneous breathing mode with pressure support at the end of general combined anesthesia has several advantages versus mandatory ventilation mode. These advantages include faster awakening, extubation and transfer of the patient to the ward, lower severity of post-extubation cough, as well as better gas exchange after extubation, lower intensity of hypertension and tachycardia before it.

Sneha V. Vemuri, MBChB, Mark L. Rolfsen, MD, Alexandra V. Sykes, MD et al.

OBJECTIVES:. Compare ICU outcomes and respiratory system mechanics in patients with and without acute kidney injury during invasive mechanical ventilation. DESIGNS:. Retrospective cohort study. SETTINGS:. ICUs of the University of California, San Diego, from January 1, 2014, to November 30, 2016. PATIENTS:. Five groups of patients were compared based on the need for invasive mechanical ventilation, presence or absence of acute kidney injury per the Kidney Disease: Improving Global Outcomes criteria, and the temporal relationship between the development of acute kidney injury and initiation of invasive mechanical ventilation. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. A total of 9,704 patients were included and 4,484 (46%) required invasive mechanical ventilation; 2,009 patients (45%) had acute kidney injury while being treated with invasive mechanical ventilation, and the mortality rate for these patients was 22.4% compared with 5% in those treated with invasive mechanical ventilation without acute kidney injury (p < 0.01). Adjusted hazard of mortality accounting for baseline disease severity was 1.58 (95% CI, 1.22–2.03; p < 0.001]. Patients with acute kidney injury during invasive mechanical ventilation had a significant increase in total ventilator days and length of ICU stay with the same comparison (both p < 0.01). Acute kidney injury during mechanical ventilation was also associated with significantly higher plateau pressures, lower respiratory system compliance, and higher driving pressures (all p < 0.01). These differences remained significant in patients with net negative cumulative fluid balance. CONCLUSIONS:. Acute kidney injury during invasive mechanical ventilation is associated with increased ICU mortality, increased ventilator days, increased length of ICU stay, and impaired respiratory system mechanics. These results emphasize the need for investigations of ventilatory strategies in the setting of acute kidney injury, as well as mechanistic studies of crosstalk between the lung and kidney in the critically ill.

Tasheen Wissanji, MD, FRCPC, Marie-Eve Dupuis, MD, Virginie Royal, MD et al.

OBJECTIVES:. Vitamin C is a novel treatment currently under investigation in the management of sepsis. Adverse renal effects of vitamin C through hyperoxaluria have been described in the past. DATA SOURCES:. We report the case of a 63-year-old man admitted in a community-based hospital with a diagnosis of sepsis of pulmonary origin. DATA EXTRACTION:. On day 19, despite a having developed oligoanuric acute kidney injury, a regimen of IV vitamin C, hydrocortisone, and thiamine was undertaken for 4 days. On day 23, the patient required renal replacement therapy with an estimated glomerular filtration rate of 7 mL/min. Renal biopsy revealed extensive acute tubular necrosis associated with the presence of intratubular crystal of calcium oxalate. Conclusion:. Although vitamin C seems to be a possible therapeutic asset in the supportive care of sepsis patients, larger cohorts are required to ensure its safety and underlying or novel kidney injury should forewarn clinicians as to its use.

Andrea Costamagna, Emanuele Pivetta, Alberto Goffi et al.

Abstract Background To assess diagnostic performance of lung ultrasound (LUS) in identifying ARDS morphology (focal vs non-focal), compared with the gold standard computed tomography. Methods Mechanically ventilated ARDS patients undergoing lung computed tomography and ultrasound were enrolled. Twelve fields, were evaluated. LUS score was graded from 0 (normal) to 3 (consolidation) according to B-lines extent. Total and regional LUS score as the sum of the four ventral (LUSV), intermediate (LUSI) or dorsal (LUSD) fields, were calculated. Based on lung CT, ARDS morphology was defined as (1) focal (loss of aeration with lobar distribution); (2) non-focal (widespread loss of aeration or segmental loss of aeration distribution associated with uneven lung attenuation areas), and diagnostic accuracy of LUS in discriminating ARDS morphology was determined by AU-ROC in training and validation set of patients. Results Forty-seven patients with ARDS (25 training set and 22 validation set) were enrolled. LUSTOT, LUSV and LUSI but not LUSD score were significantly lower in focal than in non-focal ARDS morphologies (p < .01). The AU-ROC curve of LUSTOT, LUSV, LUSI and LUSD for identification of non-focal ARDS morphology were 0.890, 0.958, 0.884 and 0.421, respectively. LUSV value ≥ 3 had the best predictive value (sensitivity = 0.95, specificity = 1.00) in identifying non-focal ARDS morphology. In the validation set, an LUSV score ≥ 3 confirmed to be highly predictive of non-focal ARDS morphology, with a sensitivity and a specificity of 94% and 100%. Conclusions LUS had a valuable performance in distinguishing ARDS morphology.

Lei Ye, Shulan Yang, Caixia Liu

The novel coronavirus disease 2019 (COVID-19) is now worldwide publicity. Five to 20% of the total COVID-19 positive cases required admission to an intensive care unit (ICU) and the mortality rate was approximately 50% among critically ill patients who developed acute respiratory distress syndrome [1–5]. Deeply concerned by the spread and severity, the World Health Organization (WHO) characterized COVID-19 as a pandemic in March 2020. In February, Wuhan was facing a sudden shortage of health workers induced by the COVID-19 pandemic. The Chinese health authorities reported that 3019 Chinese health workers were infected with COVID-19, of which 10 died [6]. Front-line health workers are at high risk of infection. Inadequate awareness and precautionary measures, patient overload, and staff burnout are considered as relevant reasons for health worker infections. As an emergency measure, the China government dispatched 189 national medical teams comprising more than twenty-thousand health workers from all over the country who volunteered to combat COVID-19 in Hubei. They had been working together with local health workers and successfully controlled the development of the epidemic. The goal of “Zero” COVID-19 infection among health workers was achieved. Actually, from February 12 to April 9, 9282 health worker COVID-19 cases were reported by the US Center for Disease Control and Prevention, and contacts with COVID-19 patients in health care, household, and community settings were all detected [7]. COVID-19 infections among health workers are common and fatal to the health system. Infection among health workers may cause widespread transmission within the system and even lead to the collapse of the whole services. And this was what exactly happened in Harbin in the past weeks; a persisting cluster centered on an 87-year-old inpatient infected more than eighty people, including 8 health workers. The affected hospital urgently suspended routine medical services as a result. Based on Wuhan’s experience, it is critical to develop tailored infection prevention and control (IPC) protocols for both workplace and non-occupational settings and to conduct effective IPC training. Thus, the following suggestions were summarized based on the first-hand experience of a national medical team from Zhejiang, to facilitate the development of IPC protocols in critical care settings.

Shang-Feng Yang, Ching-Min Tseng, I-Fan Liu et al.

F Ranjkesh, M Nasiri, SH Sharif Nia et al.

Background and Objectives: One of the most common problems during pregnancy is sleep disorders, which is the result of physiological, hormonal and physical changes in pregnancy and can be the basis for many disorders before, during, and after delivery. The aim of this study was to determine the psychometric properties of the persion version of  Sleep Condition Indicator in a sample of Iranian pregnant women.   Methods: In present study, 300 pregnant women reffered to health center of Kowsar (affiliated to Qazvin University of Medical Sciences) that were gathered via accesible sampling method, completed the Sleep Condition Indicator in 2017. Face, content, and construct validity (convergent and divergent validity) and reliability of selected questionnaire were calculated.   Results: The results of exploratory and confirmatory factor analysis showed two sustained and distinct factors, including quantity in sleep quality and the consequences of low sleep quality. The two-factor fit of Sleep Condition Indicator was approved based on standard indicators. Convergent and divergent validity were acceptable for all factors. Moreover, the internal consistency and reliability of the construct were also acceptable.   Conclusion: The results of this study showed that the Sleep Condition Indicator is valid and reliable among pregnant women, so it seems that this tool can be used to screen sleep disorders in women during pregnancy.

Makoto Aoki, Toshikazu Abe

Abstract The aim of this Letter to the Editor was to report some important biases in a recently published Article. We agreed with the notion by Yamamoto et al. that the effects of epinephrine regarding was limited without hemostasis, however, this study had major limitations such as no information on etiology of traumatic cardiac arrest (hemorrhagic or on non-hemorrhagic) and on hemostatic treatment. The results of this study should be interpreted with caution and further analysis is necessary. Finally, we commented on the necessity of future study regarding another vasopressor (ie; vasopressin) on traumatic cardiac arrest based on current evidence.

J. Balikuddembe, A. Ardalan, Davoud Khorasani-Zavareh et al.

BackgroundPre-hospital emergency care is a vital and integral component of health systems particularly in the resource constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities and trauma caused by the road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA).MethodsA cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims’ pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions respectively. Data was descriptively analyzed, and after the principal component analysis was employed to identify the most influential weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTI in the GKMA.ResultsFrom 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 2016, 4 and 5 key weaknesses and capacities respectively were identified to affect the pre-hospital emergency care for RTI victims in the GKMA. Although some strengths exist like ambulance facilitation, EMS structuring, coordination and others), the key weaknesses affecting the pre-hospital care for victims were noted to relate to absence of predefined EMS systems particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment; insufficient skills/training of the first responders; inadequate EMS resources; and avoidable delays to respond and transport RTI victims to medical facilities.ConclusionsThough some strengths exist, the weaknesses affecting prehospital care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.

Comité editorial Comité editorial

Cuando en marzo de 2016 se propuso editar una nueva revista científica sabíamos que nos enfrentábamos a un importante reto, más aun cuando se quería publicar el primer número en enero de 2017. Había que realizar las normas de la revista y configurar los comités editoriales y científicos.

V. A. Zhikharev, V. A. Porkhanov, I. Yu. Sholin et al.

Acute post-operative respiratory failure is a dangerous complication developing after thoracic surgery.The objective of the study: to assess the potential use of albuminemia, glycemia and leukocytosis as markers of acute post-operative respiratory failure after thoracic surgery.Subjects and methods. A retrospective study was conducted enrolling 300 patients, which were divided into two groups – those who developed acute post-operative respiratory failure (n=150) and those who didn't (n=150). The post-operative level of glycemia and leukocytosis and the degree of albumin level reduction were comparatively analyzed in the early post-operative period.Results. The correlation was found between the degree of reduction of the post-operative albumin level and the ratio of PaO2/FiO2 – the strong inverse correlation (r = -0.9); the strong inverse correlation (r = -0.7) was found between the leukocytosis level and the ratio of PaO2/FiO2; while it was the median inverse correlation (r = -0.7) between glycemia level and the ratio of PaO2/FiO2; and between the degree of the post-operative reduction of albumin and glycemia level, it was the median direct correlation (r = 0.7).Conclusion. The higher levels of peri-operative glycemia and leucocytosis during the first 24 hours after the surgery and more intense reduction of the post-operative level of albumin demonstrate the intensity of stress-reaction to the surgical trauma and make valuable markers of the acute post-operative respiratory failure development in the patients after thoracic surgery.